5 September 2024 (Thursday) - TACO

I watched a little video about TACO today…

 

Transfusion-Associated Circulatory Overload (TACO) is defined as acute or worsening respiratory compromise and/or acute or worsening pulmonary oedema during or up to 12 hours of transfusion, with additional features including cardiovascular system changes not explained by the patient’s underlying medical condition.

 

It’s not rocket science – if you stuff anything into a system of fluids being pumped about, that pump is going to have to work harder.

There’s an interesting article about the matter here.

 

4 September 2024 (Wednesday) - Fritsma Factor Update

The nice people at Fritsma Factor sent their update today. You can read it by clicking here. There’s not as much in this one as there has been in previous updates, but what there is is worth having.

This month’s question made me think… “At what FVIII activity level should the PTT become prolonged?”

At what level does it become prolonged? At the risk of appearing flippant, hopefully the answer is “clinically significant”.

3 September 2024 (Tuesday) - Westgard QC Update

 

The nice people at Westgard QC sent out their update today. You can read it by clicking here.

As always the stuff is rather dry, but to a reactionary old duffer llike me this is what CPD is all about.

2 September 2024 (Monday) - Daratumumab

I was asked a question today. M answer was “don’t know” so I did some finding out…

 

Daratumumab is effective in cases of multiple myeloma as a monotherapy in heavily treated patients with relapsed or refractory disease. It is a monoclonal antibody that specifically targets human CD38, which is highly expressed on myeloma cells.

However if a patient is on daratumumab when we do a group and save their antibody screen comes up positive in absolutely everything which makes crossmatching problematical.

So we send a sample to NHSBT and they send us compatible blood… what magic do they work?

 

Cells are treated with dithiothreitol (DTT) which removes the CD38. However whilst it is at it, it also removes the K antigen, and other antigens including ones of the Lutheran, Yt, Cromer, Dombrock, and Knops blood group systems.

 

Here’s an article describing what happens. There’s no magic. It’s quite straightforward. So why is this in the domain of the reference laboratory and not standard practice?

1 September 2024 (Sunday) - HCPC Standards Updated

 

The HCPC has updated its standards of conduct, performance and ethics  and its guidance on social media.  

 

I poured through both documents… the one which worries me is the bit about social media. It never hurts for me to think about what I’m saying on here. Initially I had a bit of a panic because I can sometimes be a tad scathing about the IBMS and the blood transfusion simulator and anyone and anything which gives me less than absolutely brilliant CPD material.

 

When I post something negative I *hope* people read what I am saying as “I find this less than brilliant for the following reasons…” and not as “this is a load of crap”.
I must take more care to ensure that my comments come over in a constructive way.

30 August 2024 (Friday) - NEQAS Parasitology 2403 PA

I got hold of the parasitology NEQAS results today
 
2403PA1
 
I said there were plasmodium sp parasites present.
There were.
 
2403PA2
 
I said this was P. falciparum with a 4% parasitaemia. I got the species right, but the parasitaemia was 7.9%. I was a tad low there… 
 

30 August 2024 (Friday) - NEQAS 2405 BF

I got hold of the blood film NEQAS results today
 
2405 BF1
 

I saw        (consensus rating)

 

Thrombocytopenia (1)

Blast cells               (2)

Auer rods                (7)

Neutropenia            (3)

NRBC                     (4)

 

I said this was AML – it was,

 
 
2405 BF2
 

I saw        (consensus rating)

 

Neutropenia             (3)

Blast cells                 (2)

Thrombocytopenia   (1)

Tear drop cells          (6)

Thrombocytopenia     (1)

 

I thought this was horrible, but didn’t want to commit myself any further. It was a pancytopenic cace of acute promyelocytic leukaemia.

 
I think I did OK there…