A Dull Day At Work...?

1 October 2024 (Tuesday) - More BTLP-TACT Frustration

Well… admittedly I’ve been off on holiday for a couple of weeks so I suppose that’s why I’ve been getting low participation warnings from the people at BTLP. Bearing in mind the debacle of the last exercise I’m not keen on doing any more… but if I am going to carry on in this line of work I have to do CPD.

Then again I’m not really keen on carrying on working at all. But for now…

I asked the BTLP-TACT software if I might have another go. It eventually presented me with one case – a forty-one year-old woman in the maternity department needing group & save.

I decided that the sample labelling was correct and told it so. After about five minutes it moved on to the next screen.

Actually requesting said group and save took another five minutes. Five more passed before I was able to see the result of the grouping

Both ABO and Rh group were indeterminate. It struck me that this was an AB Rh(D) Positive patient who had been transfused O Rh(D) Negative blood. In reality we would have this information.

And then the entire thing crashed in a server error.

I restarted it and eventually saw that the antibody screen was positive in cells 1 and 2.

I made a cuppa whilst I waited for it to allow me to request antibody panels, and drank the cuppa with a couple of biccies whilst waiting for it to show me the results of those panels.

The IAT panel was positive in cells 1, 2, 3 and 4 corresponding with anti-C and anti-D whilst not excluding anti-Cw. After another painfully long wait it again crashed in another server error.

I again restarted the thing and eventually saw that the enzyme panel was the same as the IAT panel. positive in cells 1, 2, 3 and 4 corresponding with anti-C and anti-D whilst not excluding anti-Cw. Once I’d given it the answer the software just hung.

After waiting for seemingly an age it gave me the thumbs-up.

1 October 2024 (Tuesday) - Westgard QC Update

The trouble with statistics in the lab is that the people using them aren’t mathematicians. I’ve got a degree in maths and often struggle with what the nice people from Westgard tell me…

Measurement of uncertainty for example. Surely common sense tells us that if you’re not measuring something very often then you will have more variability in your results than if you measure lots…

You can read the latest update from the nice people at Westgard QC by clicking here

23 September 2024 (Monday) - Transfusion Evidence Alert Update

Tranexamic acid features yet again… and an interesting article about transporting blood by drone. With the pitiful state of the road network round our way that could be the way forward?

16 September 2024 (Monday) - Getting the BTLP Wrong (?)

It’s been a while since I last did a BTLP-TACT exercise… so I had a go and was presented with two cases:

54014 – a fifty-nine year old chap under the medical team with sepsis requiring group and save. His blood group was O, but with an indeterminate Rh group, and an antibody screen positive in cells 1 and 2.
I requested antibody panels. The IAT and enzyme panels were positive in cells 1, 2, 3 and 4 being consistent with anti-C and anti-D but not ruling out anti-Cw

36430 another fifty-nine year old chap; this one with vitamin K deficiency requiring group and save and two units of cryo. His blood group was B Rh(D) Positive. It was !!! But bearing in mind that I’ve had the thumbs down on weak D reactions before I called it indeterminate. Fortunately the antibody screen was negative.
I selected two units of O cryo (as that was all there was)

I got it wrong. Again. Apparently cryo shouldn’t be used in this clinical condition. Even though the guidelines say it should.

13 September 2024 (Friday) - Another Rant

Here’s something from Medical Laboratory Observer. An article about mistakes in diagnostic error.
According to ECRI (an American healthcare provider) out of a thousand errors reviewed:

Nearly 70 percent of errors occurred during the testing process – including when healthcare staff are ordering, collecting, processing, obtaining results, or communicating results.
Twelve percent of errors occurred in the monitoring and follow-up phase; with nearly nine percent during the referral and consultation phase.
Of errors that occurred during testing, more than 23 percent were a result of a technical or processing error, like the misuse of testing equipment, a poorly processed specimen, or a clinician lacking the proper skill to conduct the test
Another 20 percent of testing errors were a result of mixed-up samples, mislabeled specimens, and tests performed on the wrong patient.

Without wishing to belittle the article it is the sort of thing that boils my piss (to be frank). Very quick to point out mistakes, but rather thin on details of exactly what these mistakes were, their severity, and offering absolutely nothing in the way of lessons learned from those mistakes.

I’m left wondering why this article was even published; if not to knock healthcare. It's prompted me to include a new label category for the articles I put on here.

10 September 2024 (Tuesday) - Value For Money ?

The IBMS sent their newsletter today. You can read it by clicking here.
The BBTS sent their newsletter today. You can read it by clicking here.

Between the two of them I spend twenty-five quid a month. I don’t think I get my money’s worth.

9 September 2024 (Monday) - NEQAS 2404 DM

A 56-year-old female attended a dermatology clinic. The haemoglobin and platelet counts were normal but the white cell count was found to be 20 x 10^9/L. A film was sent for assessment.”

Initial thoughts – it’s Sezary Syndrome

But doing it properly

Rbc

Rouleaux
anisopoikilocytosis

Wbc

Lymphocytosis
cerebreform cells
cleft nuclei
cytoplasmic blebs
Sezary cells
Eosinophilia
Blast cells

Plt

Thrombocytosis

I spotted the salient features... and it was Sezary Syndrome.

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