The nice people at the Transfusion Evidence Alert sent their update today. Again tranexamic acid featured… that stuff really is one of the wonders of our age.
Personally I liked the talk about not taking such a great volume of blood from patients for various testing… surely it stands to reason that the more you exsanguinate a patient, the more transfusions they will need?
Back in the day if you stuffed something up and made a serious mistake you found yourself up before the regulator and had conditions of practice put upon you. The stress of the process made you lose five stones in weight and gave you nightmares for years after the event.
Nowadays you write the thing up as a PowerPoint presentation for the world to download, and have no qualms about writing “Malaria was missed by BMS and consultant staff”.
Not that I'm in any way bitter...
I’m just about to go to bed for the afternoon before a night shift… time for a BTLP-TACT exercise.
I had one case – an eighty-three year old chap in the haematology clinic needing group & save. He grouped as A Rh(D) Negative with antibody screen positive in cells 1 and 2. I requested antibody panels.
The IAT and enzyme panels were positive in cells 1, 2 and 3 which was consistent with anti-D but didn’t rule out anti-Cw.
I got the green light…
Clare’s done some more science… XbarM analysis… for the most part tells you that the blood samples going through your analyser now are from a different clinic to those that went through half an hour ago…
Clare explains it in more detail here.
I saw some platelet satellites today. We often see platelets clumping in EDTA (at least once every day, but seeing them satellite around neutrophils is a relatively rare occurrence. Interestingly (and something I didn’t realise) is that demonstrably the platelets don’t form satellites around every neutrophil.
I wonder why not.
Anyway, here’s a couple of references on the matter:
The second reference says “The clinical importance of this phenomenon is that in some cases it may result in spurious thrombocytopenia or pseudothrombocytopenia leading to further unnecessary investigations. Thus, recognition of this in vitro phenomenon only re-emphasizes the necessity of age old practice of peripheral blood film examination".
Written by an old-timer like me!!!
Labels: down my microscope
One of many things that winds me up is how what is absolutely the wrong thing to do (and is cast in stone) and doing it is a disciplinary offence in the world of blood transfusion today will be the official standard and best practice tomorrow.
For over forty years I have been told to keep the platelets we away from the fridges.
Now it would seem that keeping the platelets cold is a good idea…
Time for another BTLP-TACT exercise. I was presented with one case – a forty-five year-old woman under the gynaecology team needing a group and save.
She grouped as O Rh(D) Negative with a negative antibody screen.
I got the green light…