17 March 2024 (Sunday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. The software gave me two cases:
 

38895 – a sixty-nine year-old woman needing group and save. She grouped as A Rh(D) Positive with antibody screen positive in all three cells.

I requested panels.

The IAT panel was positive in cells 1, 3, 4, 6, 7, 9 and 10 - possible anti-Cw  anti-Lu(a) anti-Fy(a) anti-Jk(a)

The enzyme panel was positive in cells 1, 3, 4, 6, 7 - possible anti-Cw anti-Jk(a)

So – this patient has anti-Fy(a) and anti-Jk(a) but anti-Cw cannot be excluded. 

17765 – a seventy-four year-old woman also needing group and save. She too grouped as A Rh(D) Positive with a negative antibody screen.

 
I got the green light.

14 March 2024 (Thursday) - Transfusion Evidence Alert Update

The Transfusion Evidence Library update arrived today. Bearing World Kidney Day in mind, the focus was on renal involvement:

 Top article

Selected articles

Safety and efficacy of hypoxia-inducible factor-prolyl hydroxylase inhibitors vs. erythropoietin-stimulating agents in treating anemia in renal patients (with or without dialysis): a meta-analysis and systematic review.Damarlapally, N., et al. (2023). Cureus.

Acute respiratory distress syndrome, acute kidney injury, and mortality after trauma are associated with increased circulation of syndecan-1, soluble thrombomodulin, and receptor for advanced glycation end products.Dixon, A., et al. (2023). The Journal of Trauma and Acute Care Surgery.

Can trajectory nor-epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double-blinded randomized controlled trial.El-Shaer, W., et al. (2022). International Journal of Urology.

Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions.Hariri, G., et al. (2023). Critical Care.

Effect of blood transfusion post kidney transplantation on de novo human leukocytes antigen donor-specific antibody development and clinical outcomes in kidney transplant recipients: a systematic review and meta-analysis.Kang, Z.Y., et al. (2023). Transplant Immunology.

Ferric citrate for the treatment of hyperphosphatemia and anemia in patients with chronic kidney disease: a meta-analysis of randomized clinical trials.Li, L., et al. (2022). Renal Failure.

The effect of perioperative blood transfusion on survival after renal cell carcinoma nephrectomy: a systematic review and meta-analysis.Liu, Y., et al. (2023). Frontiers in Oncology.

Efficacy of therapeutic apheresis for cryoglobulinemic vasculitis patients with renal involvement: a systematic review.Miao, J., et al. (2023). Blood Purification.

Two phase 3 studies on ophthalmologic effects of roxadustat versus darbepoetin.Sepah, Y.J., et al. (2022). Kidney International Reports.

13 March 2024 (Wednesday) - Hyperthyroidism

We had a patient today with a mild neutropenia. The patient’s diagnosis was hyperthyroidism.

It transpires that treatment of hyperthyroidism often causes a neutropenia which resolves on cessation of treatment.

Something to bear in mind.


12 March 2024 (Tuesday) - IBMS Newsletter

The IBMS Newsletter appeared in my in-box this morning. You can read it by clicking here.
It is widely said that in this life things go full-circle. I suspect that in thirty years’ time a future issue of the IBMS gazette will feature articles on the latest advances on blood testing analysers and reagent kits, and tutorials on cell morphology and interpretations of haemoglobinopathy traces. And the olduns of that era (today’s trainees) will hark back to the halcyon days of 2024 when the IBMS focused on what mattered to them; committees and awards and strange catchphrases.

12 March 2024 (Tuesday) - Oncology Central

The nice people at Oncology Central sent their update today. Much (most) of it went over my head, but one or two things stuck

 

10 March 2024 (Sunday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I had one case – a thirty-four year-old woman in the out patients department needing group & save for “maternal alloantibody”.
 
She grouped as O Rh(D) Negative with a negative antibody screen.
 
“maternal alloantibody” negative (!)
I got the green light

8 MArch 2024 (Friday) - NEQAS 2401 DM


This image is taken from a blood film of a man aged 61 years. A blood count sent by the GP showed that the white cell count was 40 x 10^9/L, Hb of 79 g/L and platelets of 118 x 10^9/L. What are your findings?” 
 
 

 Rbc 

 

Anisopoikilocytosis 

Nucleated red cells 

Polychromasia 

Spherocytes 

Tear drop cells 

 

Wbc 

 

Auer rods 

Blast cells 

Dohle bodies 

Dysplastic neutrophils 

Hypersegmented neutrophils 

Left shifted neutrophils 

Myelocytes 

Plts 

 

Grian plts 

Grey plts 

Megakaryocyte fragments 

 

 
In the absence of any useful clinical information I felt this was a case of primary myelofibrosis transforming into something nasty.
It was.
However I feel I must ask myself what I meant by “Grian plts” Bearing in mind nearly two months passed between my looking at the film and getting the results I have no recollection.