19 December 2014 (Friday) - BBTS Newsletter

https://www.bbts.org.uk/whatwedo/qualifications/tsp/?utm_medium=email&utm_source=British+Blood+Transfusion+Society&utm_campaign=5164192_bloodspots+Dec+14&dm_i=AHU,32OPS,IPX6YG,B1EKN,1

The BBTS newsletter came today; again by email. Being “Blood Transfusion” and much narrower in scope than yesterday’s IBMS missive I was expecting this to be more relevant to me.

Was it?

There was an update on the BBTS Specialist Certificate in Transfusion Science Practice; a qualification I should really be taking. There was news of a scientific meeting taking place next year. Will I attend? I should, but I really don’t like going to these things…

18 December 2014 (Thursday) IBMS Newsletter

https://www.ibms.org/go/nm/issues,41?utm_source=IBMS+Newsletter+Subscription&utm_campaign=bafc135bcc-IBMS_Newsletter_December_201412_17_2014&utm_medium=email&utm_term=0_66f7335c28-bafc135bcc-309574969

The IBMS newsletter came today. I say “newsletter”, but in a typical sign of the times it was via email. I perused it; without wishing to sound cynical I didn’t feel there was much of immediate import to myself.

Perhaps I’m wrong….

17 December 2014 (Wednesday) - Chloride

http://www.nice.org.uk/guidance/cg174

The NICE clinical guideline 'Intravenous fluid therapy in adults in hospital' (CG174) recommends daily serum chloride monitoring in patients receiving intravenous fluids with chloride concentrations greater than 120 mmol/L, including 0.9% ('normal') saline.

To facilitate this, all inpatient requests for serum electrolyte and creatinine measurements will automatically also have a serum chloride measured and reported.

Up until now chloride has been something of an obscure add-on. Generally chloride levels go up and down with sodium levels, so measuring chloride is a good way to spot an “iffy” sample.

Having said that, I really need to bone up on the topic.

http://labtestsonline.org.uk/understanding/analytes/chloride/tab/test

6 December 2014 (Saturday) - HCPC in Focus Magazine

The latest missive from the HCPC is now on-line at http://www.hcpc-uk.org/assets/documents/100049D3HCPCInFocus-Issue56.pdf

The headline gave me pause for thought “Registration renewal figures for operating department practitioners and social workers in England at an all-time high”. Clearly I’m missing something here. Those that don’t renew cannot continue practice. Either they’ve obtained alternate employment or retired. Either way is no big deal, so why is this headline news?

I found it very difficult to read the Fitness to Practice annual report with any degree of impartiality. Between 1 April 2013 and 31 March 2014 2 069 new concerns were raised, an increase of twenty five per cent on the previous year. 0.64% of registrants found themselves to be on the receiving end of a complaint. That’s about one in two hundred; I find that a really high number.

Of personal interest I read that revised standards of proficiency for biomedical scientists and clinical scientists have been published.

There was a report of a meeting between HCPC staff and medical managers in Belfast that took place recently. Again I found myself too close to the subject matter; wondering exactly what was discussed when I read that “Participants at the event took part in discussions using real life FTP case studies”. I see that I can go to one of these meetings if I want to by registering at www.hcpc-uk.org/meethcpc - I’m tempted to sign up.

2 December 2014 (Tuesday) - Potassium

Here’s a little something that came up whilst working in clinical chemistry a few days ago. I found this set of results:

Specimen Results Entry COBBLEPOT, Oswald                                A+       20/11/2014 u/k MRS   23/11/1946 67 yrs  F  123456               Arkham                   Mr Vladimir Freeze routine.                               Specimen No   :  AC619028V               Selected Auth Level : S --------------------T-------------------T-------------------T-------------------  NA     136    F000 |ALKP   98     F000 |                   |  K      8.8    F000 |ALT    6      F000 |                   |  KBIC   21     F008 |CRP    108    F000 |                   |  U      13.7   F000 |HINT  ^0.1    F000 |                   |  CR     131    F000 |IINT  ^6      F000 |                   |  _GFR   35     F000C|LINT  ^-0.0   F000 |                   |  PROT   35     F000 |                   |                   |  ALB    11     F000 |                   |                   |  GLOB   24     F000 |                   |                   |  TBIL   8      F000 |                   |                   | --------------------T-------------------T-------------------T------------------- LTG comments : EC,GFR,LFT,RKOD  1 Auth'd   2 Unauth'd   3 Nomin'd   4 Change   5 Reject  6 Options  7 eXit> U  Disc: CLIN    Sect: CC            David Styles       SRE/APEX    Overtype

That potassium result is high; seriously high and most interestingly JNOT consistent with previous findings

COBBLEPOT, Oswald                                A+       20/11/2014 u/k MRS   23/11/1946 67 yrs  F  123456               Arkham ------T-----------------------------------------------------------------------]   Date|20/11/2014 19/11/2014 18/11/2014 17/11/2014 15/11/2014 14/11/2014      |   Time|u/k        u/k        16:50      u/k        u/k        01:30           |   Spec|AC619028V  AC618219L  AC617116S  AC615563X  AC614400T  AC613165N       |       |BIO        BIO        BIO        BIO        BIO        BIO             | Test--+-----------------------------------------------------------------------{ NA    |136        137        134        131        127        133             | K     |8.8        3.9        4.5        4.9        4.8        5.0             | KBIC  |21                                                                     | U     |13.7                                                   15.4            | CR    |131        153        139        141        133        135             | _GFR  |35         30         33         33         35         34              | PROT  |35                                                                     | ALB   |11                                                     13              | GLOB  |24                                                                     | TBIL  |8                                                                      | ALKP  |98                                                                     | ALT   |6                                                                      | ------T-----------------------------------------------------------------------]   1 View   2 Graph   3 eXit  X                             Cursor Down for more                       More >>

                                   

There’s something wrong here. That result’s not right. So a little detective work was in order.

The age of the sample was then checked. The sample was only an hour old.

The nature of the sample was checked. The sample was a SST; not EDTA. An EDTA sample would give a much higher potassium result, but it was something that needed checking.

Perhaps there was EDTA contamination, so calcium levels were analysed. Suspecting EDTA contamination we might expect a very low calcium result.

The result was 1.6... low, but not *THAT* low.

COBBLEPOT, Oswald                                A+       20/11/2014 u/k MRS   23/11/1946 67 yrs  F  123456               Arkham routine.  Specimen No   :  AC619028V               Selected Auth Level : S --------------------T-------------------T-------------------T-------------------  NA     136    F000 |ALKP   98     F000 |                   |  K      8.8    F000 |ALT    6      F000 |                   |  KBIC   21     F008 |CA     1.6    E000 |                   |  U      13.7   F000 |$CORCA CALUNR E000 |                   |  CR     131    F000 |CRP    108    F000 |                   |  _GFR   35     F000C|HINT  ^0.1    F000 |                   |  PROT   35     F000 |IINT  ^6      F000 |                   |  ALB    11     F000 |LINT  ^-0.0   F000 |                   |  GLOB   24     F000 |                   |                   |  TBIL   8      F000 |                   |                   | --------------------T-------------------T-------------------T------------------- LTG comments : EC,GFR,LFT,RKOD  1 Auth'd   2 Unauth'd   3 Nomin'd   4 Change   5 Reject  6 Options  7 eXit> U

For completeness the potassium assay was repeated on our other analyser.  The result was identical; a genuine result.

This was rather frustrating… the result was suspect. but EDTA contamination should have given a far higher potassium result and a far lower calcium result. Perhaps there was only a little EDTA contamination in this case?

A comment was added to the result:

Note raised potassium ? due to EDTA contamination. Please send repeat sample for confirmation. Ward (staff nurse) telephoned.

A couple of days later I reviewed the case:

COBBLEPOT, Oswald                                A+       20/11/2014 u/k MRS   23/11/1946 67 yrs  F  123456               Arkham NA    |136       137        138        136        137        134 K     |H         4.3        H          8.8        3.9        4.5 KBIC  |                                21 U     |19.9      19.2       17.5       13.7 CR    |185       162        151        131        153        139 _GFR  |24        28         30         35         30         33 PROT  |44        43         45         35 ALB   |12        13         13         11 GLOB  |32        30         32         24 TBIL  |5         6          6          8 ALKP  |112       121        114        98 ALT   |11        9          7          6

Subsequent results were not consistent with that spurious result. I wonder what happened there.

But the bottom line here is that it’s not all about churning out numbers….