18 February 2015 (Wednesday) - Checking

I distinctly remembered this patient – we had a blood group on her yesterday. I can distinctly remember that she was AB Pos, and on seeing the crossmatch request I wondered if we had enough (or any) Kell-neg AB Pos units in the fridge.

                               Status and Orders

Name:PTISTOP, PENELOPE                          Group & Abs O+
DoB:13/09/1996 Sex: F Pat No:0234567              Source: WDFR       Requested 10:00
Address:  1 THE STREET Clinician: MORAN           17/02/2015
Diagnosis: hb 68, iron deficient, symptomatic
Specimen No: TK123456Z
[---------T---------T---------T---------T---------T---------T---------T--
| ANTS    | SRPAD   | PT      | XM      | HPAT    | TRIAL   | CPAD    | CXM    |
[----T----T----T----T----T----T----T----T----T----T----T----T----T----T--
     |         |         |         |         |         |         |      |
     [---------T---------T---------T---------T---------T---------T-------
   [-----------T-----------T-----------T-----------T-----------T---------
   |  CMVNEG   |  GEN      |  IRR      |           |           
   [-----------T-----------T-----------T-----------T-----------T---------
   [-----------T-----------T-----------T-----------T-----------T---------
   |   Group   |  x-Match  | Antibody  |   miSc.   | Kleihauer |Prov grp  |
   |DG     S000|X      S000|           |A      S000|           
   [-----------T-----------T-----------T-----------T-----------T---------


1 pRofiles  2 Flags  3 Enquire  4 Next  5 preVious  6 Other  7 eXit
 Disc: TRANS   Sect: TRK           David Styles       STATUS/APEX Overtype



I was wrong – she’s not AB Pos at all….. It really brings home the need to check, check and check again. NEVER rely on memory…

16 February 2015 (Monday) - HCPC Newsletter

The latest HCPC newsletter is available.


I mention this because it is the sort of thing that is billed as being “CPD material”.
At the risk of getting the thumbs-down in any future assessment the term “biomedical scientist” didn’t really feature much in this issue.
Mind you there was mention of recruiting people to sit on investigatory panels.

http://www.hcpc-uk.org/assets/documents/10003984PanelMembersRoleBrief-Aug2011.pdf


Bearing in mind the last three years I wonder if I might be able to bring some experience to bear on that role. I might just apply.

12 February 2015 (Thursday) - Malaria

Whilst perusing various blood parasite films I found this website.



It’s informative enough, but could really do with more pictures. There used to be a really good atlas on an Australian web site. Wish I could remember its url…

11 February 2015 (Wednesday) - Blood and transplant Matters #44

Quite a lot of interesting stuff…


However on a personal note the thing I like best about it is its availability in electronic format – I can read it anywhere…

10 February 2015 (Tuesday) - A New Resource

This looks like it could be a useful source of CPD.

Scientific, medical, technical and they will send me a weekly email updating me on what’s new just in case I forget all about it.

Let’s see how it pans out…

31 January 2015 (Saturday) - The IFCC

I’ve discovered the International Federation of Clinical Chemistry and Laboratory Medicine. http://www.ifcc.org

On their website they say “The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) is a worldwide, non-political organization for clinical chemistry and laboratory medicine. As such it has a range of roles that include
(1) global standard setting in collaboration with other international organizations,
(2) supporting its members through scientific and educational endeavour,
(3) providing a series of congresses, conferences and focussed meetings in order for laboratory medicine specialists to meet and present original findings and best practice.

Our mission is to be the leading organization in the field of Clinical Chemistry and Laboratory Medicine worldwide. Through leadership and innovation in science and education we will strive to enhance the scientific level and the quality of diagnosis and therapy for patients throughout the world. We will build on the professionalism of our members to provide quality services to patients. We will…..” and then it goes on in this vein.

At first sight all rather dull, but look at this link


They put their monthly journal on-line.

  • Measuring the impact of laboratory medicine on clinical management and patient outcomes
  • Diagnostic errors and laboratory medicine – causes and strategies
  • Towards better test utilization – strategies to improve physician ordering and their impact on patient outcomes
  • Collaborating with international clinical organizations
  • The impact for patient outcomes of failure to follow up on test results. How can we do better?
  • The clinical and health economic value of clinical laboratory diagnostics
  • Evaluating biomarkers for guiding treatment decisions


I can’t pretend to be the world’s greatest clinical chemist. This will be very useful. I shall keep an eye on this website…

29 January 2015 (Thursday) - Apixaban

      Here’s something out of the ordinary….. coag results seem to be to pot.    

                   Specimen Results Entry

                                      29/01/2015 18:00
DASTARDLY, DICK   06/01/1935   Male     000000            Emergency Care Centre
1 The Street Folkestone                   Dr
SOB, large pleural effusion, metabolic acidosis.On    U         HAWK
Specimen No   :  AK681632H               Selected Auth Level : S
--------------------T-------------------T-------------------T-------------------
 PT     31.3   F000 |                   |                   |
 APTT   47.5   F000 |                   |                   |                    |                   |                   |
                    |                   |                   |
--------------------T-------------------T-------------------T-------------------
LTG comments : CS,CX,CXR,DIC,EXT,IA,INT,ITS,LUPUS,PTT,RM,TS,TSW,VWF


 1 Auth'd   2 Unauth'd   3 Nomin'd   4 Change   5 Reject  6 Options  7 eXit> U
 




                   Specimen Results Entry

                                      29/01/2015 18:00
DASTARDLY, DICK   06/01/1935   Male     000000            Emergency Care Centre
1 The Street Folkestone                   Dr
Specimen No   :  AK681632H               Selected Auth Level : S

Specimen No   :  AK681632H               Selected Auth Level : S
--------------------T-------------------T-------------------T-------------------
 PT     31.3   F000 |                   |                   |
 PT50   17.0   F008 |                   |                   |
 APTT   47.5   F000 |                   |                   |
 APTT50 34.3   F008 |                   |                   |
 APTTR ^1.6    F008 |                   |                   |
 INR    2.2    F000 |                   |                   |
 FIB    2.91   F008 |                   |                   |
 TT     20.7   F008 |                   |                   |
                    |                   |                   |
                    |                   |                   |
--------------------T-------------------T-------------------T-------------------
LTG comments : CS,CX,CXR,DIC,EXT,IA,INT,ITS,LUPUS,PTT,RM,TS,TSW,VWF


 1 Auth'd   2 Unauth'd   3 Nomin'd   4 Change   5 Reject  6 Options  7 eXit> U

Further testing doesn’t really throw us any bones at first sight… is the patient on anticoagulants?

                   Specimen Results Entry

                                      29/01/2015 18:00
DASTARDLY, DICK   06/01/1935   Male     000000            Emergency Care Centre
1 The Street Folkestone                   Dr
SOB, large pleural effusion, metabolic acidosis.On    U         HAWK
Specimen No   :  AK681632H               Selected Auth Level : S

------T-----------------------------------------------------------------------]
  Date|29/01/2015 20/09/2014 19/09/2014 20/11/2012 14/11/2012 13/11/2012      |
  Time|18:00      u/k        u/k        u/k        09:30      09:45           |
  Spec|AK681632H  AW195849Z  AW195351J  AW222189T  AW206838M  AW201661M       |
      |BIO        BIO        BIO        BIO        BIO        BIO             |
Test--+-----------------------------------------------------------------------{
PT    |31.3       18.0       17.3                                             |
PT50  |17.0                                                                   |
APTT  |47.5       39.9       37.4                                             |
APTT50|34.3                                                                   |
APTTR |^1.6       ^1.3       ^1.2                                             |
INR   |2.2        1.2        1.2        7.2        2.4        2.1             |
FIB   |2.91                  4.91                                             |
TT    |20.7                  16.3                                             |
      |                                                                       |

------T-----------------------------------------------------------------------]
  1 View   2 Graph   3 eXit  X
                                                                       More >>


 But look at the history… those INRs. Warfarin?

The patient was actually taking apixaban – a factor Xa inhibitor prescribed for treatment and secondary prophylaxis of DVT and PE.

A new one on me...