26 March 2015 (Thursday) - Thick Films

Whilst I’m confident that I can spot blood bourne parasites if they are there; I’ve always been somewhat iffy about my abilities on thick films. Mind you I think it’s fair to say I’m not alone in this.

Today I had a little one-to-one session on a NEQAS thick film.

Speaking with someone a little more experienced than I am has left me a little more confident in examining thick films.

The key feature is the malarial dots. Don’t try to see the same sort of thing you see in a thin film; look for definite distinct dots. If these are parasites, then attached to them will be the wispy remains of the parasites. Having now seen them I know what to be looking for…

23 March 2015 (Monday) - Bright Yellow

This case made me think

HUDSON,ANGUS                                             23/03/2015 12:45       03/04/2013 1 yrs   F  1234567              Infirmary 185 Eaton Square                    Dr Foley Specimen No : AC654321D    Haematology & Chemistry        <PgDn> for later ------------------------------------------------------------------------------ 23/03/2015 12:45  Serum/Plasma  Request Reason :     YELLOW   MOTHER GIVES A LITER OF CAROT JUOCE EVERY 24 HOURS  Sodium                         138    mmol/L          (   133 to 146   ) Auth  Potassium                      4.7    mmol/L          (   3.5 to 5.3   ) Auth  Creatinine                     24     umol/L          (    21 to 36    ) Auth  GFR (estimated)                Inappropriate to calculate                Auth  Total Protein                  69     g/L             (    56 to 75    ) Auth  Albumin                        41     g/L             (    30 to 50    ) Auth  Globulin                       28     g/L             (    20 to 35    ) Auth  Total Bilirubin                6      umol/L          (     0 to 22    ) Auth  Alkaline Phosphatase           304    U/L             (    60 to 425   ) Auth  ALT                            11     U/L             (     5 to 45    ) Auth  Haemolysis-Integra             ^1.0                                      Auth  Icterus-Integra                ^70                    (     0 to 85    ) Auth  Lipaemia-Index                 ^0.1                                      Auth

Leaving aside all arguments about use of the word “normal” these results are pretty much “normal”. Bilirubin within acceptable levels, icteric index is fine. Despite the fact the child is bright yellow.

However look at the diagnosis. Sometimes the answer to clinical conditions doesn’t need extensive laboratory investigations

21 March 2015 (Saturday) - To Give, or Not To Give

Here’s an interesting article.

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1403612

Whether to give blood or not after heart surgery is arguable. Where’s MSBOS now…?

20 March 2015 (Friday) - Lab in a Bag

Here’s a possibly worrying article.

http://www.england.nhs.uk/2015/03/20/lab-in-a-bag/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+NHSCBoard+%28NHS+England%29

“Lab in a Bag” is a “groundbreaking mobile diagnostics service that will deliver laboratory standard test results outside of hospital and allow patients to be diagnosed and treated at the point of care”

In theory it sounds like a good thing, and *if* it works it will clearly be essential in inmproving the patient experience and outcome.

In practice the entire “near patient thing” hasn’t really impacted on my personal workload. Will this one? I don’t know. But in all of this near patient testing I always remember the works of a paediatric sister who was once telling me about a ward-based bilurubin-measuring device. She would only allow the machine to be used if it was being done “just for fun”. If the result was to be used in patient treatment the sister refused to allow the machine to be used; for that she insisted the hospital lab produce the result.

11 March 2015 (Wednesday) - Myeloid Maturation

After looking at a recent NEQAS morphology exercise this website struck me as being particularly relevant

http://allaboutblood.com/2011/06/04/morphology-of-myeloid-precurssors/

It’s a rather good walkthrough of the myeloid maturation process.

9 March 2015 (Monday) - Leukaemia

Here’s something of note….

McKerrell T, Park N, et al.. Leukemia-associated somatic mutations drive distinct patterns of age-related clonal hemopoiesis. Cell Reports. 2015. DOI: 10.1016/j.celrep.2015.02.005

At college we were told that if we lived long enough we’d get leukaemia; it was inevitable. Or so said our lecturers. Now it would seem they were right.

Comparing their findings with other research, the team concluded that the incidence of pre-leukemic cells in the general population is not only far higher than previously thought but also increases with age. "Leukemia results from the gradual accumulation of DNA mutations in blood stem cells, in a process that can take decades," said Dr McKerrell. "Over time, the probability of these cells acquiring mutations rises. What surprised us was that we found these mutations in such a large proportion of elderly people."

This study helps us understand how aging can lead to leukemia, even though the great majority of people will not live long enough to accumulate all the mutations required to develop the disease… but as medicine improves so people live longer…

2 March 2015 (Monday) - Helicopters

http://dx.doi.org/10.1016/j.jamcollsurg.2015.01.006

Trauma patients air-lifted to hospital benefit from in-flight blood transfusions, according to a major new study. These patients enjoyed improved survival and were less likely to be in shock than others, according to the US research.

The findings come from a study involving the air medical evacuation service at the University of Pittsburgh Medical Center, Pennsylvania.

Paramedics are administering the transfusions in emergency helicopters… presumably compatibility requirements have been dealt with?

Where is the role of the transfusion laboratory in this?