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…
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
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
Here’s an interesting article.
Whether to give blood or not after heart surgery is arguable. Where’s MSBOS now…?
Here’s a possibly worrying article.
“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.
After looking at a recent NEQAS morphology exercise this website struck me as being particularly relevant
It’s a rather good walkthrough of the myeloid maturation process.
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…
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
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?