30 May 2020 (Saturday) - BTLP-TACT Excercise

Well… it is seventeen days since I last did a BTLP-TACT exercise so I had better get busy…

I was presented with one case – an eighty-year old woman requiring group and save prior to a hysterectomy.

She grouped as A Rh(D) Positive with a negative antibody screen.

I got the green light…

29 May 2020 (Friday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their missive today. Finally we are moving back to updates which are about more than just the ongoing pandemic:

ARTICLE OF THE MONTH The benefits of iron supplementation following blood donation vary with baseline iron status AE Mast,, et al.Am J Hematol PICO Summary available

TOP ARTICLES Regular bleeding risk assessment associated with reduction in bleeding outcomes: The mAFA II randomised trial Y Guo, et al, Am J Med 2020 PICO Summary IVMP+IVIG raises platelet counts faster than IVIG alone: results of a randomized, blinded trial in childhood ITP M Carcao, et al. Blood Adv 2020 PICO Summary Practical Considerations for a Military Whole Blood Program M Bahr, et al. Mil Med 2020 PICO Summary Iron Chelation in Transfusion-Dependent Patients With Low- to Intermediate-1-Risk Myelodysplastic Syndromes: A Randomized Trial E Angelucci, et al. Ann Intern Med 2020 PICO Summary Interventions for preventing silent cerebral infarcts in people with sickle cell disease LJ Estcourt, et al. Cochrane Database Syst Rev 2020 PICO Summary Efficacy of quadruple treatment on different types of pre-operative anaemia: secondary analysis of a randomised controlled trial J Rossler, et al. Anaesthesia 2020 PICO Summary Effective methods for reactivating inactive blood donors: a stratified randomised controlled study J Ou-Yang, et al. BMC Public Health 2020 PICO Summary Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury - meta-analysis of randomized controlled trials J July and R Pranata. BMC Neurol 2020 PICO Summary Efficacy of intraoperative cell salvage in spine surgery: a meta-analysis J Cheriyan, et al. J Neurosurg Spine 2020 PICO Summary The role of platelet transfusions after intracranial hemorrhage in patients on antiplatelet agents: a systematic review and meta-analysis E Brogi, et al. World Neurosurg 2020 PICO Summary

28 May 2020 (Thursday) - UKAS Update

The nice people at UKAS sent their newsletter today. Apparently they have set some standards for COVID-19 testing. Reading the newspapers it would seem that anyone who wants to test for the stuff has just been having a go up till now.

Perhaps this might be a move for the better?

28/ May 2020 (Thursday) - Transfusion News Update

The Transfusion News talks about the use of convalescent plasma for the treatment of patients with COVID-19… We’ve started stocking the stuff.

Perhaps COVID-19 *is* more relevant to me than I thought?

Convalescent Plasma Decreases Mortality for Non-Intubated Patients with Severe COVID-19

May 27, 2020 Based on a preliminary propensity score-matched control study, convalescent plasma is beneficial for non-intubated patients with severe COVID-19. At the Mount Sinai Hospital in New York City, 39 hospitalized patients (average age, 55 years; 64% male) with severe to life-threatening COVID-19 were transfused with [Read More]

Convalescent Plasma for COVID-19 Safe in First 5,000 Patients

May 19, 2020 With limited therapies for patients with COVID-19 and a mortality rate of approximately 50% for patients in the ICU, demand is high for convalescent plasma from individuals who have recovered from COVID-19. Convalescent plasma has been requested for [Read More]

26 May 2020 (Tuesday) - Slacking ?

I haven’t been posting as much as I usually do on here… How I collate my CPD is I subscribe to pretty much every work/science-related mailing list in the known universe. I put all the emails into one folder, and a couple of times a week I weed through the list. “Weed” being a rather good description as I usually delete ten articles that I am sent for every one I remark about on here.

At the moment pretty much everything is about COVID-19. Which isn’t *that* relevant to what I do…

I mention this because if I am called up for audit next year I don’t want anyone to think I’m slacking…

21 May 2020 (Thursday) - Chemotherapy's Toxicity

“The Oncologist” newsletter appeared today. One article caught my eye. Predicting the toxicity of chemotherapy… Chemotherapy isn’t nice stuff; is it going to do more harm than good?

20 May 2020 (Wednesday) - Mild Bleeding Disorders

Here’s an interesting article – the investigation of mild bleeding disorders. Laboratory findings *aren’t* the be-all and end-all of the matter…

18 May 2020 (Monday) - Transfusion Evidence Library

A couple of days ago I said “The transfusion News email came in today. It seemed rather preoccupied with COVID-19, but then, isn’t everyone?”

The missive from the Transfusion Evidence Library was equally single-minded.

I am rather concerned that my CPD is being rather biased right now…

HIGHLIGHTED ARTICLE High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study Helms, J. Intensive Care Medicine

TOP ARTICLES Convalescent plasma in Covid-19: Possible mechanisms of action Rojas, M., et al.  Autoimmunity reviews 2020 Association between ABO blood groups and risk of SARS-CoV-2 pneumonia Li, J., et al.  British journal of haematology 2020 Blood Supply Milestones in the Netherlands in the First Weeks of COVID-19 Syeldy Langi Sasongko, et al. ISBT Science Series 2020 Incidence of venous thromboembolism in hospitalized patients with COVID-19 Middeldorp, S, et al. Journal Of Thrombosis And Haemostasis 2020 Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis Klok, F, et al. Thrombosis Research 2020 Convalescent Plasma to Treat Coronavirus Disease 2019 (Covid-19): Considerations for Clinical Trial Design Barone, P. and DeSimone, R. A. Transfusion 2020 Prepare to adapt: Blood supply and transfusion support during the first 2 weeks of the 2019 Novel Coronavirus (COVID-19) pandemic affecting Washington State  Pagano, M., et al. Transfusion 2020 The blood supply management amid the COVID-19 outbreak  Raturi, M. and Kusum, A. Transfusion clinique et biologique 2020 Vox Sanguinis International Forum on Transfusion Services about Response to COVID-19  Yazer, M., et al.

14 May 2020 (Thursday) - Transfusion News email

The transfusion News email came in today. It seemed rather preoccupied with COVID-19, but then, isn’t everyone?

Coagulopathy in Patients with COVID-19—Interim Guidance from the International Society on Thrombosis and Haemostasis

May 13, 2020 Although the pathophysiology of severe COVID-19 is poorly understood, coagulopathy near the lungs has been shown to play an important role. Some patients with severe COVID-19 meet International Society on Thrombosis and Haemostasis (ISTH) criteria for [Read More]

Blood Product Recalls Strain Finite Resources

May 6, 2020 With blood shortage concerns from the COVID-19 pandemic, blood products are now more than ever a precious commodity. A recent study published in Blood Advances examined the prevalence, causes, geographic patterns, and the impact of blood recalls in the United States. [Read More]

COVID-19 Convalescent Plasma with Pampee Young and Ralph Vassallo

May 4 2020 | BBGuy Podcast In the midst of the COVID-19 pandemic, does convalescent plasma from recovered patients offer fresh hope for those who are critically ill? [Listen Now]

13 May 2020 (Wednesday) - BTLP-TACT Exercise

I was a bit cheeky today. Whilst things were a tad quiet rather than asking the boss if there was anything else I might do I sneakily slipped in a BTLP-TACT exercise.

I was presented with one case; a 35 year old male in haem clinic needing 2 units irradiated blood for the next day. He grouped as O Rh(D) Neg with the antibody screen positive in cells 1 & 2.

Panels were performed which were positive in cells 1, 2 and 3 which is consistent with anti-D but does not exclude anti-Cw

I selected two O Rh(D) Neg irradiated units and I got the green light​

13 May 2020 (Wednesday) - Morphology Failures?

I found this article absolutely fascinating.

“Do We Know Why We Make Errors in Morphological Diagnosis? An Analysis of Approach and Decision-Making in Haematological Morphology”

https://www.sciencedirect.com/science/article/pii/S2352396415300736

Morphology is often described as being more of an art than a science. You don’t so much identify a cell because of certain salient features so much as you “have a feel for it”. So what happens when your “feelings” are misguided?

13 May 2020 (Wednesday) - RSS Feeds

One of the guidelines for what constitutes CPD is that whislt it is supposed to improve your practice, it might not. But even a failure is still worthy of mention…

The Journal if Immunology claimed to have an RSS feed at https://www.jimmunol.org/rss

The Blogger software doesn’t recognise it.

It took me two minutes to write this after over an hour spent fighting with the thing…

12 May 2020 (Tuesday) - The Oncologist Update

The nice people at “The Oncologist” sent their update yesterday. Clinical trials, immune toxicity… it was rather odd to get an email which wasn’t purely about COVID-19

11 May 2020 (Monday) - carlnkem.com

I’ve subscribed to another blog. “https://carlnkem.com - The random ramblings of an aspiring BMS”.

It might be useful; it might not. I must admit I’m put off by the picture of the author because he’s wearing a baseball hat back-to-front. But I suspect he’d be put off by a picture of me because I’m not wearing a baseball hat back-to-front.

But for all that I am a reactionary old git, this chap is scouring the Internet and highlighting stuff that may well be useful to me. And for that I am grateful…

11 May 2020 (Monday) - Laboratory News email

The Laboratory News email arrived today. Back in the day we all got the magazine because the boss said we coupd subscribe to it once we’d passed our ONC. No one ever read it, we just had the thig delivered as a status symbol.

Now I’ve signed up to get their email, and no one knows or cares.

Like the paper version of all those years ago most of the content wasn’t that relevant to me, but there was one rather interesting article on the haemostatic aspects of snake venoms. I once went to a fascinating lecture on the subject at St Thomas’s Hospital – I wish I knew who it was who gave that lecture.

9 may 2020 (Saturday) Oxford Academic Update

The nice people at Oxford Academic sent their update today. There was quite a bit of note – plasma protein electrophoresis for monoclonal bands, all sorts of stuff about leukaemia, various items about myelodysplasia..

What bothered me though was to help me stay up to date with the latest journal news and content I could follow @LabMedjournal on Twitter…

If they had a Facebook presence I would subscribe to that. But social media can take over your life. I’ve made a deliberate decision to stay off of Twitter…

Will I regret that?

7 May 2020 (Thursday) - IBMS Newsletter

The IBMS sent their newsletter today. With articles about how natural disasters affect health care and how A.I. doesn’t make for quite the excellent health care we thought it might, this was one of their better missives.

5 May 2020 (Tuesday) - Du? (He chuckled..)

Here’s something I might have touched on before. Weak-D and partial-D. What’s the difference, can I tell, and does it matter?

Today there was a presentation made available on the Facebook Immunohematology Reference Laboratory Page.

I particularly liked the bit “it is important that transfusionists do not interpret recently reported findings, or any change in nomenclature, as requiring a change in transfusion practice, as there is no evidence (at least in the UK) that current practice is failing patients”. Bearing in mind that when I was a lad we would “just do a Coombs test on the albumin and call it a Du”, things have changed massively in the intervening years. Advice and practice change rapidly in the transfusion world. I’m glad that (at least in this respect) I’m doing the right thing.