21 November 2021 (Sunday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise… I logged in to the website and was presented with one case – a thirty-two year old woman in theatre requiring group & save.

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

 I got the green light.

18 November 2021 (Thursday) - Transfusion News Update

The nice people at “Transfusion News” sent their update today…  One of the things I find most frustrating about transfusion medicine is how opinion changes so much. Back in the day whole blood was “the” thing to transfuse... Then it wasn’t… Now… who knows?

Who does know? That’s why we do CPD – to keep ourselves aware of who does know and what they know. Flippant? Maybe. But particularly in the world of transfusion medicine it is important to keep up with current thinking as opinion does change.

 

Platelet-Rich Plasma Injections Do Not Improve Ankle Osteoarthritis

November 17, 2021 Ankle (tibiotalar) osteoarthritis affects approximately 3.4% of adults and is associated with a reduced quality of life. Effective non-surgical treatments are not available. Based on data from four small case studies, autologous platelet-rich plasma (PRP) injections have been used with the hope that growth factors released from α-granules in platelets may modulate a regenerative response allowing affected tissue to heal. [Read More]

Benefits and Harms of Whole Blood versus Component Blood Transfusions Remain Unclear

November 9, 2021 Transfusions may be in the form of whole blood (WB) or blood components (BC). Blood components include red blood cells, platelets, plasma, and cryoprecipitate. Recently, studies have suggested that bleeding cardiac surgery and trauma patients may benefit from WB transfusions. However, storing WB solely for these patients could result in increased blood wastage. [Read More]

Red Blood Cells May Act as Immune Sentinels

November 1, 2021 Anucleated red blood cells (RBCs) are essential for delivery of oxygen throughout the body but have been considered immunologically inert. New evidence recently published in Science Translational Medicine, however, suggests that RBCs promote immune activation by binding to unmethylated, cell free CpG nucleic acid fragments and promoting cytokine production. Toll-like receptors play a key role in inflammation by identifying nucleic acid fragments. [Read More]

 

18 November 2021 (Thursday) - "Good Morning Dave"...

The nice people at the American Society of Hematology sent another update today. I don’t post about many of their updates here as most of them aren’t really aimed at me, but one little snippet of this update made me think…
Much of what I do each day involves sitting at a microscope passing judgement on what I think I see down it. I think it fair to say I have a fair idea what I’m looking at. I think it fair to say that most people peering down them do. However there is still an awful lot of subjectivity involved. I can remember my first day on the microscope bench when one inexperienced trainee MLSO (as we were back then) found something she couldn’t identify in a blood film. What was that cell she saw? There were as many opinions as there were people to offer them.
And that is just in peripheral blood. Bone marrow is far more involved and examination of smears of that stuff requires serious experience. 

Over the years flow cytometry has taken some of the guesswork out of the matter, and it would seem that neural networks are possibly the way forward

• A data set of >170 000 microscopic images allows training neural networks for identification of BM cells with high accuracy.
   
• Neural networks outperform a feature-based approach to BM cell classification and can be analyzed with explainability and feature embedding methods.

I bet they ain’t cheap… However I will comment that this sort of thing has been talked about for years and still hasn’t appeared in routine haematology labs

Highly accurate differentiation of bone marrow cell morphologies using deep neural networks on a large image data set

Artificial intelligence (AI) and machine learning algorithms are changing many facets of our lives and have great potential for disease diagnosis. In this Plenary Paper, Matek et al describe training a convolutional neural network model using 171 374 bone marrow cytology images from 945 patients with various hematological diseases before validating its accuracy in classifying single cells in an independent set of 627 images. The system can automatically classify 22 classes of bone marrow leukocytes, and with further improvements, it may bring AI-aided diagnosis of bone marrow biopsy specimens closer to fruition. Read More »

12 November 2021 (Friday) - ASH Update

The nice people at the American Society of Hematology sent their update today. This one was on MDS and Myeloproliferative Neoplasms. Like much of their output it isn’t really aimed at me, but I was glad to have a look at it; I picked up one or two snippets (as I usually do).

“Little and often” is the way with CPD…

Here are the highlights in MDS and myeloproliferative neoplasms:

Germline Variants in DNA Repair Pathway Genes May Trigger Familial MPNs Recent findings published in Blood Advances suggest these variants should be incorporated in diagnostic workups.

New Prognostic Model Outperforms Established Predictive Models in MDS Researchers reported that a newly developed personalized prediction model comprising clinical and genomic data performed better than established predictive models in patients with MDS.

Reduced-Intensity Conditioning Transplant Superior to Continuous 5-Azacitidine in Older Patients With MDS In older patients with advanced MDS, reduced-intensity conditioning alloHCT improved event-free survival compared with continuous 5-azacitidine therapy.