16 February 2023 (Thursday) - Teicoplanin

 

A couple of days ago I looked at a blood film on a patient with a neutrophil count of 1.3 and made the standard “neutropenia – suggest keep an eye on this” comment. Today we had another sample on the same patient with a neutrophil count of 0.3… but a little more information on the patient this time. The patient was on teicoplanin, which is known to cause neutropenia.  There’s an article on it that you can read by clicking here.

I learned something today…

16 February 2023 (Thursday) - NEQAS 2301 DM

 

The results of NEQAS 2301DM came in today -  I said:

Red Cells Anisopoikilocytosis  Boat cells ? Basophilic stippling Target cells Tear drop cells

White cells Blast cells Neutropenia

Platelets Large platelets

I saw trypanosomes too…
So… it’s someone with thalassemia and a leukaemic process who’s got trypanosomiasis.  

But…

Closing summary

The diagnosis is HbAE Barts. We were told that this person came from Thailand. The combination of microcytosis, target cells, contracted cells and polychromasia should suggest a thalassaemia syndrome. The absence of nucleated red cells is suggestive of HbH, and the presence of HbE should be considered in people presenting from this region – well done to all those who suggested these diagnoses!

A couple of features are worth additional comment: a significant number of participants correctly identified hemighost (blister) cells. These were certainly present in small numbers and are compatible with haemoglobin instability in this condition. However, this led some participants to consider a possible oxidative cause for the appearances (G6PD deficiency) – overall this is unlikely from the morphology shown (particularly in a female). Interestingly lead poisoning was considered by some (probably based on the basophilic stippling).

And finally, we did note that some participants selected neutropenia – certainly there were no neutrophils in this relatively small image for which we apologise (particularly to those who then considered MDS as a possible diagnosis).

 

Didn’t they see what I saw… or were they not blast cells and trypanosomes?

13 February 2023 (Monday) - BTLP-TACT Exercise

With a few minutes spare I thought I might have a go at a BTLP-TACT exercise before setting off to the late shift…

 

I was presented with two cases:

 

91546 – a thirty-one-year-old chap in the operating theatre needing two units of blood within the next two hours for an above-knee amputation

He grouped as O Rh(D) Negative with a negative antibody screen

I selected two units of O Rh(D) Negative blood

 

88251 – an eighty-four-year-old woman requiring a pre-operative group & save.

She grouped as… well… I don’t know what the software expected. The ABO group was indeterminate. The D group was negative.. the control worked. But what is the control in this case supposed to control?

I called the group ”Indeterminate Rh(D) Negative”.

To add insult to injury the antibody screen was positive in cells 1 and 2, so I selected identification panels.

The IAT and enzyme panels were positive in cells 1, 2, 3 and 4 which corresponded with anti-C and anti-D but could not exclude anti-C^w.

 

I amazed myself by getting the green light, and headed off to work feeling flushed with success.