A Dull Day At Work...?: September 2023

28 September 2023 (Thursday) - Oncology Central Update

The weekly update from Oncology Central arrived today. Like much of their stuff it is more “peripheral interest” than “directly relevant” for me. But all useful stuff…

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26 September 2023 (Tuesday) - Unstable Haemoglobin

Clare’s done some more science – how the Sysmex XN copes (or doesn’t) with unstable haemoglobin.

Mind you in over forty years I’ve never knowingly seen a case of unstable haemoglobin…

26 September 2023 (Tuesday) - BTLP-TACT Exercise

One of the sadder things about getting old(er) is that you develop set routines. One of them is that on the morning before a night shift I take the dogs for a long walk in the woods, and when I come home I get pastries for me and “er indoors ^TM” from the corner shop. I then scoff one with a cuppa whilst doing a BTLP-TACT exercise…

This morning I was presented with two cases

41051 – a forty-six year old woman in out patients requiring group and save for a cystectomy. The labelling of the blood sample bore no relation to that on the accompanying request form so I rejected it.

61095 – a twenty-four year old chap in ITU requiring four units of blood following an RTA.
He grouped as O Rh(D) Positive with a negative antibody screen.
It was at this point that the software stopped responding.
It started again after a few minutes when I selected four units of O Rh(D) Positive blood

I got the green light…

The last time I mentioned about BTLP I said that I had emailed BTLP-TACT HQ to whinge that I thought it rather unfair that they will tell me off for not doing enough of certain sorts of exercises when it is they that choose (randomly) which exercises I do. I’ve since had an email back agreeing that it is unfair, but saying that they don’t intend to change the system, and that the way round it is to do more exercises.

Ho hum…

I already do (on average) three a month. I shall create an automatic rule on my in-box to automatically delete their reminders about my (supposed) inactivity to save me doing so myself.

26 September 2023 (Tuesday) - Transfusion Evidence Alert

The nice people at the Transfusion Evidence Alert sent their update today. Not as much as they sometimes send; in fact a more manageable amount.

Again tranexamic acid features highly…

ARTICLE OF THE MONTH

Ferric derisomaltose and tranexamic acid, combined or alone, for reducing blood transfusion in patients with hip fracture (the HiFIT trial): a multicentre, 2 × 2 factorial, randomised, double-blind, controlled trial.Lasocki, S., et al. (2023). The Lancet. Haematology.PICO Summary available

+++++

25 September 2023 (Monday) - Harlequin Cells

Here’s something I don’t see every day… or every year come to that. A harlequin cell. This one was in the blood film of a chap with CLL whose white cell count was over 100. I only saw the one despite some serious searching for more.

Harlequin cells are dysplastic eosinophils with large purple-violet granules resembling basophilic granules. The literature would have me believe that they are commonly observed in acute and chronic myeloid leukaemias… I probably have seen them before but I can’t say I remember seeing one.

Here’s a few references about the things:

https://journals.lww.com/hemasphere/abstract/2019/06001/pb1991_harlequin_cell__ubiquitous_or.1861.aspx

https://onlinelibrary.wiley.com/doi/full/10.1002/jha2.576

https://imagebank.hematology.org/image/64665/harlequin-cells

https://ashpublications.org/blood/article/132/7/766/39437/Harlequin-cells

22 September 2023 (Friday) - BTLP-TACT (and a whinge)

I’ve had another reminder that I’m not doing enough BTLP-TACT exercises. Bearing in mind my abject failure on Monday I’m not going to kick off whinging about it… I’m just going to do another exercise.

I was presented with two cases:

00407 – a ninety-three year old woman needing two units of blood tomorrow for an amputation.
She grouped as A Rh(D) Positive with a negative antibody screen. I selected two units of blood for her.
80158 – an eighty-six year old chap requiring group and save following a cardiac arrest.
He also grouped as A Rh(D) Positive with a negative antibody screen

I was rather pleased to get the green light today. I was going to oh-so-sarcastically wonder how long it would be before I get another email telling me that I’m not doing enough of these exercises but…

Here’s somewhere that has made me think. Their minimum engagement targets are described in the TACT user guide which you can download here.

On page 23 it says these yearly targets are:

Request acceptance   40
ABO interpretation      40
D interpretation           40
Antibody screen          40
Antibody identification 10
Component selection 20

However I don’t get to choose what I do. The software allocates me cases. I’m (on average) asking it to give me three cases a month. It is rather unfair for it to be choosing not to allocate me certain tasks, and then critisising me for not doing that with which it has not presented me.

I’ve emailed BTLP-TACT HQ to ask if I can get some choice in selecting the type of case I get.

21 September 2023 (Thursday) - Westgard QC Update

The nice people at Westgard QC sent their update today. Some of it was rather useful. Perhaps a tad dry and statistical, but useful. Directly relevant to what I do when I look at the QC results on the analysers.

It was a shame that the rest of it referred to regulations that don’t apply to me here in the UK… mind you when you bear in mind my rant of yesterday, I’m becoming rather demanding in my old age, aren’t I?

20 September 2023 (Wednesday) - IBMS Newsletter

The IBMS Newsletter appeared in my in-box this morning. Am I really being that negative and cynical in (again) being rather disappointed in its content.

What do I want from it?

Case studies, the latest technical developments, interesting morphologies, analyser plots…

What do I get from it?

Management stuff.

I suppose (to quote my old music teacher) the IBS is like a dustbin; you only get out what you put in. Having said that I’m putting in sixteen quid a month. Am I being unreasonable in wanting more from the IBMS?

19 September 2023 (Tuesday) - Unexpected Neutropenia

Here’s something to consider when faced with an unexpected neutropenia. Otherwise unexpected neutropenia isn’t an uncommon finding in lupus.

One lives and learns… and records it on here.

18 September 2023 (Monday) - BTLP-TACT Exercise

Five days ago I wrote “With a few minutes spare I thought I might as well do some BTLP-TACT; after all it is nearly a week since they last sent me one of those emails telling me I’m not doing enough exercises…”
Four days ago I got another of those emails.
I’ve got half an hour before my appointment at the tip, so here goes.
I had two cases:

64887 – a fifty-one year old chap in the urology clinic needing two units for TURP
He grouped as O with an indeterminate Rh group. The antibody screen was negative.
I selected two units of O Rh(D) Neg blood
34435 – a twenty-seven year old woman in theatre needing four units of FFP
She grouped as A Rh(D) Positive with a negative antibody screen. I selected four units of A Rh(D) Positive FFP

I got the thumbs down. Apparently the group was all uninterpretable… I’ve made that mistake before.
And the FFP was wrong… should it have been methylene blue treated?

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