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

27 November 2023 (Monday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Alert sent their update today. Again tranexamic acid featured… that stuff really is one of the wonders of our age.

Personally I liked the talk about not taking such a great volume of blood from patients for various testing… surely it stands to reason that the more you exsanguinate a patient, the more transfusions they will need?

26 November 2023 (Sunday) - Sign of the Times?

Back in the day if you stuffed something up and made a serious mistake you found yourself up before the regulator and had conditions of practice put upon you. The stress of the process made you lose five stones in weight and gave you nightmares for years after the event.

Nowadays you write the thing up as a PowerPoint presentation for the world to download, and have no qualms about writing “Malaria was missed by BMS and consultant staff”.

Not that I'm in any way bitter...

21 November 2023 (Tuesday) - BTLP-TACT Exercise

I’m just about to go to bed for the afternoon before a night shift… time for a BTLP-TACT exercise.

I had one case – an eighty-three year old chap in the haematology clinic needing group & save. He grouped as A Rh(D) Negative with antibody screen positive in cells 1 and 2. I requested antibody panels.

The IAT and enzyme panels were positive in cells 1, 2 and 3 which was consistent with anti-D but didn’t rule out anti-Cw.

I got the green light…

20 November 2023 (Monday) - XBarM Analysis

Clare’s done some more science… XbarM analysis… for the most part tells you that the blood samples going through your analyser now are from a different clinic to those that went through half an hour ago…

Clare explains it in more detail here.

20 November 2023 (Monday) - Platelet Satellites

I saw some platelet satellites today. We often see platelets clumping in EDTA (at least once every day, but seeing them satellite around neutrophils is a relatively rare occurrence. Interestingly (and something I didn’t realise) is that demonstrably the platelets don’t form satellites around every neutrophil.

I wonder why not.

Anyway, here’s a couple of references on the matter:

https://www.labce.com/spg280957_pseudo_thrombocytopenia_platelet_satellitism_and_p.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115092/

The second reference says “The clinical importance of this phenomenon is that in some cases it may result in spurious thrombocytopenia or pseudothrombocytopenia leading to further unnecessary investigations. Thus, recognition of this in vitro phenomenon only re-emphasizes the necessity of age old practice of peripheral blood film examination".

Written by an old-timer like me!!!

18 November 2023 (Saturday) - Cold Storage (?)

One of many things that winds me up is how what is absolutely the wrong thing to do (and is cast in stone) and doing it is a disciplinary offence in the world of blood transfusion today will be the official standard and best practice tomorrow.

For over forty years I have been told to keep the platelets we away from the fridges.

Now it would seem that keeping the platelets cold is a good idea…

https://www.umc.edu/news/News_Articles/2021/07/Platelets-Trial.html

https://pubs.asahq.org/anesthesiology/article/133/6/1161/110663/Warming-Up-to-Cold-stored-Platelets

https://www.lifeblood.com.au/news-and-stories/trending-research/rethinking-platelet-storage

15 November 2023 (Wednesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – a forty-five year-old woman under the gynaecology team needing a group and save.

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

I got the green light…

14 November 2023 (Tuesday) - NEQAS 2305DM

I got the results of NEQAS 2305 DM today. I spotted that which I needed to…

Your observations:			All participants' observations:
		Participants who selected this feature (%)	Rank	Morphological Feature	Participants who selected this feature (%)
Rank	Morphological Feature	Participants who selected this feature (%)	Rank	Morphological Feature	Participants who selected this feature (%)
1	Pseudo-Pelger cells	37.07	1	Rouleaux	62.56
2	Neutrophils - atypical nuclear form	13.43	2	True Pelger cells	47.65
	Neutrophils - atypical nuclear form
3	Rouleaux	62.56	3	Pseudo-Pelger cells	37.07
4	Metamyelocytes	5.08	4	Platelet anisocytosis	32.05
5	Large platelets	24.85	5	Hypergranulation/toxic granulation	25.49
				Hypergranulation/toxic granulation

What overall description best fits these appearances?			Actual pathological diagnosis:

An infective process. Not sure about the Pelger Huet cells though			Inherited Pelger-Huet anomaly in a patient presenting with an infection.

14 November 2023 (Tuesday) - Westgard QC Update

The nice people at Westgard QC sent their update today. You can read it by clicking here.

Perhaps a tad dull and rather dry, but it’s the sort of thing that CPD is all about.

11 November 2023 (Saturday) - IBMS Update

I don’t want to appear negative, but I can remember one of the lecturers at Bromley College of Technology having a rant in 1983 in which he was listing the many failings of the IBMS. The crux of his rant was that the IBMS has lost its way.

Maybe the IBS has now found it? The IBMS has published its second Public Affairs Newsletter in which it lists how it has been trying to interact with various politicians and make a plan for the future of hospital laboratories. Whether or not it is the right plan is arguable; but a plan is definitely needed. Is the IBMS back on course. I don’t know, but someone has to plan, and (in theory) who better than the IBMS.

Having said that, the IBMS does seem to have lost sight of its motto “disce ut proficas”…

10 November 2023 (Friday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with two cases:

33627 – a sixty-three year old woman in theatre requiring two units of blood within two hours.
She grouped as A but with an indeterminate Rh group. BUT the positive control in the group made the entire group uninterpretable. I made this mistake in July, didn’t I?
So I reported everything as uninterpretable.
The antibody screen was positive in cells 1 and 2.
The IAT panel was positive in cells 1, 2, 5, 8 and 9 which corresponded with anti-M but didn’t exclude anti-Cw or anti Lu(a).
The enzyme panel was negative in everything which did exclude anti-Cw
Anti-Kp(a) was excluded by the screen
I issued two units of O Rh(D) Negative which were M negative. They weren’t labelled as Lu(a), but that’s why we crossmatch.

70760 – a fifty-six year old woman also in theatre requiring four units of blood tomorrow.
She grouped as O Rh(D) Negative with a negative antibody screen.
I selected four units of O Rh(D) Negative

I got the thumbs down. Apparently anti-Lu(a) could have been excluded… Could it? I don’t think so. Better to get the red light for erring on the side of caution, eh?

Thursday 9 November 2023 (Thursday) - Oncology Central Update

The nice people at Oncology Central sent their update today. You can see it by clicking here.

Quite often (usually) the oncology-related stuff I find for CPD goes over my head. Much of this did, but maybe some of it has stuck?

8 November 2023 (Wednesday) - Safety

The nice people at Lablogatory sent an update on safety today. You can read it by clicking here.

I won’t lie; my initial reaction was “pah – safety…” and to reach for the “delete” button.

But safety is incredibly important. As semi-retirement looms I find myself thinking about the (so-called) good old days.

When I first started in lab work there were ash trays by the microscopes, we sharpened pencils with scalpel blades (on regularly seeing people cut themselves I bought myself a pencil sharpener!), and I can distinctly recall a meeting with the senior chief MLSO (as we were called back then) in which he said he couldn’t advise me not to join the pension scheme, but said that he would make the observation that the average age of death of people in our line of work was fifty-seven, and that they often died from stuff they caught in the lab.

Safety *is* important.

6 November 2023 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I had one case – a twenty year old chap with haemophilia requiring group and save.

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

I got the green light.

2 November 20023 (Thursday) - Fritsma Factor Update

The nice people at the Fritsma Factor sent their update today. They’ve changed how they operate… rather than a monthly newsletter they just seem to regularly update their website instead… which is rather tricky for providing evidence of CPD if every month I give a link to the same website.

My issue here is that George has changed something, and I don’t do change very well.

But one of the things they updated it with today was an article describing a discussion on sticky platelet syndrome… I can vaguely remember something about that.

1 November 2023 (Wednesday) - Stago Newsletter

The nice people at Stago sent their update today. You can read it by clicking here.

I’ll be honest – don’t bother. The company’s push to being carbon neutral and its Societal Commitments and compliance with the UK Modern Slavery Act (2015) is all very necessary… but *not* in any way relevant to me improving what I do on a daily basis.

I’m off sick with COVID right now, and this is making my bad mood worse. There’s reflection for you…

31 October 2023 (Tuesday) - Westgard QC Update

The nice people at Westgard QC sent their update today. You can read it by clicking here.
I’ll be honest – I’m off sick with COVID, and this is a bit heavy for me right now. I’ll come back to it later (really!)

31 October 2023 (Tuesday) - Transfusion Evidence Alert

The nice people at Transfusion Evidence Alert sent their update today. Far from being entirely hi-tec, tranexamic acid and cell salvage are very much the way forward.

ARTICLE OF THE MONTH

Cell salvage for minimising perioperative allogeneic blood transfusion in adults undergoing elective surgery.Lloyd, T. D., et al. (2023). The Cochrane Database of Systematic Reviews.PICO Summary available

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