16 September 2024 (Monday) - Getting the BTLP Wrong (?)

It’s been a while since I last did a BTLP-TACT exercise… so I had a go and was presented with two cases:

 

54014 – a fifty-nine year old chap under the medical team with sepsis requiring group and save. His blood group was O, but with an indeterminate Rh group, and an antibody screen positive in cells 1 and 2.

I requested antibody panels. The IAT and enzyme panels were positive in cells 1, 2, 3 and 4 being consistent with anti-C and anti-D but not ruling out anti-Cw

 

36430 another fifty-nine year old chap; this one with vitamin K deficiency requiring group and save and two units of cryo. His blood group was B Rh(D) Positive. It was !!! But bearing in mind that I’ve had the thumbs down on weak D reactions before I called it indeterminate. Fortunately the antibody screen was negative.

I selected two units of O cryo (as that was all there was)

 

I got it wrong. Again. Apparently cryo shouldn’t be used in this clinical condition. Even though the guidelines say it should.

13 September 2024 (Friday) - Another Rant

Here’s something from Medical Laboratory Observer. An article about mistakes in diagnostic error.
According to ECRI (an American healthcare provider) out of a thousand errors reviewed:
 

• Nearly 70 percent of errors occurred during the testing process – including when healthcare staff are ordering, collecting, processing, obtaining results, or communicating results.
  
  
• Twelve percent of errors occurred in the monitoring and follow-up phase; with nearly nine percent during the referral and consultation phase.
   
• Of errors that occurred during testing, more than 23 percent were a result of a technical or processing error, like the misuse of testing equipment, a poorly processed specimen, or a clinician lacking the proper skill to conduct the test
   
• Another 20 percent of testing errors were a result of mixed-up samples, mislabeled specimens, and tests performed on the wrong patient.

 
Without wishing to belittle the article it is the sort of thing that boils my piss (to be frank). Very quick to point out mistakes, but rather thin on details of exactly what these mistakes were, their severity, and offering absolutely nothing in the way of lessons learned from those mistakes.
 
I’m left wondering why this article was even published; if not to knock healthcare. It's prompted me to include a new label category for the articles I put on here.

10 September 2024 (Tuesday) - Value For Money ?

 

 

The IBMS sent their newsletter today. You can read it by clicking here.
The BBTS sent their newsletter today. You can read it by clicking here.
 
Between the two of them I spend twenty-five quid a month. I don’t think I get my money’s worth.

9 September 2024 (Monday) - NEQAS 2404 DM

A 56-year-old female attended a dermatology clinic. The haemoglobin and platelet counts were normal but the white cell count was found to be 20 x 10^9/L. A film was sent for assessment.”
 
Initial thoughts – it’s Sezary Syndrome
 
But doing it properly
 

Rbc   Rouleaux  anisopoikilocytosis

Wbc   Lymphocytosis cerebreform cells cleft nuclei cytoplasmic blebs Sezary cells Eosinophilia Blast cells

Plt   Thrombocytosis

 
 I spotted the salient features... and it was Sezary Syndrome.
 

 

6 September 2024 (Friday) - e-learning (pah!)

 This link made me chuckle… but then it is a serious matter really. E-learning is all very well but if all you do in providing some training is to tell your staff to watch a video on-line what is to stop them pressing the play button and pissing off for an extended tea break?

Seriously?

Such e-learning is just laziness on the part of the person setting it. Clearly it happens enough for there to be a mem on Facebook about it. And read the comments. Go on – read them (!)

5 September 2024 (Thursday) - TACO

I watched a little video about TACO today…

 

Transfusion-Associated Circulatory Overload (TACO) is defined as acute or worsening respiratory compromise and/or acute or worsening pulmonary oedema during or up to 12 hours of transfusion, with additional features including cardiovascular system changes not explained by the patient’s underlying medical condition.

 

It’s not rocket science – if you stuff anything into a system of fluids being pumped about, that pump is going to have to work harder.

There’s an interesting article about the matter here.

 

4 September 2024 (Wednesday) - Fritsma Factor Update

The nice people at Fritsma Factor sent their update today. You can read it by clicking here. There’s not as much in this one as there has been in previous updates, but what there is is worth having.

This month’s question made me think… “At what FVIII activity level should the PTT become prolonged?”

At what level does it become prolonged? At the risk of appearing flippant, hopefully the answer is “clinically significant”.

3 September 2024 (Tuesday) - Westgard QC Update

 

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

As always the stuff is rather dry, but to a reactionary old duffer llike me this is what CPD is all about.

2 September 2024 (Monday) - Daratumumab

I was asked a question today. M answer was “don’t know” so I did some finding out…

 

Daratumumab is effective in cases of multiple myeloma as a monotherapy in heavily treated patients with relapsed or refractory disease. It is a monoclonal antibody that specifically targets human CD38, which is highly expressed on myeloma cells.

However if a patient is on daratumumab when we do a group and save their antibody screen comes up positive in absolutely everything which makes crossmatching problematical.

So we send a sample to NHSBT and they send us compatible blood… what magic do they work?

 

Cells are treated with dithiothreitol (DTT) which removes the CD38. However whilst it is at it, it also removes the K antigen, and other antigens including ones of the Lutheran, Yt, Cromer, Dombrock, and Knops blood group systems.

 

Here’s an article describing what happens. There’s no magic. It’s quite straightforward. So why is this in the domain of the reference laboratory and not standard practice?

1 September 2024 (Sunday) - HCPC Standards Updated

 

The HCPC has updated its standards of conduct, performance and ethics  and its guidance on social media.  

 

I poured through both documents… the one which worries me is the bit about social media. It never hurts for me to think about what I’m saying on here. Initially I had a bit of a panic because I can sometimes be a tad scathing about the IBMS and the blood transfusion simulator and anyone and anything which gives me less than absolutely brilliant CPD material.

 

When I post something negative I *hope* people read what I am saying as “I find this less than brilliant for the following reasons…” and not as “this is a load of crap”.
I must take more care to ensure that my comments come over in a constructive way.

30 August 2024 (Friday) - NEQAS Parasitology 2403 PA

I got hold of the parasitology NEQAS results today
 
2403PA1
 
I said there were plasmodium sp parasites present.
There were.
 
2403PA2
 
I said this was P. falciparum with a 4% parasitaemia. I got the species right, but the parasitaemia was 7.9%. I was a tad low there… 
 

30 August 2024 (Friday) - NEQAS 2405 BF

I got hold of the blood film NEQAS results today
 
2405 BF1
 

I saw        (consensus rating)

 

Thrombocytopenia (1)

Blast cells               (2)

Auer rods                (7)

Neutropenia            (3)

NRBC                     (4)

 

I said this was AML – it was,

 
 
2405 BF2
 

I saw        (consensus rating)

 

Neutropenia             (3)

Blast cells                 (2)

Thrombocytopenia   (1)

Tear drop cells          (6)

Thrombocytopenia     (1)

 

I thought this was horrible, but didn’t want to commit myself any further. It was a pancytopenic cace of acute promyelocytic leukaemia.

 
I think I did OK there…