27 December 2024 (Friday) - BTLP Exercise

Time for another BTLP-TACT exercise. I’ve not done one for a while and I’ve been getting emails telling me off.

 

It presented me with two cases:

 

10378 - a fifty-two year-old chap having a cholecystectomy needing a group and save

 

He grouped as A Rh(D) Positive. Weakly positive, but positive nonetheless. But for the purposes of this I called the RH group indeterminate and said it should be sent to NHSBT.

The antibody screen was positive in cells 1 and 2 so I requested antibody panels.

The IAT panels were positive in cells 1, 2 and three corresponding with anti-D but not excluding anti Cw.

 

 

73876 – a thirty year old needing 4 FFP and 2 cryo for a liver transplant.

 

He grouped as A Rh(D) Positive with a negative antibody screen…

Should I issue plasma products? I did. I was right to do so.

22 December 2024 (Sunday) - Historical Records

Just how believable are historic blood groups? There was a post on the Facebook “Blood Bank Professionals Group” about it today in which many people commented about the blood groups recorded on the history of patients grouped whilst on military service which were later found to be wrong.

Obviously you perform a confirmatory group…

 

What if there’s a historic antibody record? Do we trust that or are we sceptical of that too? With the passage of time it isn’t unusual for blood group antibodies to fall below the level of detection. Given that a patient turns up with a supposed history of (say) anti-S, anti-Jk(a) and anti-Jk(b) do we just crossmatch antigen-negative blood or do we phenotype the patient to see if the supposed antibody is plausible (leaving aside the entire concept of auto-antibodies)

 

18 December 2024 (Wednesday) - HCPC Newsletter

The HCPC sent their quarterly newsletter today. It started will with information about next year’s CPD week, but then for me it all went rather downhill with a whole load of stuff which wasn’t really of any interest to me.

Am I being unreasonable in expecting detailed information and updates on the specific areas in I work when the HCPC has such a diverse group with whom it works?

Probably.

17 December 2024 (Tuesday) -NEQAS 2406 DM

I got the results of NEQAS 2406 DM today.
 
When I looked at it I said
 

Rbc Anisopoik Polychromasia echinocytes NRBC

Wbc  Blast cells Vacuolated monocytes Dysplastic neutrophils Thing with strange protruberances – seen that before !!!!

Plts  Low Plts Giant plts

 
??? CMML
 

The expert opinion said a lot without saying anything “The cells in the circulation in this case are very abnormal with their shared morphological features predominantly of mature but abnormal monocytes, at least one “blast cell” form present. In a young adult the diagnosis in such cases is by far most likely to be an acute leukaemia with monocytic differentiation. This diagnosis is often difficult to make for morphologists since the monocytes appear predominantly mature, so it is important also to take into account the relatively young age of the patient and the very low likelihood of a predominantly monocytic response to severe infection. This is even more challenging in older patients where the possibility of a CMML should also be considered. If in doubt (particularly in the presence of cytopenias) the case should be alerted urgently to the clinicians as clinical and bone marrow evaluation may be vital”.

 

I’m claiming I got this right.

16 December 2024 (Monday) - Learning Monday

Learning Monday – how best to assess the progression of myeloma? Back in the day it was by bone marrow aspirate, and it still is. Admittedly these days we do different things with the marrow once it’s aspirated though.

14 December 2024 (Saturday) - Transfusion Evidence Alert Update

The nice people at the Transfusion Evidence Alert sent their update today. Well actually they sent it a few days ago and it went into my junk email…

Again tranexamic acid features, and again there’s talk of keeping platelets in the fridge.

Top article 2024

Effectiveness of ferritin-guided donation intervals in whole-blood donors in the Netherlands (FIND'EM): a stepped-wedge cluster-randomised trial.
Meulenbeld, A., et al. (2024). Lancet.
PICO SUMMARY

 

Selected articles

Andexanet for factor Xa inhibitor-associated acute intracerebral hemorrhage.
Connolly, S.J., et al. (2024). The New England Journal of Medicine.

Meta-analysis and metaregression of the treatment effect of intravenous iron in iron-deficient heart failure.
Martens, P., et al. (2023). JACC: Heart Failure.

Prehospital tranexamic acid is associated with a survival benefit without an increase in complications: results of two harmonized randomized clinical trials.
Mazzei, M., et al. (2024). The Journal of Trauma and Acute Care Surgery.    

Two-year outcomes following a randomised platelet transfusion trial in preterm infants.
Moore, C.M., et al. (2023). Archives of Disease in Childhood. Fetal and Neonatal Edition.

Darbepoetin alfa to reduce transfusion episodes in infants with haemolytic disease of the fetus and newborn who are treated with intrauterine transfusions in the Netherlands: an open-label, single-centre, phase 2, randomised, controlled trial.
Ree, I.M.C., et al. (2023). The Lancet. Haematology.

Early cold stored platelet transfusion following severe injury: a randomized clinical trial.
Sperry, J.L., et al. (2024). Annals of Surgery.

Liberal or restrictive transfusion strategy in patients with traumatic brain injury.
Turgeon, A.F., et al. (2024). The New England Journal of Medicine.   

A cost-effectiveness analysis of early detection and bundled treatment of postpartum hemorrhage alongside the E-MOTIVE trial.
Williams, E.V., et al. (2024). Nature Medicine.  

Efficacy and safety of tranexamic acid in acute traumatic brain injury: a meta-analysis of randomized controlled trials.
Zhang, M. and Liu, T., (2024). The American Journal of Emergency Medicine.

 

13 December 2024 (Friday) - The Great Big Biomedical Science Quiz

I must admit that I am very quick to find fault with the IBMS. I often rant about how they have lost their way. But this morning on their Facebook page they’ve announced their “Great Big Biomedical Science Quiz” – eight questions for each of the disciplies of biomedical science.

This is what I like to see… and I got seven out of the eight haematology questions right. I’d not heard of space anaemia before. I spent a few minutes looking up a few articles… and now I’ve learned something. Which is what CPD and my professional institute should be about.

11 December 2024 (Wednesday) - It's Important !!!

Sometimes it is easy to forget exactly what it is we do for a living. Not so much the aspect that people’s well-being depends on us getting the answer right, but what we actually do. What we test. And where it comes from.

Many years ago one of the young ladies with whom I went to college died of a brain tumour. A rather obscure one which accounts for less than one per cent of all types of brain tumours. And three of the people she worked with at the time died of exactly the same sort of tumour.

Nothing was ever proved – things were different back then. When asking for a pencil sharpener in my first place of work I was given a scalpel.

When I first started I was advised to take out the works pension but the chap advising me to do so openly admitted that he did so because he was under orders to do so. He implied a pension was a waste of money and claimed that (at that time) the average person doing the job died three years before collecting their pension from something nasty they contracted doing the job.

Was he right? I’ve never fact-checked what he said. But this brings today’s missive from the nice people at Lablogatory into focus. Don’t roll your eyes at health and safety. It’s important.

10 December 2024 (Tuesday) - Westgard QC Update

The nice people at Westgard QC sent their update today. I’ve got a degree in maths and spent five years studying the subject and still I struggle with the sort of thing that comes in their monthly update.

I saw this piccie on Facebook the other day and thought it particularly apposite

 

9 December 2024 (Monday) - Learning Monday

Bone marrow transplantation… who would be the best donor? I was right in choosing option 2.

Back in the day bone marrow was the future for the lab in the district general hospital. We did autologous transplants for a few years, but allogenic transplantation would be in our remit. HLA typing and all the testing…

Didn’t turn out that way, did it?

8 December 2024 (Sunday) - BTLP-TACT Exercise

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

93347 – a forty-three year-old woman needing group & save. 

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

 

17507 – a thirty-three year-old needing two units of blood for a surgical procedure.

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

I selected two units of A Rh(D) Positive blood

 
I got the thumbs up.

6 December 2024 (Friday) - NEQAS 2407

I got hold of the results of NEQAS 2407 BF today…
 
2407 BF1
 
I said:
 

Rbc   Macrocytes Anisopoik Echinocytes Rbc fragments Nucleated Rbs

Wbc   Myelocytes (and pro-) Dysplastic neutrophils Bi-lobed neutrophils Smear cells  Vacuolation Occasional blast

Plt   Low plts Giant platelets

 
Top ten reported comments were
 
Nucleated RBCs
Thrombocytopenia
Blast Cells
Echinocytes/Crenated Cells
Left Shift
Promyelocytes
Myelocytes
Fragments/Schistocytes
Large/Giant Platelets
Acanthocytes
I felt this was a case of Myelodysplasia. It wasn’t – it was a case of severe sepsis. I spotted all the salient features, and can’t help but feel that (as is the case in all NEQAS exercises) we are deliberately hobbled by a total lack of clinical information and lack of blood count information.
 
 
2407 BF2
 

I said:
 

Rbc   Rouleaux Tear drop cells NRBCs

Wbc   Neutropenia Blast cells

Plt   Low plts

 

Top ten reported comments were
 
Thrombocytopenia
Nucleated RBCs
Blast Cells
Neutropenia
Tear Drop Poikilocytes
Rouleaux
Polychromatic Cells
Poikilocytes
Hypochromic Cells
Macrocytes
 
I said this was “?? something nasty ? AML”.  
It was

3 December 2024 (Tuesday) - NEQAS 2404 PA

I got hold of the results of NEQAS parasitology survey 2402 today.
 
2404 PA1
"Returned from safari in Tanzania with suspected malaria"
 
I saw trypanosomes -  T. brucei
I was right
 
2404 PA2
"Fever on return from Thailand"
 
I said no parasites seen
I was right

2 December 2024 (Monday) - Fritsma Factor Newsletter

The Fritsma Factor newsletter appeared in my in=box today. You can read it by clicking here.

One article made me think…  how do you know if a sample has got a clot in it? Well, you pop it open and fish about with a wooden stick, don’t you? We’ve certainly been doing that since 1981. It would seem there’s no evidence that this doesn’t activate an otherwise decent sample…

So what are we supposed to do?