22 April 2015 (Wednesday) - Something New

Back in the day science knew that T cells were either CD4+ 8- or CD4- 8+. They simply weren’t CD4- 8-.

However it would seem science has changed its mind. Gamma-delta T cells are quite a recent discovery, but they illustrate that lymphocyte immunophenotyping still has much to learn

http://en.wikipedia.org/wiki/Gamma_delta_T_cell

20 April 2015 (Monday) - The Historical Record

Here’s something which, although I knew it, illustrates a point.

Name:TRACY, VIRGIL              Group & Abs A-      <*ABS*  <SRPAD> Diamed Group      Clinically Approved By M.L. ESSO  Confirmed Group                A Rh(D) Negative Group  Coded comments :  PLEASE NOTE Delay in providing x-matched blood possible  Free text Previously identified anti-Jka not detected on this occasion.

It’s quite possible for blood group antibodies to reduce in titre to the point of undetectability. As is the case here. In cases like this it’s vital that the history be available so we know the patient has an antibody record.

In this particular case if no history was available it’s possible that an incompatible transfusion might have been given.

10 April 2015 (Friday) - On-Line Malaria Morphology

On-line malaria morphology training…. I’ve been hunting down a decent site for ages. I found one today. Brilliant. Or so I thought until I called the website up

http://biogames.ee.ucla.edu/training

It’s so out of focus as to be unusable. Which is a shame

(I mention this if only to record a lot of effort resulting in failure. C.P.D. doesn’t always work…)

7 April 2015 (Tuesday) - AKI

Acute kidney injury refers to an abrupt loss of renal function. It’s a new test offered based on existing renal parameters. I received a presentation on the subject today.

There’s more on-line

http://en.wikipedia.org/wiki/Acute_kidney_injury

If nothing else it’s shown I’m rather shaky on the intricacies of the kidney. The sooner I get going on my Diploma in Biomedical Science the better….

5 April 2015 (Sunday) - What *Are* We Measuring?

Here’s an article which made me think.

http://clinical-laboratory.blogspot.fi/2015/04/is-it-possible-to-standardize-cardiac.html

“The IFCC Working Group for the Standardization of Cardiac Troponin I (WG-TNI) believes it is possible to standardize cTnI measurement and has evaluated 16 current assays for measurement equivalence and their standardization capability using an initial harmonization approach. At the same time serum pools prepared in various ways from cTnI-positive patient sera were tested for harmonization. 

Results of the pilot study showed about a 10-fold difference in cTnI concentrations among assays and that this is largely due to differences in calibration. When these calibration differences were removed by a mathematical recalculation (using regression slope and y-intercept values), the inter-assay variation is typical of External Quality Assessment Scheme results of methods measuring more common analytes.”

Blah blah blah…. Or so I thought until I read the next bit

“The ability to mathematically recalibrate assays is an indication that the assays are measuring the same analyte despite the diversity of cTnI antibodies in use and the inherent structural variability of the cTnI analyte.” 

That’s rather important. For all that we come up with these numbers in the lab and the controls we use say we’ve got the right number, can we *really* be sure what we’re coming up with?

Apparently so.

3 April 2015 (Friday) - Dabigatran

BARNES, HEDWARD                                      06:38 MR      20/08/1940   Male   654321            Emergency Care Centre 185 Eaton Place                   Dr Foley Specimen No : AK564330X    Haematology & Chemistry         03/04/2015 06:38  Citrated Blood  Request Reason :     chest pain  PT                        20.4   s         (    12 to 16    ) Auth  APTT                      51.3   s         (  22.0 to 35    ) Auth  APTT Ratio                ^1.8                                Auth  I.N.R.                     1.4                                Auth   Coag Screen   LTG Comments :     Patient is on dabigatran

Dabigatran (Pradaxa or Prazaxa) is an oral anticoagulant acting as a direct thrombin inhibitor. It is being trialled for various clinical indications and is claimed to offer an alternative to warfarin as the preferred orally administered anticoagulant since it does not require INR monitoring while offering similar results in terms of efficacy.

There is no specific way to reverse the anticoagulant effect of dabigatran in the event of a major bleeding event unlike warfarin although a potential dabigatran antidote (pINN: idarucizumab) is undergoing clinical studies.

It was developed by the pharmaceutical company Boehringer Ingelheim… on July 26, 2014, the British Medical Journal (BMJ) published a series of investigations that accused Boehringer of withholding critical information about the need for monitoring to protect patients from severe bleeding, particularly in the elderly.

Reviews of internal communications between Boehringer researchers and employees, the FDA and the EMA revealed that Boehringer researchers found evidence that serum levels of dabigatran vary widely. The BMJ investigation suggested that Boehringer had a financial motive to withhold this concern from regulatory health agencies because the data conflicted with their extensive marketing of dabigatran as an anticoagulant that does not require monitoring.

I can’t help but wonder how many other “wonder drugs” aren’t quite so wonderful. Perhaps if they weren’t quite so lucrative…? 

2 April 2015 (Thursday) - HCPC Newsletter

The HCPC newsletter came out today.

http://www.hcpc-uk.org/assets/documents/10004B57HCPCInFocus-Issue58.pdf

At the risk of being saying something rather brave, the newsletter rarely has anything which I find directly relevant to me personally, and this one was no exception.

Mind you whilst I can’t say I found it relevant, it was (in places) interesting.  I didn’t realise that all of the HCPC’s activities are funded entirely out of the fees paid by registrants such as me.

Is that *really* any way to run such a body?