14 October 2024 (Monday) - BTLP-TACT

 
Time for another BTLP-TACT exercise… it’s pouring hard outside and I’m a tad bored.
I asked it if I might have a go. The spinny wheel thingy spun and spun. Eventually it crashed. I started it again and it told me to process any samples in the in-tray. There weren’t any. After a lot of fiddling about I came out of the thing and went back in again. It gave me the thumbs down for that.
I tried again.
Again the spinny wheel thingy spun and spun. Finally it gave me two cases.
 

34385 – a twenty-five year old woman needing group and save.

She grouped as O Rh(D) Positive with antibody screen positive in all three cells. I requested antibody panels. The IAT panel was variable. It was 3+ in cells 3 and 9 and 1+ in cells 1, 2, 5, 6, 7 and 10. Being negative in only cells 4 and 8 I could only really exclude anti-C, anti-c, anti-e, anti-N, anti-s, anti-P1, anti-Fya,

The enzyme screen was negative in everything therefore excluding all Rh antibodies and anti-Lu(a).

So heaven only knows what’s going on here… it could be an unholy combination of anti-S and Fy(a) from which I couldn’t exclude anti-K. I don’t know – I would refer this. I’d appreciate going through this with someone…

 

08821 – a fifty-seven year old chap also needing group and save.

He grouped as A Rh(D) Positive with antibody screen positive in cell 2. I requested antibody panels. The IAT panel was positive in cells 2 and 6 corresponding to anti-K, as was the enzyme panel.

                                         
I got it wrong… apparently there was a clinically significant antibody masked but not noted in case 34385. Was there? I’d like to know what it was.

11 October 2024 (Friday) NEQAS 2406BF

Got the results of NEQAS 2406BF today. I saw…
 

 

BF1   Sickle cells (consensus #2) Eosinophilia (consensus #1) Nucleated red cells (consensus #3) Target cells (consensus #4) Howell-Jolly bodies (consensus #6)   I felt this was a haemoglobinopathy with something setting off the eosinophils. The expert opinion was that this was sickle cell disease with an unexplained eosinophilia

BF2   Target cells (consensus #1) Tear drop cells (consensus #2) Fragments (consensus #8) Basophilic stippling (consensus #5) Polychromasia (consensus #4)   I felt this was a haemolytic condition. It was haemoglobin H disease… The expert opinion started off with “this case indicates how difficult it can be to think of the possibility of the correct diagnosis in the absence of clinical history and ethnic origin” I think this just shows we should be given a *lot* more information in these cases

 

I saw the salient features, didn’t miss anything, and would have dealt with each appropriately. That'll do...

11 October 2024 (Friday) - NEQAS 2403DF

Got the results of NEQAS 2403DF today
 
Neutrophils 7.9 - 10.9 10.2
Lymphocytes 3 4 - .7 3 3.4
Monocytes 0.6 -  2.0    0.9
Eosinophils 2.4 - 4.8    3.7
Basophils  0.0 - 0.1  0.0
Metamyelocytes 0.0 0.1  0.0
Myelocytes 0.0 - 0.3  0.0
Promyelocytes 0.0 - 0.0  0.0
Blast cells 0.0 - 0.0  0.0
Smear cells 0.0 - 0.0  0.0
Neoplastic cells 0.0 - 0.0  0.0
 
That’ll do…

10 October 2024 (Thursday) - UKAS Newsletter

The nice people at the UK Accreditation Service published their quarterly newsletter today. You can read it by clicking here.

I read it.

It is all very interesting from a theoretical hypothetical point of view. It would men so much more (and grab my interest so much more) if they would give specific examples of professional practice and explain how that is directly relevant to their standards.

 

But, bearing in mind that they expect me to pay to see what their standards are, that ain’t going to happen.

A missed opportunity

 

9 October 2024 (Wednesday) - Little Bit of Politics

The IBMS have published their response to Lord Darzi’s review of the NHS. I’m reminded of my grandmother listening to a cousin jabbering on at great length loudly and ostentatiously about the failings of the committee of the local fishing club whilst doing nothing himself other than sitting on his bum and finding fault. Gran listened patiently, then announced “fine words butter no parsnips” and this is true of both what Lord Darzi has found and the IBMS’s response.

 

Lord Darzi’s report highlights the rising number of people living with multiple long-term conditions and the strain this places on hospitals. To address these challenges he says that immediate action and a strengthened diagnostic infrastructure are needed to ensure early detection, continuous monitoring, and better management of chronic diseases.

Can’t disagree there.

He goes on to say that a shift in focus from hospitals to community-based care is essential, and expanding the reach of diagnostics into community settings will enable earlier interventions and reduce pressure on hospitals.

We can’t argue with that in theory, can we?

But in practice? Lord Darzi has done reviews of the NHS before. He feels (probably rightly) that the NHS is too big, and would work better in smaller units. However at the time pathology service were reviewed by Lord Carter of Coles and he said “big is better”.

 

It’s no secret that path labs struggle to recruit. It wasn’t that long ago that an NHS Trust not a million miles away from where I live was seriously considering closing one of its three laboratories because it (probably) had enough staff to run two labs, but three was a stretch.

And look at today’s trend for pathology networks in which individual labs are reducing their test repertoire and centralizing tests for economies of scale.

 

If Lord Darzi wants diagnostic testing out in the community and a massive increase in point of care testing he needs to staff it. So he can either de-skill the workforce, and we all saw what a shambles that was (on national TV!), or he can recruit a *lot* more biomedical scientists. And he can only do that by making the job more attractive. And that will cost.

 

Having said (ranted) that, personally I’m taking whatever Lord Darzi has to say with a pinch of salt. Whatever he says simply won’t happen. At the risk of appearing to be an old reactionary, I really have seen it all before. Many times.

There will be all sorts of meetings at the Department of Health. Meetings, meetings about meetings that have happened. Meetings about meetings that are to happen. Eventually NHS Trusts will get orders from these meetings… and at that very point where something might actually happen, Lord Darzi’s ideas will be superceded by the next great NHS shake-up.

Look at what Lord Darzi is suggesting… he feels that (effectively) community-based care will call the shots in the NHS. That’s been done before (at least twice) and abandoned both times because of political ideology rather than any tangible evidence.

 

What the NHS needs is a load more money to recruit and train staff. And having recruited and trained staff it needs to be left alone for whatever current review and shake-up to take effect. Then this current review and shake-up needs to be formally reviewed and assessed, and fine-tuned on the strength of verifiable objective data, not the whim of whatever politician is in vogue at the time.

9 October 2024 (Wednesday) - Turning Off Immunity?

Here’s something… two injured comb jellies have been seen to merge into one individual.

It’s been established that comb jellies do have an immune system, so what’s going on here. Clearly there is some mechanism in which the recognition of “non-self” is modified.

Could this have relevance to humans? Could this trick be used to increase the success rate of organ and bone marrow transplant? Will this herald a whole new era of lab tests for us to be doing?

7 October 2024 (Monday) - Learning Monday

It’s Monday – time to turn to the European Hematology Association’s “Learning Monday”.

Perhaps the start of learning is finding out what you don’t know.

 

Apparently Ruxolitinib is indicated in patients with symptomatic splenomegaly and/or constitutional symptoms due to IM-2 and HR PMF. Bearing in mind I don’t know what Ruxolitinib IM-2 or HR PMF are, there’s the start of today’s CPD…