19 November 2024 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. Having got six right I must be due a thumbs-down…

I was presented with an eighty-five year old chap in theatre having a TURP needing two units of blood as soon as possible.

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

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

That’s now seven green lights in a row…

 

19 November 2024 (Tuesday) - Westgard QC Newsletter

 Well, there’s no denying it is dull… But the Westgard newsletter is something for nothing, and no one ever pretended that statistics was riveting.

Speaking as someone with a degree in mathematics some branches of mathematics are beautiful and elegant - look at fractal geometry. Some are amazing – look at group theory. Some are just “wow” – look at differential calculus. And some are mind-blowing – look at complex numbers.

But statistics…  Sadly dull. But the good people at Westgard come up trumps with whaty they do.

18 November 2024 (Monday) - Horiba Update

The Horiba newsletter appeared in my in-box today. Just lately I’ve been rather derogatory about the CPD material that people are good enough to give me for free… but this one is setting the standard to which all others really should aspire. A case study, morphology tips, science, and technology updates…

Here’s hoping this continues in the same vein…

16 November 2024 (Saturday) - Another use for FFP

The other day I was ranting about the BTLP-TACT simulator. I do that a lot; I really shouldn’t. That particular rant prompted me to write up when fresh frozen plasma and cryoprecipitate are useful and when they are not.

Here’s another use of fresh frozen plasma. The stuff can be useful in extreme cases of angioedema.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5298931/

14 November 2024 (Thursday) - BTLP-TACT Exercise

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

85624 – a sixty-nine year old chap in A&E needing four units of blood as soon as possible

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

I selected four units of O Rh(D) Positive blood

 

12582 – a forty-three year old woman needing four units of FFP and two units of cryo for a liver transplant

She grouped as O Rh(D) Negative with antibody screen positive I cells 1 and 3. I requested antibody panels. The IAT panel was positive in cells 1, 3, 6, 9 and 10 corresponding with anti-Fy(a) but does not exclude anti Lu(a) and anti Cw. The enzyme panel was negative which (in this plane of existence) does exclude anti Lu(a) and anti Cw.

I selected four units of FFP and two units of cryo

 

I got the thumbs-up

13 November 2024 (Wednesday) - Spot the Difference

Had an interesting conversation today which made me think. What *exactly* is the difference between a myelocyte and a promyelocyte?

They can be rather tricky to tell apart…

So I’ve had a think and done some Googling…

 

• Promyelocytes are bigger.
• Promyelocytes have prominent nucleoli and Golgi apparatus.
• Myelocytes do not have nucleoli and Golgi apparatus.
• Compared to the myelocyte, much more of the promyelocyte is nucleus
• Promyelocytes have huge, dark purple, primary (azurophilic) granules both in the cytoplasm and overlying the nucleus.
• Promyelocytes do NOT have secondary (specific,to neutrophil, eosinophil or basophil) granulation – not even the beginnings of it!  If you see any of that secondary granulation (even just a little blush of it in the cytoplasm) then it’s a myelocyte. The promyelocytes of the three granulocytic lineages cannot be distinguished by routine light microscopy.

 

Here’s some references…

 

https://www.sciencedirect.com/topics/medicine-and-dentistry/promyelocyte

https://www.pathologystudent.com/how-to-tell-apart-promyelocytes-and-myelocytes/

https://imagebank.hematology.org/image/60399/promyelocyte?type=upload

12 November 2024 (Tuesday) - IBMS Update

The IBMS sent their monthly newsletter today. It was on the dull side; it usually is. I was going to write about how their focus is on people and management and science is of peripheral interest, but I say that every month don’t it?