21 October 2024 (Monday) - Learning Monday

I wasn’t sure but wondered if it was Sezary syndrome. 

It wasn’t.

"The clinical presentation, the morphology, the immunophenotype and the positive finding for HTLV-1 were all consistent with adult T-cell leukemia lymphoma. 

All the other T-cell disorders are HTLV-1 negative.  

In addition, the patient was of African descent and central and West Africa have been shown to be endemic for the virus and the associated diseases". 

Reference:  Cook LB, Phillips AA.  How I treat adult T-cell leukemia/lymphoma. Blood. 2021;137:459-470.

 

Well – I learned something there…

20 October 2024 (Sunday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise... it's not as though there's anything worth watching on the telly.
It gave me two cases:

 

40274 – A sixty eight year old woman needing two units of blood tomorrow for surgery.

The ABO group was indeterminate but the Rh(D) group was negative. Fortunately the antibody screen was negative. I selected two units of O Rh(D) Negative blood.

 

97135 – a sixty nine year old chap from the renal clinic needing group & save. My heart sank when I saw this one. It’s O Rh(D) positive, but with a weak D. But the BTLP-TACT does odd things, so I called it O with an indeterminate D group. Even though it wasn’t.

The antibody screen was negative… I was grateful for small mercies.

 

I got the green light. I was pleased about that. However…

The first case was implausible. It was clearly an AB patient who had received O blood in a transfusion… just like the one I’d set up for them. Such a case would be known to the blood bank.

Similarly someone of that age not having had a weak D previously identified? And given that there was why hasn’t the software got an option for weak D?

This BTLP-TACT simulator is a work in progress in which (sadly) no progress is being made.

 

19 October 2024 (Saturday) - Slide Saturday Challenge

 

The American Society of Hematology have started something new – “Slide Saturday Challenge”. I shall have to remember to tune in every Saturday…

 

Well, it’s a myeloblast with an auer rod. Mostly indicative of AML, but also seen in MDS, CMML, and other conditions.

As always just giving one cell in isolation isn’t perhaps the best way to assess morphology, but (quite frankly) this is something for nothing, and if they are going to give me the answer tomorrow (as they claim) then that is streets ahead than the schemes for which my employer pays a small fortune.

17 October 2024 (Thursday) - DIC Case Study

The nice people at Lablogatory sent a rather good case study about DIC today. You can read it by clicking here.

It was a rather good refresher…

17 October 2024 (Thursday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update with World Trauma Day 2024 in mind. If one thing has changed over the last forty years it is how little blood is used in trauma cases these days compared to the bad old days.

Is that because of tranexamic acid?

Top article

Pelvic packing or endovascular interventions: Which should be given priority in managing hemodynamically unstable pelvic fractures? A systematic review and a meta-analysis. Zhang, D., et al. (2024). Surgery Open Science.
PICO SUMMARY

 

Selected articles

The efficacy and safety of pre-hospital plasma in patients at risk for hemorrhagic shock: an updated systematic review and meta-analysis of randomized controlled trials. Abuelazm, M., et al. (2024).  European Journal of Trauma and Emergency Surgery. [Record in progress].

Prehospital tranexamic acid in trauma patients: a systematic review and meta-analysis of randomized controlled trials. 
Acharya, P., et al. (2023). Frontiers in Medicine.

Management of non-compressible torso hemorrhage of the abdomen in civilian and military austere environments: a scoping review.
Adams, D., et al. (2024). Trauma Surgery & Acute Care Open.

Efficacy and safety of early administration of 4-factor prothrombin complex concentrate in patients with trauma at risk of massive transfusion: the PROCOAG randomized clinical trial.
Bouzat, P., et al. (2023). JAMA.

Prothrombin complex concentrate (PCC) for treatment of trauma-induced coagulopathy: systematic review and meta-analyses.
Hannadjas I., et al. (2023). Critical Care.

Emergency department resuscitative endovascular balloon occlusion of the aorta in trauma patients with exsanguinating hemorrhage: the UK-REBOA randomized clinical trial.
Jansen J.O., et al. (2023). JAMA.

Predicting blood transfusion following traumatic injury using machine learning models: a systematic review and narrative synthesis.
Oakley W., et al. (2024). The Journal of Trauma and Acute Care Surgery.

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

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.

 

16 October 2024 (Wednesday_ - BTLP-TACT Success

Having had endless disasters with the BTLP-TACT recently I thought I might have another go…

It presented me with two cases:

 

13323 – a forty year old woman in the ante-natal clinic needing group & save.

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

 

89767 – a sixty eight year old woman requiring six units of blood for AAA.

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

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

 

I got the green light which, bearing in mind my track record with BTLP-TACT, I felt was frankly amazing.

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.