February 28 2011 (Monday) - C.M.L.

Look at this white cell count:

                             Specimen Results Entry

NEW, Patient                                        
DOB  16/09/1963 Sex F Pat No 907310       Source   
Address   Their House                     Clinician
Specimen No   :  AW168788Y               Selected Auth Level : S

 HB     7.7    F000  MONO   *      F000 
 WBC    404.0  F000  EOS    *      F000
 PLT    332    F000  BASO   *      F000
 RBC    2.96   F000  
 HCT    0.250  F000
 MCV    84.5   F000
 MCH    26.0   F000
 MCHC   30.8   F000
 NEUH   *      F000
 LYMPH  *      F000

And just to be sure there’s no error, look at the buffy coat and the IMI channel plot

Microscopy revealed it to be a case of CML. There were no previous blood count results at all….

February 24 2011 (Thursday) - Making Medical Lab Quality Relevant: Preparing for ISO inspection

Making Medical Lab Quality Relevant: Preparing for ISO inspection: "It is commonly said that when your quality management system is in place it doesn’t matter when the assessment visit occurs because you ar..."

(click on the link for the complete article…)

I got rather angry when I read part of it:

"Not to be too over the top, medical laboratories have a long history and tradition of not taking quality management too seriously"....

(takes a deep breath...)

"Quality Management" is a concept which has lost its way. A good idea in theory, in practice it is too often seen to be all about making sure trivial paperwork is completed in the right colour ink.

Were those who tout the "Quality Management" honest with me and called the thing "trivial paperwork" then I would at least respect them, and possibly take the subject more seriously. But from my thirty years of experience in medical laboratories, "Quality Management" is something that gets in the way of providing high quality blood test results.

It should not be that way. Would that "Quality Management" actually benefited me professionally, rather than hindered me...

(Going to lie down now!!)

February 18 2011 (Friday) - On-Line Morphology

Sometimes I worry about my ability as a morphologist. I take part in the NEQAS scheme when we get blood films every so often, and I assume I’m doing OK with the scheme. NEQAS also offer a program where one signs up on an individual basis, gets blood images electronically, and gets individual feedback. I’ve been promised that I’ll get enrolled on that scheme for years, but nothing’s ever happened.

Recently I heard about the e-MEDICINimage scheme, and I’ve signed up. I’ve been given an on-line atlas of haematology together with various case studies, and periodically I’ll be emailed a test which I have a go at, submit my results, and get personal feedback from the organisers.

As a beta-tester for the UK website, my first year is free: thereafter it’s about £150 (ish) per year. I shall see how the scheme pans out and if it’s good I shall see if I can recoup the cost from work next year

February 16 2011 (Wednesday) - Macrophage Activation Factor

Macrophage activation factor isn't something I've thought about for a long time, but today was a welcome refresher. A brief overview of the molecular structure of the thing, how the factor interacts with various cells, how cancer cells cleverly disable the factor, and an insight into ongoing research and a potential cure for HIV infection and some cancers.

Our speaker put on an excellent show – today’s talk was very interesting, especially when one bears in mind that it was a presentation put together at the last minute to cover for a speaker who was suddenly unavailable...

February 15 2011 (Tuesday) - A Resource

Here’s an interesting website. Loads and loads of work-related PowerPoint presentations that are free to download. Very useful. Or are they…

Personally I feel that a PowerPoint presentation is a very personal thing. I’ve tried delivering other people’s presentations, and it hasn’t worked. I’ve always had to tweak them first. But this archive will provide a lot of starting points for presentations – I can download them and adjust them as I see fit. And so can other people as well. Maybe I won’t have quite so many problems covering the Wednesday CPD seminars if I publicise this website a bit….

February 13 2011 (Sunday) - Award Winning?

I found this link whilst browsing. It would seem some health service managers want to single out one or two members of the healthcare professions and give them awards for being wonderful.

Now I’m in no way disparaging the efforts of those who will be nominated, but I can’t help but wonder how what they do would be any different to what any other health care related workers do on a regular basis.
I myself received no thanks when I came home early from holiday (leaving family and friends behind) because there was no one else available to provide cover at work. On more than one occasion.
And I was hard at it (for an unbroken twenty four hours) on the day after my son was born when no one else was available to provide emergency cover.
Perhaps those who give out such awards are also blissfully ignorant that it was not until my daughter was eight years old that I was able to be present at one of her birthday parties: for seven years no one else was available to provide emergency cover on that one day in early June.

I’m not just blowing my own trumpet: I am in no way unique. I know of people who have worked every bank holiday of the last year.  I know people who’ve worked on the night of their wedding anniversaries. I know of one chap who actually worked on the morning of his own wedding day, such were the demands of the service (!)
I know of many people who have at various times abandoned their own commitments and tirelessly and cheerfully come into work, at sometimes only an hour’s notice. Most of my colleagues who currently do “out of hours” shifts rarely get a weekend free from work commitments.
And the same thing goes on in every hospital in the world. But now by singling out one or two people as being wonderful, I for one feel that I (and the vast majority of the health care professionals) am now seen to be second rate.

I suspect that should my superiors read this posting, then I would (again) be in hot water. But the fourth criteria I must satisfy when performing my CPD work is that “I must seek to ensure that my CPD benefits my service users (patients, medical staff, students).” And my service users will not benefit from demoralised professionals.
I am aware that one or two of my postings on this blog are being re-circulated on other pathology boards and forums. Perhaps those giving such awards might find this post. Perhaps I might ask if they would like to consider the effect of their awards on the morale of those of us who don’t make the grade?

Perhaps I’m missing the point of awards? Maybe I’d feel differently if I’d received one.
If nominated, I’d like to think that I’d turn it down….

February 11 2011 (Friday) - H.E.

A couple of days we had a lunchtime seminar on H.S. – today as  a totally chance finding we found it’s related condition – H.E. The incidence of hereditary elliptocytosis is hard to determine, as (like in H.S.) most sufferers of the milder forms of the disorder are asymptomatic and their condition never comes to medical attention. Around 90% of those with this disorder are thought to be asymptomatic.
It is estimated that its incidence is between 3 - 5 per 10,000 in the Caucasian population and that those of African and Mediterranean descent have higher incidence due to elliptocytosis conferring resistance to malaria: hereditary elliptocytosis are significantly more prevalent in regions where malaria is endemic:

  • in equatorial Africa its incidence is estimated at 60-160 per 10,000
  • in Malayan natives its incidence is 1500-2000 per 10,000
Almost all forms of hereditary elliptocytosis are autosomal dominant disorder, and both sexes are therefore at equal risk of having the condition. The exception is hereditary pyropoikilocytosis (HPP), which is autosomal recessive.

As always, Wikipedia is a useful starting point for more information….

February 9 2011 (Wednesday) - H.S.

Hereditary Spherocytosis is most prevalent in Caucasians, occurring in one in every 2500 of us. Or so the textbooks say. In practice it’s a very rare phenomenon. On reflection it’s an increasingly rare phenomenon.
Most cases of H.S. are very mild – the anaemia is very well compensated and patients aren’t unwell with it. Most cases these days are found because of a known family history, or because those presenting have some other reason for needing a blood count. And as blood counting technology has improved over the years, so the amount of blood films requiring scrutiny has fallen, and so more and more cases go undiagnosed.
Which really doesn’t matter: if the so-called condition isn’t symptomatic, it’s not really a condition.

Today’s talk was interesting and informative, and made me think, which is always a good thing.

February 8 2011 (Tuesday) - Q.C.

(Apologies for rather iffy photograph…)

When checking QC it's not enough that the spots on the plot are the right colour. One needs to be sure that results aren't all bouncing at the high or low limits. Also one needs to look out for trends. In this case it is clear that the QC results, whist still perfectly acceptable, are noticeable going off as the red cell count slowly climbs. And as the red cell count climbs, so all associated parameters are slowly deteriorating too.

Replacement of an O-ring brought all results back to the expected mean before a QC failure occurred.

February 7 2011 (Monday) - An Email

I received an email today from a professional contact who asked me a question. Do I need help with training budget constraints? 
Well, yes. I do. I opened the email to find a range of seminars to which I was invited. Titles of the seminars included:

  • Your Practical Guide to Preoperative Assessment: How to deliver a rapid and streamlined patient preparation service
  • Advancing your Gynaecology Service: Redesigning your patient pathways: overcoming financial constraints to optimise your patient your outpatient provision and workforce potential
  • NHS Clinical Research Collaborations: Working with Researchers, RM&G, Networks and the commercial sector to realise new collaborations
  • Best Practice Guide to Research Management and Governance: Real solutions for implementing sustainable RM&G systems that relieve bottlenecks and achieve consistent governance
  • Structuring Finance for Clinical Research: How to implement, develop and improve your financing processes
  • Redesigning Emergency Care: Delivering Positive Outcomes - Innovative ideas and practical advice for effective service development
  • Progressive Practical Clinical Coding: Keep at the forefront of coding: in-depth and innovative approaches shared
  • Achieving Compliance in NHS Medical Device Regulation: Your practical guide to interpreting and fulfilling regulatory demands
  • Your Interactive Masterclass on Avoiding Litigation within NHS Medical Devices: Practical step-by-step guide to preventing and managing legal action
  • Practical Masterclass: How to Progress your Early Pregnancy Service -Tackle the demands on your service: standards of care, facilities, staffing, patient flow and patient information 
Presumably this sort of thing is financially viable – these courses don’t come cheap. But does nobody do a one day course in practical parasitological or on blood film morphology any more?
Or am I being cynical in feeling that courses these days are aimed at those who have time to go off on courses….

February 2 2011 (Wednesday) - C.P.D.

It occurred to me that for all that I’ve been doing this CPD stuff, I’ve not actually registered any of it with my professional organisation. So I’ve tried to do so. The problem I’ve found is that two of my major projects (the websites of advice) don’t actually come into any specific CPD category. Using a little bit of imaginative thinking I’ve supposed that writing a website is like writing a book, and so have claimed points accordingly. Failing that, I can go for the miscellaneous category and claim one point per hour’s effort, which would probably double the amount of points I’ve claimed. Here’s what I’ve put in for:


Feb 2011

On-going Reflective diary




Feb 2011

Discussion group organiser

Summary on-line at:




Feb 2011

On-going work on website of advice for pre-registration portfolio





Feb 2011

On-going work on website of advice for specialist portfolio





It occurs to me also that I’ve not claimed for any pre-reg portfolio assessments that I’ve done, or the haematological atlas I’ve recently started. But if memory serves, one gets a diploma for every twenty-five points. So I should be OK for points for the time being….

February 1 2011 (Tuesday) - Glandular Fever

A somewhat typical case of glandular fever, but none the less interesting for being so. In my set case studies for the pre-reg portfolio I have one on glandular fever. Today’s case can be added to it.

                             Specimen Results Entry

DOB  06/08/1996 Sex F Pat No 123456       Source    Tomato
Address   Her House   
Diagnosis: Swollen glands. Boyfriend with similar symptoms

Specimen No   :  AW101487D              

 HB     13.9   Q000  MONO   2.8    Q000
 WBC    16.3   Q000  EOS    0.0    Q000
 PLT    129    Q000  BASO   0.8    Q000
 RBC    5.04   Q000  G             E000
 HCT    0.440  Q000  ~F1   ^ALAB   Q008
 MCV    86.5   Q000  ~F2   ^FILMW  Q008
 MCH    27.6   Q000
 MCHC   31.9   Q000
 NEUH   1.3    Q000
 LYMPH  11.4   Q000