29 April 2014 (Tuesday) - Discrepant Blood Group?

An interesting case - a manual blood group: the automated analyser wasn't happy with the results it had obtained. Look at the results of the B cells with the patient's own serum. (Right hand end). Reaction is there, but weak.
The patient has received a bone marrow transplant. Once blood group "O", now he is "B". His natural anti-B antibodies are now disappearing.

27 April 2014 (Sunday) - Errors

"Laboratory errors don't necessarily originate in the lab itself, contrary to what many hospitals might think, according to a new ECRI Institute patient-safety report (PDF) studying the impact of lab-testing errors in the clinical setting. This misperception can have serious consequences because those who work outside the laboratory may not recognize their role in the issue, the report warned."

23 April 2014 (Wednesday) - Red Cells

Red cells – target cells, inclusions, odd shaped cells…..all bringing back memories in today’s refresher session.

16 April 2014 (Wednesday) - Morphology Refresher

Half an hour's morphology refresher training reviewing cases of:

  • Myelodysplasia in thalassaemia
  • Pernicious Anaemia
  • Sezary's syndrome
  • Glandular Fever
  • Monocytic leukaemia
  • Neutrophil clumping

It's all coming back

10 April 2014 (Thursday) - Rivaroxoban

I went to a seminar last week - forgot to write it up...

Rivaroxaban is an orally active direct factor Xa inhibitor. Rivaroxaban is well absorbed from the gut and maximum inhibition of factor Xa activity occurs about four hours after a dose; however the effects last between 8 to 12 hours. Therefore unlike warfarin only one dose per day is necessary which leads to greater compliance.

Bearing in mind factor Xa activity does not return to normal within 24 hours so once-daily dosing is possible.
With lower reported mortality and morbidity than that reported for warfarin added to no need for continual INR measurements rivaroxaban and other new oral anticoagulants such as Dabigatran are becoming more common.

But they are anticoagulants: and as such they will have a direct effect on laboratory coagulation investigations. Something to bear in mind when faced with prolonged clotting times and a rather non-committal diagnosis.


9 April 2014 (Wednesday) - Clumps

Whilst having a morphology training session (I’m a little rusty with blood films…!) we reviewed a case with clumped lymphocytes. I’d never seen anything like it before.
It’s rather rare, and the clumpling would seem to be an in-vitro thing of dubious significance.