29 December 2015 (Tuesday) - IBMS Newsletter

I finally got round to looking at the IBMS Newsletter; it actually came out two weeks ago.

As always not all of the stuff is relevant to me.

·  Much as I find microbiological and cell pathology stuff interesting, it isn’t immediately useful to my day to day practice.
·  There is a new president of the IBMS; with no disrespect to the chap I try to avoid the politics of any organisation these days.
·  Similarly I steer clear of on-line discussion forums as they are usually little more than a fight
·  I’m interested to see what changes the IBMS are making to their CPD scheme; but until compulsory changes are made I shall carry on using this blog as a way of recording (most of) what I do

There were also a load of links, but precious few seemed relevant to me. More and more the IBMS seems to be focussing on stuff which is more relevant to lab managers. Been there, done that. Doing something different now.

Having said that I do feel I expect more from the IBMS…

28 December 2015 (Monday) - Pre Analytical Variables

We spend so long in the lab making sure the results we produce are reproducible and reliable. It is easy to overlook the fact that we are only as good as the sample with which we have been provided.

It I surprisingly easy to be provided with a sub-standard sample.

27 December 2015 (Sunday) - On-Line Morphology

Following on from the morphology quiz I saw earlier today I’ve found an on-line morphology atlas.

It isn’t laid out as well as it might be, but any on-line atlas is a good thing,

27 December 2015 (Sunday) - Morphology Quiz

The Clinical Laboratory Blogspot used to run morphology challenges. Looks like they’ve started again.

2 years old girl from Spain has been in fever over a week. She is very tired and crying a lot. In primary health care center basic blood count, peripheral blood smear and CRP was taken. CRP was 12 mg/L. In FBC leukocytes were: 17,0 x 10E3/μL, erthyrocytes 4,2 x 10E6/μL and Hb 100 g/L. Blood smear was sent to central laboratory and the findings are in the image below. Those mononuclear cells covered 70% of all leukocytes in the smear.

Can you identify these mononuclear cells?”

Well I thought they were a monocyte and a lymphocyte. And then I got wondering. Would it be that simple? And I started doubting myself. But I was right.

24 December 2015 (Thursday) - Anticoagulation

I finally read the weekly BloodMed email . It comes in weekly. Sometimes it has snippets of note; often it doesn’t. Today’s was interesting though. Researchers have investigated the effectiveness of guidelines on anticoagulation treatment among susceptible cancer patients.

Some cancer patients develop chemotherapy-induced thrombocytopenia during treatment, and have an increased risk of bleeding. Treatment for their bleeding risk must be weighed up against the risk of thrombosis.
At present, guidelines recommend using the anticoagulant low-molecular-weight heparin, but the evidence supporting the correct dosage for chemotherapy-induced thrombocytopenia is limited.

So a study was conducted on the safety and efficacy of the current guidelines. They looked back at the outcomes of cancer patients from 2011 to 2013 who had thrombocytopenia for a minimum of a week, and were given a low-molecular-weight heparin.
This included 102 patients, who had a total of 143 episodes of thrombocytopenia. Drug doses were reduced in 20 episodes, withheld in 89 episodes, and treated with a combination of reduction or withheld in 27 episodes.

During 95% of the episodes, medication dose adhered to the institution's guidelines. None of the patients had a relapse of their thrombosis or a major bleed when their treatment was in line with the anticoagulant guidelines.

Dr Soff and his team say: "The data support the safety and efficacy of following the Memorial Sloan Kettering Cancer Center guidelines for therapeutic low-molecular-weight heparin dose modification, balancing the dual risks of recurrent thrombosis and potential bleeding during periods of chemotherapy-induced thrombocytopenia in cancer patients. More research is needed to see if a similar strategy would be appropriate for other oral anticoagulants."

The research was presented on 5 December at the 57th American Society of Hematology (ASH) Annual Meeting held in OrlandoFloridaUSA.
Soff, G. et al. Enoxaparin Dose Reduction for Thrombocytopenia in Patients with Cancer: A Quality Assessment Study. Presented at the 57th American Society of Hematology (ASH) Annual Meeting held 5-8 December 2015 in Orlando, Florida, USA.