28 February 2016 (Sunday) - Anaplasma phagocytophilum

Every two weeks there is a case study. Looking back through the archives I’m not sure how many will be relevant to me but here’s one that is. What is this white cell inclusion?

My first thought was Ehrlichia chaffeensis… but isn’t that monocyte-only? It turns out this is a case of Anaplasma phagocytophilum.  Predominantly something from the Americas it is being seen in Europe more and more….

26 February 2016 (Friday) - HCPC Newsletter

This month’s newsletter from the HCPC arrived by email today.

It focussed on the revised standards of conduct, performance and ethics, which were published on 26 January 2016. It is probably a sign of the times that there is a section about the use of social media.

25 February 2016 (Thursday) - No More Needles ?

How practical is this?

Through capillary action this gadget creates a slight vacuum that pulls blood from capillaries though tiny channels in the skin into a small tube. The device collects 0.15 cubic centimeters of blood, which is enough to test for “cholesterol, infections, cancer cells, blood sugar and other conditions”.

Well, that quote was enough to put me off the whole idea. And bearing in mind how unrepresentative capillary samples can be I must admit I am rather sceptical about the whole thing.

But time will tell. It always does…

20 February 2016 (Saturday) - White Cells in Action

I found this video on Facebook – white cells doing their thing:

19 February 2016 (Friday) - NHSBT Newsletter

The NHSBT Newsletter arrived by email today

As always it came in three sections:

For Action
1.1  Update on Extended Blood Group Testing for patients with Sickle Cell and Thalassaemia Disorders

For Information
2.1 From 1st March 2016 NHSBT Filton plans to reduce the amount of CMV screening it performs
2.2 Updated SHOT Reporting Definitions, including reference to HEV negative components
2.3 Forthcoming extension to past-thaw expiry of FFP

For Training
3.1 Training & Education Events and Courses

For me the interesting thing was the discussion about extending the lifetime of thawed FFP. Back in the day the stuff had four hours after defrosting. Now it has one day. And it looks like this will be extended to five days….

18 February 2016 (Thursday) - Transfusion Evidence Library

The Transfusion Evidence Library sent me an email today.

It had found forty-one publications which matched my preferences. At first I thought this might be rather interesting. It wasn’t. It was all rather dull. Effectively it had sent me every article remotely related to blood transfusion.
I logged in to my account. The problem was with “My Preferences” as I had ticked every box I could find.

I need to be somewhat more judicious in setting up these email alerts.

17 February 2016 (Wednesday) - Risk Wise

The Trust’s bulletin on risk management came through on email today.

There was a lot to take in:

Page 01 - Don't miss vital information
Page 02 - Confidence in Confidentiality
Page 03 - Cases of unnecessary exposure to radiation due to errors in the radiology referral process Referrer’s responsibilities under the Ionising Radiation (Medical Exposure) Regulations – IR(ME)R 2000
Page 04 Clinical MHLAs bariatric training sessions
Page 04 - Health and safety alert Prompt management of spillages
Page 06 - Do you know about Deprivation of Liberty Safeguards (2007)? The CQC hope you do
Page 07 - Incidents and Datix Guidance
Page 08 - News from the Sepsis Collaborative
Page 09 - Learning from Serious Incident Investigations:
Page 09 - Never events
Page 09 - Case 1-Never event, wrong ankle surgery
Page 10 - Case 2 - Never event, misplace naso-gastric tube prior use
Page 11 - Case 3 - Diagnostic conundrum and sequence of problems leads to maternal death
Page 12 - Case 4 - Delayed diagnosis of thoracic spinal cord compression leading to paralysis
Page 13 - Case 5 - Treatment for acute coronary syndrome exacerbates bleeding in splenectomy patient
Page 14 - Case 6 - Colorectal rapid access pathway, not so rapid
Page S1 – SPECIAL EDITION - Teams Improving Patient Safety.

I’m usually rather negative about these semi-regular newsletters. This one was quite interesting.

17 February 2016 (Wednesday) - A Cure For Cancer ?

At first sight it would seem that cancer has been cured. However that initial impression very soon turned out not to be the case. Having heard all about it constantly on the radio it would seem that here was a lot of hype and very little substance.
Apparently this cure is something to do with T-cells, but then isn’t all of immunology?

I expect there will be more news updates if there is anything in this story…

11 February 2016 (Thursday) - Geeky Medics

Here’s an interesting website: http://geekymedics.com/  

It is intended as a revision guide for doctors. It covers all branches of medicine and surgery. It has case studies and quizzes.
I’ve found one or two useful little snippets in there.

Mind you I can’t help but feel it would be a lot better without the silly pictures which (if anything) undermine the website’s credibility.

1 February 2016 (Monday) - NHSBT Newsleter

The NHSBT e-newsletter arrived today.

For Action
1.1  New OBOS 7.1.5 Release

For Information
2.1 NHSBT TACSI Platelet Production
2.2 Customer Satisfaction
2.3 Patient Blood Management (PBM) Team PBM Newsletter – Issue 5
2.4 Consent pages on the Hospitals and Science website
2.5 Single Unit Transfusion Policy – Implementation Guide
2.6 An invitation to help to identify the uncertainties that surround Blood Transfusion and Blood Donation

For Training
3.1 Scientific & Clinical Course dates

This newsletter doesn’t actually carry the information. It just tells me what is available at http://hospital.blood.co.uk/  - perhaps I’m thick but I struggle to find anything on that website

31 January 2016 (Sunday) - Flow Cytometry

Here’s something useful:

I can’t pretend to be an expert on flow cytometry, so finding a few You-Tube videos on the subject is quite handy…

28 January 2016 (Thursday) - Haematuria

An interesting article -  the American College of Physicians have released new clinical guidelines on Hematuria

For me the most telling point is that the lab’s role in diagnosis is limited to dipsticks. I suppose one gets so insular and blinkered that one comes to think that medicine can’t cope without high-tech huge analysers…..

21 January 2016 (Thursday) - IBMS Newsletter

The IBMS e-newsleter arrived today.

 I’m usually rather negative about these. And at the risk of appearing cynical today’s  didn’t grip me. More and more the IBMS newsletters are about the “I” part of “IBMS” and less about the “BMS”, which is a shame…

11 January 2016 (Monday) - Tripanosomiasis

Here’s an interesting article: A 49-year-old woman presented immediately on return from a 2-week visit to Tanzania with

·  Malaise
·  Fatigue
·  Arthralgia
·  high fever (39°C).

Physical examination revealed signs of an arthropod bite on the neck.  
Hepatosplenomegaly and lymphadenopathy were absent. Blood analysis showed

·  leukopenia (2.3 × 109/L)
·  thrombocytopenia (55 × 109/L)
·  low prothrombin index expressed as a percentage (66%)
·  increased lactate dehydrogenase (622 IU/L; normal, 250-450 IU/L), aspartate aminotransferase: 159 IU/L; normal, 5-40 IU/L
·  alanine aminotransferase: 207 IU/L; normal, 5-40 IU/L.
·  Cerebrospinal analysis and an abdominal computed tomography scan were normal.

The peripheral blood film was diagnostic for trypanosome infection, showing the presence of extracellular flagellated parasites


I found this particularly relevant as I’d missed these in a recent NEQAS survey…

9 January 2016 (Saturday) - Free e-book

This morning’s haul of emails brought in a freebie at http://site.iugaza.edu.ps/akhudair/files/Atlas-of-Clinical-Hematology-6th-Edition.pdf
 Atlas of Clinical Hematology - Free eBook

From the reviews of the sixth edition: "With over 1000 illustrations the 6th revised edition covers the whole spectrum of haematology. The quality of the illustrations and the clarity of the accompanying texts make the Atlas a valuable companion to the haematology and oncology professions."

This atlas has integrated the 2001 WHO classification and made use of figures and descriptions to document recently described types of leukemia and lymphoma. The latter include leukemias of dendritic cells, rare lymphomas and persistent polyclonal B lymphocytosis, which takes a special place in the classification.

It covers all the microscopic methods in haematology that form the basis of diagnosis as well as the results of modern immunologic, cytogenetic and molecular-genetic investigation. Special emphasis is placed on the cytogenetic and molecular-genetic characterization of biological entities that might form the basis for innovative therapies.
Normal results and pathological findings are compared, and the various findings made during therapy are depicted.

All in all the Atlas of Clinical Hematology represents a complete and helpful reference work which should be present in every hematologic and oncologic department as well as in clinical laboratories for online diagnostics and scientific research… or so it claims.

Well, something for nothing can’t be bad…

8 January 2016 (Friday) - Leukaemia and Sunlight


Here’s some food for thought. Epidemiologists at University of California, San Diego School of Medicine report that persons residing at higher latitudes, with lower sunlight/ultraviolet B (UVB) exposure and greater prevalence of vitamin D deficiency, are at least two times at greater risk of developing leukemia than equatorial populations.

The UC San Diego study analyzed age-adjusted incidence rates of leukemia in 172 countries from GLOBOCAN, an international agency for research on cancer that is part of the World Health Organization, comparing that information with cloud cover data from the International Satellite Cloud Climatology Project. The study follows similar investigations of other cancers, including breast, colon, pancreas, bladder and multiple myeloma. In each study, they found that reduced UVB radiation exposure and lower vitamin D levels were associated with higher risks of cancer.

Leukemia rates were highest in countries relatively closer to the poles, such as Australia, New Zealand, Chile, Ireland, Canada and the United States. They were lowest in countries closer to the equator, such as Bolivia, Samoa, Madagascar and Nigeria.

How about that !!

7 January 2016 (Thursday) - BBTS Newsletter

The BBTS e-newsletter came today. At the risk of appearing cynical it seemed to say a lot without saying much at all. It started off with a review of what had happened in the BBTS in 2016. It went on to talk about plans for 2016, but in the vaguest terms, and ended with talk about a bursary for junior staff to go to the BBTS annual conference for free.

I would like to have seen a bit more detail in this newsletter,,,

3 January 2016 (Sunday) - Sunday Blood Cell Challenge

Case:  36 years old male from Turkey, Alanya have been in fever for two weeks. He has headache and nausea as well. CRP is slightly elevated and basic blood count parameters are within the reference limits. Peripheral blood smear was taken and the findings are in the image below.

What are the findings and what is your suggestion for diagnosis?

The eye is immediately taken to the two white cells. At first sight they look to be a normal neutrophil and a normal eosinophil. Hoever closer scrutiny reveals malarial parasites; looks like P falciparum to me…