20 April 2016 (Wednesday) - HCPD e-Newsletter

The HCPC e-newsletter arrived in my inbox today. In the past I have been less than complementary about it.

There was an interesting article about the duty of candour; being open and admitting when mistakes have been made. Personally I’m ambivalent about the matter. On the one hand I can see that we should be open when mistakes are made and they should.

But on the other hand does advertising our failings not just give ammunition to those in the media who make a living out of glorifying our failures?

There were several things mainly only of note to other professions managers.

Mind you the last part looked interesting; views will soon be being taken on registrants’ views on the use of social media. I must admit I’ve seen some quite inappropriate stuff posted by some rather senior people (*not* from my Trust I hasten to add) over the last few weeks. I shall be interested to see how this consultation proceeds.

18 April 2016 (Monday) - A Survey ?

This looked really interesting. “This is your chance to share views on how you can deliver future care in England – and this is for wherever you practice, not just the NHS. This is not just about the health service. It’s about local authorities, housing, private practices and the voluntary sectors too.”

I got really fired up about this so I signed up. It was all a bit dull. There were all sorts of rather meaningless statements and I was asked whether or not I agreed with them.

I shan’t be logging in again…

17 April 2016 (Sunday) - http://www.ebiomedicine.com/

Yesterday I found an interesting article. Today I had a look at the web site from where that article originated.

Another source of CPD maybe….

16 April 2016 (Saturday) - Blood FIlm Review

Here’s an interesting article. Basically it investigates the processes by which people make mistakes whilst examining blood films. Apparently having made a mistake one then goes on to compound those mistakes.

This may well go some way to explain where I once went wrong…. But even after five years this is all just a tad too close to home for me….

15 April 2016 (Friday) - Bennett Goodspeed

The Bg blood group system is actually a system of Human Leukocyte Antigens that cause confusing results on serological tests of erythrocytes.

We’ve been having intermittent problems with antibody screening recently; antibody screens clearly weakly positive but panels were clearly negative; the negative results then confirmed by NHSBT.

It transpired that the screening cell in question was Bg(a)+ Bg(b)+. That explains a lot….

14 April 2016 (Thursday) - A Reflection

I found this article today…. It doesn’t really say anything of scientific or technical wonder, but it does bring home just why I do what I do

13 April 2016 (Wednesday) - Transfusion Evidence Library

A little while ago I subscribed to the Transfusion Evidence Library. They emailed me today – here’s a selection of what they emailed me today (based on the preferences I set)

• The role of iron in the management of chemotherapy-induced anemia in cancer patients receiving erythropoiesis-stimulating agents

• Mhaskar R; Wao H; Miladinovic B; Kumar A; Djulbegovic B

• The Cochrane Database of Systematic Reviews. 2016;(-2):CD009624

• Local heating of the wound with dressings soaked in saline at 42 degrees C can reduce postoperative bleeding: a single-blind, split-mouth, randomised controlled clinical trial

• Haraji A; Rakhshan V; Hosseini V

• The British Journal of Oral & Maxillofacial Surgery. 2016

• Use of n-of-1 (single patient) trials to assess the effect of age of transfused blood on health-related quality of life in transfusion-dependent patients

• Hsia CC; Mahon JL; Seitelbach M; Chia J; Zou G; Chin-Yee IH

• Transfusion. 2016

• Benefits and harms of red blood cell transfusions in patients with septic shock in the intensive care unit

• Holst LB

• Danish Medical Journal. 2016;63(-2):B5209

• Platelet concentrates for revitalization of immature necrotic teeth: a systematic review of the clinical studies

• Lolato A; Bucchi C; Taschieri S; El Kabbaney A; Del Fabbro M

• Platelets. 2016;:1-10

• Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial

• Smith PA

• The American Journal of Sports Medicine. 2016

• Anti-hemorrhagic effect of prophylactic tranexamic acid in benign hysterectomy - a double-blinded randomized placebo-controlled trial

• Topsoee MF; Bergholt T; Ravn P; Schouenborg L; Moeller C; Ottesen B; Settnes A

• American Journal of Obstetrics and Gynecology. 2016

• Pre-hospital blood product resuscitation for trauma: a systematic review

• Smith IM; James RH; Dretzke J; Midwinter MJ

• Shock (Augusta, Ga.). 2016

• A randomized trial of the effect of low dose epinephrine infusion in addition to tranexamic acid on blood loss during total hip arthroplasty

• Jans O; Grevstad U; Mandoe H; Kehlet H; Johansson PI

• British Journal of Anaesthesia. 2016

• Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials

• Jankowska EA; Tkaczyszyn M; Suchocki T; Drozd M; von Haehling S; Doehner W; Banasiak W; Filippatos G; Anker SD; Ponikowski P

• European Journal of Heart Failure. 2016

• Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial

• Aguilera X; Martinez-Zapata MJ; Hinarejos P; Jordan M; Leal J; Gonzalez JC; Monllau JC; Celaya F; Rodriguez-Arias A; Fernandez JA; Pelfort X; Puig-Verdie L

• Archives of Orthopaedic & Trauma Surgery. 2015;135(-7):1017-25

• The safety of intravenous iron preparations: systematic review and meta-analysis.

• Avni T; Bieber A; Grossman A; Green H; Leibovici L; Gafter-Gvili A

• Mayo Clinic Proceedings. 2015;90(-1):12-23

• Single dose intravenous tranexamic acid as effective as continuous infusion in primary total knee arthroplasty: a randomised clinical trial

• Hourlier H; Reina N; Fennema P

• Archives of Orthopaedic & Trauma Surgery. 2015;135(4):465-71

• Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial

• Wikkelso AJ; Edwards HM; Afshari A; Stensballe J; Langhoff-Roos J; Albrechtsen C; Ekelund K; Hanke G; Secher EL; Sharif HF; Pedersen LM; Troelstrup A; Lauenborg J; Mitchell AU; Fuhrmann L; Svare J; Madsen MG; Bodker B; Moller AM; FIB-PPHtrial group

• British Journal of Anaesthesia. 2015;114(4):623-33

• Transfusion-related adverse events in the Platelet Dose study

• Kaufman RM; Assmann SF; Triulzi DJ; Strauss RG; Ness P; Granger S; Slichter SJ

• Transfusion. 2015;55(1):144-53

• Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial

• Pinheiro de Almeida J; Vincent JL; Barbosa Gomes Galas FR; Pinto Marinho de Almeida E; Fukushima JT; Osawa EA; Bergamin F; Lee Park C; Nakamura RE; Fonseca SM; Cutait G; Inacio Alves J; Bazan M; Vieira S; Vieira Sandrini AC; Palomba H; Ribeiro U Jr; Crippa A; Dalloglio M; Del Pilar Estevez Diz M; Kalil Filho R; Costa Auler JO Jr; Rhodes A; Hajjar LA

• Anesthesiology. 2015;122(1):29-38

Clinical Commentaries

11 April 2016 (Monday) - Cost Cutting?

Here’s a backwards step. In the past in certain circumstances only parts of the blood count get reported. When I first started we never did a diff on the ante-natals. Now it is being suggested that only certain parts of the blood count be reported in certain circumstances.

Personally I see this more as a money-spinner; most analysers do a complete full blood count. The pennies saved by picking and choosing which elements are reported and which are not will be more than spent in having staff decide which elements are reported and which are not.

There was also talk about not performing chemistry tests as profiles but only measuring specific analytes as requested.

It might save a few pennies but surely the whole point of testing by panels is that the tests which constitute the panels should best be considered in relation to each other?

10 April 2016 (Sunday) - GTT

Here’s something which is worrying. Measuring glucose levels and performing glucose tolerance tests is something which has been going on for over thirty years.

Now it seems we may have been wasting our (and everyone else’s) time. There is a lot of evidence that this test is being done a month too late.

I shall await updates on this…

9 April 2016 (Saturday) - In Vitro Platelets

This has been on the drawing board for years.  Up till now platelets are extracted from volunteer donors. However it is now possible to get them directly from megakaryocytes grown it-vitro. There’s a minor hiccup in that the lab-grown cells produce around ten platelets each. But each one functioning normally in the bone marrow would produce up to two thousand. But in many ways that is just a trivial detail. Now that they can be grown in vitro…

I wonder who long it will be before this is rolled out for the likes of me to be using…

7 April 2016 (Thursday) - Paperless Lab?

Here’s something which is so simple it is brilliant. Rather than having loads of paper ticklists about the lab have the same thing electronically on tablets.

The article from the hyperlink does seem to labour the point somewhat (I suppose they are trying to sell their product) but it is a good idea. I shall ask the boss….

5 April 2016 (Tuesday) - Hepatitis E

We had a rather interesting talk today on Hepatitis E and how NHSBT are now providing Hep-E negative blood and blood products.

The recommendation has been made that Hep-E negative components were required for specific patient groups:

• Allogeneic stem cell/bone marrow transplantation
• Solid organ transplantation

5 April 2016 (Tuesday) - Romberg's Syndrome

Last night I had a patient with a diagnosis of which I'd not heard before. Romberg' syndrome is a rather unpleasant disfiguring condition. Possibly an auto-immune condition; the condition is often treated with methotrexate.

Another condition in which low cellc counts might not be entirely unexpected.

2 April 2016 (Saturday) - IBMS E-newsletter

The IBMS newsletter came in this morning. I've said before that the IBMS newsletters try to be all things to all people and (in my honest opinion) don't really do it. Maybe if they offered a newsletter which was somewhat more targetted to the individuals (like the BloodMed ones are) I might be more enthusiastic about it.

The IBMS gazette also arrived with the post. A week later and it was still unopened...

1 April 2016 (Friday) - Stating the Obvious

An Australian article.... I thought it might be useful. In all honesty it wasn't really... Having found it on a pathology-related newsgroup I assumed it would be aimed more at the professionals in pathology rather than the general public.

I suppose if nothing else it shows that one needs to be a bit judicious in seleccting stuff from which to attmept to draw CPD...

31 March 2016 (Thursday) - BBTS Conference

The annual BBTS conference has opened for registrations. I *really* don't like going on these sorts of things; a shame really. I could learn so much. I shall have to look out for abstracts after the event.

30 March 2016 (Wednesday) - Hepatitis E

The boss gave us a twenty-minute presentation on hepatitis E and the availability of Hep-E negative blood products today.

Again - something new so the day wasn't wasted.

 

28 March 2016 (Monday) - BloodMed email

Today's BloodMed content wasn't of direct relevence to me, but it is always interesting

News

• Drug combination hope for CLL patients
• Sepsis treatment hope after immune study
• Male fertility challenge after child cancer

Trainees and CPD - This includes Essay practice, MCQs, EMQs and Case reports.

• New Content has been added to the Trainees and CPD section

8 March 2016 (Tuesday) - A Quiz

Well.... this picture appeared as an on-line quiz. Can I identify the cell? Simple answer - no. It turns out this is an example of erythrophagocytosis by a myeloma cell.

I had no idea.... I learned quite a bit from this.

7 March 2016 (Monday) - Platelet Clumps

Here's an interesting case study. EDTA-dependent pseudothrombocytopenia comes in various forms. Platelets can clump together or clump around the neutrophils...

Something to bear in mind where there is a low platelet count in a sample which isn't clotted.

7 March 2016 (Monday) - Weekly BloodMed email

This morning's BloodMed Email Alert had some stuff of interest:

News

• Clue to ALL drug toxicity
• Teen weight and height link to lymphoma
• Primary care offered guidance on leukaemia symptoms

Slides

• Aggressive NK cell leukaemia/lymphoma

It makes for rather dull viewing here... unless you have a valid log-on... which I do.

2 March 2016 (Wednesday) - Howell Jolly Bodies ?

Howell-Jolly–like bodies in neutrophils

Posted by Medical Laboratory and Biomedical Science on Tuesday, 1 March 2016

1 March 2016 (Tuesday) - The Bigger Picture

Here's an interesting article. It is hardly news that healthcare is a team effort. Everyone is involved in obtaining the best outcome possible.

But certainly I myself sometimes feel somewhat isolated from the wider picture. I suppose it is the nature of what I do; we are by necessity away from everyone else. After all lab tests have to be done in the lab. It is easy to get rather caught up in the minutae of what I do. Taking a step back to consider the bigger picture is something I should do more often.