20 November 2016 (Sunday) - 1604 DM

The results of the latest digital morphology became available. The case was “A 39 year old female presents unwell at the emergency department. Hb 120g/L, WBC 6.5 x 10*9/L, Platelets 150 x 10*9/L. The analyser fails to produce a differential so a blood film is examine”

I first looked at the image some time ago and I said there was left shift with toxic granulation and some early myeloid cells.

Your Observations: Rank Morphological Feature Participants who selected this feature 1 Blast cells 63.6% 2 Promyelocytes 36.5% 3 Toxic granulation 19.8% 4 Reactive lymphocytes/Plasmacytoid lymphs/Turk cells 20.5% 5 Clumps 36.1% Considering the morphological features you have selected which of the following diagnostic categories do you think might be most likely. Acute Leukaemia Chronic Myeloproliferative disorder Actual pathological diagnosis: Bone marrow infiltration by carcinoma

The red cells showed polychromasia  and there were some stomatocyes seen. I didn’t rate those as important enough.

I don’t think I did too badly….

It seems odd that the system told me I didn’t participate but recorded my entry…

20 November 2016 (Sunday) - Zika-Negative

This morning I learned something from one of the lab-related Facebook groups I follow. Blood donations in America are being screened for the zika virus.

Here in the UK we already screen for quite a lot of stuff; Hepatitis E being the most recent (to my knowledge).

I wonder how long it will be before I see these stickers…

19 November 2016 (Saturday) - Transfusion Evidence Library Email

The Transfusion Evidence Library email arrived this morning. Recently I pruned my interests on their website to try and tailor the articles they were sending me.

This morning’s missive still had 4192 evidence-based publications based on the Areas and Topics of Interests I selected including:

• Effects of positive suggestions on the need for red blood cell transfusion in orthopedic surgery
  Szeverenyi C; Csernatony Z; Balogh A; Simon T; Varga K
  The International Journal of Clinical and Experimental Hypnosis. 2016;64(-4):404-18
• Effect of perioperative colloid and crystalloid fluid therapy on coagulation competence, haemorrhage and outcome
  Rasmussen KC
  Danish Medical Journal. 2016;63(-9)
• Local corticosteroid versus autologous blood injections in lateral epicondylitis: meta-analysis of randomized controlled trials
  Sirico F; Ricca F; Di Meglio F; Nurzynska D; Castaldo C; Spera R; Montagnani S
  European Journal of Physical and Rehabilitation Medicine. 2016
• An update on topical haemostatic agents in liver surgery: systematic review and meta analysis
  Brustia R; Granger B; Scatton O
  Journal of Hepato-Biliary-Pancreatic Sciences. 2016
• Blood transfusions for treating acute chest syndrome in people with sickle cell disease
  Dastgiri S; Dolatkhah R
  The Cochrane Database of Systematic Reviews. 2016;(-8):CD007843
• Tolerability and efficacy of eltrombopag in chronic immune thrombocytopenia: meta-analysis of randomized controlled trials
  Elgebaly AS; Ashal GE; Elfil M; Menshawy A
  Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2016
• Uterine salvage management for atonic postpartum hemorrhage using "modified lynch suture"
  El-Sokkary M; Wahba K; El-Shahawy Y
  Bmc Pregnancy and Childbirth. 2016;16:251
• Ultrasonically activated shears reduce blood loss without increasing inflammatory reactions in open distal gastrectomy for cancer: a randomized controlled study
  Oh SY; Choi B; Lee KG; Choe HN; Lee HJ; Suh YS; Kong SH; Lee HJ; Kim WH; Yang HK
  Annals of Surgical Oncology. 2016
• Double-blind, placebo-controlled pilot study on the use of platelet-rich plasma in women with female androgenetic alopecia
  Puig CJ; Reese R; Peters M
  Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [Et Al.]. 2016
• Comparison of efficacy and safety of topical versus intravenous tranexamic acid in total hip arthroplasty: a meta-analysis
  Li J; Zhang Z; Chen J
  Medicine. 2016;95(-36):e4689

I think I need to prune the list some more…

17 November 2016 (Thursday) - Green Granules

A little while ago I posted here about the “green granules of death”; green granules seen in neutrophils in people in extremis. A lot of people were originally rather sceptical about the things but here’s another example of them.

I’ve not seen these yet myself… I can’t help but wonder why they’ve not been identified years ago. Are they new or have people just not noticed them. You’d think someone would have…

15 November 2016 (Tuesday) - Critical Results

Here’s an interesting article. I’ve actually seen it a couple of times recently in various on-line groups.

The gist of it is that we in the lab work hard to get results available quickly. But what do you do with that unexpectedly abnormal one? Obviously it needs to be brought to the attention of someone who is in a position to act on it. But wards are busy; often a phone in the background is the last thing they need.

Mobile technology perhaps…?

15 November 2016 (Tuesday) - Transfusion News

The Transfusion News e-newsletter arrived in my inbox this morning. Food for thought there. ..

Laboratory Testing is Suggested Before Intravenous Immunoglobulin is Given to Neonates November 9, 2016 Although intravenous immunoglobulin (IVIG) use is documented to treat a wide range of severe disorders in adults, IVIG use in neonates is not well-characterized. A retrospective study recently published in TRANSFUSION describe IVIG use in neonates in the NICU at one Canadian hospital. Only 37 neonates received IVIG over 11 years. [Read More] Blood Donation Intervals Should Be Extended to 180 Days to Avoid Iron Deficiency November 2, 2016 Most blood collection agencies require a 56-day minimum interval between donations of whole blood to allow hemoglobin levels to return to normal. However, new insight from recent studies, including research published in Blood, suggest that the deferral should be lengthened to prevent iron deficiency. [Read More] Standard Issue RBCs are Equivalent to Fresh RBCs for Transfusion October 27, 2016 Results of the Informing Fresh versus Old Red Cell Management (INFORM) trial have recently been presented at the AABB annual meeting and published in The New England Journal of Medicine. The INFORM trial is the largest randomized, controlled trial examining whether fresh red blood cells (RBCs) are superior to older RBCs. [Read More]

The article about reducing donation intervals will have an impact on blood stocks. Miond you only the other day I read something about how blood might well have a longer shelf life than currently advocated….

15 November 2016 (Tuesday) - TACO

The Blood Bank Guy presented a podcast on TACO (Transfusion associated circulatory overload)

“TACO is a very serious disease. TACO is responsible for the second-most number of deaths from transfusion every year in the United States (and is actually #1 in countries with active hemovigilance programs such as the United Kingdom). It’s not something to mess around with, but far too many clinicians and blood bankers fail to give it the respect it deserves”.

14 November 2016 (Monday) - LabQuality Facebook Group

I’ve signed up to a new Facebook group – “Labquality EQAS - Medical Laboratory Quality Control”. It seems to have one or two snippets. In the first instance it’s plugging an international congress in Finland in a couple of months’ time, and got some interesting thoughts about INR measurement.

I shall see what else pops up on this group…