18 May 2017 (Thursday) - Image Challenge

Whilst perusing Facebook I found a link to the New England Journal of Medicine’s image challenge.

Given the rather ropey photo above I was supposed to choose a probable diagnosis out of:

• Acute promyelocytic leukemia (APL)
• Chronic lymphocytic leukemia (CLL)
• Multiple myeloma (MM)
• Acute lymphocytic leukemia (ALL)
• Chronic myeloid leukemia (CML)

  I’d say it was myeloid; the vast majority of twenty three thousand participants went for APL. I’ll take that as something of a success…

16 May 2017 (Tuesday) - Grey Platelet Syndrome

The Lablogatory people sent me an email about a case study today. A twelve year old girl presented with thrombocytopenia. Previous platelet counts performed at a different facility showed a similarly reduced platelet count. The patient had a history of bruising and intermittent epistaxis.

It was a good case study about Gray Platelet Syndrome…

16 May 2017 (Tuesday) - Transfusion News email

The Transfusion News email arrived today:

Higher Hematocrit Levels Are Associated with Increased Thrombosis Risk and Reduced Bleeding

May 10, 2017
A growing number of recent studies have observed an association between elevated hematocrit levels and thrombosis. However, the mechanism behind this pathway has remained elusive. A recent study induced an elevation of hematocrit levels in otherwise healthy mice to tease apart the etiology of the thrombosis formation under increased RBC levels. Compared with control mice [Read More]

Early Administration of Tranexamic Acid Reduces Maternal Deaths Due to Bleeding

May 3, 2017
Administration of tranexamic acid, an antifibrinolytic drug, has been shown to reduce bleeding in trauma and surgery patients. The results of the WOMAN (World Maternal Antifibrinolytic) trial recently published in The Lancet show that tranexamic acid also reduces the risk of maternal death due to bleeding. Between 2010 and 2016, over 20,000 women with post-partum [Read More]

Transfusion of Red Blood Cells from Younger Donors Is Not Associated with Improved Survival

April 26, 2017
Animal models suggest that blood from younger donors may provide revitalizing benefits, but findings from observational cohort studies on this topic have been inconsistent. Investigators in Scandinavia recently performed a retrospective cohort study following 968,264 red blood cell (RBC) transfusion recipients for 10 years. Since multiple transfusions can confound results, researchers used multiple approaches to [Read More]

15 May 2017 (Monday) - Transfusion Evidence Library email

The Transfusion Evidence Library email arrived in my inbox this morning:


Click on any of the links below to view the article in the Transfusion Evidence Library database. Enjoy your update!

• Erythromycin infusion prior to endoscopy for acute nonvariceal upper gastrointestinal bleeding: a pilot randomized controlled trial
  Na HK; Jung HY; Seo DW,. Lim H; Ahn JY; Lee JH; Kim DH; Choi KD; Song HJ; Lee GH; Kim JH
  The Korean Journal of Internal Medicine. 2017
  
• Autologous platelet-rich plasma versus readymade growth factors in skin rejuvenation: a split face study
  Gawdat HI; Tawdy AM; Hegazy RA; Zakaria MM; Allam RS
  Journal of Cosmetic Dermatology. 2017
  
• Prevalence of shunt dependency and clinical outcome in patients with massive intraventricular haemorrhage treated with endoscopic washout and external ventricular drainage
  Johnson JR; Idris Z; Abdullah JM; Alias A; Haspani MS
  The Malaysian Journal of Medical Sciences : Mjms. 2017;24(-1):40-46
  
• A phase 3 trial of IV immunoglobulin for Alzheimer disease
  Relkin NR; Thomas RG; Rissman RA; Brewer JB; Rafii MS; van Dyck CH; Jack CR; Sano M; Knopman DS; Raman R; Szabo P; Gelmont DM; Fritsch S; Aisen PS
  Neurology. 2017
  
• A randomized trial comparing triple versus single uterine tourniquet in open myomectomy
  Al RA; Yapca OE; Gumusburun N
  Gynecologic and Obstetric Investigation. 2017
  
• Different effects of fluid loading with saline, gelatine, hydroxyethyl starch or albumin solutions on acid-base status in the critically ill
  Spoelstra-de Man AM; Smorenberg A; Groeneveld AB
  Plos One. 2017;12(-4):e0174507
  
• Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials
  Mi B; Liu G; Zhou W; Lv H; Liu Y; Zha K; Wu Q; Liu J
  Archives of Orthopaedic and Trauma Surgery. 2017
  
• Pharmacokinetics and pharmacodynamics of cisatracurium in patients undergoing surgery with two hemodilution methods
  Guo J; Yuan X; Zhou X; Jin X
  Journal of Clinical Anesthesia. 2017;38:75-80
  
• The Ferumoxytol for Anemia of CKD Trial (FACT)-a randomized controlled trial of repeated doses of ferumoxytol or iron sucrose in patients on hemodialysis: background and rationale
  Macdougall IC; Dahl NV; Bernard K; Li Z; Batyky A; Strauss WE
  Bmc Nephrology. 2017;18(-1):117
  
• Phase 2 studies of oral hypoxia-inducible factor prolyl hydroxylase inhibitor FG-4592 for treatment of anemia in China
  Chen N; Qian J; Chen J; Yu X; Mei C; Hao C; Jiang G; Lin H; Zhang X; Zuo L; He Q; Fu P; Li X; Ni D; Hemmerich S; Liu C; Szczech L; Besarab A; Neff TB; Peony Yu KH; Valone FH
  Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2017
  

Clinical Commentaries

• Does tranexamic acid prevent postpartum haemorrhage? A systematic review of randomised controlled trials
  Ker K; Shakur H; Roberts I
  Bjog : an International Journal of Obstetrics and Gynaecology. 2016
  
• 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
  
• 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
  
• 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

12 May 2017 (Friday) - Case Study

This case appeared on Facebook this morning. “Question is Cll or Prolymphocytic leukemia?? Any ideas”.

At the risk of appearing sarcastic my first idea was to improve the English…

Reading the comments there were as many opinions as there were people to offer them. For myself it has been my experience that automated analysers are good at identifying lymphoid cells. However this device has found a monocyte count of 50 x 10⁹ cells /l (converting units to what I am used to!). Those would be myeloid cells. Several people had said flow cytometry would be useful here. I’d have to agree…