26 February 2018 (Monday) - Cabot Ring

Look what I saw down the microscope today. Cabot rings are thin, red-violet staining, threadlike strands in the shape of a loop or figure of eight that are found on rare occasions in red blood cells  They are thought to be the microtubules which are all that remains of mitotic spindles. Their presence indicates an abnormality in erythropoiesis. There’s an entry on the things in Wikipedia (so it must be true!)

They are incredibly rare; for all that I’ve seen them in text books, I can’t remember seeing any in real life before.

The patient presenting this had a congenital dyserthyopoetic anaemia. There’s a more scholarly article on the things here.

But look at the case in which this ring presented (It’s not really him from Star Trek!)

KIRK Admiral James T   22-3-2233 
R,18.0023742.K       R 26.02.18  Clinical details CDA      

            HBM   WBCM    PLT    HCT   RBCM   MCVM   MCHM  MCHCM    RDW      N
211216      105   4.55    281  0.319   3.23   98.8   32.5    329   32.0   2.47
270317 F    105   5.50    217  0.307   3.17   96.8   33.1    342   31.3   3.22
070917 F    101   4.60    230  0.309   3.06  101.0   33.0    327   34.4   2.50
260218 F    108   5.71    328  0.323   3.31   97.6   32.6    334   31.7   2.95

              L      M      E      B    NUC   NUCA    ESR     GF
211216     1.38   0.42   0.10   0.18                            
270317 F   1.49   0.44   0.15   0.20                            
070917 F   1.50   0.40   0.10   0.20                            
260218 F   1.83   0.53   0.16   0.24 

It struck me as rather interesting that such an unusual morphological finding would occur in such a mundane blood count; other than a mild anaemia there is not a lot wrong with the blood count. I can only assume that a CDA on presentation would have something in the blood count prompting preparation of a blood film…

26 February 2018 (Monday) - Hepatitis C

The nice people at Lablogatory sent me a rather interesting article about hepatitis C today. Can’t say that it is a subject about which I hitherto knew an awful lot…

25 February 2018 (Sunday) - Lablogatory

The nice people at Lablogatory sent me this case study today. Rosai-Dorfman disease (RDD) is a new one on me…

23 February 2018 (Friday) - New Format for Presenting?

The Facebook Haematology Interest Group posted this today. For all that it is a rather good article about myelofibrosis, I’m rather impressed with the format of the document.

I wonder if I might make something like that myself….

23 February 2018 (Friday) - Transfusion Evidence Library

The Transfusion Evidence Library sent their update today. Loads of information here…

Top 10 new publications
Application of tourniquet in civilian trauma: systematic review of the literature
Beaucreux C, Vivien B, et alAnaesthesia, Critical Care & Pain Medicine 2018
Meta-analysis of the sources of bleeding after adult cardiac surgery
Biancari F, Kinnunen E M, et al. Journal of Cardiothoracic and Vascular Anesthesia 2017
A systematic review of transfusion-transmitted malaria in non-endemic areas
Verra F,  Angheben A, et al. Malaria Journal 2018

22 February 2018 (Thursday) - Photography

I struggle to get half-way decent photos of what I see down the microscope. With this You-Tube tutorial I might be able to do better in future…

22 February 2018 (Thursday) - Oncologist Newsletter

The Oncologist Newsletter arrived in my in-box today

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Most-Read Articles in Hematology Oncology
FDA Approval Summary: Daratumumab for Treatment of Multiple Myeloma After One Prior Therapy
Vishal Bhatnagar, Nicole J. Gormley, Lola Luo, Yuan Li Shen, Rajeshwari Sridhara, Sriram Subramaniam, Guoxiang Shen, Lian Ma, Stacy Shord, Kirsten B. Goldberg, Ann T. Farrell, Amy E. McKee, Richard Pazdur
Tumor Lysis Syndrome in Chronic Lymphocytic Leukemia with Novel Targeted Agents
Bruce D. Cheson, Sari Heitner Enschede, Elisa Cerri, Monali Desai, Jalaja Potluri, Nicole Lamanna, Constantine Tam
Best Practices in Chronic Myeloid Leukemia Monitoring and Management
Simona Soverini, Caterina De Benedittis, Manuela Mancini, Giovanni Martinelli
Most-Read Articles in Medical Oncology
Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi‐State Markov Modeling
Chen Hsiu Chen, Fur‐Hsing Wen, Ming‐Mo Hou, Chia‐Hsun Hsieh, Wen‐Chi Chou, Jen‐Shi Chen, Wen‐Cheng Chang, Siew Tzuh Tang
Clinical Management of Potential Toxicities and Drug Interactions Related to Cyclin‐Dependent Kinase 4/6 Inhibitors in Breast Cancer: Practical Considerations and Recommendations
Laura M. Spring, Mark L. Zangardi, Beverly Moy, Aditya Bardia
Preventing and Managing Toxicities of High-Dose Methotrexate
Scott C. Howard, John McCormick, Ching-Hon Pui, Randall K. Buddington, R. Donald Harvey

22 February 2018 (Thursday) - New Group on Facebook

I’ve found a new group on Facebook – billed as the BMT and Hematological Malignancy Interest Group, at first sight it looks rather interesting.
I suspect it will be like all the other Facebook groups; for every one knowledgeable contributor there will be a half-wit spouting rubbish, and half a dozen people like me looking to get stuff out of it whist not actually contributing much.

But whilst my expectations are low, my hopes are high. Will it be worthwhile? It costs nothing to follow the group. If it is rubbish I will just click the “stop following” button…

20 February 2018 (Tuesday) - Time Mastery (?)

The nice people at Lablogatory sent their update today. Titled “Time Mastery” I was hoping for an erudite article on practical time management in the laboratory form which I might personally learn something.
Instead it was an essay in management-speak which the younger generation of lab managers delight in spewing.

I was once a lab manager. I will not be one again. I don’t speak the language.

20 February 2018 (Tuesday) - Platelets...

An interesting case appeared on Facebook today

With this patient we didn’t release the platelet count to the clinician due to the severe platelet clumping as seen in the pics above. This phenomenon is called platelet satellitism and as some correctly identified there is also some platelet phagocytosis occurring in the neutrophils which appear as large vacuoles.
Due to their agranular appearance we considered grey platelet syndrome but we were able to rule this out because when a single platelet was seen it had normal granulation.
We have suggested that they recollect in a citrate tube to see if we can get a more accurate platelet count.
We also vortexed the sample just for interest in an attempt to break up the aggregates and we got a platelet count of 214 but with no accurate platelet count available we were unable to determine how close this was to the real result.
This patient has MGUS and we wonder if this might be playing a part so we have forwarded the film to our consultant haematologist for comment.”

Satellites and phagocytosis…

16 February 2018 (Friday) - Anti-Kp(a)

Here’s an interesting case…. Patient presented in A&E with a G.I. bleed. The patient’s address was three hundred miles away so obviously we had no history.

Positive in cells 2, 6 and 7… a familiar pattern. Anti-K. But what’s that in cell 8? Looks like an anti-Kp(a) as well. I did the three cell screen which had a cell positive for Kp(a) but negative for K, so… anti-K and anti-Kp(a).

I know a bit about anti-K, but anti-Kp(a)? I did a little reading-up. Here’s one article on the matter. There were several others…

16 February 2018 (Friday) - Mono-maturation

This appeared on Facebook today… Nothing particularly earth-shattering, but a useful little picture…