31 March 2019 (Sunday) - Best Practice ?

Here’s something which appeared on one of the work-related Facebook groups I follow. I must admit I copied out the link and forgot which group it came from.

Questions  What is the current evidence base for patient blood management (PBM) in adults, and what international clinical recommendations can be derived for preoperative anemia, red blood cell transfusion thresholds, and PBM implementation strategies?

Findings  Diagnosis and management of preoperative anemia is crucial, and iron-deficient anemia should be treated with iron supplementation. Red blood cell transfusion thresholds for critically ill, clinically stable patients (hemoglobin concentration <7 g/dL), patients undergoing cardiac surgery (hemoglobin concentration <7.5 g/dL), patients with hip fractures and cardiovascular disease or risk factors (hemoglobin concentration <8 g/dL), and hemodynamically stable patients with acute gastrointestinal bleeding (hemoglobin concentration 7-8 g/dL) are relatively well defined, although the quality of evidence is moderate to low.

Meaning  Further high-quality research to support PBM is required for a range of clinical scenarios and implementation of PBM programs.

One of the things I find very difficult about blood transfusion science is  that what is considered to be “best practice” seems to change very regularly…

30 March 2019 (Saturday) - BTLP Exercise

I thought I might have a go at another BTLP exercise today..
One case – a forty-year old female under the gynaecology team. A history of previous pregnancies and requiring six units for a ruptured ectopic pregnancy for the next day.
The next day?
If this were a true simulation I’d be able to ask why there was a delay.

The blood group was O Rh(D) Pos with Ab screen negative. I entered the results and the software accepted them without me pressing any button to confirm I’d actually entered the result correctly.

I selected six O Rh(D) Pos K neg units, and exited the app, fully expecting to get a red light again…
I didn’t. It was happy this time. And so was I…

29 March 2019 (Friday) - UKAS Update

UKAS sent their quarterly update today. Back in the day I would have had sleepless nights over this. Nowadays I read it perhaps more as I should do.

Interestingly the nice people at UKAS are “undertaking an exploratory research project to quantify and gather conclusive evidence of the direct impact of accreditation on the service quality of healthcare service providers”.
At the risk of appearing cynical, we put a tremendous amount of effort into meeting statutory UKAS requirements. Thirty years ago we had no such standards to meet. But we knew what was required of us, and we did every bit as good a job then as now. If not better.
I’d be intrigued to see what they discover. Mind you I’d respect it more if some independent body was doing this research.

29 March 2019 (Friday) - Healthcare Science Update

NHS England sent their Healthcare Science Bulletin today. At the risk of appearing reactionary or argumentative, I mantion it purely because it is the sort of thing which I am reliably assured is valuable CPD.
I honestly see the 2019 healthcare science awards as being divisive; singling some out for praise automatically detracts fro mthe efforts of others fulfilling exactly the same role.
As for the NHS long term plan… whilst the NHS needs one, it is of passing interest at best as few attempts to prophesy ever work. For me – my long term plan is retirement on full pension at th earliest opportunity.
Mind you I did like the link to the blog posts… in theory. In practice some were good, some were written in management-ese.

I shell persevere with this update…

28 March 2019 (Thursday) - Transfusion News Update

The nice people at Transfusion News sent their update today. I’ll include one or two snippets, but the web link they gave has been blocked by NHS I.T. people.
Go figure?!?!

ABO Blood Group Alters Platelet Binding to von Willebrand Factor
March 27, 2019
Since individuals with type O blood have a lower risk of myocardial infarction, researchers hypothesized that the ABO blood group on platelets may play a role in thrombosis formation. Thrombosis formation in arterial circulation is a multi-step process that is initiated when [Read More]
Recommendations for Patient Blood Management in Adults
March 20, 2019
Since blood transfusions are one of the most common and most overused procedures in developed countries, patient blood management (PBM) programs aim to protect and build up the patient’s own blood before transfusing. The PBM International Consensus Conference met in 2018 and evaluated key areas of the PBM field, including [Read More]
Transfusion and Jehovah’s Witnesses with Jed Gorlin
March 18, 2019 | BBGuy Podcast
Jehovah's Witnesses refuse transfusion based on religious beliefs, but blood bankers are still important in their care. Jed Gorlin shows us why. [Listen Now]
Listen on Apple PodcastGet It on Google Play MusicStitcherGet It on Android

27 March 2019 (Wednesday) - ASH Update

The American Society of Hematology sent their monthly clinical news update today. Use of apixiban, new treatments for haemophilia, and even alien blood… all interesting stuff. However it wasn’t the most readable of juornals. Too much emphasis on what I might describe as “wow-I.T.” What’s wrong with a plain web page?

26 March 2019 (Tuesday) - Prolonged APTT...?

The nice people at Lablogatory sent an interesting article today. Factor XI deficiency with a concurrent lupus anticoagulant. I’ve often mentioned that my CPD is weak with regards to haemostasis; this is the sort of thing I need…

22 March 2019 (Friday) - 1902 DM

The results of the digital morphology NEQAS excercise became available today. I did OK… there was something odd about those cells. When I saw it I commented

Macrocytic picture with some crenated cells and Howell Jolly bodies. Right shifted neutrophils and large platelets. However all I could add was observations. No way to add diagnosis or to comment

I would have referred it for consultant review, and given any blood count data I may well have made a better go of it. The case was a G6PD deficiency. Bearing in mind that in nearly forty years I’ve only ever encountered two patients with this condition…

21 March 2019 (THursday) - The Oncologist Update

The nice people at “The Oncologist” sent their newsletter today:

Review Article

This article provides recommendations for the clinical management of key adverse reactions reported with lorlatinib. Despite the advancement of second‐generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs), the emergence of resistance and progression of central nervous system metastases remain clinically significant problems in ALK‐positive non‐small cell lung cancer. Lorlatinib is a potent, brain‐penetrant, third‐generation, macrocyclic ALK/ROS1 TKI, with broad‐spectrum potency against most known resistance mutations that can develop during treatment with existing first‐ and second‐generation ALK TKIs.
Practice-Changing Article

Patients with a history of autoimmune diseases (AIDs) have not usually been included in clinical trials with immune checkpoint inhibitors but are frequent in clinical practice. This study quantifies the increased risk of developing immune‐related adverse events (irAEs) in patients with pre‐existing AIDs who had to be treated with anti‐programmed death‐1 immunotherapy. Nevertheless, their toxicities are mild and the incidence of grade 3/4 irAEs is not significantly higher compared with those of controls. These results will help clinicians in everyday practice, improving their ability to offer a proper counselling to patients, in order to offer an immunotherapy treatment even to patients with pre‐existing autoimmune disease.