30 December 2020 (Wednesday) - Digital Morphology

I did an IBMS journal based learning exercise this evening: “Digital morphology analyzers in hematology: ICSH review and recommendations” based on the article linked here.

I scored eighteen out of twenty questions correctly…  or did I. On the first go through having completed the lot rather than giving me a score, the web page asked if I would like to log in to the IBMS website. So having wasted half an hour I then did the thing again only to meet with a similar disaster. On the third time I entered the results from memory… Had I remembered them right?

But that’s piddling details. What did I learn from it all… Digital morphology is a wonderful tool, but still has quite a way to go.
After all, most UK labs have a digital morphology analyser sitting unused…

30 December 2020 (Wednesday) - e-haematimage 20.08

20.08     A 70-Year-Old Man with Fever, Fatigue and Dyspnoea of Recent Onset 

Again my colleague had already done the diff, but she pays for it and I am in no way complaining. I felt the diff was 98% lymphocytes and 2% neutrophils 
I felt the diagnosis was CLL (Chronic lymphocytic leukemia) with a haemolytic anaemia  
The obvious next step was to perform direct antiglobulin test (DAT), a reticulocyte count and lymphocyte subtyping 

To answer the questions: 

1 Comment on the results of the erythrocyte indices. 

The MCV is very raised and haemoglobin very low.  
The red cell indices show an implausibly low MCHC suggesting something awry in the red cell indices measurements/calculations.   

2 In view of all the laboratory findings, how do you explain the abnormalities of the erythrocyte indices? 

The RBC histogram shows that a population of huge (relatively) cells is present.  
Red cells and white cells are counted together by the impedance technique which does not cause issues at usual levels of white cell count. However when the white cells count is  high it can cause an erroneous overestimation of the red cell count and mean cell volume and consequently haematocrit. 

Thus the MCHC is calculated wrongly (i.e. very low) 

3 Which results of the blood count do you think are really informative? Would you validate them? 

These red cell results are not accurate (i.e. wrong). The sample should be diluted and re-analysed.   

4 What is the most likely mechanism of this patient’s anaemia? (The answer to this question must not be repeated in the diagnostic hypotheses.) 

The presence of polychromasia and spherocytes suggest a possible haemolytic anaemia. 

 I did ok… not sure I understood the last question though...

29 December 2020 (Tuesday) - Cardiac Tamponade

I saw a diagnosis I’d not seen before… at the risk of appearing conceited, after thirty-nine years that don’t happen that often, but (as I might have said before) a day when you learn nothing is a day wasted.


Cardiac tamponade, also known as pericardial tamponade, is when fluid in the pericardium (the sac around the heart) builds up, resulting in compression of the heart. Onset may be rapid or gradual. Symptoms typically include...


Well, you can read the rest of this on Wikipedia by clicking here.

There are a lot of people who look down on Wikipedia. I won’t pretend it is the be-all and end-all, but *provided* you realise the limitations of the site, for a broad overview it is not too bad,.

28 December 2020 (Monday) - Chronic Leukaemias

 The nice people at the American Society of Hematology sent an update focussing on chronic leukaemias today.

Video: LOXO-305 Demonstrates Efficacy in Patients With CLL/SLL
Anthony Mato, MD, shares findings from a phase I/II trial evaluating LOXO-305 in patients with heavily pretreated chronic lymphocytic leukemia/small lymphocytic lymphoma.
Mogamulizumab Demonstrates Antitumor Activity in Adult T-Cell Leukemia/Lymphoma
Nearly two-thirds of patients with adult T-cell leukemia-lymphoma responded to treatment with mogamulizumab as a single agent or as part of a treatment combination.
Video: Asciminib vs. Bosutinib in Chronic Myeloid Leukemia
Andreas Hochhaus, MD, discusses results from a phase I study suggesting asciminib may have superior efficacy to bosutinib in patients with heavily pretreated chronic myeloid leukemia.


28 December 2020 (Monday) - Stem Cell Evidence Alert

The nice people at the Stem Cell Evidence Alert sent their update today. I must admit that being on Christmas holiday I didn’t peruse it as much as I might have done… but thalidomide !?! 

That stuff is cropping up with more and more uses…


Risk of relapse in patients receiving azithromycin after allogeneic HSCT.
Kutzke, J. L., et al. (2020) Bone Marrow Transplantation [record in progress].


Fresh versus Frozen Allogeneic Peripheral Blood Stem Cell Grafts: a Successful Timely Option.
Alotaibi, A. S., et al. (2020) American Journal of Hematology [record in progress]

Treosulfan-Based Conditioning Regimen for Second Allograft in Patients with Myelofibrosis.
Atagundus, I. K. et al. (2020) Cancers [record in progress]

Full Donor Chimerism After Allogeneic Hematopoietic Stem Cells Transplant For Myelofibrosis: The Role Of The Conditioning Regimen.
Chiusolo, P., et al. (2020) American Journal of Hematology [record in progress]

The challenge of COVID-19 and hematopoietic cell transplantation; EBMT recommendations for management of hematopoietic cell transplant recipients, their donors, and patients undergoing CAR T-cell therapy.
Ljungman, P., et al. (2020) Bone Marrow Transplantation [record in progress]

Predictors of recovery following allogeneic CD34+-selected cell infusion without conditioning to correct poor graft function.
Cuadrado, M. M., et al. (2020) Haematologica [record in progress]

Comparison of Haploidentical Bone Marrow versus Matched Unrelated Donor Peripheral Blood Stem Cell Transplantation with Post-transplant Cyclophosphamide in Patients with Acute Leukemia.
Nagler, A., et al. (2020) Clinical Cancer Research [record in progress]

A phase 3 randomized study of 5-azacitidine maintenance vs observation after transplant in high-risk AML and MDS patients.
Oran, B., et al. (2020) Blood Advances [record in progress]

A validated pediatric disease risk index for allogeneic hematopoietic cell transplantation.
Qayed, M., et al. (2020) Blood [record in progress]

Bortezomib, thalidomide, and dexamethasone followed by double autologous haematopoietic stem-cell transplantation for newly diagnosed multiple myeloma (GIMEMA-MMY-3006): long-term follow-up analysis of a randomised phase 3, open-label study.
Tacchetti, P., et al. (2020) The Lancet. Haematology [record in progress]