20 September 2021 (Monday) - Getting It Wrong (?)

With a few minutes spare I thought I might have a look at the BTLP-Tact simulator…

I was presented with one case – a sixty-year-old woman on the medical ward with a GI bleed needing four units of blood tomorrow.

She grouped as B Rh(D) Positive with a positive antibody screen (positive in cells 1&2). I requested antibody panels.
The IAT panel was positive in cells 2,3,5, 7 & 9 which corresponded with anti-S but didn’t exclude anti-E or anti-Lua

The enzyme panel was negative in all cells. Was this supposed to say there was no anti-E there? There’s plenty of anti-E that don’t work by enzyme…

The Lua didn’t appear in the screening antigram – was it supposed to be negative in that?
In any event there was not enough blood in the stock fridge that was both S- and Lua- negative.

I didn’t make the guess that the simulation had an error and that Lua could be excluded from the antigram, or that the enzyme panel ruled out anti-E because that would have killed in real life. So I selected no blood at all and exited knowing I’d get a red light, wondering what I was supposed to have done.

One or both of the anti-E and anti-Lua antibodies weren’t there. I wonder which one, and how I was supposed to have known that.
This simulator isn’t all it might be…


17 September 2021 (Friday) - Transfusion Evidence Library Update

The nice people at the “Transfusion Evidence Library” sent their monthly update today. Loads of snippets, this month focussing on obstetric cases..

Top Article

Selected Articles

The effect of tranexamic acid by baseline risk in acute bleeding patients: a meta-analysis of individual patient-level data from 28 333 patients.
Ageron, F.X., et al. (2020). British Journal of Anaesthesia.

Tranexamic acid for treatment of primary postpartum hemorrhage after vaginal delivery: a systematic review and meta-analysis of randomized controlled trials.
Della Corte, L., et al. (2018). The Journal of Maternal-Fetal & Neonatal Medicine.

Effects of Liberal vs Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants: The ETTNO Randomized Clinical Trial.
Franz, A.R., et al. (2020). JAMA.

The Recognition of Excessive blood loss At ChildbirTh (REACT) Study: A two-phase exploratory, sequential mixed methods inquiry using focus groups, interviews, and a pilot, randomised crossover study.
Hancock, A., et al. (2021). BJOG: an International Journal of Obstetrics and Gynaecology. [Record in progress]

Single- versus multiple-unit transfusion in hemodynamically stable postpartum anemia: a pragmatic randomized, controlled trial.
Hamm, R.F., et al. (2021). American Journal of Obstetrics and Gynecology.

The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines.
Ruiz de Viñaspre-Hernández. R., et al. (2020). Birth.

Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants. Kirpalani, H., et al. (2020). The New England Journal of Medicine.

Uterotonic agents for first-line treatment of postpartum haemorrhage: a network meta-analysis.
Parry Smith, W.R., et al. (2020). The Cochrane Database of Systematic Reviews.

The WOMAN trial: clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries.
Picetti, R., et al. (2020). BMC Pregnancy Childbirth.

16 September 2021 (Thursday) - Oncologist Newsletter

The nice people at “The Oncologist” sent their newsletter today. I tried to blog it here by clicking on the “Blogger” link but I didn’t like how it looked… I prefer to copy in the salient bits… even if much of it went over my head, not all of it did…