26 November 2022 (Saturday) - Completely Wrong

Here’s something that appeared on one of the Facebook groups I follow…

Here’s an answer to a question. It is a definite answer, and it gives reasoning… and it is completely and utterly wrong on more than one level. However if you didn’t know very much about blood group serology you might well believe it.

 

Facebook groups *can* be a very good source of CPD… but don’t take it all at face value…

25 November 2022 (Friday) - Absolute or Relative

Here’s an interesting case that came up today…(for those not familiar with the display, the bottom results are the current, and those above the previous)

The results show that the patient is anaemic. I’d expect hypochromia given these results, but target cells and pencil cells too?

 

KIRK JAMES T             M1234567           01.04.44   Dr McCoy

H,22.7654321.A       R 25.11.22  Clin. det.                                    

DIFF Blood Film Review           Diagnosis                                      

--------------------------------------------------------------------------------

            HBM   WBCM    PLT    HCT   RBCM   MCVM   MCHM  MCHCM    RDW      N

310122      145   8.91    218  0.454   4.51  100.7   32.2    319   13.0   5.52

050322      135   9.28    210  0.418   4.23   98.8   31.9    323   13.9   5.92

080422      132   6.96    289  0.418   4.15  100.7   31.8    316   13.6   3.69

251122 F     72   8.04    292  0.246   2.95   83.4   24.4    293   16.2   4.36

 

              L      M      E      B   RETP   RETA    IRF    NUC     GF    ESR

310122     2.32   0.80   0.23   0.04                                          

050322     2.40   0.76   0.16   0.04                                          

080422     2.28   0.77   0.19   0.03                                          

251122 F   2.49   0.89   0.24   0.06    1.8  54.90   28.9    

 

Iron deficient anaemia???  The patient had a very low ferritin. But look at the MCV from nearly a year ago… Given that the patient runs an MCV of about a hundred, the MCV is currently running at only eighty percent of what it was. Perhaps not microcytic in absolute terms, but consider how they have changed.

As Albert once said, “everything’s relative”

24 November 2022 (Thursday) - Tumour Lysis Syndrome

A diagnosis appeared on a blood count today… “tls”. What was that all about? I had a look on Google and found something that made me think.

The news that a tumour is shrinking is a good thing, obviously… or is it? If the tumour is shrinking, what is happening? Where is it going? And what is happening to the bits that aren’t there any more?
Tumour Lysis Syndrome is the result of a rapid breakdown of cancerous tissue cells and the consequential release of large amounts of intracellular contents into the bloodstream which then overwhelms the usual homeostatic processes.

The British Medical Journal has an article on the condition which can be read by clicking here.

18 November 2022 (Friday) - BTLP-TACT Exercise

 

I got the thumbs-down the last time I did one… let’s try another.

I was presented with two samples:

 

32022 -  a fifty-one year-old chap in the orthopaedic clinic requiring group & save

 He grouped as A Rh(D) Positive with a negative antibody screen

 

71616 – a forty-nine year-old woman in theatre requiring group & save for a cholecystectomy.

She grouped as O Rh(D) positive with a positive antibody screen (positive in cell 2). I requested antibody panels.

The IAT panel was positive in cells 2,3,5 and 6

The enzyme panel was also positive in cells 2,3,5 and 6

This corresponds to anti-E and anti-K

 

I got the green light this time