26 October 2023 (Thursday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise… This time I was presented with two cases:

 

98067 – A thirty-nine year old woman in maternity requiring a group and save from pre-eclampsia. 

She grouped as O Rh(D) Negative with an antibody screen positive in cell 1. I requested antibody panels.

The IAT and enzyme screens both came up positive in cells 2, 4, 5, 8, 9 and 10 which was consistent with anti-Jk(b)

54739 – a twenty-seven year old woman in the ante-natal clinic requiring group and antibody screening.

She grouped as AB Rh(D) Positive with a negative antibody screen

 

I got the green light…

20 October 2023 (Friday) - Corrected Counts

Here’s an interesting case from the nice people at Lablogatory. Correcting the counts for massively high white cell counts…

You can read the article by clicking here. This is the sort of thing we should be paying attention to. But just how practical is it in a busy laboratory?

19 October 2023 (Thursday) - HCPC Newsletter

The nice people at the HCPC sent their update today. You can read it by clicking here.

I’m reminded of my rant about the UKAS yesterday. Like them, the HCPC is trying to have one set of standards which are applicable to a very disparate group of professions and are translated into practical applications in all sorts of workplaces by all sorts of assessors.

 

What the HCPC present is far more practical than that which the UKAS have come up with… but still it is aimed at professions who deal with real-live patients which (for the most part) we don’t.

 

19 October 2023 (Thursday) - Oncology Central Update

Diagnosis of myelodysplastic syndromes, immunotherapy… More good stuff from the nice people at Oncology Central. I like their new format – not so much and manageable…

Does that MDS diagnosis need a second opinion? An interview with Mikkael Sekeres   A study has demonstrated that blood cancers known as myelodysplastic syndromes/neoplasms (MDS) are commonly misdiagnosed, putting patients at risk for treatment mistakes and other potentially harmful consequences. In this interview we provide you with a breakdown of key points of the research.

Latest articles

AI detection software achieves 100% sensitivity rate for melanoma   Presented at this year’s European Academy of Dermatology and Venereology Congress (EADV; 11–14 October, Berlin, Germany), impressive results have emerged from a study using AI software to detect skin cancer. Read the full news piece on Future Medicine AI Hub.

Tackling disparities in cancer care across Europe: how can we improve access for all patients in Europe?   Across Europe there are significant disparities in access to cancer care. Access to new medicines varies from 4 months to almost 2 years post-market authorization across countries and regions. In this opinion piece Gerwin Winter (BeiGene, Basel, Switzerland) and Eric Low (ELC, UK) discuss potential innovative solutions to address these disparities.

Looking to the future of immunotherapy in cancer treatment   Millions of people with cancer already benefit from immunotherapy, but there is always more we can do to develop transformative treatments. Find out about patient-focused solutions, such as immune-cell engagers and next-generation cell therapies in our latest opinion article.

18 October 2023 (Wednesday) - UKAS Update

The nice people at the United Kingdom Accreditation Service sent their update today. You can read it by clicking here. It makes for interesting reading. There’s no denying that I’m not the UKAS’s greatest fan, but to be fair to them they are trying to achieve the impossible. They seem to be trying to have one set of standards written in what I can only describe as “management catchphrases” which are then translated into practical applications in all sorts of workplaces by all sorts of assessors.

 

Perhaps it is time to admit that this isn’t working and going back to having something directly applicable to blood testing just like the old Clinical Pathology Accreditation used to be. And while we’re at it, let’s stop re-inventing the wheel at every turn and having the people who make each bit of apparatus produce one standard operating procedure for that bit of kit which is applicable worldwide.

Is that really so unreasonable?

16 October 2023 (Monday) - BTLP-TACT Exercise

I’m sitting quietly with the dogs as the wife has gone bowling. I could be watching anything I like on the telly, I could be playing any of a myriad of computer games. I could be reading anything I like on my Kindle.

Instead I’m doing a BTLP-TACT exercise at quarter to ten at night…

I was presented with one case – a twenty-four year old woman in theatre requiring group and save for a caesarean section.

The cell group was AB; the serum group B. That makes the blood group indeterminate and would need referral to NHSBT. The Rh group was negative though

The antibody screen was negative.

I got the green light… and the red mist. Quite frankly what a nonsensical exercise. Given that someone is having a caesarean section what is the likelihood of being unaware of such an unlikely blood group until the labour is at such a stage that surgery is required.

At the risk of sounding very ungrateful for something which is very useful to me (and free to me!), the BTLP-TACT simulator is very much something of a work in progress. Sadly there’s not much progress going on.

13 October 2023 (Friday) - NEQAS 2306 BF

I got hold of the results of NEQAS 2306 BF today.
 
2306BF1 
 

Blasts          (1)

Low Plts       (2)

Neutrophilia (7)

Smear cells (8)

lymphocytosis 

 

?? Megakaryoblastic leukaemia. It was AML with Megakaryoblastic appearance. 

 

2306BF2 

 

Red cell fragments      (1)

Toxic granulation         (2)

Left shifted neutrophil  (3)

Low plts                        (5)

 

? Microangiopathic Haemolytic anaemia ? DIC and sepsis. It was fulminant sepsis and disseminated intravascular coagulation (DIC)

I’m rather pleased with that…

 

13 October 2023 (Friday) - 2303 DF

I got hold of the results of manual diff NEQAS 2303 DF. Here’s my diff and the 2sd range:
 
Neut  32.2   25.7-52.3
Lymph15.7   2.7 – 23.3
Mono  0.9    0 – 14.4
Eos   0.0      0
Baso  0.0     0
Meta  0.0     0.0 – 2.0
Myelo 0.0    0.0 – 4.0
Pro   0.0      0.0 – 1.5
Blast 12.6   18.6 – 55.4
Nrbc  0.0     0
 
Well… there’s no denying that I rather underestimated the blast cell count. But when you look at the spread of those 2sd ranges…

11 October 2023 (Wednesday) - Storage Changes?

If I see something like this my initial thought would be that this is artefactual; a change brought about by storage.

But not necessarily… Botryoid nuclei are also seen in cases of feature of burns and of hyperthermia, and… (this is where I learned something today) – in cases of abuse of cocaine or methamphetamine.

 

There’s an article about this that you can read by clicking here

10 October 2023 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with one case – an eighty-five year old woman with appendicitis requiring group and save.

She grouped as AB Rh(D) Positive with a negative antibody screen.

 

It gave me the thumbs-down claiming I’d said she was O…  Seriously?

Rather fed up with the entire thing I asked for another one. This time I got an eighty-seven year old woman in the haematology clinic requiring group and save.

She grouped as O Rh(D) Positive with 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 did not exclude anti-E or anti-Lu(a)

The enzyme panel was negative which did exclude anti-E (according to BTLP-TACT; not according to anyone who’s ever worked in a blood bank…not that I’m sulking about getting the thumbs down earlier).

Did this exclude anti-Lu(a)? Bearing in mind that the NHSBT guidelines say to crossmatch patients with anti-Lu(a) by IAT I’ll take this to say it does…

So we’ve got someone who is O Rh(D) Positive with anti-S

This time I got the green light.

 

5 October 2023 (Thursday) - Fritsma Factor Update

The Fritsma Factor newsletter appeared in my in-box this morning. You can read it by clicking here. I like this newsletter. There’s not too much of it, it is manageable… perhaps not directly related to me this time, but gratefully received nonetheless.

 

3 October 2023 (Tuesday) - The IBMS Gazette (!)

The IBMS Gazette came through the post today (how last century!) Usually the thing goes straight into the dustbin unopened but today I thought I might have a look at it.
It’s not called the IBMS Gazette any more – it’s now “The Biomedical Scientist”… it’s amazing what happens when you aren’t paying attention.
 
There was something about advanced and consultant biomedical scientist roles in which three different people seemed to compete to see who could write the most unintelligible article. I couldn’t understand what any of them were getting at.
There was an article about a histopathology lab which was on target to achieve ninety-eight percent turnaround of all its work within ten days… back in the day at the (now demolished) Royal East Sussex Hospital we used to do all the histology sectioning in the morning, have an early lunch break, do all the cut-up in the early afternoon and be finished by three o’clock…
Admittedly there were a few articles about people’s personal experiences which were interesting, but there was quite a bit of semi-political ranting and more than a little of the IBMS blowing its own trumpet.
 
I was pleased to see the IBMS Gazette (as it will always be to me) has improved somewhat since I last read the thing…

 

2 October 2023 (Monday) - The Future (?)

The nice people at Oncology Central sent an interesting article about the future of immunotherapy in cancer treatment. You can read it by clicking here.

Back in the day this was billed as the future for the likes of me. Doing blood counts would all be automated and so I’d be using my skills on this sort of thing, coming up with custom-designed therapies for individual patients.

However there’s more and more blood counts for fewer and fewer people, and what with all this competency assessment stuff, our repertoire is getting smaller and smaller. The article talks about “off the shelf” immunotherapies… so is what we were promised likely to happen…

It wouldn’t seem so.