14 February 2024 (Wednesday) - Getting the BTLP-TACT Wrong. Again.

Time for another BTLP-TACT exercise… It gave me two cases.
00403 – a fifty-eight year-old woman needing group & save for a hernia repair.
Her blood group was indeterminate as a positive result in the control tube invalidated the entire blood group. Apparently.
Fortunately the antibody screen was negative.
92445 – a seventy-six year old woman needing four units of FFP for reversal of warfarin therapy. Personally I wouldn’t have used FFP for reversal of warfarin therapy, but presumably the nice people at BTLP-TACT had already had that argument.
She grouped as A Rh(D) Negative with antibody panel positive in cell 3. I requested antibody panels. The IAT and enzyme panels were positive in cell 8 corresponding with anti-Kp(a)
I issued two units of A Rh(D) Negative FFP, and two units of A Rh(D) Positive FFP as there was no more A Rh(D) Negative FFP or any AB Rh(D) Negative FFB
I got the thumbs-down. I wasn’t supposed to issue any plasma at all. Well, I know that. But when I said “presumably the nice people at BTLP-TACT had already had that argument”, clearly they hadn’t.
I’m getting fed up trying to second-guess this software…


13 February 2024 (Tuesday) - Eighty Four Point Five Per Cent

I started this quality management course three weeks ago when I said “I’ve always considered “Quality Management” to be a load of blah-blah-blah that gets in the way of doing my job, and for years I’ve been wondering just what I’m missing. I must be missing something.
So far the course has been nothing but blah-blah-blah, and all it is doing is confirming my preconceptions.
I finished the course today and got eighty four point five per cent. I’ve clearly learned something during this time, but it has to be said there was a *lot* of “blah-blah-blah”. It really could have done with a whole lot less general theoretical and a whole lot more specific practical examples.
But eighty four point five per cent is eighty four point five per cent, isn’t it? There’s something tangible I can stick in a CPD audit should the need arise.
The course I’ve just done made it quite clear that a CPD audit of the sort I’m talking about here in no way contributes to workplace quality. And that’s why I’m still cynical.

8 February 2024 (Thursday) - MDS

The nice people at Oncology Central sent their update today. As always, much of it went over my head, but there was one rather interesting article about the diagnosis of myelodysplastic syndrome.

Back in the day MDS was something of a catch-all labelling of pre-leukaemic conditions. Things are getting a tad more specific these days

7 February 2024 (Wednesday) - Placental Growth Factor

The future? Here’s an article about a quick, accurate new blood test for pre-eclampsia which is contributing to safer pregnancies and better outcomes for tens of thousands of women and their unborn babies every year.

How long will it be before I’m performing placental growth factor assays?

6 February 2024 (Tuesday) - Fritsma Factor Newsletter

Cryoprecipitate, platelet function tests… again the Fritsma Factor newsletter comes up trumps.
You can read it by clicking here. There’s not lots, but what there is, is good.

3 February 2024 (Saturday) - More Quality Management

Having identified a problem... is it really a problem? Was there an error that came to light? Has there been a complaint? Or is there something in the workplace that could be changed easily and that would be used to tick a quality management box?
Having identified a real (as opposed to imagined or made up for a paperwork exercise) problem, is this one that can be readily rectified? And exactly how can we be sure that what changes we make actually eliminate or reduce the percieved problem?

An example was given from a well-known manucaturer of office equipment who felt they were paying far too much in transport costs when getting stuff in from their suppliers. At the end of the process they cut a list of three thousand suppliers down to three hundred; thereby eliminating the transport and administration costs of dealing with two thousand seven hundred companies. 

Suddenly quality management is all making sense.

2 February 2024 (Friday) - Haemostasis Update

The Journal of Thrombosis and Haemostasis sent its update today. Some interesting articles…

I’m always interested in haemostatic articles – when you think about it, there is such a fine line between our bodies bleeding out and clotting into one solid lump.

1 February 2024 (Thursday) BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I had one case – an eighty-five year-old woman needing four units of FFP as soon as possible.
Her ABO blood group was indeterminate; cell group B but no reaction with A cells, but she grouped as Rh(D) Positive.
Her antibody screen was negative.
I selected four units of FFP; two AB and two B
I got the green light.

31 January 2024 (Wednesday) - Seen The Light !! (Possibly)


I did some more of my course this evening...
How exactly do we measure quality. What criteria do we pick? It was said that we need to choose the right measures in the right situation and use them in the right way. There needs to be a proven link between the measure chosen and the patient’s eventual outcome. And there has to be a link between a measured low performance and a low level of patient care.
And suddenly something has clicked…
I’m now getting into this course… I’m seeing why I’ve been utterly disillusioned with the entire concept of quality management. The important thing is to choose the right criteria as a measure of quality. For example what is the point of demanding that certain blood tests need to be completed (and results available) in a couple of hours when the results aren’t actually needed until the patient’s next appointment which is in two months’ time?
We fall at the first hurdle in the labs. Because it is easy to count what we do in a given period of time, there’s an obvious metric. But is it the right thing to measure in every situation? And should we churn out any old result regardless of the accuracy and precision…
I’m actually looking forward to the next lecture.

30 January 2024 (Tuesday) - Stem Cell Evidence Alert Update

The nice people at the Stem Cell Evidence Alert sent their update today… This is the sort of thing that I keep hearing that I should be reading as CPD… for all that it is rather interesting, it’s not practically improving what I do on a daily basis


Prospective Multi-Institutional Study of Eculizumab to Treat High-Risk Stem Cell Transplant Associated TMA.Jodele, S., et al. (2023) Blood [record in progress]PICO SUMMARY



Peripheral Blood Haploidentical Allogeneic Stem Cell Transplantation in Older Adults with Acute Myeloid Leukemia and Myelodysplastic Syndromes Demonstrates Long Term Survival, Results from the Australasian Bone Marrow Transplant Recipient Registry.Abadir, E., et al. (2023) Transplantation and Cellular Therapy [record in progress]

Fludarabine melphalan versus fludarabine treosulfan for reduced intensity conditioning regimen in allogeneic hematopoietic stem cell transplantation: a retrospective analysis.Chichra, A., et al. (2023) International Journal of Hematology [record in progress].Reconstitution of Natural Killer cells after allogeneic hematopoietic stem cell transplantation is facilitated by Huiyang-Guben decoction through activating the Smad7/Stat3 signal pathway.Gao, X., et al. (2023) Molecular and Cellular Biochemistry [record in progress]

Prevention of CMV/EBV reactivation by double-specific T cells in patients after allogeneic stem cell transplantation: results from the randomized phase I/IIa MULTIVIR-01 study.Gerbitz, A., et al. (2023) Frontiers in Immunology 14:1251593

Peripheral blood haploidentical hematopoietic cell transplantation for patients aged 70 years and over with acute myeloid leukemia or high-risk myelodysplastic syndrome.Harbi, S., et al. (2023) Bone Marrow Transplantation [record in progress]

Chronic graft-versus-host disease is characterized by high levels and distinctive tissue-of-origin patterns of cell-free DNA.Pang, Y., et al. (2023) iScience 26:108160

Assessment of monocytic-myeloid-derived suppressive cells (M-MDSC) before and after allogeneic hematopoietic stem cell transplantation in acute leukemia patients.Peterlin, P., et al. (2023) EJHaem 4 (4):1089-1095

Diverse macrophage populations contribute to distinct manifestations of human cutaneous graft-versus-host disease.Strobl, J., et al. (2023) The British Journal of Dermatology [record in progress]

Prophylactic versus Preemptive modified donor lymphocyte infusion for high-risk acute leukemia after allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study.Yang, L., et al. (2023) Bone Marrow Transplantation [record in progress]

29 January 2024 (Monday) - Glad I DIdn't Pay For It...

I had a look at more of my Coursera course on Quality Management.
The lectures played for the best part of an hour; they said an awful lot without actually saying anything and I got ninety per cent in a multiple choice exam by choosing the answers that weren’t frankly ridiculous or laughable.
I've started on this course because I make no secret of my contempt for the subject, and I want to be proven wrong. I want to be shown that there is merit in Quality Management. One third of the way into the course and so far it seems to be little more than learning from your mistakes in a blame-free and open way, which is something we should all be doing anyway.
Clearly I'm still missing the point. Hopefully that point will become apparent in the next two thirds of the course.