25 April 2024 (Thursday) - Finally Getting It Right

Bearing in mind that the last time I did a BTLP-TACT exercise I decided that I’d had enough of failing because of its vagaries it was with a heavy heart that I had another go this evening.

 

I had one case – a ninety-nine year-old woman with CVA who needed group & save.

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

 

I got a green light… the first for over a month.

 

23 April 2024 (Tuesday) - Westgard QC Update

The nice people at Westgard sent their update today. There was a lot of what I might flippantly call “blah blah blah”, but one article made me think.

Just what are the QC limits on our blood counters? I naively thought they were the standard two standard deviations. It would seem they might not be. It was claimed that some parameters have ranges of up tp 10 SD; MCV, and MCHC were quoted.

 

I’ve always worked in places that use the limits that the machine’s manufacturers give. Personally I haven’t a clue just how wide these limits are though.

Apparently globally, only about 42.4% of laboratories use such manufacturer-supplied control limits. 60% of labs surveyed in China use their own limits

 

I suppose that justifying making our own limits would be a regulatory minefield. CPA wouldn’t be at all keen. Mind you I wonder if they are aware of this article.  

I imagine those who make blood counters will have something to say about it… and about this article too.

21 April 2024 (Sunday) - Failing the BTLP-TACT Again

Time for another BTLP-TACT exercise. I was given two cases:
 
18673 – a ninety-three year-old woman in out patients requiring group & save
 
She grouped as O Rh(D) Positive with a negative antibody screen
 
14253 – a forty-two year-old woman needing two units of blood for tomorrow
 
The control being positive invalidates the entire group
 
The antibody screen was positive in cell 1. I performed antibody panels.
The IAT and enzyme panels were positive in cells 2, 4, 5, 8, 9 and 10
This looks like anti Jk(b) but doesn’t exclude Lu(a) or Kp(a)
Bearing in mind there was no suitable blood available I was bound to get a red light…
 
What was I supposed to do?

19 April 2024 (Friday) - IBMS Update

The IBMS sent its update today. You can read it by clicking here. Please do click there.

What is the purpose of the IBMS? I really don’t know any more.

I used to be a member of the IBMS as it was my professional body and in its monthly magazine it would come up with all sorts of useful articles to help me in my job.

Back then the IBMS Gazette was pretty much the only place that adverts for jobs in this line of work appeared.

Then the IBMS started offering professional indemnity insurance.

And now…

The IBMS hasn’t so much lost its way as gone the way it has been led by those who can be bothered to do the leading. However they aren’t leading it the way I would have done.

18 April 2024 (Thursday) - UKAS Update

The quarterly update from UKAS arrived in my inbox this morning. Yesterday I mentioned how the good old days weren’t that good. Another way in which they weren’t good is exemplified when I moved to a new place of work in 1984 after three years elsewhere.

“You can do blood groups?” asked the chap in charge of the blood bank.

“Yes” I answered.

“Get on with it then” he replied.

And so, with no written instructions I got on with doing blood groups in the way I’d been taught in the long-bulldozed Royal East Sussex Hospital. After a few weeks and months it turned out that how I was doing them was subtly different to colleagues who’d been taught in hospitals in London, Tyneside, and various other parts of the world.

Were we all getting the same results…? Who knows?

 

We all laughed at the idea of having standard operating procedures, and were horrified at the thought of facing accreditation when these were introduced in the early 1990s, but they were needed.

Thirty years later we’ve now got the UK Accreditation Service which seems to be trying to instill the same strange practices into the management structures of many and varied diverse lines of work. From my personal and narrow perspective it has lost sight of the frankly wonderful achievements of thirty years ago.

We all do blood groups the same way at work. But how we do them is still subtly different to how they are done in hospitals in London, Tyneside, and various other parts of the world. Perhaps we as a profession might be looking at standardizing nationwide and internationally? Is there any appetite for that? I doubt it

17 April 2024 (Wednesday) - The Good Old Days ?

On the week when I (finally) got hold of my pension the nice people at Lablogatory sent their update somewhat co-incidentally reminiscing about the good old days.

I remember the good old days. I originally wrote a diatribe about how things were so much better forty years ago… but then remembered a conversation with the boss at the time who said he was legally obliged to recommend that I join the pension scheme but he felt he would make the observation that people in this line of work usually died aged fifty-seven from something nasty they caught from the job. Was this true? “Uncle Cyril” actually told me that, and I took him at his word.

I’ll make the observation that had we had today’s health and safety legislation back then we wouldn’t have used post-mortem material to make reagents. And one of the girls with whom I went to college probably would still be alive.

15 April 2024 (Monday) - e-Learning

 

I did my Infection Control and Information Governance e-learning today. I passed both... as well I might.

12 April 2024 (Friday) - NEQAS 2402 BF

I got the results of NEQAS 2402 BF today. Here’s my results together with the consensus findings:

 

2402 BF1

 

Mott cells / Plasma cells (1^st)

Rouleaux                        (2^nd)  

Thrombocytopenia          (3^rd)

Nucleated Rbs                 (4^th)

 

I felt this was a myeloma; it was

 

2402 BF2

 

I felt this was a normal film. It was.

 

Again… that’ll do…

12 April 2024 (Friday) - NEQAS 2401 DM

I got the results of NEQAS 2401 DF today. Here’s my results together with the 2SD of all participants.

 

Neut    3.9  (2.2 – 4.0)

Lymph 4.7  (0.2 – 7.4)

Mono   0.3  (0.0 - 0.6)

Eos      0.0  (0.0 - 0.1)

Baso    0.0  (0.0 - 0.0)

Meta    0.1  (0.0 - 0.4)

Myelo  0.1   (0.0 - 0.2)

Blast    0.0  (0.0 - 0.2)

 

That’ll do…

10 April 2024 (Wednesday) - HCPC Newsletter

The HCPC sent their newsletter today. You can read it by clicking here. I mention it because as my professional regulator I feel I should be reading it.

Mind you there is a rather interesting bit about revisions to the standards of conduct, performance and ethics and accompanying social media guidance. This is something which we actually need. 

It wasn't that long ago that ago those who didn’t understand social media unilaterally announced that just mentioning that you were a bit tired at 6am on a night shift was a disciplinary offence. I’ve still got the written warning somewhere…

9 April 2024 (Tuesday) - IBMS Newsletter

Yesterday I mentioned my constantly finding fault with the IBMS as a so-called CPD activity. This morning their newsletter arrived in my in-box… and I’m finding fault with them again. You can see the newsletter by clicking here.

 

There’s some good stuff in there… but I forced myself to read the entire newsletter before writing this. The trouble is that it starts with political nonsense and giving out awards that most people have lost interest before they get to the relevant stuff.

I would write to the IBMS about it… I have done so in the past to no avail.

8 April 2024 (Monday) - Am I Doing It Right?

I beaver away behind the scenes here copying and pasting stuff from all sorts of sources, openly admitting to my failings with BTLP-TACT and constantly finding fault with the IBMS in a shallow attempt to curry favour with anyone who might be unfortunate enough to have to assess the worth of this blog as evidence of my performing CPD.

So… now’s as good a time as any to winder if I’m actually doing what I’m supposed to be doing. According to the rules at https://www.hcpc-uk.org/cpd/what-is-cpd/ I am supposed to:

 

1. Carry out learning activities on a regular basis.
2. Carry out different kinds of learning activities.
3. Keep a record in the way that is most convenient for you.
4. Carry out activities that might improve your practice and benefit your service users.
5. Take part in an audit if asked.

Well… I think I can take the first two criteria as done. There’s usually a couple of things happening on here every week.

And despite my being told by a previous employer to use their (so-called) “proper” headed A4 paper filed in someone else’s office, the third makes it quite clear that this blog is quite acceptable.  

The fifth hasn’t arisen yet, but if it does I will do as asked.

The fourth one is the tricky one. The first part is OK – I’m clearly doing loads in an attempt to improve what I’m doing… but does it benefit my service users?

 

The trouble here is what is a biomedical scientist’s service user? The medics sending us the blood tests? The patients whose blood we test?

I’m going to take the line that part of the service I provide is imparting the benefits of my forty-odd years to those new to this line of work.

Here’s one of them who’s been looking at blood films with me recently. 

 

8 April 2024 (Monday) - A Mitotic Figure

Mitotic figures are rather obscure things but I saw one today… apart from NEQAS and Google, this would be the fourth I’ve ever seen. I’ve taken the opportunity of updating my atlas.

3 April 2024 (Wednesday) - A New Cell Counter?

I had an email today inviting me to a presentation about the use of artificial intelligence in haematology. You can see the company’s video by clicking here.  

The video was an eye-opener… not because of amazing outstanding technical developments, but because it said its system would do away for the need for endless manual differential counting. No one would seem to have had the heart to tell this company that endless manual differential counting went out the window with the advent of the Technicon H1 analyser in the mid-1980s (I was there!).

Furthermore if the lab’s cell counter can’t do a differential count on a particular sample, this artificial intelligence system can’t either.

Having watched the video, I shall give this presentation a miss…

 

3 April 2024 (Wednesday) - FFP

For some time anyone born after 1996 who needs fresh frozen plasma must be given stuff which has been virally inactivated with methylene blue…
Or so I always thought. Whilst I wasn’t paying attention the guidelines have been changed.
I’ve always been thinking Octoplas or commercially prepared stuff. But it turns out that methylene blue treated stuff hasn’t been available for some time. It’s amazing what you miss if you don’t pay attention.

 

2 April 2024 (Tuesday) - Fritsma Factor Newsletter

The Fritsma Factor newsletter appeared in my in-box this morning. Platelet satellites, mixing studies, validation of calcium chloride… all very relevant stuff.

 

2 April 2024 (Tuesday) - Ethnic Neutropenia

For a long time I’ve known that people of African origin have lower neutrophil counts than others. Why is this?

People of African origin are more likely to have the Duffy null phenotype, Fy(a-b-). Very rare among Caucasian and Asian populations, it is the most common phenotype in people of African origin, occurring in over two-thirds of those people.

Low neutrophil count is actually more strongly associated to the Duffy variant than to ancestry though, suggesting that the variant itself causes benign ethnic neutropenia.

Individuals with the Duffy null phenotype do not express the Duffy protein on their RBCs and therefore are immune to P. vivax infection.

It’s another thing to do with malaria.

 

Many years ago (1981 – 1983) when I was at Brighton Technical College one of our lecturers maintained that every subject of study had key topics; if you knew about those topics then you knew everything about that subject of study. He said that for biology the topics were sex, surface area and the liver.

For haematology one of them is malaria…

1 April 2024 (Monday) - BTLP-TACT Issues (Again!)

Time for another BTLP-TACT exercise. I was presented with two cases:

 

23693 – a sixty-one year-old woman in A&E needing group & save. She grouped as O Rh(D) Positive with antibody screen positive in cells 2 & 3.

I requested antibody panels. The IAT and enzyme panels were negative in cells 1 and two and positive in all others (cells 3 – 10) which was consistent with anti-c but did not rule out anti-E, anti-Lu(a) or anti-Kp(a). This would go to NHSBT for further investigations 

66242 – a twenty-two year-old chap on the surgical ward needing two units of blood to treat anaemia. He grouped as A Rh(D) Negative with a negative antibody screen.

I selected two units of A Rh(D) Negative blood

I got the thumbs down. Supposedly the blood group of 66242 was uninterpretable. I disagree. It was fine. I can’t help but wonder why the software doesn’t show us pictures of that which we supposedly got wrong. Do I *really* need to be taking screen shots of everything?

28 March 2024 (Thursday) - Transfusion Evidence Alert Update

The Transfusion Evidence Alert arrived in my in-box today. I keep saying it, but tranexamic acid… Even more mentions of the stuff.

ARTICLE OF THE MONTH Effectiveness of care bundles for prevention and treatment of postpartum hemorrhage: a systematic review. Vogel, J. P., et al. (2024). American Journal of Obstetrics and Gynecology. [Record in progress] PICO Summary available +++++

TOP ARTICLES Full correction of posttransplant anemia is associated with stabilized cardiac dimensions among kidney transplant recipients: a prospective randomized controlled trial. Al-Otaibi, T., et al. (2024). Experimental and Clinical Transplantation. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Bus, S.R., et al. (2024). The Cochrane Database of Systematic Reviews. Missingness matters: a secondary analysis of thromboelastography measurements from a recent prehospital randomized tranexamic acid clinical trial. Donohue, J.K., et al. (2024). Trauma Surgery & Acute Care Open. Alveolar hemorrhage in ANCA-associated vasculitis: results of an international, randomized, controlled trial (PEXIVAS). Fussner, L.A., et al. (2024). American Journal of Respiratory and Critical Care Medicine. [Record in progress] Reporting bias is highly prevalent in systematic reviews and meta-analyses of platelet rich plasma injections for hip osteoarthritis. Kim, D., et al. (2024). Arthroscopy, Sports Medicine, and Rehabilitation. Results of clinical effectiveness of conventional versus Mirasol-treated Apheresis Platelets in Patients with Hypoproliferative Thrombocytopenia (MiPLATE) trial. Koepsell, S.A., et al. (2024). Transfusion. Kidney disease in trials of perioperative tranexamic acid. Liu, C.W., et al. (2024). Journal of Clinical Anesthesia. Evaluation of spin bias in systematic reviews and meta-analyses of rotator cuff repair with platelet-rich plasma. Moulton, S.G., et al. (2024). The American Journal of Sports Medicine. [Record in progress] Mitapivat improves ineffective erythropoiesis and iron overload in adult patients with pyruvate kinase deficiency. van Beers, E.J., et al. (2024). Blood Advances. [Record in progress]

26 March 2024 (Tuesday) - Westgard QC Update

The nice people at Westgard sent their update today. Usually a source of really useful CPD, the focus of this one seemed to be about how labs should be using QC tools to achieve accreditation criteria. Which is all very well all the time those accreditation criteria are written by people who actually understand what is going on in blood testing labs. However when we are jumping through hoops purely because some silly regulation says we should…