23 May 2024 (Thursday) - BTLP-TACT Exercise

I thought I might as well do a BTLP-TACT exercise. It gave me two cases

 

82403 – a twenty-six year-old chap with sickle cell disease needing eight units of blood for an exchange transfusion.

His ABO group was uninterpretable, but the Rh group was clearly negative. I took a screenshot as this is the sort of thing where BTLP is at odds with reality.

The antibody screen was positive in cells 1 and 2 so I requested antibody panels.

The IAT and enzyme panels was positive in cells 1, 2, 3 and 5 which corresponded with anti-D and anti-E but didn’t rule out anti-Cw.

So I needed eight units of ORh(D)-Neg E-Neg which were also HbS negative.

There were only two units of ORh(D)-Neg E-Neg which were also HbS negative… so (to be blunt) WTF was I supposed to do? 

02162 – a seventy-eight year-old woman in A&E with epistaxis needing group and save

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

 

I got the thumbs down… partly my mistake as one of the two HbS units wasn’t E-Negative. But this exercise set me up to fail, didn’t it?

23 May 2024 (Thursday) - Transfusion Evidence Alert

Every month when the Transfusion Evidence Alert comes in I say about what wonderful stuff tranexamic acid is… I gets mentions this time as well…

ARTICLE OF THE MONTH Association between tranexamic acid and decreased periprosthetic joint infection risk in patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis of over 2 million patients. Elmenawi, K.A., et al. (2024). The Journal of Arthroplasty. [Record in progress]. PICO Summary available +++++

TOP ARTICLES A review and analysis of outcomes in randomized clinical trials of plasma transfusion in patients with bleeding or for the prevention of bleeding: the BEST collaborative study. Apelseth, T.O., et al. (2024). Transfusion. [Record in progress]. The statistical fragility of tranexamic acid use in the orthopaedic surgery literature: a systematic review of randomized controlled trials. Brown, A.N., et al. (2024). The Journal of the American Academy of Orthopaedic Surgeons. Blood donation for iron removal in individuals with HFE mutations: study of efficacy and safety and short review on hemochromatosis and blood donation. Infanti, L., et al. (2024). Frontiers in Medicine. Defining ultra-massive transfusion through a systematic review. Meyer, C.H., et al. (2024). American Journal of Surgery. Intravenous immunoglobulin for the treatment of severe maternal alloimmunization: individual patient data meta-analysis. Mustafa, H.J., et al. (2024). American Journal of Obstetrics and Gynecology. [Record in progress]. Fewer severe infections with tranexamic acid in patients with hematologic malignancies. Poston, J.N., et al. (2024). Research and Practice in Thrombosis and Haemostasis. Multicenter, phase 1 study of etavopivat (FT-4202) treatment for up to 12 weeks in patients with sickle cell disease. Saraf, S.L., et al. (2024). Blood Advances. [Record in progress]. Tranexamic acid versus placebo in individuals with intracerebral haemorrhage treated within 2 h of symptom onset (STOP-MSU): an international, double-blind, randomised, phase 2 trial. Yassi, N., et al. (2024). The Lancet. Neurology. Efficacy and safety of immunosuppressive therapy combined with eltrombopag for severe aplastic anemia: a systematic review and meta-analysis. Zhang, Y., et al. (2024). Systematic Reviews.

22 May 2024 (Wednesday) - Westgard QC Update

 The nice people at Westgard QC sent their update today. It is thirty years since I took my degree in maths; my statistical theory is rather rusty, but some of it made sense. It’s a shame that the nice people at Westgard seem to be moving away from tangible mathematical stuff and moving into the more airy-fairy stuff, but there it is…

Tempora mutantur, nos et mutamur in illis

22 May 2024 (Wednesday) - IBMS Newsletter

The IBMS sent their update today. Part of it was their response to the infected blood scandal. You can read it here.

The whole infected blood scandal thing winds me up. I’m in no way belittling what happened, but is “scandal” the right word for it? I can distinctly remember a lecture in the second year of my ONC at Brighton Technical College when our lecturer (my old boss Paul Cabban) was telling us about the UK blood product situation. He made it quite clear that it was well known and accepted that the UK was not able to meet its own needs for blood products. There was no secret about where the USA was sourcing its blood products. It was known that there was a risk of contracting unidentified (at the time) diseases from these transfusions. We were told that transfusions of imported blood products (or any transfusions come to that) were supposedly a last-ditch treatment and that those receiving them were to be made aware of this.

I also went to a seminar (also in Brighton) about the first case of HIV in the UK outside of London where the same information was openly discussed.

This was in 1982…

The same information was openly acknowledged when I was doing HNC at Bromley Technical College (1983-85)

 

Wasn’t this information made clear to everyone? Was there really a cover-up? To the best of my knowledge there was never any secrecy about it.

21 May 2024 (Tuesday) - BTLP-TACT Exercise

I’m getting rather fed up with the BTLP-TACT thingy. In theory it is a good idea. In practice it differs from reality in several important ways. But all the time I get the thumbs-up it is good CPD, and all the time I don’t it gives me something to whinge about.

So here we go…

 

I had one case – a woman in maternity with pre-eclampsia. She grouped as A Rh(D) Positive with a negative antibody screen.

 

For once I got the green light…

20 May 2024 (Monday) - In the Hardware Shop

I was standing in the queue in one of the town’s hardware shops today listening to the tradesmen with bigger houses than me who drive better cars than me having a competition to see who could shout the F-word the loudest and with most feeling. Having recently taken semi-retirement I might have left it a little late to consider a career change.

You would have thought the shop staff wouldn’t encourage that sort of thing, wouldn’t you?

Whilst they did what they do, I did a little CPD.
In the hardware shop.
I called up the European Hematology Association’s Facebook page on my phone and had a look at their #LearningMonday quiz.

 

There was a case of something basophilic from what I could see on a rather small phone screen. What wouldn’t be a first step of disease management?

It struck me that given various other treatments available, hoiking out the spleen was a tad radical.

 

I was right to think so.  I was probably also right to think that a profession which involves competitions to see who could shout the F-word the loudest and with most feeling might have suited me better these last forty-odd years.

16 May 2024 (Thursday) - Updating My Atlas

If you look on-line there are many atlases of haematology; websites showing all sorts of weird and wonderful things you see down the microscope. Some are rather obscure and you rarely if ever see these things outside of an atlas. Years ago I started one of my own. It’s nothing special, the photos are rather dreadful, but it is all stuff that I have seen myself. You can see the atlas by clicking here (if you feel so inclined).

I spent a little while this morning updating it with things I’ve seen over the last couple of months.

• Basophilic stippling
• Howell Jolly bodies
• May-Hegglin Anomoly
• Mitotic figures

15 May 2024 (Wednesday) - Wasting My Time

Time for another BTLP-TACT exercise…

I was presented with two cases:

 

40357 – a sixty-six year-old woman in the urology clinic requiring group and save.

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

 

23941 – A twenty-one year-old male in ITU needing group and save and two units of cryo.

He grouped as B Rh(D) Negative also with a negative antibody screen.

Assuming the petty bickering about whether or not cryo was needed (and how much) had already been bickered I looked for two units of B or AB cryo. There wasn’t any, so I didn’t issue any. Bearing in mind it wasn’t needed until tomorrow in reality I would phone NHSBT and have some sent down…

 

I got the thumbs down because I didn’t select cryo for the second patient… even though there wasn’t anything suitable available.

If I’d actually paid anything to use this simulator I’d be asking for my money back.

14 May 2024 (Tuesday) - IBMS Newsletter

The IBMS sent its newsletter today. You can see it by clicking here.
There was talk about two young ladies who have been announced as biomedical scientist of the year, and of a shortlist for other awards. Without wishing to undermine anyone in any way, I’ll make the observation that (not including my at-least-weekly) night shifts I was called out of bed at least twice a week for twenty years, and that demands of the workplace meant that I missed my daughter’s first eight birthday parties. No one even said thank you. And I didn’t really do much that thousands of others didn’t do. But singling out one for praise undermines all the others.
There was talk of the IBMS’s involvement in the London Pride march. Much as I support the rainbow community (with family and friends in it) perhaps the IBMS might concentrate on things more relevant to its core business.
There was talk about the proposed raise in HCPC fees… they go up regardless of how much anyone might whinge.
And as for the Harvey’s Gang lab tours… how has the IBMS managed to take over something which surely must be the job of a paediatric nurse?
 
I suppose it is all about priorities. Mine are clearly sadly at odds with those of my professional body.

13 May 2024 (Monday) - Watch and Wait (!)

#LearningMonday… I hate hashtags with a passion. But the Learning Monday thing is good.

Given that photo it looked like PK deficiency… but the options given were all a tad radical so I plumped for watch and wait… the haemolysis can get less of a problem with age.

And I was right to do so…

 

13 May 2024 (Monday) - New Technology?

The nice people at Ortho turned up at work today, offered us all free food, and gave us a little talk about their latest blood grouping machine.

Personally I quite like the sound of their machine, but the reps are very good at making things sound good, aren’t they?

13 May 2024 (Monday) - Painful Wrist ?

I was looking at the NEQAS parasitology slide today. According to the information given, the patient had a painful wrist. So what? Why mention wrist?
Apparently microfilaria migrate into lesions on the extremities… typically on the knees or in the wrists.
I never knew that… 

9 May 2024 (Thursday) - Oncology Central Update

The nice people at Oncology Central sent their update today. Much of it floew over my head… some stuck though.

 

RNA-LPAs: the latest breakthrough in immuno-oncology?   From 'cold' to 'hot' in just 48 hours. Read about a novel mRNA vaccine technology, which rapidly reprograms the tumor microenvironment, triggering a robust immune response against cancer.

Poster highlights from AACR 2024 READ MORE >>>

Championing diversity and inclusion in neuro-oncology READ MORE >>>

ANKTIVA® receives US FDA approval for bladder cancer subtype READ MORE >>>

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Promising response to vemurafenib and cobimetinib treatment for BRAF V600E mutated craniopharyngioma: a case report and literature review Here the authors report on a case of a patient with a strictly third-ventricle papillary craniopharyngioma with a BRAF V600E mutation. After initial surgery with subtotal resection, the patient demonstrated durable response to targeted BRAF and MEK inhibitor therapy with vemurafenib and cobimetinib, suggesting that targeted therapy may reduce the need for radiation and impact surgical interventions in select cases. MORE >>>

Dabrafenib-trametinib in BRAF V600-mutated non-small-cell lung cancer: a single center real world experience In this study, researchers retrospectively evaluated the effects of dabrafenib/trametinib combination in patients with BRAF-mutated NSCLC. They observed a longer, statistically significant median progression-free survival in patients receiving the combination in first-line vs those in the second/subsequent lines.  MORE >>>

LEAP-014: first-line lenvatinib + pembrolizumab + chemotherapy in advanced/metastatic esophageal squamous cell carcinoma This study outlines the design and rationale for the randomized, open-label, Phase III LEAP-014 study of lenvatinib in combination with pembrolizumab plus chemotherapy in patients with advanced or metastatic ESCC. Overall survival and progression-free survival are the dual primary end points. MORE >>>