24 June 2024 (Monday) - Schistocytes

Clare’s done some science again. She’s rather good at it. Schistocyte counts… You can see the ICSH recommendations on the matter by clicking here.
I won’t repeat what Clare has said – she’s said it far better than I could, and you can read it by clicking here anyway. 

But I will make an observation… what is an acceptable measurement of uncertainty? Am I being utterly unreasonable in thinking that in numerical terms a schistocyte count won’t be a million miles from a parasitaemia count? Look at the most recent malaria NEQAS – we made the answer 0.2. Plenty of other people made the answer double or triple that number. What is an acceptable measurement of uncertainty?

24 June 2024 (Monday) - Porphyria

 

Monday – “learning Monday” and I learned something today. What I thought was probably a case of haemochromatosis wasn’t.

I suppose the clue was the photosensitivity. This was a case of porphyria – a range of conditions caused by abnormally high levels of porphyrins and porphyrin precursors due to deficiency of certain enzymes essential to the synthesis of haem.

These are rather obscure…

 

This is what CPD should be about. I’ve been reminded of something I used to know, and having been prompted I’ve given myself a little refresher.

18 June 2024 (Tuesday) - Mindray

There’s a new kid on the block. Back in the day every blood counter in the country was made by Coulter. And I mean *every* one.

Then Technicon launched the H1. With a five-part differential that (at the time) Coulter could not compete, it wasn’t long before Technicon made serious in-roads into the market.

Then along came Sysmex with faster smaller machines…

 

Mindray looks interesting. Particularly with their platelet de-aggregation capability. I doubt they will have their machines in at work before I retire, but maybe a year or two after…

17 June 2024 (Monday)- Learning Monday

Should I worry about this strange looking cell? At first sight I laid an egg. Then I looked again and read the words that came with it.

It’s bone marrow – that’s an osteoclast, isn’t it?

Panic over.

13 June 2024 (Thursday) - Oncology Central Update

The nice people at Oncology Central sent their update today. As always most of it went over my head, but one article made me think.

Quadruplet therapy – four drugs where once three were used. There was a lot of talk about avoiding side effects… I can remember my grandmother having a spate of “funny turns” when it turned out that for every medication she’d been prescribed she’d been prescribed another because of the side effects of the first. In the end the consultant in charge of her care stopped all of the tablets and she was suddenly fine.

This was fifty years ago – some things never chage…

10 June 2024 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise… I was presented with one case – a ninety-year-old chap in theatre needing two units of blood for a TURP. Back in the day we did two units of blood for every TURP… they never used any. Ever.

But I digress.

 

He grouped as O Rh(D) Positive with antibody screen positive in cell 2 so I requested antibody panels. The IAT and enzyme panels were positive in cells 2 & 6 corresponding with anti-K.

I selected two units of O Rh(D) Positive K Negative blood

 

I got the green light.

 

10 June 2024 (Monday) - Fritsma Factor Newsletter

Threshold limits for platelet transfusions, factor assays (remember those?) and poking about in samples with wooden sticks to check for clots. This month’s Fritsma Factor newsletter is a tad old-skool… but then, so am I.

I’ll just make the observation that in this high-tech age of science there is still a place for getting hold of a snake, milking its venom and using that as a reagent. Back in the day (early to mid 1980s) there was a very active haematology group which met at St Thomas’s hospital on Thursday evenings. People would do round trips of over a hundred miles to be there (I did) and back then people were sneering at the rough and ready use of snake venom in haemostasis.

Has nothing been developed in the meantime to replace Russell’s viper?

7 June 2024 (Friday) - NEQAS 2403 BF

I got hold of the NEQAS results today…
 

2403 BF1

 

Anisopoikilcytosis 

Polychromasia

NRBC 

Fragments 

 

Thrombocytopenia

 

eosinophilic myelocytes 

Blast cells

Neutropenia

Auer rod

 

?? AML

 

 

2403 BF2

 

Target cells

Rouleaux

 

Neutrophilia

Toxic granulation

Monocytosis

 

? infection

 
I got these right too…

7 June 2024 (Friday) - NEQAS 2402 PA

I got hold of the NEQAS results today…
 

2402PA1

P falciparum 0.2%

2402 PA2

microfilaria ?? loa loa

 
I got it right…

6 June 2024 (Thursday) - Transfusion Evidence Library Update

The nice people at Transfusion Evidence Library sent out a special update in honour of international Children’s Day.

Top article

Whole blood versus red cell concentrates for children with severe anaemia: a secondary analysis of the Transfusion and Treatment of African Children (TRACT) trial.
George, E.C., et al. (2022). Lancet Global Health.
PICO SUMMARY

 

Selected articles

Effects of delayed cord clamping at different time intervals in late preterm and term neonates: a randomized controlled trial.
Chaudahary, P., et al. (2023). European Journal of Pediatrics.

Tissue oxygenation changes after transfusion and outcomes in preterm infants: a secondary near-infrared spectroscopy study of the transfusion of prematures randomized clinical trial (TOP NIRS).
Chock, V.Y., et al. (2023). JAMA Network Open.

Comparative efficacy and safety of restrictive versus liberal transfusion thresholds in anemic preterm infants: a meta-analysis of 12 randomized controlled trials. 
Fu, X., et al. (2023). Annals of Hematology.

Two-year outcomes following a randomised platelet transfusion trial in preterm infants.
Moore, C.M., et al. (2023). Archives of Disease in Childhood - Fetal and Neonatal Edition.

Effective management of foetal anaemia in Rh(D) alloimmunised pregnant women with intrauterine transfusion: a Systematic review.
Prescott, B., and Jackson, D.E., (2023). Hematology, Transfusion and Cell Therapy.

Darbepoetin alfa to reduce transfusion episodes in infants with haemolytic disease of the fetus and newborn who are treated with intrauterine transfusions in the Netherlands: an open-label, single-centre, phase 2, randomised, controlled trial.
Ree, I.M.C., et al. (2023). Lancet Haematology.

Platelet transfusions in preterm infants: current concepts and controversies-a systematic review and meta-analysis.
Ribeiro, H.S., et al. (2023). European Journal of Pediatrics.

Effects of freshly irradiated vs irradiated and stored red blood cell transfusion on cerebral oxygenation in preterm infants: a randomized clinical trial.
Saito-Benz, M., et al. (2022). JAMA Pediatrics.

Transfusion-associated delirium in children: no difference between short storage versus standard issue RBCs.
Traube, C., et al. (2022). Critical Care Medicine.

 

 

4 June 2024 (Tuesday) - UKAS Update

The nice people at UKAS sent out some links to their free webinars today. You can sign up to them by clicking here. I didn’t. I’ll be honest – I didn’t see the point. Until such time as the standards are freely available and open to all (i.e you don’t have to pay to get a copy) it’s all just hot air, isn’t it?

4 June 2024 (Tuesday) - BTLP-TACT Exercise

Flushed with success at having got one right at the weekend, I thought I might have another go at the BTLP-TACT…
I was given two cases:
 

68116 – a forty-two year-old woman in A&E requiring group & save

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

 

53366 – a forty-seven year-old chap in theatre requiring group & save and four units of FFP for bleeding varices.

He also grouped as O Rh(D) Positive but with an antibody screen positive in cells 1 & 2.

I performed antibody panels. The IAT panel was positive in cells 2, 4, 5, 7,8 and 10 which corresponded with anti-Fy(b), and the enzyme panel was negative.

I didn’t issue FFP as according to the guidelines it isn’t recommended in this condition.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9218432/ 

 
I got the green light… 

3 June 2024 (Monday) - Learning Monday

It’s Monday… it’s Learning Monday. I say “learning”… I suspect things in the European Hematology Association are rather different to how they are in my world. Again I’m doing CPD which isn’t so much brushing up what I know and updating it as remembering the good old days before the job was dumbed down and de-skilled.

The picture is of hairy cells. Back in the day we’d take a bit of the patient’s blood, and do an acid phos stain.

Science advanced, and we’d take a bit of blood to the flow cytometer and test for all sorts of CD markers.

Nowadays the lab assistant packs up the blood and sends it to London and we call it progress.

Such a shame…

 

I really should stop being so negative in what I post here. Wow – look! – a reflection!!

2 June 2024 (Sunday) - BTLP-TACT Exercise

Another BTLP-TACT exercise… I was presented with one case – a nineteen-year-old lady in the outpatient department needing two units of irradiated blood for the following morning.

 

Her ABO group was indeterminate. Does that invalidate the Rh(D) group? Her Rh(D) group was negative as the control was also negative. So I said it was negative. Because it was. If a new finding the whole lot would go off to NHSBT, and if a known patient we’d know what was going on. Wouldn’t we?

Anyway…

The antibody screen was positive in cells 1 & 2 so I performed antibody panels. The IAT and enzyme panels were positive in cells 1, 2 and 3 which corresponded with anti-D but didn’t rule out anti-Cw.

I selected two units of irradiated O Rh(D) Negative blood which were K-Negative

 

I got the green light…

 

28 May 2024 (Tuesday) - Healthcase Science Bulletin

The office of the chief scientific officer sent the Healthcare Science Bulletin today. You can read it by clicking here.

Please do.

This is clearly the sort of thing that the chief scientific officer thinks healthcare scientists should be up to. Personally I disagree, but what I think is irrelevant. And so I try to keep abreast of this sort of thing…

27 May 2024 (Monday) - Seriously?

Well… here’s a weird one. Leaving aside the fact that no one has performed an osmotic fragility in the last thirty years I’ve never seen a curve showing greater resistance to lysis. The curve is shifted to the right. Bearing in mind that HS, HE and AIHA would give lower resistance to lysis (curve shifted to the left) the correct answer must be sickle cell anaemia. Which thinking about it would seem to be right (which it was).

But who on earth would do an osmotic fragility when a simple blood film would point you in the right direction?