Just done an on-line morphology quiz. I got it right…
This is (supposed to be) a reflective diary by a (not very) anonymous biomedical scientist who works somewhere in the south of England. One day this diary may well be submitted to the Health and Care Professions Council as evidence of ongoing continual professional development....
6 November 2025 (Thursday) - BTLP-TACT Exercise
I suppose I should really do a BTLP-TACT
exercise…
I had one case – a seventy year old woman
supposedly needing FFP for reversal of warfarin therapy.
Her ABO group was indeterminate (cell
group A, no reaction in reverse group) but her Rh(D) group was negative.
The antibody screen was weakly positive
in cells 1 and 2 so I performed antibody panels.
The IAT and enzyme panels were positive
in cells 1, 2 and 3 corresponding with anti-D but not excluding anti-Cw.
Bearing in mind warfarin
isn’t recommended for the reversal of warfarin therapy, I didn’t issue any.
I got it right this time…
5 November 2025 (Wednesday) - TACO-Related Fever
Here’s something
to think about… back in the day transfusion trigger limits were a *lot*
higher than they are these days. We’d give three or four units of blood where
these days we’d only give one. And back in the day we were investigating quite
a few alleged transfusion reactions which were characterized by post
transfusion fevers. We’d do blood cultures… but nothing ever grew.
Were we seeing fevers related to transfusion associated circulatory overload?
4 November 2025 (Tuesday) - Fritsma Factor Newsletter
The Fritsma
Factor newsletter appeared in my in-box this morning. As always it’s a
rather useful source of information on matters haemostatic…
4 November 2025 (Tuesday) - Information Governance
I did my e-learning on information
governance today. Governance… it’s a simple concept really. I have access to
confidential information. I only discuss it with those who have a bona-fide
reason to know what I know, and I keep my trap shut to everyone else. I make
sure that no one could accidentally find out what I know… simple, really.
3 November 2025 (Monday) - A.P.L.
Acute promyelocytic leukaemia… There’s some
pictures here and an article about how the condition is
best treated here.
Oh… Statements 1, 3, and 4 are correct.
The images given show dumbbell-shaped
blasts consistent with acute promyelocytic leukemia (APL), a subtype of AML
known for its aggressive presentation and high risk of bleeding and/or
thrombosis due to coagulopathy. Unlike other AML variants, APL often leads to
disseminated intravascular coagulation (DIC), supported by lab findings such as
elevated INR, prolonged aPTT, low fibrinogen, and high D-dimer.
Despite its favorable long-term
prognosis, APL is a hematologic emergency requiring urgent treatment. The coagulopathy in APL is primarily driven
by tissue factor (TF) released during promyelocyte destruction,
triggering excessive activation of the coagulation cascade. With the advent of
all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) as frontline therapy,
APL has become the most curable AML subtype. APL blasts are typically negative
for HLA-DR and CD34, distinguishing them from other AML variants.
2 November 2025 (Sunday) - Slide Saturday Challenge
Strange-looking cells…. Obviously derived
from basophils… or are they? The nuclei aren’t right.
This is a case of systemic mastocytosis.
Here’s some information
on the condition.
2 November 2025 (Sunday) - BTLP-TACT Exercise
It’s raining, I’m sulking… Might as well
do another BTLP-TACT exercise until the rain stops.
I was presented with two cases:
76896 – a fifty-one year old chap needing four units of FFP for bleeding varices.The control well was weakly positive so the entire group was invalidated and would need referral to NHSBT. The antibody screen was negative.FFP is NOT recommended for bleeding varices https://pubmed.ncbi.nlm.nih.gov/33969607/ so I didn’t issue any.45944 – a seventy-five year old chap with beta thalassemia needing two units of bloodHe grouped as A Rh(D) Positive with antibody screen positive in cells 2 and 3, so I performed antibody panels. The IAT and enzyme panels were positive in cells 2, 3, 7, 8 and 9 corresponding with anti-Le(b) but not excluding anti-Lu(a) or anti-Kp(a)https://pmc.ncbi.nlm.nih.gov/articles/PMC11747971/ says anti-Le(b) is not clinically significant, and bearing in mind that there were no units available which were Le(b)-negative I treated it as not significant. But there wasn’t any units at all that were Kp(a) negative so I didn’t issue any.
I got the thumbs down. Apparently anti-Lu(a)
and anti-Kp(a) could be excluded…
I’d like to know how.
1 November 2025 (Saturday) - Daratumumab - Remember That Stuff?
Seven years ago I wrote something on here about daratumumab and how it gives false positive results in antibody screening, and what we do about it. Somewhat ironic that the entire matter slipped my mind and I wasted a couple of hours messing around on completely unnecessary antibody panels this evening…
Subscribe to:
Comments (Atom)