21 February 2025 (Friday) - Pure Genius

Here’s an idea which is simple and brilliant which I saw on a work-related Facebook page this morning. When trying to figure out how the pattern of reactions might fit a given antibody, take a highlighter pen and highlight the rows which have come up positive.

So simple. Why didn’t I think of this years ago?

 

23 August 2024 (Friday) - Long Long Ago

As I peered into Facebook this morning there was something on one of the haematology-related pages that made me think. Someone was talking about LE cell preparations…

Compared to the technology of today, LE cell preparations were somewhat laughable.

 

Back in the day we would take ten millilitres of blood into a glass jar which contained several glass beads. We would then seal the jar with a tight cap and shake. I say “shake” – we would thrash the thing as vigorously as we could with all of our might. And at the point of exhaustion we would pass the jar to a colleague who would carry on thrashing the thing. And when they were worn out someone else would take over.

After fifteen minutes it would go into an incubator for half an hour or so. The contents would then be poured through a muslin cloth (which made a real mess and spilled blood everywhere) into a tube, gently spun, and a blood film prepared from the buffy coat.

We would then look under the microscope for neutrophils which had engulfed other cells – these were the LE cells. Seeing the cells was diagnostic of systemic lupus erythematosus, and not seeing them excluded the condition. In the three years that I did this procedure (whilst working in a long-since bulldozed hospital) we never had a positive result. Not one. And neither had anyone else with whom I spoke about them at day release college.

 

It would seem that lupus is on the rise. And has been for the last few decades Is this because the disease is really becoming more prevalent, or because nowadays there’s a much more involved diagnostic process which employs tests which are nowhere near so medieval.

 

Did we miss cases of lupus back in the day because they really were less common? Are we finding more these days because the condition is more prevalent. Or because the technology is better? I don’t know, but I can remember doing at least one LE cell preparation a week for three years and never getting a positive result. At the time I was only a trainee, and the frankly bullying atmosphere in which I worked actively discouraged comment, but surely someone would have thought there was something wrong in a test which was *always* negative.

Unless it really was always negative? 

 

18 November 2023 (Saturday) - Cold Storage (?)

One of many things that winds me up is how what is absolutely the wrong thing to do (and is cast in stone) and doing it is a disciplinary offence in the world of blood transfusion today will be the official standard and best practice tomorrow.

 

For over forty years I have been told to keep the platelets we  away from the fridges.  

Now it would seem that keeping the platelets cold is a good idea…

 

https://www.umc.edu/news/News_Articles/2021/07/Platelets-Trial.html

https://pubs.asahq.org/anesthesiology/article/133/6/1161/110663/Warming-Up-to-Cold-stored-Platelets

https://www.lifeblood.com.au/news-and-stories/trending-research/rethinking-platelet-storage

 

9 August 2023 (Wednesday) - Stago Newsletter

 

The monthly update from Diagnostica Stago appeared in my in-box today. You can see it by clicking here.

Sadly it focused on trying to sell me stuff… On the one hand I really need to be aware of what analysers are on the market; on the other hand… do I really? I need to know the limitations of the analysers I use and what to do with the numbers the generate.

 

Interestingly there was an article on the medical laboratory scientists Facebook group today asking for advice on best coagulometers. Twenty years ago Stago was everyone’s choice… from what I saw today, not any more.

27 May 2023 (Saturday) - Lysosomal Storage Diseases

Mott cells? In a seven year old?

No.

These are characteristic of lysosomal storage diseases; a group of over seventy rare inherited metabolic disorders that result from defects in lysosomal function. This came up in an article posted on one of the Facebook groups I follow.

But personally I found the entry on Wikipedia to be far more on my level…

22 May 2023 (Monday) - Knowing it All?

 

I saw this on one of the work-related Facebook pages. It made me think… It rather sums up CPD in a nutshell, doesn’t it?

12 April 2023 (Wednesday) - X-bar N Analysis

X-Bar-N analysis… such a brilliant idea in theory. Leaving out all the technicalities, you take the average value of twenty analytes and record it. You then take the average value of the next twenty, and the next twenty and because you are dealing with patients from the same population, the average value should remain pretty much unchanged.

Therefore if the average value does noticeably change, then (because you are dealing with the same population), your analyser is poggered.

 

However in practice you aren’t dealing with patients from the same population. The day kicks off with samples from the haemato-oncology ward. Then there’s a wodge of pre-operative work. Then the outpatient oncology stuff arrives. Then the ante-natal clinic. And you can see differences between these populations by looking at the X-Bar-N charts.

There’s probably a window of about three to four hours in the afternoon when the workload is a genuine mix of patients…

 

Consequently I chuckled when I saw this picture on Facebook.