18 July 2011 (Monday) - Specialist Portfolio Assessment

I received the IBMS newsletter today. Some of it was interesting, some was relevant, some was dull, and one bit made me see red.

The IBMS are still advertising for Specialist Portfolio Assessors. I applied to be one back in January, and despite my regularly chasing them up I have heard nothing.

Perhaps they don’t want me….  Having said that, on reflection it took about five years to finally get accepted as a Blue Book assessor.

I had hoped they’d got more efficient over the years…..

17 July 2011 (Sunday) - Facebook

It’s a sign of the times that both the IBMS and the HPC are now on Facebook. Personally, for all that I continually spout drivel on Facebook, I feel that professional bodies such as the IBMS and the HPC should be above Facebook. Or if they must be there, then they shouldn’t be openly available as pages for all and sundry to join.

It is clear that they are not targetting their “proper” audiences as the umbrella parent organisation has two hundred followers, but the smaller subsidiary one had over two thousand.

Take the (current) most recent posting on the IBMS Facebook page from someone who clearly knows nothing of the profession: “I can't wait to be a member of this great institute. Can I join as a Master Student in Biomedical Science.” Master Student – my arse!

I suppose I should be grateful that the HPC’s page doesn’t seem to attract the crackpot element. In fact the HPC writes a blog.

14 July 2011 (Thursday) - Churg Strauss Syndrome

A new diagnosis. All sorts of allergies and asthma in someone who’s never previously had them: Churg–Strauss syndrome is a medium and small vessel autoimmune vasculitis which can lead to necrosis. It involves mainly the blood vessels of the lungs, gastrointestinal system, and peripheral nerves, but also affects the heart, skin and kidneys.

It is a rare disease that is non-inheritable and non-transmissible. Differentiation from Wegener's granulomatosis is not difficult. Wegener's is closely associated with c-ANCA, while Churg-Strauss shows elevations of p-ANCA.

The French Vasculitis Study Group has developed a five-point score that predicts the risk of death in Churg–Strauss syndrome

• reduced renal function (creatinine >1.58 mg/dL or 140 μmol/l)
• proteinuria (>1 g/24h)
• gastrointestinal hemorrhage, infarction or pancreatitis
• involvement of the central nervous system
• cardiomyopathy.

Presence of one of these indicates severe disease (five-year mortality 26%) and two or more very severe disease (five-year mortality 46%). Clearly the blood science lab is crucial here...

13 July 2011 (Wednesday) - BCSH

I received an email from the British Committee for Standards in Haematology today. The gist of their communication was that the use of rabbit ATG in immunosuppressive therapy for aplastic anaemia hasn’t turned out to be quite the success that they had been hoping for. The full text of the article is reprinted here.

I must admit that when I joined the BCSH’s mailing list I rather expected it to be a very useful source of CPD material. This is only the second or third email I’ve had from them….

9 July 2011 (Saturday) - Near Patient Testing

Having taken up the local pharmacist on their offer of free diabetes checking, and seeing what happened, I’m wondering how reliable the concept of non-lab based blood testing is. The pharmacist who checked me out seemed to think my glucose level was high: bearing in mind the limits my lab quotes, it wasn’t (especially) high.

But at no stage did the nice lady doing the testing perform any QC whatsoever. And she seemed rather vague about the operation of the device. Rather than doing a blood test she seemed to be generating random numbers.

The problem with near-patient testing is that having generated a random number, people use that number. In my case I only wanted a ball-park figure. I haven’t got diabetes – that’s the result.

But when more accurate and precise figures are needed, why do people still believe these silly little uncontrolled hand-held devices? Here’s a worrying example of someone believing a hand-held random number generator rather than a proper laboratory result.

People died in this case….

7 July 2011 (Thursday) - Geese

Geese have haemoglobinopathies !!!

I suppose it is only logical that they would do – the mechanics and logistics of protein production are much the same for geese as they are for humans.

Bar headed geese fly over the Himalayas as they migrate. There’s not much oxygen at those altitudes, and so consequently a haemoglobinopathy has arisen: a high-affinity haemoglobin. Hb Olympia, Hb Heathrow and a hundred other high affinity variants are known in humans. It’s only logical that animals in low oxygen environments would have them too…..

I can’t help but wonder if malaria has given rise to variant haemoglobins in the animal kingdom like it has in humans (sickle cell disease and the like…)

5 July 2011 (Tuesday) - Thrombocythaemia

HIGH,PLATELETS     DOB  04/03/1974 Sex F Pat No 996655  Source    GP Address   HOUSE                      Clinician KILDARE Specimen No : AW260451P    (Haematology)             Platelets      1228           10^9/l       (   150 to 400   ) Auth   Potassium      5.6            mmol/L       (   3.5 to 5.3   ) Auth   Serum Folate   1.9            ug/L         (   4.8 to 19.0  ) Auth

There are several causes of a high platelet count. However this is a case of essential thrombocythaemia. A primary condition as evidenced by the low folate indicative of the high cell turnover in a proliferative condition.

Also the potassium is raised, - this pseudohyperkalaemia is artefactual and is a feature of many haematological proliferations in which potassium leaks from the cells on storage. Potassium levels on fresh samples are normal.