A Dull Day At Work...?

8 July 2014 (Tuesday) - Duff Result

A sodium result of over 200? And a potassium of over 10? It's just not possible. On inspection electrolytes had been mistakenly requested on a glucose sample. I've always known that the anticoagulant and preservative in glucose samples is flouride oxalate. Buut today I made the realisation that it's sodium fluoride and potassium oxalate...

Rather obvious really...

7 July 2014 (Monday) - Renal Failure

Here's an interesting case - look at the potassium and creatinine.

CARTMAN, ERIC 08/08/2014 15:55

MR 22/05/1945 69 yrs M 667269 Northgate M/P Canterbury

U NORC

Specimen No : AC660246W Selected Auth Level : S

--------------------T-------------------T-------------------T-------------------

NA 134 S000 |ALT 35 S000 | |

K 8.2 S000 |CA 2.6 S000 | |

KBIC 14 S008 |$CORCA 2.6 S000 | |

CR 243 S000 |CRP 1 S000 | |

_GFR 23 S000 |HINT ^0.1 S000 | |

PROT 82 S000 |IINT ^16 S000 | |

ALB 38 S000 |LINT ^0.1 S000 | |

GLOB 44 S000 | | |

TBIL 18 S000 | | |

ALKP 73 S000 | | |

--------------------T-------------------T-------------------

High potassiums are always suspect; were samples taken in the wrong order leading to EDTA contamination? In this case probably not - look at the (if anything) raised calcium. Creatinine is seriously up; GFR down. Renal failure?

Historically there has been raised creatinine.

CARTMAN, ERIC 08/08/2014 15:55

MR 22/05/1945 69 yrs M 667269 Northgate M/P

------T-----------------------------------------------------------------------]

Date|07/07/2014 07/07/2014 07/07/2014 17/06/2014 15/06/2014 13/06/2014 |

Time|u/k 19:50 15:55 08:45 u/k 11:00 |

Spec|AC660200Q AC660186R AC660246W AC642143X AC640438G AC638999V |

|BIO BIO BIO BIO BIO BIO |

Test--+-----------------------------------------------------------------------{

NA |131 H 134 139 137 139 |

K |7.9 H 8.2 4.4 3.8 4.0 |

KBIC |7 H 14 |

CR |235 H 243 132 127 114 |

_GFR |24 H 23 47 49 56 |

PROT | H 82 79 80 |

ALB |36 H 38 35 37 |

GLOB | H 44 44 43 |

TBIL | H 18 15 21 |

ALKP |70 H 73 75 81 |

ALT | H 35 16 14 |

CA |2.6 H 2.6 |

------T-----------------------------------------------------------------------]

Results were phoned; patient admitted, repeat samples sent. The patient *was* in renal failure

2 July 2014 (Wednesday) - Anti - D

Whilst issuing anti-D this morning I found myself wondering if my knowledge on the subject was as current as it might have been. I did a little literature search and came up with a few references:

www.nice.org.uk/nicemedia/live/12047/41690/41690.pdf

http://www.bcshguidelines.com/documents/Anti-D_bcsh_07062006.pdf

http://www.rcog.org.uk/files/rcog-corp/GTG22AntiDJuly2013.pdf

The last reference was perhaps for me the most interesting... it was from the obstetric point of view, and I was approaching the topic from a laboratory point of view. And it turned out that I was au-fait with current policies and procedures for the ante-natal administration of anti-D.

Mind you the whole thing is rather pertinent to me as I was watching when my daughter was given an anti-D injection a couple of months ago.

25 June 2014 (Wednesday) - Bombay Blood

As a lad I can remember getting a copy of the Guinness Book of Records one Christmas. It told me the rarest blood group in the world was "Bombay Blood". At the time only thee people in the world were known to have that blood type (according to that year's Guinness Book of Records).

I can remember on my first day working in a blood bank (in February 1982) in an impromptu tuorial being told that I would never ever in my working career either encounter an example of "Bombay Blood", or meet any other biomedical scientist (or medical laboratory scientific oficer as we were known then) who had.

Today whilst working alone on the late shift I had a patient with a positive antibody screen. The confirmatory panel was positive (4+) in all cells in both IAT and enzyme techniques. There was a historical report on file:

JANEWAY, KATHRYN 20/06/1987

CMCBC O+

25.02.14 Anti-H present.

This lady types as the very rare Oh (Bombay) phenotype.

If blood is required for this patient, it will need to be sourced from the frozen blood bank. Contact NHSBT with as much notice as possible if a requirement for blood is anticipated.

Rh/K Phenotype: C+ c+ E- e+ K- (20.01.14)

NHSBT Extended Phenotyping: M+ N+ S- s+ P1+ Lu(a-b+) K- k+ Kp(a-b+)

Le(a+b-) Fy(a+b+) Jk(a+b-) Cw- H-

"Bombay Blood" - as rare as rocking horse poo. But I've now seen it.

17 June 2014 (Tuesday) - Anti-M

Another strange result when performing a blood group. Supposedly A Pos; what's happening with the A cells?

... anti-M - an antibody which works at room temperature. There's far more to blood groups than just sticking the samples on an analyser...

9 June 2014 (Monday) - HPC Newsletter

The latest "HPC in Focus" magazine came out via email today. It seems there's to be a revision to the Standards of Practice for biomedical scientists like me.

The new stadards can be seen here.

I can't help but feel that whilst there is a serious need to document exactly what is expected from a healthcare professional; it's perhaps not such a sensible idea to try to have a "one size fits all" approach with the standards. A healthcare professional who has face to face contact with patients constantly (such as a chiropodist or a physiotherapist) will have different expectations and requirements to someone who does not (such as a pharmacist or me!!)

Take for example the new standard #5 "be aware of the impact of culture, equality and diversity on practice". Someone who has face to face contact with people must be far more aware of the diversity of their patients than I am because they actually see that they are a diverse bunch... to give but one example.

3 June 2014 (Tuesday) - Another Discrepent Blood Group

A discrepant blood group. Historically known to be blood group AB Pos, today we had dual populations in anti-A, anti-B and both anti-D. It transpired that the patient had received a blood transfusion of O Neg blood yesterday.

Name: PENDING, Pat Group & Abs AB+

DoB: 01/02/1903 Sex: F Pat No:123456 Requested 11:20 02/06/2014

Specimen No : TK440311H Blood Transfusion <PgUp/PgDn> for more

------------------------------------------------------------------------------

02/06/2014 11:20 Clotted Blood

Diamed Group Clinically Approved By David Styles

Confirmed Group AB Rh(D) Positive

Crossmatch Clinically Approved By David Styles

G052 514 179 609 1 O- RBC IN OA LEUCODEP 05/06/2014

Issued (U)

G052 514 344 908 R O- RBC IN OA LEUCODEP 05/06/2014

Issued (U)

Antibody Screen Clinically Approved By David Styles

Antibody Screen Negative