The IBMS newsletter
came today. I say “newsletter”, but in a typical sign of the times it was via email.
I perused it; without wishing to sound cynical I didn’t feel there was much of immediate
import to myself.
Perhaps I’m
wrong….
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....
17 December 2014 (Wednesday) - Chloride
http://www.nice.org.uk/guidance/cg174
The NICE clinical guideline 'Intravenous fluid therapy in
adults in hospital' (CG174) recommends daily serum chloride monitoring in
patients receiving intravenous fluids with chloride concentrations greater than
120 mmol/L, including 0.9% ('normal') saline.
To facilitate this, all inpatient requests for serum
electrolyte and creatinine measurements will automatically also have a serum
chloride measured and reported.
Up until now chloride has been something of an obscure
add-on. Generally chloride levels go up and down with sodium levels, so
measuring chloride is a good way to spot an “iffy” sample.
Having said that, I really need to bone up on the topic.
6 December 2014 (Saturday) - HCPC in Focus Magazine
The latest missive from the HCPC is now on-line at http://www.hcpc-uk.org/assets/documents/100049D3HCPCInFocus-Issue56.pdf
The headline gave me pause for thought “Registration renewal figures for operating department practitioners and
social workers in England
I found it very difficult to read the Fitness to Practice
annual report with any degree of impartiality. Between 1 April 2013 and 31
March 2014 2 069 new concerns were raised, an increase of twenty five per cent
on the previous year. 0.64% of registrants found themselves to be on the
receiving end of a complaint. That’s about one in two hundred; I find that a
really high number.
Of personal interest I read that revised standards of
proficiency for biomedical scientists and clinical scientists have been
published.
There was a report of a meeting between HCPC staff and
medical managers in Belfast
2 December 2014 (Tuesday) - Potassium
Here’s
a little something that came up whilst working in clinical chemistry a few days
ago. I found this set of results:
Specimen Results Entry
COBBLEPOT, Oswald A+ 20/11/2014 u/k MRS 23/11/1946 67 yrs F 123456 Arkham
Mr Vladimir Freeze
routine. Specimen No : AC619028V Selected Auth Level : S --------------------T-------------------T-------------------T------------------- NA 136 F000 |ALKP 98 F000 | | K 8.8 F000 |ALT 6 F000 | | KBIC 21 F008 |CRP 108 F000 | | U 13.7 F000 |HINT ^0.1 F000 | | CR 131 F000 |IINT ^6 F000 | | _GFR 35 F000C|LINT ^-0.0 F000 | | PROT 35 F000 | | | ALB 11 F000 | | | GLOB 24 F000 | | | TBIL 8 F000 | | | --------------------T-------------------T-------------------T------------------- LTG comments : EC,GFR,LFT,RKOD 1 Auth'd 2 Unauth'd 3 Nomin'd 4 Change 5 Reject 6 Options 7 eXit> U Disc: CLIN Sect: CC David Styles SRE/APEX Overtype |
That
potassium result is high; seriously high and most interestingly JNOT consistent
with previous findings
COBBLEPOT, Oswald
A+ 20/11/2014 u/k
MRS 23/11/1946 67 yrs F 123456 Arkham ------T-----------------------------------------------------------------------] Date|20/11/2014 19/11/2014 18/11/2014 17/11/2014 15/11/2014 14/11/2014 | Time|u/k u/k 16:50 u/k u/k 01:30 | Spec|AC619028V AC618219L AC617116S AC615563X AC614400T AC613165N | |BIO BIO BIO BIO BIO BIO | Test--+-----------------------------------------------------------------------{ NA |136 137 134 131 127 133 | K |8.8 3.9 4.5 4.9 4.8 5.0 | KBIC |21 | U |13.7 15.4 | CR |131 153 139 141 133 135 | _GFR |35 30 33 33 35 34 | PROT |35 | ALB |11 13 | GLOB |24 | TBIL |8 | ALKP |98 | ALT |6 | ------T-----------------------------------------------------------------------] 1 View 2 Graph 3 eXit X Cursor Down for more More >> |
There’s
something wrong here. That result’s not right. So a little detective work was
in order.
The
age of the sample was then checked. The sample was only an hour old.
The
nature of the sample was checked. The sample was a SST; not EDTA. An EDTA
sample would give a much higher potassium result, but it was something that
needed checking.
Perhaps
there was EDTA contamination, so calcium levels were analysed. Suspecting EDTA
contamination we might expect a very low calcium result.
The
result was 1.6... low, but not *THAT* low.
COBBLEPOT, Oswald
A+ 20/11/2014 u/k
MRS 23/11/1946 67 yrs F 123456 Arkham routine.
Specimen No
:
AC619028V
Selected Auth Level : S
--------------------T-------------------T-------------------T------------------- NA 136 F000 |ALKP 98 F000 | | K 8.8 F000 |ALT 6 F000 | | KBIC 21 F008 |CA 1.6 E000 | | U 13.7 F000 |$CORCA CALUNR E000 | | CR 131 F000 |CRP 108 F000 | | _GFR 35 F000C|HINT ^0.1 F000 | | PROT 35 F000 |IINT ^6 F000 | | ALB 11 F000 |LINT ^-0.0 F000 | | GLOB 24 F000 | | | TBIL 8 F000 | | | --------------------T-------------------T-------------------T------------------- LTG comments : EC,GFR,LFT,RKOD 1 Auth'd 2 Unauth'd 3 Nomin'd 4 Change 5 Reject 6 Options 7 eXit> U |
For
completeness the potassium assay was repeated on our other analyser. The result
was identical; a genuine result.
This was rather frustrating… the result was
suspect. but EDTA contamination should have given a far higher potassium result
and a far lower calcium result. Perhaps there was only a little EDTA
contamination in this case?
A comment was added to the result:
Note raised potassium ? due to EDTA contamination. Please send
repeat
sample for confirmation. Ward (staff nurse) telephoned. |
A
couple of days later I reviewed the case:
COBBLEPOT, Oswald
A+ 20/11/2014 u/k
MRS 23/11/1946 67 yrs F 123456 Arkham
NA |136 137 138 136 137 134
K |H 4.3 H 8.8 3.9 4.5
KBIC | 21
U |19.9 19.2 17.5 13.7
CR |185 162 151 131 153 139
_GFR |24 28 30 35 30 33
PROT |44 43 45 35
ALB |12 13 13 11
GLOB |32 30 32 24
TBIL |5 6 6 8
ALKP |112 121 114 98
ALT |11 9 7 6
|
Subsequent
results were not consistent with that spurious result. I wonder what happened there.
But
the bottom line here is that it’s not all about churning out numbers….
13 November 2014 (Thursday) - Dur !!!
Is this true?
“….. The 44 percent of people who tested positive for the virus
performed 7 to 9 points lower on IQ tests…..”
Seems somewhat
strange… I can’t think of any causative mechanism. But it’s food for thought.
If true it makes you wonder what else viruses might do.
And perhaps you *can*
fix stupidity…?
4 November 2014 (Tuesday) - Nasal Polypectomy
Nasal polyps are growths
of abnormal tissue that form in the nose or deeper sinuses. They are
usually benign, but larger polyps can block nasal passages causing
breathing difficulty and sleep apnoea. It's quite amazing just how
much sinus space one has, and how blocked they can become.
If conservative treatment
for nasal polyps is not successful or if polyps are problematical a
consultant may recommend a nasal polypectomy. This is (usually)
performed under general anaesthetic and takes about 30 minutes. The
surgeon will access polyps through the nostrils so there will be no
incision. Polyps will be removed using special suction and
instruments.
After surgery the nose is
packed with dressing to help control any bleeding.
Nasal polypectomy is
usually done as a day case however sometimes an overnight stay is
necessary.
There is a world of
difference between reading these dull dry words and having one's
sinuses surgically ravaged....
1 November 2014 (Saturday) - The Error Budget (?)
Food for thought...
“When
you set a financial budget, you know that if you spend too much in
one place, you run over your budget. The analogy for lab tests is an
‘error budget.’ We know we have certain sources of error like
precision and inaccuracy. How much of the budget gets spent by
different error sources, and is it possible that we will overrun the
budget if a problem occurs?”
“Well,
we have information on that, in the form of what quality is required
for the test. If you define that in your budget, then you can measure
the errors for your methods in the laboratory to be sure they fit
within the budget. That should be an ongoing part of quality
management: keeping track of how big these errors are and how they
relate to the amount of error that is allowable.”
An interesting interview
with one of the leading lights in the QC analysis world...
http://www.captodayonline.com/lab-qc-much-room-improvement/
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