21 August 2016 (Sunday) - Zika virus

Food for thought… for all that the media is alive with panic about zika virus here’s something of direct relevance. Can zika be passed on by blood transfusions? I expect so – other viruses such as hepatitis can be.

It would seem there is a test which might be used; although it is still in the experimental phase. Screening out the likely carriers will be the way forward for the time being…

However I wonder if this will be a realistic problem, or just media generated hype?

17 August 2016 (Thursday) - SHOT Report

The SHOT report came through today. It made for rather worrying reading. However for all of the doom and gloom I was pleased to see the emphasis on education. And when considering mistakes in blood transfusions we should really bear in mind the operative word is “mistake”. No one deliberately gives the wrong blood component.

16 August 2016 (Wednesday) - Mosquitoes

When I think of mosquitos I think of malaria. I suppose that is because that is what I do. However I do see (relatively) a lot of negative malarial screens. The immediate reaction to those is “what a waste of my time”, but here’s an article which has reminded me that mosquitos carry far more than just malaria.

• ·         Chikungunya
• ·         Dog Heartworm
• ·         Dengue
• ·         Yellow Fever
• ·         Eastern Equine Encephalitis
• ·         St. Louis Encephalitis
• ·         LaCrosse Encephalitis
• ·         Western Equine Encephalitis
• ·         West Nile Virus
• ·         Zika Virus

So many conditions… not just malaria. It is so easy to get blinkered by my own narrow specialty. 

14 August 2016 (Sunday) - Non-Invasive?

Here’s food for thought… non-invasive bilirubin measurement means premature babies can be treated without having to be poked with needles to have blood removed. In theory this is wonderful for the babies.

“The new transcutaneous jaundice meters are the most technologically advanced models available to screen for newborn jaundice, which affects approximately 60% of all babies.  Held against a newborn’s chest the meters measure jaundice by analyzing the spectrum of light reflected by the skin.  It is a painless, non-invasive test with immediate results.

“This testing has eliminated a significant number of painful newborn heel pokes and provides important information for follow up and treatment that extends into the community by the nurses of the Healthy and Home program,” says Julie Smith-Fehr, Manager of the Maternal & Newborn Care Unit/Healthy & Home for the Saskatoon Health Region. “One immediate result in hospital is that parents don’t have to wait for lab work which means happier families because discharge is seldom delayed. Moreover, the meters have the capacity to quickly identify newborns that are truly at risk.”

Bearing in mind that it operates by analyzing the spectrum of light reflected by the skin I’d be intrigued to know just how the devices are calibrated and controlled. The whole idea of these machines presupposes that the numbers coming out of the device are actually reliable.

I’d like to know more about them.

12 August 2016 (Friday) - Outcomes

Today’s NHS England e-newletter had the annual data for patient reported outcome measures… I suppose at first sight this report is purely stating the bloody obvious… but is it?

Following hip replacement, 96.4% of patients with complete pre- and post-operative questionnaires reported an improvement. Following knee replacement, 93.2% of patients reported improvement, and following varicose vein surgery, 82.3% of patients reported improvement.

I must admit that we probably all take it as read that medical procedures are performed with the intention of making things better for the patient. And this report is proving that they are.

11 August 2016 (Thursday) - Relevant Information

Here’s an interesting case. A blood count from the A&E department. Diagnosis: shortness of breath.

Look at the white cell count and platelet count.

KIRK,CAPTAIN                                     O+        11/08/2016 16:07 MR       07/02/1939   Male     NCC1701          A&E 21 HIGH STREET, CANTERBURY                      Dr Leonard McCoy Specimen No : 123456    ------------------------------------------------------------------------------ 09/08/2016 16:07   Request Reason :     sob.....  Haemoglobin                    ^9.3   g/dl            (    13 to 18    ) Auth  Haemoglobin                    93     g/L             (   130 to 180   ) Auth  White Blood Cells              73.9   10^9/l          (   4.0 to 11.0  ) Auth  Platelets                      40     10^9/l          (   150 to 400   ) Auth  Red Blood Cells                3.61   10^12/l         (   4.5 to 6     ) Auth  Haematocrit                    0.294  ratio           (   0.4 to 0.50  ) Auth  Mean Cell Volume               81.4   fl              (    80 to 100   ) Auth  Mean Cell Haemoglobin          25.8   pg              (    27 to 32    ) Auth  Mean Cell Haemoglobin Concn    ^31.6  g/dl            (    32 to 36    ) Auth  MCHC                           316    g/L             (   320 to 360   ) Auth  Neutrophils                    4.4    10^9/l          (   2.0 to 7.5   ) Auth  Lymphocytes                    0.0    10^9/l          (   1.5 to 4.0   ) Auth  Monocytes                      0.0    10^9/l          (   0.2 to 1.0   ) Auth  Eosinophils                    0.0    10^9/l          (  0.02 to 0.5   ) Auth  Basophils                      0.0    10^9/l          (   0.0 to 0.1   ) Auth  Metamyelocytes                 0.0    10^9/l                             Auth  Myelocytes                     0.0    10^9/l                             Auth  Promyelocytes                  0.0    10^9/l                             Auth  Blast Cells                    69.4   10^9/l                             Auth  Atypical Mononuclear Cells     0.0    10^9/l                             Auth  Plasma Cells                   0.0    10^9/l                             Auth  Blood film                     ^Referred to consultant haematologist     Auth  Nucleated Red Cells            1.0     /100WBC                           Auth

Alarm bells rang in my head. A blood film showed rip-roaring leukaemia. I phoned the A&E department and referred the film urgently to the consultant haematologist.

After a little while it transpired that this was not news. The patient was well aware of his leukaemia. He’d been diagnosed a little while ago in Devon and had moved here in order to be near family during his illness. He’d been told to come to the local hospital on arrival. That’s what he did. But he didn’t tell anyone that he’d got leukaemia. He just said he was unwell.

The moral of the story here is communication…

10 August 2016 (Wednesday) - Missing the Point ?

I subscribe to the NHS England e-newsletter. One such email comes through most days. Many are dull; some are noteworthy. Today’s made me think I really must be missing something.

What is the NHS for? Cutting through all the management-buzz-words, it is all about healing the sick. And more and more it is all about doing more and more of  that with less and less resources. It is a matter of public record that nationally the NHS is billions of pounds overspent.

Is an “NHS Employers Bus” *really* a good use of limited resources? Does the NHS *really* need an active involvement in various Gay Pride activities?

Don’t get me wrong – I have nothing against the gay community. Friends and family members are gay. But by the same token friends and family members have pet dogs and/or go fishing. No NHS resources are spent on them.

I think I must be missing the point…