17 March 2017 (Friday) - Transfusion Guidelines

This month, my place of work has launched the "Appropriate Transfusion Project" which aims to change practice and ensure the full implementation of the latest NICE Transfusion Guidelines with the Trust. 

What does NICE recommend?

·         Single unit transfusions on patients who do not have active bleeding and to clinically re-assess patients and check haemoglobin levels after each unit of red blood cells.

·         Use a restrictive transfusion threshold of 70g/L and a target haemoglobin level of 71—90g/L after transfusion.

What are the exceptions?

A restrictive transfusion threshold is not appropriate in cases of:

Major haemorrhage

·         Acute coronary syndrome – For these patients consider a threshold haemoglobin level of 80g/L and a target haemoglobin concentration of >81-100g/L after transfusion.

·         Chronic anaemia – for patients who require transfusion for chronic anaemia, consider setting individual thresholds and haemoglobin targets for each patient.

It is recommended that when transfusing patients these best practice parameters should be borne in in mind.  It is important that when requesting blood that the clinical justification and Hb level are stated on the request form.

I’m looking forward to starting in blood bank to see how this will be applied in practice

17 March 2017 (Friday) - IBMS Newsletter

The IBMS newsletter arrived in my inbox this morning. It seemed far more interesting that usual; however it did have lots of pictures and bright colours. Style over substance perhaps?

It started with a preamble from the IBMS president talking about what was going on with the IBMS. Healthcare science week was covered as was talk about the STEM project.

There was then several in-depth reports on a range of issues including the IBMS congress, Point of Care testing, upcoming events, news of deals obtainable with IBMS membership, and a call for contributions to the IBMS newsletters.

All very good apart from the bit about “Harvey’s Gang”. There seems to be a trend to get small ill children into the labs. It is a very good and laudable idea… personally I don’t like it.

 

15 March 2017 (Wednesday) - Niemann-Pick Disease

I came across this posting whilst perusing Facebook over brekkie this morning.

“45 yr female was investigated for splenomegaly and pancytopenia that progressed over the past 15 years. She also has conversion disorder with seizures, but the EEG were normal while convulsing. She had learning disabilities when she was at high school but her cognitive functions were normal. Despite her slight impaired balance problem, she was always employed. A bone marrow was ordered and the images show here is from her aspirate. No peripheral blood film images as it is not very interesting, other than pancytopenia.

The bone marrow images showed both the lipid containing foamy histiocytes and ceroid containing histiocytes (sea-blue histiocytes). From the patient history and further testing, this should be classified as Niemann-Pick Type B.”

Niemann-Pick…. Not heard of that for some time. A refresher is always good.