22 March 20107 (Wednesday) - Cats and Elephants...

A rather interesting case study appeared on one of the Facebook groups I follow this morning:

“A girl 10 yo with anemia Hb 7 WBC 10,000 Plt 250,000. Iron status is in normal limit. The blood film and Hb electrophoresis below. U can see the two methods of Hb elect here.

What is the diagnosis and what is the differences between left side and right side of graphic? Thanks for your comment.”

There were all sorts of theories expounded about exactly what was the cause of the haemoglobinopathy but one of the comments made me smile. The order in which haemoglobin peaks appear on an alkaline gel can be remembered by this simple mnemonic: “Cats And Elephants Digest Soft Gooey Fudge And Kangaroo Jumps Blindly Into Hedges”.

The acid strip will see haemoglobins coming out as “Farts Are Smelly Creation”

I’ve never heard that before….

21 March 2017 (Tuesday) - Transfusion News email

The Transfusion News email came in this morning. Several interesting things including:

Liquid Plasma Acceptable for Severe Trauma Patients with Major Bleeding

March 16, 2017
Recent studies have highlighted the importance of expeditious transfusion of plasma, platelets and red blood cells in a 1:1:1 ratio for severe trauma patients who are at risk of exsanguination. Since thawing plasma can be time-consuming, a recent study published in TRANSFUSION examined the hemostatic properties of thawed and liquid plasma over several days of [Read More]

New PLASMIC Scoring System to Help Diagnose Thrombotic Thrombocytopenic Purpura

March 8, 2017
Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder caused by a lack of ADAMTS13 activity, which normally cleaves the von Willebrand factor. TTP patients have increased risk of thrombosis leading to blockage of blood flow to major organs. TTP is fatal if not treated quickly by plasma exchange. However, diagnosis of TTP by testing [Read More]

Administration of Fibrinogen Concentrate during Cardiac Surgery Does Not Significantly Reduce Blood Loss

March 1, 2017
Since fibrinogen plays a key role in hemostasis and it is rapidly depleted during cardiac surgery, many cardiac surgeons give fibrinogen to control bleeding during surgery for high-risk patients. The efficacy of this treatment, however, had not been previously confirmed in large, randomized clinical trials. A recent study in the Netherlands randomized 120 high-risk cardiac [Read More]

20 March 2017 (Monday) - BSH Guidelines

My inbox was busy today - I also got an email from the BSH telling me of updates to their guidelines about:

1. Investigation and Management of Eosinophilia
2. Management of Drug-Induced Immune and Secondary Autoimmune Haemolytic Anaemia
3. The Diagnosis and Management of Primary Autoimmune Haemolytic Anaemia
4. Peri-Operative Management of Anticoagulation and Antiplatelet Therapy
5. Red Cell Transfusion in Sickle Cell Disease Part l and Part II
6. Use of Platelet Transfusions


The BSH also said to follow their Facebook page to receive updates as soon as they are published... I do and I don't.

20 March 2017 (Monday) - Transfusion Evidence Alert email

The Transfusion evidence Alert game into my inbox this morning - loads of snippets today:

Latest Evidence in Transfusion Medicine

Tranexamic acid in bleeding trauma patients: an exploration of benefits and harms
Roberts I, Edwards P, et al.,  Trials 2017

New film-coated tablet formulation of deferasirox is well tolerated in patients with thalassemia or lower-risk MDS: Results of the randomized, Phase II ECLIPSE study
Taher AT, Origa R, et al. American Journal of Hematology 2017

Simulation training program for midwives to manage postpartum hemorrhage: a randomized controlled trial
Kato C, Kataoka Y. Nurse Education Today 2017

The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review
Bennett S, Baker LK, et al. HPB 2017

Combined use of intravenous and topical versus intravenous tranexamic acid in primary total knee and hip arthroplasty: a meta-analysis of randomised controlled trials
Li JF, Li H, et al. Journal of Orthopaedic Surgery and Research 2017

The effect of tranexamic acid in traumatic brain injury: a randomized controlled  trial
Jokar A, Ahmadi K, et al. Chinese Journal of Traumatology 2017

Role of prophylactic tranexamic acid in reducing blood loss during elective caesarean section: a randomized controlled study
Lakshmi SD, Abraham R. Journal of Clinical and Diagnostic Research. 2016.

Single-dose intravenous iron infusion or oral iron for treatment of fatigue after postpartum haemorrhage: a randomized controlled trial
Holm C, Thomsen LL, et al. Vox Sanguinis 2017.

Red blood cell concentrates treated with the amustaline (S-303) pathogen reduction system and stored for 35 days retain post-transfusion viability: results of a two-centre study
Cancelas JA, Gottschall JL, et al. Vox Sanguinis 2017.

Mortality outcomes in patients transfused with fresher versus older red blood cells: a meta-analysis
Chai-Adisaksopha C, Alexander PE, et al.  Vox Sanguinis 2017.

20 March 2017 (Monday) - BloodMed email alert

The BloodMed email alert came in this morning. As usual there was all sorts of snippets. I spent a little while perusing the article on the Pelger-Huet anomaly.

Congenital Pelger-Huët anomaly is a clinically benign autosomal dominant condition, the overall incidence in the general population ranges from 0.01%-0.1% Compared to normal neutrophils, PHA neutrophils have normal bactericidal, metabolic, biochemical and phagocytic function with a normal life span.

The acquired form, on the other hand, can result from infection or myelodysplastic syndromes or be induced by drugs such as tacrolimus or ibuprofen. Morphologically, there are several points to look at when comparing the two types (PHA: Pelger-Huët anomaly and the PPHA: acquired or pseudo-PHA);

• The acquired form could have some vacuolation.
• Chromatin clumping usually involves the neutrophils only in the acquired form whereas eosinophils, and basophils are also affected in the congenital form.
• The percentage of the PMN cells with the PHA morphology is really high up to 93% compared to around 38% in the acquired form.
• No cytopenia nor chromosomal abnormalities had been reported in the congenital form in comparison with the acquired one. 

20 March 2017 (Monday) - Transfusions in Sickle Cell Disease

This morning the British Society of Haematology sent me the updated guidelines for red cell transfusions in cases of sickle cell anaemia.

Unlike many other conditions, patients with sickle cell might require more than just a “top-up”; sometimes a complete exchange might be on the cards. The article made for interesting reading.

However the thing which struck me most was the guideline was dated last November. I received it today…