2 July 2024 (Tuesday) - Fritsma Factor Update

The Fritsma Factor update appeared in my in-box today. You can read it by clicking here. Unlike previous instalments this one was rather dull, but all good background reading if nothing else.

 

2 July 2024 (Tuesday) - BTLP TACT Exercise

Time for another BTLP-TACT exercise. I had one case – a forty-four year-old chap with appendicitis requiring group and save.

He grouped as O Rh(D) Positive with a negative antibody screen.

I got the green light.

1 July 2024 (Monday) - Learning Monday

Learning Monday….  Thrombocytopenia with apparently normal megakaryocytes in the bone marrow?  Immune thrombocytopenia.

I quite like these little exercises. Especially when I get them right…

26 June 2024 (Wednesday) - Westgard QC Update

The nice people at Westgard sent their update today. You can read it by clicking here. It’s a tad dry, but it’s the sort of thing that is relevant to what we do every day.

 

25 June 2024 (Tuesday) - Transfusion Evidence Alert

The Transfusion Evidence Alert email arrived in my in-box this morning.

 

Back in the day the worst thing that you could do with a bag of platelets was to stick it in the fridge. Now this is being encouraged.

And transfusion volumes – one unit transfusions were a no-no. Now one unit is the amount most people seem to have.

One thing I’ve found over the years is that what is terrible practice at one moment becomes standard practice the next.

 

ARTICLE OF THE MONTH Andexanet for factor Xa inhibitor-associated acute intracerebral hemorrhage. Connolly, S.J., et al. (2024). The New England Journal of Medicine. PICO Summary available +++++

TOP ARTICLES The impact of social media intervention based on functional motivation on repeat blood donation behavior: A prospective randomized controlled trial study. Gao, C., Mei, H., and Mao, X., (2024). Transfusion. [Record in progress]. The role of sealants for achieving anastomotic hemostasis in vascular surgery. Ma, G.W., et al. (2024). The Cochrane Database of Systematic Reviews. Predicting blood transfusion following traumatic injury using machine learning models: a systematic review and narrative synthesis. Oakley, W., et al. (2024). The Journal of Trauma and Acute Care Surgery. [Record in progress]. Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support. Radford, M., et al. (2024). The Cochrane Database of Systematic Reviews. Recombinant ADAMTS13 in congenital thrombotic thrombocytopenic purpura. Scully, M., et al. (2024). The New England Journal of Medicine. Early cold stored platelet transfusion following severe injury: a randomized clinical trial. S perry, J.L., et al. (2024). Annals of Surgery. [Record in progress]. A randomized trial of the inflammatory cytokines levels and the blood transfusion rate between miniaturized tubing group and conventional tubing group in congenital heart disease open heart surgeries. Wang, P., et al. (2024). Perfusion. [Record in progress]. Quantitative blood loss measurement methods for early detection of primary postpartum haemorrhage following vaginal birth: a scoping review. Wang, T., et al. (2024). Journal of Clinical Nursing. [Record in progress]. Andexanet alfa versus PCC products for factor Xa inhibitor bleeding: a systematic review with meta-analysis. White, C. M., et al. (2024). Pharmacotherapy. +++++

24 June 2024 (Monday) - Schistocytes

Clare’s done some science again. She’s rather good at it. Schistocyte counts… You can see the ICSH recommendations on the matter by clicking here.
I won’t repeat what Clare has said – she’s said it far better than I could, and you can read it by clicking here anyway. 

But I will make an observation… what is an acceptable measurement of uncertainty? Am I being utterly unreasonable in thinking that in numerical terms a schistocyte count won’t be a million miles from a parasitaemia count? Look at the most recent malaria NEQAS – we made the answer 0.2. Plenty of other people made the answer double or triple that number. What is an acceptable measurement of uncertainty?

24 June 2024 (Monday) - Porphyria

 

Monday – “learning Monday” and I learned something today. What I thought was probably a case of haemochromatosis wasn’t.

I suppose the clue was the photosensitivity. This was a case of porphyria – a range of conditions caused by abnormally high levels of porphyrins and porphyrin precursors due to deficiency of certain enzymes essential to the synthesis of haem.

These are rather obscure…

 

This is what CPD should be about. I’ve been reminded of something I used to know, and having been prompted I’ve given myself a little refresher.