November 1 2010 (Monday) - The R.D.W.

Last Wednesday I gave a talk on anaemia, and when we were discussing the iron deficiency anaemias I was asked about the use of red cell distribution widths.

The RDW is a parameter I have felt we should be reporting for some years, but various inertias have prevented getting this test into routine use. Which is a shame – our analysers routinely produce this parameter with every blood count we do. Reporting them wouldn’t incur any extra expense. And they clearly would be useful. After all, as a trainee (at a hospital long since bulldozed) I was reporting these way back in 1983.

On the other hand, since I moved to my current lab in 1984, we’ve only ever once (to my recollection) been asked to report an RDW. Are they really *that* useful…?

October 30 2010 (Saturday) - Section 1b

I spent a few minutes this morning working on my website of advice for students tackling the IBMS pre-registration portfolio.

I’ve now revisited all of the set questions for section 1a, and have been through the various other evidences and added a page of evidences specifically aimed at providing evidence for section 1b. The obvious next steps are to do the same for sections two and three.

Perhaps I’m now wasting my time in that yesterday I applied for another of my students to have his portfolio assessed. This with be the third of my current batch of six students. Perhaps I’ve left it a bit late to be revising the website. The trouble is it takes this long to build up the experience to be able to make the suggestions.

Mind you I will always have more students in the future. And I suspect that word is getting around about this website….

October 28 2010 (Thursday) - Eisenmenger's Syndrome

Yesterday I was lecturing on the subject of anaemia, and mentioned that when considering anaemia, one shouldn’t overlook other problems causing a reduced oxygen supply to the tissues – a low haemoglobin level isn’t the only cause of such a problem.

Today I learned about Eisenmenger's syndrome. A congenital heart deformity in which there is a hole between the left and right ventricles of the heart (ventricular septal defect). The hole allows blood that has already picked up oxygen from the lungs to flow back into the lungs, instead of going out to the rest of the body. The increased blood flow and high pressure generated by the (effectively) single ventricular chamber damages the small blood vessels in the lungs.

And because of the ventricular blood mixing, the blood getting to the tissues isn’t as oxygenated as it might be, which leads to the breathlessness and fatigue which one may associate with an anaemia.

October 27 2010 (Wednesday) - Anaemia

What with one thing and another we were short of a speaker for the CPD seminar today, so I stepped into the breach. Over the years I’ve prepared a few talks that I can give at short notice. The talk I gave today was on anaemia – a subject with which I have a passing acquaintance.

With an audience of double the average attendance of last year’s sessions, I was quite pleased with the turn out.

Mind you, I have noticed that no matter how much I prepare and practice and rehearse, when it comes to actually give the talk, I over-run.  What should have lasted fifteen minutes went on for nearly twenty five minutes. I need to stick to my pre-prepared spiel, and stop ad-libbing things that come to mind as I’m wittering on.

October 25 2010 (Monday) - Pre Reg Portfolio

In my considered opinion, the most difficult part of the IBMS pre-registration portfolio is finding evidence for Sections 1a.1 – 1a.8. They are all very “admin & management” and are rather difficult for the new starter to get to grips with. To that end I’ve put together some set questions to provide evidence specifically for those sections.

Whilst they are based on something I shamelessly blagged from other people many years ago, now they bear very little (if any) relation to their original form. I’ve been working on (yet another) revision of these questions, and am about two thirds of the way through. Over the last week or so I’ve touched on such topics as professionalism, the working day, accountability and incident reporting. Over the next week I intend to beef up the secions on Health & Safety, the European Working Time Directive, CPD, and dealing with adversity.

If any of my loyal readers have any other ideas or suggestions for Portfolio section 1a.1 – 1a.8 evidences, I’d be very pleased to hear from you…

October 22 2010 (Friday) - Malaria

Whilst browsing the web (on my day off!!!) I found something worrying. Malaria was eradicated from Spain fifty years ago. Now it’s back. One can’t help but wonder if this is an isolated occurrence, or whether this is a shift in the global distribution of mosquitoes that the global warming pundits have been threatening.

After all, the marshes just down the road from me were malarious ot that long ago…

The fact that I now have to update my pre-prepared lectures on malaria is now the least of my malaria-related worries….

October 20 2010 (Wednesday) - Massive Transfusions

Today's lunchtime session was on a new development - the massive blood transfusion protocol.

I can remember the bad old days when a serious trauma case in A&E was synonymous with panic in the blood bank. Nowadays there's a policy which gives guidance, saves money and has a higher survival rate.

Wish we’d had it years ago….