7 May 2024 (Tuesday) - Giving Up on the BTLP-TACT

Flushed with a sense of success having got two consecutive green lights the last times I did a BTLP-TACT exercise, and with nothing else going on this evening, I thought I might do another.

 

I had one case – a forty-six year-old woman going for a caesarian section needing group and save.

She grouped as A Rh(D) Positive with a negative antibody screen.

 

I got the thumbs-down. Supposedly the group was uninterpretable.

Sorry – quite frankly that’s wrong and I was right.

If I’m going to continue with these exercises (and right now that is a great big “if”) I clearly need to be taking screen shots.

6 May 2024 (Monday) - EHA Quiz

Every Monday I see a post on Facebook from the European Hematology Association about their “learning Monday”. There’s a photos and a question… and I never bother with it because I know I will forget all about it and never come back for the answer.

Today I took the radical step of actually reading what they had written, and I saw that by clicking one link I could get instant feedback…

 

In which of the listed diseases is a raised basophil count important? CML!

I clicked that link…

“The correct answer is: Chronic myeloid leukemia

Explanation

The cells depicted above are basophils. One criterion of chronic myeloid leukemia in the accelerated phase is the increase of basophils over 20% in the peripheral blood.

Ref:

Baccarani M, Deininger MW, Rosti G, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122(6):872-884. doi:10.1182/blood-2013-05-501569”

I shall do these little exercises more often…

3 May 2024 (Friday) - BTLP-TACT Exercise

Time for another BTLP-TACT…

I was given two cases

 

13081 – a seventy-four year-old chap in theatre with the dreaded AAA needing six units of blood within two hours

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

I issued six units of O Rh(D) Positive blood.

39198 – a sixty-eight year-old chap in theatre needing four FFP and two cryo

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

I issued four units of O Rh(D) Positive FFP and two units of O Rh(D) Positive cryo… on the understanding that any arguments about suitability had already been argued as policy is never to refuse a request.

 

I was frankly amazed to see I got the green light.

3 May 2024 (Friday) - Transfusiuon Evidence Alert Update

Every time the transfusion evidence alert email comes in I comment about “oh look – tranexamic acid again”… and here’s three more reports of the stuff.

ARTICLE OF THE MONTH Effect of minimization of early blood sampling losses among extremely premature neonates- a randomized clinical trial. Balasubramanian, H., et al. (2024). The Journal of Pediatrics. [Record in progress]. PICO Summary available +++++

TOP ARTICLES Efficacy and safety of restrictive versus liberal blood transfusion strategies in acute myocardial infarction and anemia: a systematic review and meta-analysis of randomized controlled trials. Amin, A.M., et al. (2024). Coronary Artery Disease. Prehospital tranexamic acid is associated with a survival benefit without an increase in complications: results of two harmonized randomized clinical trials. Mazzei, M., et al. (2024). The Journal of Trauma and Acute Care Surgery. [Record in progress]. Routine pretransfusion testing before primary total hip or knee arthroplasty are an expensive and wasteful routine. Systematic review and meta-analysis. Nuñez, J.H., et al. (2024). Archives of Orthopaedic and Trauma Surgery. Outpatient COVID-19 convalescent plasma recipient antibody thresholds correlated to reduced hospitalizations within a randomized trial. Park, H.S., et al. (2024). JCI Insight. Prophylactic tranexamic acid in Cesarean delivery: an updated meta-analysis with a trial sequential analysis. Provinciatto, H., et al. (2024). Canadian Journal of Anaesthesia Assessing the one-month mortality impact of civilian-setting prehospital transfusion: a systematic review and meta-analysis. Schoenfeld, D.W., et al. (2024). Academic Emergency Medicine. [Record in progress]. Randomized controlled trial of Intravenous ferric-carboxymaltose vs oral iron to treat iron deficiency anemia after variceal bleed in patients with cirrhosis. Tabish, M., et al. (2024). The American Journal of Gastroenterology. [Record in progress]. Effect of dexmedetomidine on intraoperative hemodynamics and blood loss in patients undergoing spine surgery: a systematic review and meta-analysis. Wang, M., et al. (2024). Chinese Medical Sciences Journal. Efficacy and safety of tranexamic acid in acute traumatic brain injury: a meta-analysis of randomized controlled trials. Zhang, M., and Liu, T., (2024). The American Journal of Emergency Medicine. [Record in progress]. +++++

2 May 2024 (Thursday) - 2402 DM

I got hold of the results of NEQAS 2402 DM this morning…

 

The narrative started off by saying “We felt that the abnormal morphology in this case was well worth sharing!” and, to cut a long story short, then listed all the features I’d seen without actually coming to a conclusion.

To be honest it was a rather horrible film… I’d spotted what I needed to.

1 May 2024 (Wednesday - Fritsma Factior Update

The Fritsma Factor newsletter appeared in my in-box today. You can read it by clicking here. Lupus, platelets… all good stuff.

30 April 2024 (Tuesday) - Beckman Coulter Update

The nice people at Beckman-Coulter sent their update today. You can see it by clicking here.

To be honest there’s not much to see. I mention it because back in the day every blood counter in the country was made by Coulter. After five years the Technicon H1 was released and everyone went with them… then Sysmex.

I wonder which company will take over next.