Tuesday 26 October 2010

19th Oct - 20th Oct

Went to the NEQAS Haematology meeting in Birmingham. It was a really good meeting. On Tuesday 19th, I went to a session about new NEQAS schemes. It was a discussion session and we talked about n-RBC's, ESR's, MPV, RDW and iron deficiency indicators. NEQAS are piloting an n-RBC scheme at the moment and are trying to create their own in-house material. Our Sysmex XE analysers are capable of n-RBC counts. At the moment, we only perform counts on neonatal samples. If any adult specimens contain n-RBC's, the analysers produce a NRBC flag and a film is looked at. We informed NEQAS that it was more important that the n-RBC material was able to generate an NRBC flag, which we cold then go on and quantitate.

The value of the ESR was discussed, a couple of laboratories no longer perform an ESR but conduct plasma viscosity testing instead. It was felt that despite the ESR being a non-specific test, GPs and A&E staff find it a good indicator of disease status and as a monitoring tool. Despite the vast number of years over which the ESR test has been performed, there is still no external quality assurance scheme available. NEQAS are trying to produce an ESR scheme. Most laboratories did use internal QC material for automated ESR's.

The Mean Platelet Volume was introduced as a new parameter. Very few laboratories reported the MPV. The science is that MPV can be an indicator of risk of thrombosis. The larger the MPV, the greater the risk. The room ws asked why the MPV was not being reported. One answer was that there was no room on the printed report. One answer to this was to stop reporting the MCHC as this, although a useful parameter in the laboratory for assessing sample integrity, was of no clinical value. It' space on the report could be taken by the MPV. Most laboratories stated that they were not reporting the MPV as clinicians were not requesting it. This led to a debate on who's responsibility it was to educate the clinicians about new parameters available from the laboratory. Some felt it was the responsibility of biomedical scientists to educate their consultants and to try an get the word to the hospital doctors via the grand rounds. My feeling is that until a guideline is written, we are unlikely to begin reporting this parameter. Many laboratories said that they do report the RDW. Currently, the laboratory I work in does not report this parameter. The use of the percentage hypochromia, and some others, were also mentioned as a new parameters for iron deficiency.. Again, many laboratories had analysers that can measure this parameter but very few reported it.

On Wednesday 20th, we had a talk about harmonisation in haematology. This talk was about Carter; moving services closer to the patient, exploring new ways of working, consolidation/networks, innovation in workforce and technology etc. We were then given a talk about trying to harmonise reference ranges across the UK, Wales have achieved this to a certain extent. As ideal as this would be, different analysers using different reagents require different reference ranges. All laboratories were urged to at least report their parameters in harmonised units ie Hb in g/dL not g/L. NEQAS schemes are helping to achieve this by requesting results back to them in specified units. The use of comments was also approached. Comments should be standardised, meaningful, consistent, add value and be evidenced based.

A talk was then given about the Haematinic's NEQAS scheme and the problems experienced with specific analysers. The measurement of Holotranscolabumin (active B12) was mentioned.

A funny talk was given about the naming of cells. Check out the website www.photobucket.com/morphological similes.

An overview of the Tuesday afternoon session was given and also for the other session about Digital Morpohology. NEQAS run a digital morphology scheme that biomedical scientists can sign up to for CPD.

Overall, it was a really good meeting.

Monday 11 October 2010

4th Oct - 8th Oct

This week was spent working on re-writing the 'Procedure with Incompatible Crossmatch' SOP. Almost there!

I also managed to get an audit done. I did a comparative audit between the result interpretations that we submitted with our NEQAS Haematinics results and the consensus results. The results suggested that a revision of the normal range in use for Folates should be considered. Hope to get some feedback.

Placed an order for some neonatal group A- platelets from our NHSBT centre. We were called to say that no group A neonatal platelets were avaliable, would group O be OK? Intitially I agreed to the group O platelets but felt uneasy at doing so and therefore sort advice from a more senior collegue. He called the blood centre and asked if they could check whether group A neonatal platelets were avaliable at the next closest blood centre, there was a unit of A+ neonatal platelets which we requested. My senior advised me to write to our local blood centre to ask why the stock at the next nearest blood centre was not checked before we were contacted to say no group A units were avaliable. I await a response.

Our TP finished off a new prophylactic anti-D request and combined traceability form that myself and a collegue helped her to design. This is in response to a couple of recent incidents where the layout of the anti-D request form was a contributary factor to (i) the incorrect dose of anti-D being issued and (ii) anti-D not being issued for the patient's appoinment resulting in an appoinment reshedule. We were also not conforming to traceibilty protocols for anti-D being sent to satelitte antenatal clinics, we therefore chose to combine the redesign of the request form with a new traceability form. It needs to go for consultation but hopefully will be in use in the not too distant future.