Bloody Minded

It’s an early trip to the lab this season to explore exactly how we safely match the blood in the bank to the patient on the ward. Follow your trusty hand-labelled group-and-hold tube as we unpack what actually goes into blood grouping, antibody screening and the final hurdle, the crossmatch!

Timestamps

0:52 - Nick lives in squalor, surprising nobody
2:56 - The Group
4:22 - The Forward Group
6:53 - The Reverse Group
10:55 - The Antibody Screen
18:12 - DAT vs IAT
20:39 - The Crossmatch
25:08 - Anamnestic Antibody Responses
27:58 - Phenotyping

We’re back again to answer all of your questions- what’s exactly is a "unit" of blood and how do we go about giving it? What on earth is the difference between FFP and ELP and cryodepleted plasma? And what do each of them sound like, if you were to interpret them via a completely unnecessary collection of household objects? As always, we’ve got you covered.

Timestamps:

00:55 - Bashar's special presentation
03:42 - Where do we get blood from?
05:53 - Packed Red Blood Cells (PRBC)
08:20 - When and how to transfuse PRBC

We’ve been out of line with the rest of #FOAM #MedEd podcasts for the longest time. Forget that haematology stuff, it’s time to talk about RESUS. Break out your adrenaline, it’s time to crack some chests and… wait what? You meant Rhesus? With an H? Oh right… okay. Put down those trauma shears as the only thing we’ll be cracking open are the ISBT Red Cell Immunogenetics guidelines. Join the Bloody Minded Crew take you though the basics of blood grouping with a focus on ABO and Rhesus. 

Timestamps:

0:56 - Cale needs...

Do you fear – The Power of Blood? Have you been warned – You can’t Hurry Blood? Today we tackle all the ways Blood (and love) can go wrong. . . and how to manage it on the wards.

Too cryptic? Join Bloody Minded's own consultant haematologist Dr Alison Chandler and the rest of the Bloody Minded Crew as we cover the many and varied reactions patients can have when you try and fix that haemoglobin level on the ward. 

Timestamps

00:53 - 3-4 nerds chatting about nonsense
03:37 - Your first transfusion reaction
05:08 - What...

Myeloma beware, it's time to bring out the big guns. We are incredibly thankful to be joined by a peak predator of plasma cells, Dr. Christian Bryant. He is a consultant Haematologist at RPA in Sydney, has a PhD on the immunology of myeloma and is driven by a passion to improve the treatment and understanding of all things myeloma.

TIMESTAMPS
2:18 - Intro to Christian Bryant
3:05 - Why Haematology?
5:31 - Why (oh god why) myeloma?
7:28 - Heavy metal, heavy chains
9:28 - Chromothripsis - The Cause That Breaks The Camel's Back?<...

Ferritin keeps climbing and you’re getting jumpy? Did you consult Haem and then they were bedside 5 minutes later? Ever had to donate your own blood to test the patient for something? Join Nick, Cale and Bashar as we unpack a very special bonus episode on another deadly TLA, HLH.

TIMESTAMPS
3:24 - History of HLH
5:26 - What is a histiocyte?
7:44 - How do you turn *off* an immune response?
8:52 - HLH - A Definition
10:49 - What are NK cells?
13:03 - Primary HLH - "HLH Disease"
13:34 - Se...

Thankfully, it's time for an actual expert to join us again on Bloody Minded! We are thrilled to be sitting down and chatting with A/Prof. Tracy King, Myeloma CNC from RPA Hospital in Sydney, Co-Founder and past president of the HSANZ Nursing Group. From convenient treatment schedulers to the side effects we should be thinking more about to many ideas to improve clinical practice, this is a veritable hour of power worth diving into.

TIMESTAMPS
2:23 - Intro to Tracy King
3:30 - A Nightingale Sang in Hammersmith Square
5:22 - How did you...

All that glitters isn’t gold, and all that paraproteins isn’t myeloma. But if we’re not going to blame myeloma, then what else might be responsible? Hold on to your M-Spikes as we the Bloody Minded Team dive into the weird and wonderful world of paraproteins causing havoc in patients without myeloma. This episode isn’t for the faint of blood so get ready for an advanced look at paraproteins and take a bit of the U out of MGUS. 

2:12 - The Problem with "Unknown" Significance
8:45 - Waldenström's macroglobulinemia/Lymphoplas...

Its time to hit the hot girl summer of haematology (we're in Australia after all) but also the hot boy winter and Autumn and Spring. Because our patients are hot all year round and sadly all night shift and possibly all throughout your ward round.   

Welcome to our next On The Wards episode looking at fevers in the haematology patient with a focus on the management of febrile neutropenia. There's a lot to cover in this jumbo sized episode and we're super happy that Dr Alison Chandler agreed to return after last time. 

Tim...

Can’t get enough of obscure haematological lab chat, can you? Well we’ve got good news for you! Join us today as we delve even deeper into the arcane depths of flow cytometry, mass spectrometry and cytogenetics as they apply to myeloma. We promise we didn’t just make these words up.

02:23 - Flow cytometry: overview
04:01 - The flow cytometer: practical aspects
09:01 - How we interpret flow
11:44 - Myeloma flow markers
14:32 - Quality in flow
21:26 - Mass spectrometry
25:59 - Cytogenetics
27:46 - Cytogenetics assay principles
30:30 - Karyotype abnormalities
31:44 - FISH...

Thought you were free of myeloma acronyms? Don’t be ridiculous - this is the haematology lab! We were born in the acronyms, moulded by them. We didn’t see a complete word until advanced training and even then it was nothing but BLINDING. Your lab tests betray you because they belong to us… but in this episode we’ll let you in on some secrets. Join Nick, Cale and Bashar in the haematology (and closely adjacent immunology) lab as they chat about just how we do that electrophoresis, why an iEPG is different to an EPG and just how usef...

MGUS and Myeloma too simple for your tastes? Do you like vague presentations and biopsying many tissues in a sometimes wild goose chase? Why does Congo have all the birefringent apples? Go 'AAaah' as we TTRy to unpack ALl the problems that come with that most protean of disease - Systemic Amyloidosis!

Timestamps
3:04 - Pathophysiology of Amyloid
6:52 - All The Subtypes of Amyloid
7:56 - AA Amyloid
10:08 - ABeta2M Amyloid
11:04 - Age-Related Amyloidosis = wtATTR = WTTA = SSA
14:38 - AL...

RVd, KTd, CyBorD, DVd, EloRd - Looks like the cat got on the keyboard. Oh wait, this is just the myeloma regimens in day therapy today. 

Come on a journey as we attempt (mostly successfully) to avoid drug trade names! Let go of your proteasome inhibitions, phenotype your red cells and let us modulate your understanding of what it is to treat myeloma with an alphabet soups worth of drugs. We sincerely apologise to our endocrinology colleagues for how much dexamethasone we use in this episode but also generally. 

Timestamps
4:00 - Overview of the tr...

==
I do not like blue eggs and ham,
I do not like them, Sam I Am.
They crowd and clump, they grow too fast,
Causing troubles that can last.
They make my bones feel weak and sore,
And through my kidneys they gnaw!
I do not like blue eggs, you see,
They're signs of something wrong with me.
==
Timestamps
3:35 - Recap of MGUS + smouldering myeloma
4:42 - Clinical case - Mr. Peter Rotein
8:15 - What is rouleaux?
10:30 - Bone marrow biopsies - what, how, how much...

Ordered something you shouldn’t have and accidentally found a paraprotein again? Shame on you, but now you have to do something with it. Maybe you were genuinely suspicious for myeloma. If incidentally discovered lab findings are leaving you smouldering, this is the episode for you! 

Join Nick, Cale and Bashar as they chat about the spectrum of plasma cell dyscrasias, and cover the precursor conditions MGUS and Smouldering Myeloma.

Timestamps
2:53 - What is a paraprotein?
5:56 - The heavy chain component
9:40 - The spectrum of plasma cell disorders
10:12 - MGUS
11:33 - H...

A is for Antibody. B is for B-cell. C is for Cryoglobul… wait no we’ve covered that already. If you struggle to tell your thymus from an isthmus, can’t see the humour in humoural immunity and think a bursa is just some fancy elbow cushion then THIS is the episode for you. Join the Bloody Minded Crew as they dust off their undergraduate immunology degrees, get back to the classroom and cover the foundations of the immune system in preparation for tackling our upcoming malignant diseases. 

Timestamps
3:4...

Help! After a disastrous 3 way ward swap you now have to cover the haem ward as an intern in... 45 minutes time. If only there were some way you could get a crash course on everything you might need to know. Well are you in luck today! Join our new guest host Dr Alison Chandler for a whole new subtype of episodes, our new "On the Wards" series.“ These are for those new interns and residents who have been drafted to cover the dreaded haem wards and need to prepare all the practical day to day th...

Tired of listening to the three of us? Why not listen to an actual expert!? Today we're joined by Dr Danny Hsu, consultant haematologist, clinical lead of Immune Haematology & Therapeutic Apheresis at Liverpool Hospital, THANZ council member and all around top bloke to dig down into the nitty gritty of TTP and PNH. 

Any question you might have about these conditions Dr Hsu is your go to. Sadly we didn't ask him every question you might have, but he certainly came up with incredible answers to the ones we asked of him. 

Timestamps

Have you been spending too much time outside of the lab lately? So have we! Come with us on a whirlwind tour through the high altitudes of thermal amplitudes, the chilly depths of cold agg titres, the bright lights of EMA testing, the flocculated wetlands of unstable haemoglobins (don’t ask) and more! All from the safety of the lab, of course. We don’t go outside.

Timestamps
2:14 - Cold agglutinin testing
8:05 - PCH (Pretty Cool Haem)/Donath-Landsteiner testing
14:52 - G6PD testing
23:25 - Unstable Haemoglobin testing
28:55 - Take homes

Chec...

Do you have a FLAER for the exotic? All at sea without your GPI-anchor? Come on a deep dive into the world of paroxysmal nocturnal haemoglobinuria - which isn’t really a disease of haemolysis at all but hey we're putting it here anyway and you can't stop us

Timestamps
1:46 - What is PNH? Baby don't hurt me...
4:48 - Signs and Symptoms
7:27 - Pathophysiology
11:27 - Diagnosis
17:04 - Managing Pretty Not Happy Blood

Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

MAHA TMA Gandhi once said a cell for a cell makes the whole body anaemic, or something along those lines. There’s so much more to DAT negative haemolysis than just DIC. Get out those buckets and put your sorting hats on - it’s time to go where detective Coombs never dared to and look over the DAT negative haemolytic processes. 

Timestamps
2:42 - Approach to DAT negatives - main categories
4:53 - Intrinsic Bucket 1: Membrane disorders
16:16 - Intrinsic Bucket 2: Enzyme disorders
18:51 - Intrinsic Bucket 3: Haemoglobin disorders
24:05 - Extrinsic Bucket 1: Microangiopathies
26:54 - Extri...

Grab your hot beverage of choice and come out of the cold as we give you a warm welcome to the world of cold-dependent antibodies! No need to cry(o) as we unpack CAD vs CAS, get personal with PCH and gaze without alliteration at whatever the hell cryoglobulins are.  If you're desperate for a medical reason to move to the tropics, this is the episode for you.

00:58 - Deliberately inflammatory pop-culture discussions
02:45 - Clearing up nomenclature
6:12 - How cold is cold?
8:40 - Clinical case and problems with the FBC
13:27 - Testing for C...

Is there a glow surrounding your red cells? Things feeling heated in your reticuloendothelial system? An antibody to keep your bed warm at night? We don’t know where this is going either but grab a coconut and hop in the pool because we are excited to welcome you back with a chat about warm autoimmune haemolysis! 

Timestamps
00:57 - Introduction & Case
05:08 - wAIHA - What is it?
07:04 - Reminder about the RES
08:35 - Surface Targets & Drugs
11:45 - Brief Mid-Ep Summary
13:05 - Causes
22:30 - Treatment
26:20 - Misc Points & Episode Summary

Feel your knowledge fragmenting? A MAHA doesn't make you haha? I mean, that's probably a good thing - they're quite serious. Time to unpack the troublesome schistocytes. Hope you brought your helmets as we teach you the bare minimum about fragments so you can save lives on the ward. 

Timestamps

02:26 -  What is a red cell fragment? 
06:09 -  How are schistocytes born? 
09:40 -  DIC. The haem one, we mean. 
13:32 -  TTP or not TTP 
16:15 - Sorry, he's not single 
19:02 -  HUS - a harsh renality 
20:19  - aHUS - complements incoming 

“It’s Test. Coombs Test. And I like my erythrocytes shaken, not stirred.” Return the lab (where some of the Bloody Minded Crew truly belong) and uncover the secrets of the most important test in haemolysis - the Direct Antiglobulin Test. Learn to whisper its secrets and it can guide you to identifying the true culprit behind these broken red cells. 

Timestamps:
0:57 - Coombs Noir
2:05 - Naming History
4:32 - DAT in the Lab
11:52 - Doing a DAT - Exam Version
14:35 - Eluates (Briefly)
15:45 - False Positiv...

Haemolysis? Do I really hapto send off more tests? This is reticulous! Now you know what a red cell is - lets learn about how they can break down. Join us as we explore what your boss actually wanted you to do when they asked for a haemolysis screen, and about Cale's deep seated distrust of hepatologists. 

Timestamps
2:30 - Haemolysis - what is it (good for?)
7:58 - Reticulocytes? What a reticulous name for a cell
9:36 - LDH - Nick will talk about biochemistry here, I'm SORRY okay?
11:36 - Bilirubin feat. Gilbert - winner o...

What is blood (Baby don't hurt me)? Rejoice as we escape the land of coagulation and look at some of the questions we have all asked during our medical training- what is blood? Does everybody have blood? Why is there so much of it on this floor? Who are you and how did you get in here? Join us as we we answer all these questions and more this episode with a focus on red cells. 

Timestamps
1:33 - Blood - What is it (good for)?
3:49 - Differentiation of blood cells (my progenitors would be proud)

Echis carinatus, Daboia russelii, Uxyuranus scullatellas. Never has so much been owed by so many humans to so few... snakes. In this split episode, For the first time the Bloody Minded Crew is delighted to welcome guests! Join our coagulation experts Dr Maeve Crowley and Kent Chapman for a tour of the wonderful world of exotic clotting times.

This episode was so big we split it in half! In Part 2 of this episode we step out of the lab and chat with consultant haematologist Dr Maeve Crowley about the clinical uses of snake based testing...

Echis carinatus, Daboia russelii, Uxyuranus scullatellas. Never has so much been owed by so many humans to so few... snakes. For the first time the Bloody Minded Crew is delighted to welcome guests! Join consultant haematologist Dr Maeve Crowley and senior hospital scientist Kent Chapman for a tour of the wonderful world of exotic clotting times. 

This episode was so big we had to split it in two! In this first half of the episode we interview Kent Chapman, senior hospital scientist in haemostasis at John Hunter Hospital in Newcastle regarding t...

The Bethesda Assay has been tormenting haematology trainees since well before Fallout or Skyrim. Uncover its secrets in this episode and you'll be sorting acquired haemophilia faster than you can say Fus Ro Dah 

Timestamps:
01:50 - Bethesda Assay Intro
05:17 - How it works (and Bethesda Units)
10:25 - Nijmegen modification & dealing with Emicizumab
13:48 - Bethesda Assay summary for Exams
18:55 - Clinical Relevance

Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

One step, two step, red step, blue step! Get stuck in to assessing factor levels in this episode looking at the differences between one and two step factor assays, the basis of chromogenic testing and how to resolve discrepancies between different methods. 

Timestamps:
01:33 Intro to Factor Assays
04:33 One-Stage Assays
09:33 Historical Diversion - What's an IU?
15:28 Factor VIII levels
17:15 Two-Stage Assays
21:31 Resolving Discrepancies
25:24 FXIII Assays
32:32 Summary

Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Finding your coagulation knowledge "LAC-ing"? Do you also hate things that were named terribly and thrive on pedantry? This week we pop the hood on that most mysterious of lab tests - the lupus anticoagulant. Listen to this episode again in 12 weeks time for an authentic lupus anticoagulant experience. 

Timestamps:
02:10 - Introducing the LAC
04:47 - What's in a name - nomenclature issues
07:06 - LACs and the APTT
11:31 - Testing for Lupus Anticoagulants
16:55 - LAC testing and anticoagulation
18:15 - Short Pre-Exam Cram Summary
20:10 - Hexagons are Bestagons
22:44 - Clinical Segue