Bloody Minded

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

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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 - Extrinsic Bucket 2: Infections
28:07 - Extrinsic Bucket 3: "Macroangiopathies"
30:58 - Extrinsic Bucket 4: Liver stuff
34:07 - Take home messages

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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 Cold Agglutinins & What are they binding?
16:14 - CAD, CAS and Causes
21:41 - Management - Stay toasty
28:07 - Cold Agg Summary
29:40 - Cryoglobulins
36:45 - Cryglobulinaemia Summary

NB We actually ran out of time to talk about PCH so apologies - keep an eye out in future episodes

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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

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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 
23:14  Take home messages 

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“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 Positives & Negatives
18:24 - When to DAT?
21:55 - Distilling the DAT - Interpretation
25:38 - DAT-Vanced Topics
29:24 - Takehome Points

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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 of the 2015 Triple J's Hottest 100
16:10 - Haptoglobin (with apologies to my anaesthetist friends)
20:32 - Who is DAT?
23:49 - Haemolysis screen recap - click here when med reg is impatient
27:35 - Take home messages!

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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)
6:29 - Where did blood come from? Where did blood go? Where did you come from cotton blood Joe?
07:47- White cell summary is here. Basophils still a mystery.
10:30 - Finally the red cell talk I've been waiting for
12:07 - Four ingredients to make a red cell. Prep time 5 min, cleanup 120 days
13:26 - Iron (in more detail than anyone could possibly want)
16:34 - B12 and folate. Don't do nangs, kids (despite this bit here)
21:28 - MCV - Why haematologists care about cell size (I mean it's more about how you use it)
25:18 - Take home messages, predominantly nang based

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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 and the subtleties of lupus anticoagulant testing. 

Timestamps
1:43 - Introductions
05:07 - The DRVVT
06:57 - LA Testing in Practice
09:00 - Mixing Studies
13:33 - Testing and Anticoagulation
19:27 - Significant LAs 
21:20 - RAPS, TRAPS and Decision Making in LA
27:20 - Taipan and Echis Times

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

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 the variety of snake venom testing available in the lab. 

Kent has over 20 years of experience in laboratory haemostasis and coagulation with a special interest in von Willbrand factor, ADAMTS13 testing and complement interactions with the coagulation cascade

Timestamps:
00:59 - Interview Overview
03:46 - Introductions
08:12 - What's in the snake drawer?
10:39 - Dilute Russell Viper Venom Time
15:05 - DOAC interference
19:20 - Echis Time
24:02 - Taipan Time
26:14 - Pathological Envenomation
33:15 - Sandflies?!

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