Bloody Minded

Perfectly balanced, as all things should be. All that blood doesn’t just arrive when you snap your fingers together. The REALITY is you need the TIME and SPACE to thaw that frozen plasma and the strength of MIND to keep all the components in the right ratios. Only the chosen few with the POWER of transfusion medicine and the SOUL of the laboratory can direct the most immense of transfusions - the massive transfusion. Listen to this episode and maybe you can run the GAUNTLET of the MTP.

Timestamps:

0:53 - Get ready for MASSIVE. TRANSFUSION. PROTOCOL.
1:45 - What is an MTP?
4:10 - A bleedy example
7:11 - Activating the MTP
8:52 - Consent in MTPs
11:16 - MTP packs
12:27 - Crossing plasma groups
15:30 - 1:1:1 Transfusion
17:29 - Whole Blood Transfusion
19:49 - Acidosis
22:21 - Hypothermia
23:14 - Hypocalcaemia
25:12 - Resus Associated Coagulopathy
25:49 - DIC
26:58 - Trauma Induced Coagulopathy
29:19 - Summary of Resuscitative Endpoints
31:05 - Viscoelastic testing
33:12 - Factor Concentrates
34:55 - Take home messages

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

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
30:25 - Episode Summary

Support the show

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

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
11:07 - Clerical checks
13:02 - Platelets
18:12 - Plasma products
18:32 - Fresh Frozen Plasma (FFP)
20:00 - FFP vs ELP
24:00 - Cryodepleted plasma
25:10 - Cryoprecipitate
27:24 - Albumin
28:15 - Fractionated clotting factors
29:07 - Immunoglobulins
31:12 - Leukocyte tranfusion
34:57 - Reducing transfusion-transmitted infection
38:00 - Take home messages

Support the show

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

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 help with the target
3:00 - Intro to blood groups
6:02 - What is a "blood group?"
8:40 - Historical diversion on blood groups!
9:47 - Cale speaks flawless German
13:49 - The ABO group: the hatted and the hatless
18:12 - The Bombay phenotype! No hat, no hair.
20:38 - ABO frequencies
21:11 - ABO compatibilities
21:49 - Interesting (to us) ABO tidbits
24:43 - Intro to Rhesus
29:13 - Nomenclature - RhD, C, c, E, e
36:27 - Wiener classification (brace yourself)
46:27 - Take home messages

Support the show

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

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 is a transfusion reaction?
5:52 - Categorising transfusion reactions
7:26 - Acute febrile reactions
17:20 - Summary of acute febrile reactions
17:45 - Acute non-febrile transfusion reactions
22:11 - Workup and management of an acute reaction
37:44 - Delayed febrile reactions
50:08 - Delayed non-febrile reactions
53:46 - Summaries

Support the show

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

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?
13:45 - In praise of plasma cells
18:38 - Genomics to risk-stratify precursor states - should we bother?
20:32 - Predicting response and high risk disease
21:43 - IMS Criteria - High Genomic Risk
28:22 - Response Kinetics - When are you nervous?
31:31 - Balancing maintenance Len vs. secondary malignancies
39:34 - Other agents for maintenance?
44:44 - CAR-T - A New Hope?
49:10 - T cell exhaustion
50:21 - What are the CAR-T target molecules for MM?
53:27 - Any hope for a cure?
57:35 - MRD Matters

Support the show

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

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 - Secondary HLH - "HLH Syndrome"
14:46 - Causes of familial HLH
16:34 - Infective causes
18:05 - Malignant causes
20:24 - Clinical presentation and diagnostic criteria
32:47 - H-Score
34:36 - Treatment - Replacing Your Dodgy Off Switch
38:04 - Prognosis
38:55 - Take Home Messages

Support the show

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

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 get into myeloma nursing?
9:35 - If not nursing, what?
10:50 - What is a CNC?
14:12 - Nursing expertise in myeloma - best supportive care
16:57 - The most asked questions
19:54 - Strategies to manage complex regimens
23:13 - MyeTxScheduler - A Godsend
26:37 - What do we miss, what should we be asking more?
28:21 - The crux of communication issues
29:33 - "What matters to you today"
29:49 - Patient advocacy groups
32:04 - Steroid side effects - there's just so much dex...
35:37 - M protein variations - how to see the forest for the trees
38:22 - Time toxicity
45:44 - Quality of life assessment tools
49:35 - How to get started in advocacy/education/further work?
51:57 - Organisations - find your tribe

Also we promised to link MyeTx here so have at it 
https://rego.interact.technology/myetx/#/main

Support the show

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

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/Lymphoplasmacytic Lymphoma
11:17 - Marginal zone lymphoma
12:42 - Cold Agglutinin Disease
15:09 - Heavy chain disease
16:27 - POEMS Syndrome
23:10 - Other Paraproteinemic Neuropathies
25:55 - TEMPI
27:03 - CANOMAD
29:16 - Schnitzler Syndrome
31:34 - Scleromyxedema
34:06 - The “paraprotein AND...” approach

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

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. 

Timestamps
2:08 - Episode Overview
4:47 - What is Febrile Neutropenia?
8:59 - Reminder: What are neutrophils
13:08 - Where did the neutrophils go?
18:24 - Why is FN a big deal?
20:00 - Assessing the neutropenic patient
30:15 - Antibiotics: Get them in
33:29 - Bugs: What grows?
36:15 - That fever isn't going away
41:01 - After the fever
42:24 - Can we make the neutrophils go up?
48:00 - Prophylaxis
52:50 - Summary

Support the show

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