Where’s Wally @ 5th Floor, North Wing, St. Thomas’ Hospital
In other words – the haematology lab where blood films are scrutinised under the microscope. Provided with a brief clinical history, they report their findings of the blood films – often indispensable to working out the differentials to complex cases.
How apt... Wally is dressed in red and white - much akin to RBCs (Image credit: Martin Handford)
To the untrained eye, the cells seem to blend into an endless identical sea of… cells. very much like Wally (or Waldo) in a sea of distractions. However, to the very experienced haematologists, they are able to accurately discern the density of cells, the presence of abnormal cells (and whether in sufficient quantity to warrant concern), and morphology of cells – all in relation to the patient’s age and medical background. For instance, lymphocyte vs lymphoblasts can look very similar. Also, burr cell (echinocyte)* vs acanthocytes** – I mean… how they even differentiate between these two is beyond me! It was actually quite exciting looking for the Wally i.e. aberrant cell! Have a look below and see if you can spot the aberrant cell.
Not to give the answers entirely away but spot the target cells, pencil cells, burr cells, platelets, and more
*Echino meaning spiny or prickly, sea urchin, or hedgehog – in Greek/Latin. Unhelpfully, acantho** has a similar meaning.
***Poikilo meaning varied – of which tear drop, sickle cell, pencil (ellipto) cells fall under this umbrella.
Perhaps even more impressive is that they count the cells manually to get the percentages of each cell type i.e. quick scan then literally have a counter where a button pressed increases the tally for that cell type. (a very ancient looking heavy device)
Sickle Cell Clinic @ Ground Floor, Evelina Children’s Hospital
So many takeaways from this clinic and memorable impressions in the interaction between the consultant and the children.
#1 In the most smiley well-behaved child (of 6 kids) who had some (physical) developmental delay – dispelling his erroneous belief that vitamin D helps him grow, and allowing him to understand why he had to take exjade to treat his iron overload.
#2 Understanding the school environment and safety-netting – did his friends know? Do people tease him about it? Does the school have rules on ‘water-breaks’ and coats (in other words, something as simple as having a coat available when cold and keeping hydrated can effectively prevent sickle crises.
#3 Is there a cure for sickle-cell? Kinda not really – it’s tough! Can parents be bone marrow donors instead of the recommended sibling? (With HLA matching, there is 1 in 4 chance of a complete match between siblings of same parents, but if the parent were to donate, then it would only be half a match) That is a conversation to be had with all stakeholders and after much consideration.
#4 The multi-system effect of sickle cell cannot be underestimated – enuresis, sleep apnoea, priaprism, stroke, acute pain crises, infection (dental abscesses, osteomyelitis etc).
(Other) Haematology Clinic
#1 Child with chronic ITP: very shy child who had recently started new medication (IVIG) – balancing side effects vs keeping purpura and bleeds under control
#2 Child with Caroli disease with massive hepatosplenomegaly and caput medusae
Haematology was well-spent – learnt so much (and actually so interesting how much more there is to explore with haematology!) and absolutely appreciate the magic the haem team/lab does in interpreting bloods.
This was also the week of the ATP in Australia. Did Stephano Tsisipas win? (cracked me up how my consultant was actively avoiding checking the notifications! It was buzzing!)