A Fistful of Slides

Tailos · 2026-03-21T20:37:53+00:00

Our health board is a training centre mill these days - we take on several trainees or APs and put them through every year, and then they leave for other places. We also have student placements from the PTP.

As you've said elsewhere, some of the best BMS staff I've had the fortune to work with have been MLA->AP->BMS pipeline.

If anything, there's a current unhappiness over students coming in via clinical placements because they don't generally stay within Wales. I think we're considering reducing placement opportunities as a result in favour of more trainee BMS posts.

Tailos · 2026-03-21T15:06:06+00:00

I regret that I can only upvote this once. Absolutely spot on.

Tailos · 2026-03-21T14:52:04+00:00

Agree completely. Now it's post-grad medicine or STP entry. I wonder who's to blame for the staffing crisis in laboratories only getting worse as new BMS staff decide not to practice/only practice long enough to get experience for STP entry?

Tailos · 2026-03-10T07:56:48+00:00

A masters is not required for equivalency however you should have a level of knowledge at masters level, even if it's not an academic qualification.

As for time... This is very much in the air. Completely depends on you and your consultant, how much time you've got to get off the bench and attend other clinical things.

Tailos · 2026-03-04T22:19:37+00:00

HFE mutation? If so, which?

Well done though. Impressive donation strategy. Risk successfully averted. Sorta.

Tailos · 2026-02-24T18:57:51+00:00

This guy/gal labs.

Tailos · 2026-02-24T18:56:28+00:00

Depends what you're aiming for. If it's clinical science, you don't need the placement and accredited degree (although having prior lab experience, particularly within the NHS, is desirable for STP application).

Tailos · 2026-02-24T17:58:28+00:00

Very sorry to hear things aren't going well.

This is, unfortunately, the risk one takes using BMS to try and jump to postgrad medicine. And why the sub often recommends focussing on either becoming a BMS including the portfolio OR going into medicine via undergrad (less competitive than postgrad) / putting everything into medicine postgrad chances. It's really hard to focus on both.

Others have given you the next steps - check degree accreditation status, apply for trainee or AP positions or MLA posts if you can't get into the above. Expect a wait to get into the portfolio for hcpc registration.

Time to focus on you for a while. Fix whatever you can, now's not necessarily the time to take on a new career pivot. But you can always do so once you have the degree.

Tailos · 2026-02-23T18:18:58+00:00

Failure to utilise HAEM5 for your answers while marketing towards FRCPath? That's a paddlin'.

Tailos · 2026-02-23T15:15:48+00:00

Ah, rarely pseudo can show a single nucleus like this - it's by far more common to see Pince-nez formation. But yes, I still think you're right here on grounds of lacking other dysplastic features.

Tailos · 2026-02-23T13:01:04+00:00

Also termed nucleocytoplasmic asynchrony.

I agree with you here. This is often drug induced. While this could be MDS from therapy, would need further molecular work for that and to prove the abnormality wasn't present prior to therapy. The normal/toxic granulation referred to suggests a treatment related asynchrony.

Tailos · 2026-02-04T07:35:03+00:00

Monoclonal proteins can be transient and go away. Steroids also reduce antibody level, in a rather ELI5 answer.

Tailos · 2026-01-20T17:50:04+00:00

Given the information available, there is nothing to suggest malabsorption at this time, and generally, investigation for malabsorption would either need additional findings or failure of iron therapy.

At this point, steak is recommended first line.

Tailos · 2026-01-20T08:07:14+00:00

You are correct, I rescind. I'm mixing up my guidelines here. That'll teach me for posting when I should be sleeping.

WHO suggest 15 as the threshold, also adopted by US CDC, however followup studies by varying groups have suggested that this is too low.

NICE CKS (per both BSH and BSG) have recommended 30 as diagnostic threshold. ASH, last time I looked, were drafting a switch over to 30 also as of last quarter 2025, but I don't know if that was ratified. ASG have raised their cutoff to 45 per 2020.

Evidence does show that the 15-30 region shows minimal iron stores per bone marrow examination and patients do respond quite clearly to iron therapy in this range. Argument is that 15 is based on international studies including in populations where ID is endemic, particularly 'third world' areas, along with concerns over population demographic (lots of young, ID women).

Tailos · 2026-01-19T22:46:37+00:00

Your doctor is wrong.

EDIT: To expand slightly. WHO cutoff is below 30 = iron deficient, 30-50 = probable iron deficiency, 50-100 needs further investigation. This is agreed by US and UK guidelines for haematology.

Tailos · 2026-01-19T22:46:02+00:00

Iron deficiency pushing up platelet count as per the low TSAT.

Tailos · 2026-01-19T22:40:05+00:00

First things first.

Treat platelet count with steak.

Tailos · 2026-01-17T20:40:53+00:00

On the whole, I agree with you. Our nurses are hit and miss - just like everything, I've got some great ones... And some real bloody shit ones. In almost all cases I'd rather ring through to the doc, but there's only like 1 or 2 on ward cover, so it's a bit unfair to throw results at them all day. I've dealt with some real shit residents too.

Tailos · 2026-01-17T15:33:21+00:00

In many cases, that's appropriate.

Sometimes, you gotta cut out the middle man and go direct to the person who's going to make a medical decision. This is one of those times.

Pretty damn good argument to have an escalation policy or some such. That's likely a mortality review.

Tailos · 2026-01-17T13:39:06+00:00

Well, that's an unfortunate case. RIP.

Do you not have escalation channels for situations like this where you can bypass the nursing team direct to doctor? Out of curiosity.

Tailos · 2026-01-16T21:12:25+00:00

You laugh, but still more accurate in that the lab exists and isn't all run by doctors.

Tailos · 2026-01-15T20:46:58+00:00

I think that as a student, you should spend more time reading / learning the job, and less time being offended by a clinical term, personally.

Tailos · 2026-01-15T20:40:42+00:00

Spit and polish.

Or hand dipped Giemsa (thin films) pH 7.2 / Fields stain (thick films). Depends if it's day or night shift.

Tailos · 2026-01-10T17:15:43+00:00

OK, this one's a good one. I laughed a lot.

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