Description
In this issue we review two topical and contentious aspects of everyday practice. Dr Bolton-Maggs highlights the results of her own recently published national audit of childhood ITP and the emerging conflict between our own perceptions of management and those of our transatlantic colleagues. The UK audit provides an uncomfortable reminder that, in many cases, our practice does not conform to either our own or US guidelines. Much has been written about more effective monitoring of oral anticoagulation and the Birmingham group, with their extensive experience of devolved care, provide a timely summary. We (and our long suffering patients) would all like to escape from the nightmare of oversubscribed and undermanaged hospital anticoagulant clinics. It seems that computerised dosing, better technology for near patient testing and well trained paramedical personnel are all factors that may finally allow us to do so.
Having been trained at Northwick Park I had thought to have heard the last about B12 and folate metabolism. However, it now reappears in a different guise in the continuing discovery of new causes of thrombotic disease. Dr Perrys review emphasises the difficulties inherent in biochemical assays for hyperhomocysteinaemia. The availability of DNA testing for mutant MTHFR will perhaps raise the debate about screening for this allele as it has for the prothrombin G20210A mutant (see Clinical Article Reviews).
Professor Goldman provides us with a summary of management issues in CML – a field that never seems to stand still long enough for the establishment of fixed guidelines. The same can hardly be said of DIC, however Dr Collins review is a reminder of good practice as well as of the debate about the more expensive new options for therapy.
In addition to a review on placental transfusion by Drs Holland and Wardrop, we also include a section on molecular diagnostic techniques in leukaemia from Drs Tobal and Yin from Manchester. Dr Colvins article about the new examination should be of interest to both trainees and their supervisors and we would welcome correspondence from both these groups about this or indeed any other matter.
