The edition · Pathology
Releasing the tourniquet at the first tube cut haemolysed emergency samples by a third
A randomised phlebotomy trial targets the commonest pre-analytical error, short-course endocrine therapy is shown to change breast resection grading, TFEB RNA-ISH separates a rare renal tumour from its mimics, and seven experts rarely agreed on goblet cell adenocarcinoma grade.
The edition in brief
In a randomised trial of 790 adult emergency patients of non-critical acuity, starting cuff release as blood entered the first tube reduced haemolysed serum samples from 26.1% to 17.2% (absolute reduction 8.9 points, 95% CI 3.1-14.5; NNT about 11). The result applies to direct 21-gauge venepuncture at a standard 60 mm Hg, not catheter draws or elastic tourniquets. In 180 women given a median 29 days of preoperative endocrine therapy for ER-positive, HER2-negative breast cancer, Ki67 fell to 10% or below in 73.9%, and histological grade fell in 36.7% against 7.9% of untreated controls; PR expression often fell and HER2-low status became more frequent. Among renal tumours, TFEB RNA-ISH stained all 16 TFEB-altered carcinomas and none of the controls, including TFE3-rearranged tumours, while cathepsin K and GPNMB lacked specificity. And seven pathologists agreed on the WHO three-tier grade in only 4 of 20 appendiceal goblet cell adenocarcinomas (kappa 0.29).
A month of preoperative endocrine therapy changed grade, Ki67 and PR in breast resections
When a breast resection follows short-course endocrine therapy, report grade and Ki67 as post-treatment values and flag the context.
TFEB RNA-ISH distinguished TFEB-altered renal carcinoma from all its mimics in one series
Where FISH is not available, TFEB RNA-ISH is the most specific light-microscopy test for TFEB-altered renal carcinoma in this series.
WHO three-tier grading of appendiceal goblet cell adenocarcinoma was poorly reproducible
Treat the WHO grade of goblet cell adenocarcinoma as uncertain, and describe the high-grade component explicitly in the report.
A haemolysed potassium is not a potassium
Annotate haemolysed results and ask for a repeat before anyone treats a spurious hyperkalaemia.
Release the tourniquet as the first tube fills, not after the last
Add early tourniquet release to emergency phlebotomy protocols and track the effect through the laboratory's haemolysis index.
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