The Auricle 2022 Edition 1

THE AURICLE Volume 5 Edition 1

January-February 2022

IN THIS EDITION...

Editors' Letter ................................................................................................................... 1 Humans of Medicine: Izzy Greer ................................................................................ 2 Photo Journal by Ben Hunt .......................................................................................... 4 "Presence": a poem and artwork ............................................................................... 8 Research Corner: Thyroid Disease and Symptomatology ................................. 9 Paradise Lost: The Demise of the John Flynn Placement Program .......................................... 12 "A Vicious Cycle": a poem ......................................................................................... 16 Spotlight: Golden Blood ............................................................................................ 17 The Crossword ............................................................................................................. 21 Vampire Cup - you're invited! .................................................................................. 23

EDITORS' LETTER Dear valued readers, Welcome to The Auricle’s January-February Edition, our first instalment for 2022. We are absolutely delighted to share this publication with you and the creativity of the contributors featured in these pages.

As Editors, in 2022 we are pursuing a slightly different editorial direction to recent years. We are returning to the pre-2016 format of regular editions of The Auricle but with a twist - instead of publishing quarterly, we will be publishing bi-monthly! This means even more of The Auricle for your enjoyment.

Lachlan Coman is currently completing a Master of Public Health.

We are also keen to share with you some regular segments in the Auricle that will be featured each edition: A Community and Wellbeing segment The Spotlight Series, focusing on interesting stories within medicine Research Corner featuring the Medical Research Students Society The Crossword to get your brain ticking!

Between each edition, we will be featuring stories from within these pages by publishing them to our website and the MUMUS Facebook page in blog format. But keep a careful eye out - we will also be publishing new content between editions.

Jordi Shahab is undertaking a BMedSc (Hons) year.

If you want to contribute to The Auricle, please get in touch with us! Details about the kind of submission we are looking for can be found at https://theauricle.org/contributing/ or if you have any questions, email us at publications@mumus.org We hope you enjoy reading this first edition of 2022. There’s a whole lot to get stuck into!

Happy reading.

Lachlan Coman and Jordi Shahab

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HUMANS OF MEDICINE Each edition of The Auricle, we interview a member of the Monash medical cohort who has been up to something interesting that they are willing to tell to readers of The Auricle. If you think you or someone you know would have an interesting story to share, please contact us!

Name: Izzy Greer CAN YOU TELL US ABOUT YOURSELF AND YOUR JOURNEY THROUGH MEDICINE SO FAR? Yep! I’ve just finished my fourth year of med, having spent Year 3 at Traralgon (when not locked down!) and Year 4 at Frankston Hospital. I was so lucky to have the first two years on campus and make some awesome friends in the course. This year I’m taking a gap year to travel and work, and then looking to do a Masters of Public Health next year, before completing final year.

of Chief Lifeguard for Geelong Area. It was a huge jump in responsibility, but I’ve learnt an incredible amount about people management and emergency incident response.

WHAT DOES YOUR ROLE ENTAIL? I UNDERSTAND YOU ARE THE CHIEF LIFEGUARD FOR THE GEELONG AREA. HOW DID YOU GET INVOLVED IN THIS AND WHAT'S YOUR EXPERIENCE BEEN LIKE SO FAR? I grew up in Ocean Grove and I’ve been involved in Surf Lifesaving since I was a kid. I became a Beach Lifeguard at 17-years-old and then last summer stepped into the role

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As a Chief Lifeguard I am responsible for all the lifeguards on beaches in the Geelong region (Ocean Grove, Pt Lonsdale, Queenscliff, 13th Beach, Bancoora, Eastern Beach) and the Geelong RWC service (jetskis). My primary role is to manage the lifeguards (e.g. rostering, auditing, support) and liaise with surf lifesaving clubs (e.g. equipment) as well as local councils (e.g. service delivery).

ANY ADVICE TO READERS TO PROMOTE BEACH SAFETY? OR ANYTHING FOR US TO KNOW ABOUT AS FUTURE MEDICAL PROFESSIONALS?

ANYTHING YOU HAVE LEARNT IN LIFESAVING THAT TRANSLATES TO THE MEDICAL PROFESSION?

A big emphasis on prevention! For lifeguarding Swim between the red and yellow flags! Make we have shifted to evaluating performance by sure you swim within your ability and with number of preventative actions instead of someone! For me a massive take away is not number rescues. Risk mitigating through to take your own experiences and skill sets for educating people before they get into the granted and extrapolate this to other people, water and setting up flags in the safest part of because a lot of people have no exposure to the beach results in much better outcomes water safety (or medicine/health) and so compared to being reactive and rescuing those common sense isn’t necessarily ‘common’! in trouble. Similarly in medicine, prevention orientated health strategies often yield the DO YOU HAVE ANY INTERESTING STORIES best patient outcomes.

TO SHARE FROM YOUR WORK? WHAT WOULD YOUR ADVICE BE TO YOUNG Heaps!! A lot of the stories are context specific MEDICAL STUDENTS TRYING TO BALANCE but highlights include treating gnarly first aids THEIR STUDIES WITH EXTRACURRICULAR for surfboard fin cuts, swimming with dolphins HOBBIES AND INTERESTS? in between the flags and coordinating missing people searches by communicating with the Nothing new - but having interests outside of lifesaving helicopter and water police. It's a job medicine is invaluable as it allows you to tap that is majority just hanging out with friends on out of the medical world and keep perspective. the beach, a few interesting first-aids and For me I can totally switch off my med brain rescues, and occasionally really serious when lifeguarding over summer so I feel incidents. Ultimately, it’s the friendships within rejuvenated and keen to learn when coming the lifesaving community that make me come back for another year of full on study. My back every summer. As Chief Lifeguard it’s a lot advice would be to prioritise time for activities of admin and COVID has been an absolute killer and spending time with friends/family for rostering - so heaps of work but pretty otherwise it doesn’t happen (there is always boring stories there! more study to do!)

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"PRESENCE" A poem from our friends at Community and Wellbeing

Words and artwork by Virginia Su

My mind an angry hive of bees A tornado, a storm of buzzwords - I flee ‘Beta blockers’ run wild like weeds I’m exhausted, a shell, an imposter I see

Virginia Su is a student in Year 4C and is the Co-Chair of Community and Wellbeing

My mind a scribbling mess I need respite A mirage I glimpse among the charcoal axons A single window to a field of ruby and gold And soft emerald mats and a sweet cobalt bike.

Beyond my mind an oasis just a blink away.

I stop. I sit. I close my eyes. I sigh with each whisper of the wind.

I feel the soft dew drops on each blade of grass; I paint with petals and dance with the leaves.

My mind is clear as a blue summer sky, Just the jangle of keys as I swing onto my bike.

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RESEARCH CORNER: Thyroid disease and symptomatology

Written by Vikash Yogaraj The relationship between thyroid disease and symptomatology is one that is surprisingly under-explored.

How I got here: This finding was not the original goal of my literature search – my main project involves developing a validated questionnaire to assess quality-of-life symptoms specific to thyroid patients. A natural first step to creating this questionnaire is to determine what symptoms are present and in what frequency in the various types of thyroid disease.

Why is this important?

In the case of thyroid goitre and nodules, patientperceived symptoms is a stand-alone indication for surgical intervention (1).

As such, understanding the prevalence of reported symptoms in the literature can help us better understand which symptom(s) most commonly drives thyroid patients to seek specialist consultation. Is it difficulty swallowing or a hoarse voice? Is it pressure in the neck or is it cosmetic concerns? Knowing which symptom(s) most interfere with quality of life and assessing the extent to which surgical treatment resolves these issues will enable us to better counsel patients pre-operatively about their likelihood of symptom resolution and enhanced quality of life with surgical intervention.

The second step involves determining the specificity and predictive value of each symptom to a disease process. For example, does the presence of dysphagia serve as a strong indication that the patient has a single thyroid nodule? Can the presence of a hoarse voice increase our suspicion that a patient is hypothyroid postoperatively? Understanding these relationships will enhance the specificity of a questionnaire by ensuring that a positive response to a question like “Do you find swallowing solids uncomfortable?” has a higher chance of indicating that a patient is (for example) hypothyroid. This process of determining whether the question truly assesses what it was intended to assess is called “validation” and is a key component in developing “validated questionnaires” (2).

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Conducting the systematic review: The initial step of this stage is to search the literature to see what data is available concerning thyroid disease and symptoms. A search was conducted across Embase, Cochrane CENTRAL, and PubMed. Key search terms included variations and subsets of “thyroid disease” and “symptom”, using MeSH terms where possible and Boolean operators to capture as many relevant studies as possible. Conversations with my supervisors resulted in the exclusion of thyroid cancer for this study as symptoms and presentations for malignancy are so varied as to be confounding for the purposes of this project - for example, can the dysphagia of a thyroid cancer patient be attributed to the enlarged thyroid gland, or is it the result of local invasion, nerve palsy or metastatic disease?

For this reason, only benign thyroid disease was included, with plans to explore malignancy in the future to ensure the validated questionnaire captures the full spectrum of thyroid disease.

What did I find?

All 41 of the included studies detail the prevalence of symptoms in their cohort of patients with varying levels of detail. Many studies used the term “compressive symptoms” to encompass dysphagia, dyspnoea, and neck fullness without specifying the frequency of each individual symptom in their cohort (3).

One drawback of the literature is poor profiling of the structural/endocrine characteristics of thyroid disease to symptoms. Most studies detail the prevalence of, for example, dyspnoea in their cohort of goitre patients, and then mention that tracheal compression was found in 37% of that goitre cohort. What is lacking is a correlation between symptom frequency and the clinical finding itself.

Image from @AmtullahQudsia via Twitter thyroid disease can take this question one step further. For example, is dysphagia more likely to be seen in patients with a left-sided thyroid nodule that is greater than 3cm in size? Similarly, when thinking about thyroid function and functional diseases (e.g. hypothyroidism, hyperthyroidism), correlating symptom presence with TSH level could be useful in determining the extent to which hypothyroidism influences symptomatology. However, no extracted study presents a correlation between symptoms and continuous patient TSH levels – all studies merely mention that their hypothyroid patients had elevated or normal TSH before mentioning symptom frequency.

What is lacking is a correlation between symptom frequency and the instrumental finding itself.

What is the utility of this?

Terminology

We asked previously whether we can determine how specific a symptom such as dysphagia is to a single thyroid nodule.

Profiling patient presentations with the characteristics of their thyroid

Another particularly interesting finding was the widespread use of the term “compressive symptoms” that was reported separately from “voice symptoms” (4, 5). The implication that voice

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voice symptoms are discrete from compressive symptoms is misleading as dysphonia can be the result of both compressive (goitre compressing laryngeal nerves) and non-compressive (hypothyroidism causing fluid accumulation in lamina propria of vocal folds) processes (6). This categorisation, then, conveys a false picture of the underlying pathophysiology behind reported symptoms.

Stay tuned!

What do I want to do about this?

I aim to complete a systematic review on this topic to gain a full picture of what the available literature tells us about thyroid disease symptomatology. It will likely serve as a call for more comprehensive reporting of pre-operative characteristics so that a relationship between thyroid disease structure and symptoms can be better explored. During the course of my BMedSc (Hons) year, I intend to collect retrospective – and potentially prospective – data with these variables in mind, not only better describe this relationship but also to allow its findings to inform the development of the aforementioned questionnaire.

What it boils down to (like most things in research)….we need more data!

This article by Vikash is the first in a new series from the Medical Research Students Society featured in "Research Corner" Viikash Yogaraj is currently undertaking a BMedSc (Hons) year. He is also the Education Officer for the Medical Research Students Society.

References 1.

Iyer, N. G., & Shaha, A. R. Management of thyroid nodules and surgery for differentiated thyroid cancer: Clinical oncology (Royal College of Radiologists (Great Britain)). 2010;22(6), 405–412.

2.

Boateng, G. O., Neilands, T. B., Frongillo, E. A., Melgar-Quiñonez, H. R., & Young, S. L. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer.

Frontiers in public health, 6, 2018;149.

3. Pradeep PV, Agarwal A, Baxi M, Agarwal G, Gupta SK, Mishra SK. Safety and efficacy of surgical management of hyperthyroidism: 15-year experience from a tertiary care center in a developing country. World J Surg. 2007;31(2):306-12 4.

Rodrigues MG, Araujo VJF Filho, Matos LL, Hojaij FC, Simões CA, Araujo VJF Neto, Ramos DM, Mahmoud RL, Mosca LM, Manta GB, Volpi EM, Brandão LG, Cernea CR. Substernal goiter and laryngopharyngeal reflux. Arch Endocrinol Metab. 2017;61(4):348-353.

5.

Singh Ospina N, Maraka S, Espinosa de Ycaza AE, Brito JP, Castro MR, Morris JC, Montori VM. Prognosis of patients with benign thyroid nodules: a population-based study. Endocrine. 2016;54(1) 6.

Junuzović-Žunić, L., Ibrahimagić, A., & Altumbabić, S. (2019). Voice Characteristics in Patients with Thyroid Disorders. The Eurasian journal of medicine. 2019;51(2), 101–105.

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PARADISE LOST: The demise of the John Flynn Placement Program

Words by Jasmine Elliott With contributions from Andrea Li Ruxi Geng Amber May

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Photograph by Ruxi Geng

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THE EMAIL LANDS IN YOUR INBOX. Finally, “Congratulations! We wish to offer you a place in the John Flynn Placement Program (JFPP) cohort."

My placements were consistently cancelled due to COVID.

"The JFPP will allow you to experience life and clinical practice as a rural doctor.”

In 2021, the Federal Government redirected funding from JFPP. The students who received the “Congratulations!” in 2020, would be the last students to receive that email.

Excitement bursts inside you as you anxiously await the details of your mentor. Where will you be going? What will you be seeing? In my second year, my application was successful for JFPP, and I was paired with a lovely rural generalist in Leongatha.

But I’m not the only person who’s missing out.

They would also be the last students to participate in one of the most life changing rural health programs for medical students.

Coming from Albury/Wodonga, I already had an interest in rural practice when I started my degree. However, JFPP has cemented that interest and provided me with invaluable learning opportunities typically unavailable to medical students. For example, in my second placement, I was allowed to perform an excision biopsy under supervision. This placement was at the start of my third year at university, where most students had only learnt about this procedure and the lucky ones had observed one. Whereas I’d had first-hand experience of doing one myself!

I am currently on the last of my 8-week JFPP program completed over four years. I am placed in Cunnamulla, an outback town located in south-west Queensland. Toowoomba, the closest city people usually know of, is a seven-hour drive away. There are at most two doctors working in the town who cover both the hospital and the GP clinic. Without the assistance provided by JFPP, I could never dream of coming to Cunnamulla for placement. The doctors that I have met throughout my placements have inspired me to apply for the Rural Generalist Pathway after I graduate. It would be a dream to achieve a lifestyle like the snapshots I have experienced.

Andrea Li, Year 5D, Cunnamulla I spent a total of four weeks away for my JFPP placement in Palm Cove, a coastal village near Cairns, with one GP for the whole suburb, which I was placed at. My supervisor had been an OBS/GYN and ED physician, and was a wealth of knowledge and experience in addition to being fantastic with her patients.

During clinic days the patients I saw varied from local residents, most having seen the GP for years, to tourists and holiday makers, often with a wide variety of backgrounds. Wednesdays are set aside for surgery, when lesions and cancers are removed, seemingly endlessly, and it’s no wonder why when the far North QLD beaches are so tempting. But the days go fast, especially when I’m able to assist and help suture.

The two weeks feels like no time at all. I’m thankful I was able to experience practice in a regional area for my JFPP placement, but I wish I was able to do more. Programs like the JFPP are able to give medical students like us a personal experience of the issues of healthcare access, and it's been incredibly influential in my decision to practice rurally in the future.

Ruxi Geng, Year 5D, Palm Cove

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I’ve looked up to Dr Sara’s work in Mallacoota with lifestyle medicine and bushfire recovery ever since she came to speak during my first year of medicine. When I was accepted into JFPP, I contacted Dr Sara and she became my mentor. Placement at Mallacoota clinic covered a broad scope including minor trauma, motivational interviewing, patient consults and nurse-managed face wounds and ECGs. Rural communities can be friendly and welcoming, and Mallacoota was no exception.

People would wave and greet me on my morning walks to the beach and the local bushwalking group even invited me on a hike to Shipwreck Bay. I was also able to take part in the local radio show, student art exhibition and bushfire recovery activities.

Dr Sara and her family involved me in their snorkeling, surfing and horse-riding. From my 8 weeks across 4 years, I learnt that doctors can have vibrant and exciting lives while balancing the responsibility of working in a rural town.

Amber May, Year 5D, Mallacoota

JFPP BEGAN IN 1997, providing thousands of students each year with short-term rural placement opportunities. JFPP wasn’t just a “short-term rural placement,” it was an unmatched opportunity for students to be immersed in a rural community, across the course of their degree. The funding of placements, and their short-term nature made rural health exposure accessible to students unable to partake in university-based rural placement, which is often costly or requires significant time away from support.

Unfortunately, the JFPP is in the same boat as many other rural health strategies - limited data was collected. This meant that although it’s anecdotally been influential in the lives of thousands of students (and now rural doctors), we don’t have the numbers to back it. For federal funding, numbers are crucial.

A significant portion of the evaluation of rural clinical school (RCS) programs is numbers. The percentage of students doing 6 week placements, the percentage of students doing 1+ year of placement, the research output… it’s endless.

mentorship from a rural clinician? More closely at minimising the barriers to rural placement?

More closely at the outer rural and remote communities and being directly linked in with support while you’re there?

A REPORT WE WROTE IN THE AMSA RURAL HEALTH COMMITTEE surveyed students and analysed some of these factors. We also looked at that “tick box” - career intention. 80% of students and junior doctors believed JFPP played a significant role in their decision to practice rurally. 65% thought the same about their university rural placements.

Perhaps we’ll never see the rebirth of JFPP for medical students. But if we don’t, we know there’s a gap to fill. I hope that one day the “JFPP magic” is part of the student experience again.

Jasmine Elliott is a final year student currently placed at Bendigo in Victoria's North-West. In 2021 she was the Chair of the AMSA Rural Health Committee.

Time at an RCS might be more cost-effective in terms of ticking the boxes. But is ticking the box enough? Is physically completing a rotation in a rural area what encourages students to fall in love and return?

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"VICIOUS CYCLE" A poem.

Written by Savannah Mandakini Start Day 1 Seems like fun End of the week Already I’m weak There’s 5. new. assignments.

Too chilled out to bother now I’mma waste my time even though There’s now only 5 more weeks to go Oops, I forgot that I gotta study For exams, but it’s not the right moment yet Gotta plan it out – oh my! There’s 2 more weeks left

I’m crying now – cannot sleep; my empty brain cells seep Up the stress instead of this medical content mayhem

“Friend, please make sure I don’t repeat this cycle again” Yet I keep going back to self-destructive habits

I keep going back to the Start Savannah Mandakini is a student in Year 3B. In 2021 she was the preclinical representative for Community and Wellbeing 16 The Auricle January-February 2022

THERE ARE FEWER THAN 50 PEOPLE across the globe known to possess an exceptionally rare blood type known as Rhnull1.

What is this blood type? We are commonly taught that there are eight groups – A, B, AB, and O, each accompanied by either a ‘positive’ or ‘negative’ symbol representing the RhD antigen.

But as in all things medicine, it is rarely as simple as we are taught in second-year haematology.

The A, B, AB, O and RhD antigens are only a handful of the many hundreds that are commonly expressed on human red blood cells, and thus they give rise to millions of potential blood types based on an individual’s unique combination. The Rhesus system, which contains 49 of these antigens, is arguably the most important. People with the Rhnull blood group possess none of these 49 antigens2.

Right: Karl Landsteiner’s experiments in 1901 involved the mixing of red blood cells and sera samples from himself and his colleagues3.

THE HISTORY OF BLOOD TRANSFUSION has been long, and bloody. In the late 19th and early 20th centuries, patients were subjected to dangerous and unpredictable transfusions. Animals were quickly outlawed as blood donors after many patients died during procedures by British physician Richard Lower1. But mysteriously, physicians in the late 19th and early 20th centuries still found that many patients were dying after transfusions with human blood.

It was in 1909 that the ABO system was described by Austrian physician Karl Landsteiner, a discovery that won him the 1930 Nobel Prize for Medicine3. Landsteiner built on previous knowledge that transfusing blood between animals sometimes led to “clumping” or agglutination. He hypothesised that a similar phenomenon could be causing the mysterious deaths of large numbers of human patients undergoing transfusion. By taking the blood of 5 healthy fellow scientists and himself, Landsteiner realised that some of the samples agglutinated when the red cells and sera were mixed, and some did not.

Landsteiner then classified the ABO system based on the presence or absence of two main types of antigens on the surface of red blood cells (A and B) and two types of antibodies (Anti-A and Anti-B). Landsteiner himself belonged to Group O, as he lacked both the A and the B antigens.

BUT WHAT OF THE OTHER COMPONENT of blood types, the ‘negative’ or ‘positive’ that denotes the Rhesus-D antigen?

By the 1940s, blood banks were proliferating, and many thousands of transfusions were occurring daily4. This was a mostly successful system, but doctors were noticing a persistent incidence of intra-group transfusion reactions.

If the same ABO blood type was transfused from donor to recipient, why were reactions still occurring? In 1940 Karl Landsteiner and A.S Weiner discovered the Rhesus factor5.

This was an extra antibody that was highly immunogenic and was able to explain the previously mysterious transfusion-related deaths.

INTERESTING FACT The Rhesus system was originally named after the Rhesus monkey. It was thought that the antibody that commonly caused reactions (RhD) was the same as an antibody that had been found in this species of monkey. However, research later found that the RhD antibody is distinctly different from those in the monkeys, but the name had already caught on! Now, the system is referred to simply as “Rh” to avoid confusion.

So, what about Golden Blood?

When we say that someone has a negative or positive blood group, this refers to the RhD antigen. The ABO system combined with an indication of RhD status is sufficient in safely

managing transfusion between the vast majority of patients.

However, RhD is only one of 49 antibodies in the Rhesus system, a group primarily encoded by the RHD and RHAG gene6. The RHAG gene codes the Rh-associated glycoprotein.

The most common Rh antigens include D, C, E, c and e7.

“Golden blood” refers to the special group of people who lack all 49 of the Rhesus antigens, a blood type known as Rhnull. It was first discovered in an Australian Indigenous woman8.

A blessing or a curse?

One of the benefits of the Rhnull blood type is that it is considered to a “universal donor”, especially those who also possess the ABO group O. As it lacks the antibodies which commonly cause transfusion reactions, it is an incredibly valuable resource.

The flip side of the rarity of this blood group is that people with Rhnull blood can only receive transfusions from others with Rhnull.

Receiving blood from someone who has any of the other Rhesus antigens might cause a serious transfusion reaction due to the reaction with their own antibodies. With a network of only 9 known regular blood donors from this group, it means these patients depend on an incredibly valuable and scarce resource9. Some patients are encouraged to donate blood and freeze it should they require a transfusion in the future.

Additionally, the genetic mutations that cause a Rhnull blood type are also associated with a morphological defect called hereditary stomatocytosis. This causes a long-term, but mild, haemolytic anaemia7.

THERE IS ONE IMPORTANT QUESTION that stands out: if there are 49 Rh antigens, and thousands of combinations of blood groups, how come we only commonly record RhD? And why aren’t transfusion reactions happening every day due to the incompatibility of the other 48?

The answer is that the RhD antigen is highly immunogenic, meaning that if a person with a negative blood group is exposed to a positive blood group, they will always develop antibodies and attack the donated cells. The other Rh antibodies are less common, and less immunogenic, meaning that it’s less likely to cause problems in the case of incompatibility.

Rhnull is exceptionally rare, and it’s more than likely that most of us will never encounter it in our medical careers, even if we specialise in haematology. However, it’s a fascinating

INTERESTING FACT This article examines the role of the Rhesus system, a collection of 49 antibodies present on the surface of red blood cells. However, there are actually more than 30 other systems of antibodies which collectively contain hundreds of individual antibodies10! Some of these include Kell, Kidd, MND, and Duffy. Of these, the Rhesus system (and specifically RhD) is the most immunogenic, meaning it’s the most likely to cause reactions if transfused incorrectly.

example of how complex blood is, and that there are many more layers of complexity than we are led to believe.

Lachlan Coman is the Co-Editor of The Auricle and a Master of Public Health student. He has a special interest in haematology.

References 1. Golden Blood: The rarest blood type in the world [internet]. BigThink; 2018 Oct 7 [updated 2022 Jan 17], available from https://bigthink.com/health/golden-blood/ 2. Pablo Méndez and David Nelson. What is ‘Golden Blood’, the incredibly rare blood type known as Rhnull [internet]. Madrid: AS; 2022 Jan 20, available from https://en.as.com/en/2022/01/21/latest_news/1642730650_264778.html 3. Schwarz HP, Dorner F. Karl Landsteiner and his major contributions to haematology. BJHaem. 2003 May 16;121(4):556-565 4. History of Blood Banking [internet]. Dayton, OH: Blood Community Centre; 2022. Available from https://givingblood.org/about-blood/history-of-blood-banking.aspx 5. Rh Blood Group System [internet]. Encyclopaedia Britannica. Available from: https://www.britannica.com/science/Rh-blood-group-system 6. Suto Y, Ishikawa Y, Hyodo H, Uchikawa M, Juji T. Gene organization and rearrangements at the human Rhesus blood group locus revealed by fiber-FISH analysis. Hum Genet. 2000 Feb;106(2):164-71 7. Dhanorka A. What is the Golden Blood Type? [internet] MedicineNet; 2022 Feb 3. Available from https://www.medicinenet.com/what_is_the_golden_blood_type/article.htm 8. Grabowska K. Rhnull: The ‘Golden Blood’ Type [internet]. The University of Melbourne [internet]. Melbourne (AU): 2020 Sep 8. Available from https://blogs.unimelb.edu.au/sciencecommunication/2020/09/08/rhnull-the-goldenblood-type/ 9. Faletto J. Rhnull, the rarest blood type on earth , has been called the “golden blood” [internet]. Discovery. 2019 Aug 1. Available from https://www.discovery.com/science/Rhnull-Rarest-Blood-Type-on-Earth 10. Rare Blood Types [internet]. Australian Academy of Science. Available from https://www.science.org.au/curious/people-medicine/rare-blood-types

THE CROSSWORD

by LC Answers on next page.

ACROSS 7 navel (8) 8 -lytics, a drug class used to slow labour (4) 10 a triad of hypersensitivity reactions (6) 11 a degenerative disease characterised by memory loss and personality change (8) 12 palms down (8) 15 relating to vision (6) 17 region of the thorax (11) 21 a hair-like organelle (6) 22 membrane of the outer and middle ear (8) 24 absence of a major filtration organ (8) 27 PO (6) 29 major cardiac operation (abbr.) (4) 30 ___ disease – adrenal insufficiency (8) DOWN 1 banes of any critical care doctor, determining work hours (7)

2 3 4 5 6 9 13 14 16 18 19 20 23 25 26 28

common treatment for sleep apnoea (abbr.) (4) influential English medical journal (6) umbilical ___ (4) may be ventral or dorsal (4) method of administering medication (7) types include air, fat, and thrombo- (6) spidery liver disease effects (5) lose oxygen concentration (abbr.) (5) structure arising from the soft palate (5) system to which leukocytes belong (6) what one would do in an anatomy lab (7) treat those with CRF (7) ocular affliction associated with opioids one of four sections of the liver (4) potentially fatal complication of human immunodeficiency virus infection (4) part of a nerve cell (4)

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Crossword answers

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2 April - 31 May

YOU'RE INVITED! Join #TeamMonash in the

2022 Vampire Cup The Vampire Cup is the annual blood donation competition between all Australian medical schools. Anyone's invited to join the Monash team, including you!

How can you help?

Sign in or sign up on the Lifeblood app Join our team: Monash University Medical Undergraduates Society (MUMUS) Donate as many times as you can (maximum 5) during the competition window of 2 April - 31 May!

Join our Facebook group (Monash AMSA Vampire Cup 2022) for more info!

Donate for MUMUS and go in the running to win dozens of prizes!