18 March 2025 (Tuesday) - Westgard QC Update

The Westgard QC update arrived in my in-box this morning. It was rather hard-going, but it usually is. But it’s stuff which is (usually) pretty much directly applicable to what I do on a daily basis.

Here’s a warning about warnings… makes you think, doesn’t it?

16 March 2025 (Sunday) - Slide Saturday Challenge

Slide Saturday Challenge – target cells.  These form when there's an increased surface area to volume ratio in red blood cells leading to a distinctive "bullseye" appearance.

This is often seen in liver disease, iron deficiency and haemoglobinopathies; particularly thalassemias, and HbC and E.

14 March 2025 (Friday) - BTLP-TACT Exercise

I’m at something of a loose end, so why not do another BTLP-TACT exercise? I was presented with one case – an eighty-three year-old woman in theatre needing group & save.

She grouped as O Rh(D) Positive with antibody screen positive in cells 2 & 3.

I requested antibody panels.

The IAT and enzyme panels were positive in cells 1, 3, 4, 6 and 7 which corresponded with anti Jk(a)

 

I got it right. That’s four this month (and it is only the 14^th). I checked my performance dashboard; all is in the green.

So why am I still getting emails badgering me about “need to complete further TACT participations to improve your engagement target with the system”?

13 March 2025 (Thursday) - ASH Update

The nice people at the American Society of Hematology sent their update today. You can read it by clicking here. Much of it went over my head, but some of it made sense, some of it was a useful update, and something for nothing is always a bargain.

11 March 2025 (Tuesday) - NEQAS 2501DM

I got the results of NEQAS 2501DM today.

 

“You are asked your opinion of this blood film that was prepared from a 64-year old female who had attended her GP complaining of tiredness. The automated analyser had reported a lymphocytosis with a flag indicating the possible presence of blast cells”.

 

I saw

 

Rbc

 

Rouleaux

 

Wbc

 

Lymphocytes with blebbing

Lymmphocytes with Burkett-like vacuoles

Smear cells

Blast cells

Dysplastic neutrophils

Toxic granulation

 

Plt

 

Giant platelets

 

I felt this was something lymphoproliferative.

 

The expert opinion said ”The abnormal cells are variable. However, most cells have a mature appearance, and the preservation of neutrophil and platelet numbers makes a diagnosis of acute leukaemia less likely. Furthermore, the overall nuclear and cytoplasmic features are not typical of either circulating blast cells. Making a morphological diagnosis of MCL can be difficult and we can rarely (if ever) be confident of the diagnosis using morphology alone. However, MCL is a potentially aggressive disorder, so it is important not to simply report the appearances as reactive. Features to look for include – marked variability between malignant cells with some cells looking quite mature and others more aggressive; a variable but often abundant and basophilic cytoplasm; and nuclear complexity, classically indented but often quite variable. Confirmation can then be made using marker studies and molecular testing.”

 

Which (quite frankly) means that I’d spotted the salient features and gone about as far as I could with a microscope. I’ll take that as a success.

11 March 2025 (Tuesday) - e-learning

Today I was tasked with supervising one of the trainees… well, not so much supervising as being there if he needed me. As he cracked on (very competently) I took the opportunity to catch up on my e-learning. I got quite a bit done:

 

• Sexual misconduct in the Workplace
• Resus training
• NHS Counter Fraud, Bribery and Corruption Training
• Equality & diversity

 

I got 100% on sexual misconduct in the Workplace… is that good or bad?

10 March 2025 (Monday) - BTLP-TACT Exercise

Well.. I’ve done six exercises in the last month and still I’m getting emails saying that I need to “improve my engagement target” even though when I call up my participation history all is in the green.

But… here goes again.

I was presented with two cases:

58214 – a forty-five year old woman in the ante-natal clinic needing group and save. The label on her blood sample was blank. I rejected it. That might have come from absolutely anyone.

65191 – a thirty-one year-old woman requiring group and save prior to a splenectomy. She grouped as O Rh(D) Positive with a negative antibody screen.

 

I got the thumbs-up.