15 March 2026 (Sunday) - I Disagree...

 Well… I wouldn’t have said that was hypersegmented. I would have said that was a botryoid neutrophil.
I think the take-home message here is not to judge on the strength of just one cell…

12 March 2026 (Thursday) - BTLP-TACT

Well I’ve made a few mistakes with the BTLP-TACT recently, so let’s try again…

It presented me with two cases:

 

22286 – a ninety-six year-old chap with bleeding varices needing four units of FFP. He grouped s A Rh(D) Positive with a negative antibody screen.

However FFP is NOT recommended for bleeding varices so I didn’t issue any.

 

 

26881 – a fifty-one year-old chap in ITU needing two units of blood. He also grouped as A Rh(D) Positive with a negative antibody screen.

I issued two units of A Rh(D) Positive blood

 

I got the thumbs-up. Bearing in mind I’ve had the thumbs-down for three of the last four I saw that as something of a result.

 

10 March 2026 (Tuesday) - The RDW

Here’s something I found randomly on my Facebook feed – a rather useful little dissertation on a much-overlooked blood count parameter; the RDW.

 

9 March 2026 (Monday) - NEQAS 2601DM

 

I got the results of 2601DM this morning. I did it a month ago when I was presented with an image of a blood film and this statement:

 

“A 60-year-old man had commenced treatment for a serious haematological disorder. His white cell count was raised, and platelet count reduced. He then became increasingly anaemic with changed blood film features. You are asked for your opinion. The film arrives outside of normal hours”

 

In my notes I wrote “Well, there’s a bit of everything in this film, isn’t there. The red cells show echinocytes, microspherocytes, blister cells, nucleated red cells, Howell Jolly bodies, rec cell fragments.

The white cells are a bit of a disaster – cerebriform/flower type lymphocytes, toxic granulation, vacuoles in monocytes and neutrophils, smear cells, target cells, pyknotic neutrophils, eosinophilia. 

The platelet appeared reduced, but we were told that anyway.

 

I didn’t fiddle about trying to get the observations in order… time was pressing.

As this arrived out of normal hours I would put it for the consultant to review in the morning… they don’t thank us for being bothered about this sort of thing… this sort of thing being a patient of which they are already well aware”.

 

The expert opinion was rather odd… it waxed on as it so often does but seemed to completely overlook the fact that this was in a patient with a known haematological condition.

But I spotted that which needed spotting and made the right decision

8 March 2026 (Sunday) - Crigler-Naijar Syndrome

Crigler-Najjar syndrome? No – I’d never heard of it either. Here’s a little write-up on the subject. As I always say, a day when you learn nothing is a day wasted.

 

8 March 2026 (Sunday) - Neutrophil Clumping

 I have seen this... but it's not common.

7 March 2026 (Saturday) - BTLP-TACT Exercise

I had a go at the BTLP-TACT thingy today. It presented me with one case – a twenty-nine year-old woman in theatre having an above-knee amputation and needing two units of blood.

She grouped as O Rh(D) Positive with antibody screen positive in all three cells. I requested antibody panels.

The IAT panel was positive in cells 1, 2, 3, 5, 6, 7, 9 and 10 corresponding with anti-S and anti-Fy(a) but not excluding anti-K.

The enzyme panel was negative throughout which excluded quite a bit..

 

I selected two units of O Rh(D) Positive S-negative Fy(a)-negative K-negative

 

I got the thumbs-down. Apparently there was a clinically significant antibody masked but not noted. I’d love to know what it was.

This is a major failing of the BTLP-TACT simulator. You can’t learn anything from your mistakes.