22 December 2025 (Monday) - BTLP-TACT Exercise

I had hoped for a Learning Monday thingy today, but clearly they’ve packed up for the holidays. I did a morphology quiz instead, and then did another BTLP-TACT exercise.

 

I was presented with one case – a forty-three year-old woman in the ante-natal clinic needing group and antibody screen.

She grouped as A Rh(D) Positive with a negative antibody screen

 

I got it right.

22 December 2025 (Monday) - Morphology Quiz

 

I had hoped for a Learning Monday thingy today, but clearly they’ve packed up for the holidays. I did a morphology quiz instead…

21 December 2025 (Sunday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with two cases:

 

40635 – a ninety-three year-old woman who having had a CVA needed group and save.She grouped as O Rh(D) Positive with a negative antibody screen.

87793 – a nine month old child with epistaxis also needing group and save.He grouped as A Rh(D) Positive, albeit with weak reaction in the anti-D. I called that indeterminate as that’s what the software wanted last time.

He too had a negative antibody screen

 

I got it right

19 December 2025 (Friday) - Unexpected Thrombocytopenia

Temozolomide is a drug commonly used to treat brain tumours. One of it’s less common side effects is that it can cause thrombocytopenia.

Which would explain why a patient’s platelet count dropped massively…

17 December 2025 (Wednesday) - Westgard QC Update

 

The nice people at Westgard QG sent their update today. You can read it by clicking here. As always it is rather heavy going, but one article made me think. A range of haematology analysers that are quite popular in the far east have been shown to have “significant imprecision problems”. You automatically assume that the manufacturers have sorted this sort of thing don’t you?

No?

Well I do…

16 December 2025 (Tuesday) - On-Line Morphology Quiz

Being at a loose end I did an on-line morphology quiz.
I got full marks…

16 December 2025 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise… I’ve had an email telling me I’m not doing enough…

I was presented with two cases:

 

64442 – a thirty-eight year-old woman with a fractured femur needing two units of blood.

She grouped as O Rh(D) Positive with a negative antibody screen. I selected two units of O Rh(D) Positive K negative blood

 

33268 – a thirty-one year-old woman in A&E needing six units of blood for a ruptured ectopic pregnancy.

She grouped as A Rh(D) Positive with a negative antibody screen. I selected six units of A Rh(D) Positive K negative blood

 

I got the thumbs-up.

 

15 December 2025 (Monday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. Prevention of PPH, massive transfusions following trauma, tranexamic acid (again)…

Again too much to take in at one stiing…

TOP ARTICLE 2025

Mitapivat in adults with non-transfusion-dependent α-thalassaemia or β-thalassaemia (ENERGIZE): a phase 3, international, randomised, double-blind, placebo-controlled trial.
Taher, A.T., et al. (2025). Lancet.
PICO SUMMARY

 

Selected articles

Prophylactic strategies for prevention of postpartum haemorrhage in caesarean delivery: a systematic review and Bayesian network meta-analysis of randomised controlled trials. Amaral, S., et al. (2025). The Lancet. Global Health.

Blood transfusion strategies for major bleeding in trauma.
Brunskill, S.J., et al. (2025). The Cochrane Database of Systematic Reviews.

Long-term transfusion independence with luspatercept versus epoetin alfa in erythropoiesis-stimulating agent-naive, lower-risk myelodysplastic syndromes in the COMMANDS trial.
Garcia-Manero, G., et al. (2025). Advances in Therapy.

Safety and efficacy of rilzabrutinib vs placebo in adults with immune thrombocytopenia: the phase 3 LUNA3 study.
Kuter, D.J., et al. (2025). Blood.

Rice-derived recombinant human serum albumin as an alternative to human plasma for patients with decompensated liver cirrhosis: a randomised, double-blind, positive-controlled and non-inferiority trial.
Niu, J., et al. (2025). Gut.

Darbepoetin alfa to reduce transfusion episodes in infants with haemolytic disease of the fetus and newborn who are treated with intrauterine transfusions in the Netherlands: an open-label, single-centre, phase 2, randomised, controlled trial.
Ree, I.M.C., et al. (2023). The Lancet Haematology.

Tranexamic acid for preventing postpartum haemorrhage after vaginal birth.
Rohwer, C., et al. (2025). The Cochrane Database of Systematic Reviews.

Efficacy and safety of different treatments in chemotherapy-induced thrombocytopenia: a systematic review and network meta-analysis.
Yang, H., et al. (2025). Frontiers in Pharmacology.

Blood component therapy for dry eye disease: a systematic review and network meta-analysis.
Zhang, Y., et al. (2024). Frontiers in Medicine.

 

11 December 2025 (Thursday) - Schistocytes

11 December 2025 (Thursday) - BTLP-TACT Exercise

Having had another email about how I’m not doing enough BTLP-TACT exercises, I suppose I ought to do one…

 

I was presented with two cases:

18493 – a seventy-two year-old chap who is tired all the time who needs a group and save.  

He grouped as O Rh(D) Positive with a negative antibody screen.

08556 – an eighty-four year-old chap in A&E needing four units of blood for a GI bleed. 

He also grouped as O Rh(D) Positive but with antibody screen positive in cell 2. I performed antibody panels. The IAT and enzyme panels were positive in cells 3 and 5 corresponding with anti-E.

I issued four units of O Rh(D) Positive E-negative blood.

 

I got it right…

10 December 2025 (Wednesday) - Unexplained (?) Neutropenia

I had a case of unexpected neutropenia today. The given diagnosis was “MS on Lemtrada”.

Lemtrada is a brand name for alemtuzumab, a known side effect of which is neutropenia.

Rather than laying an egg and running screaming to the consultant, I didn’t end up setting off a totally unnecessary red alert.

Here’s an article on the matter.

I learned something today.

 

8 December 2025 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise.  I was given two cases:
 

14406 – a forty-nine year-old woman with a ruptured ectopic pregnancy needing six units of blood tomorrow (?).

She grouped as O Rh(D) Positive with a negative antibody screen. I selected six units of O Rh(D) Positive K Negative blood.

03592 – a thirty-two year-old woman in the ante-natal clinic needing group and save.

She grouped as O Rh(D) Positive with antibody screen positive in cell 2. I performed antibody panels. The enzyme and IAT panels were positive in cells 2 and 6 corresponding with anti-K

 
I got the green light.

8 December 2025 (Monday) - Learning Monday

It’s aplastic anaemia…
 
In hypocellular MDS you’d expect to see blasts in the bone marrow.
Mycobacterial infection doesn’t result in hypocellularity.
Haemophagocytosis wasn’t seen.
It’s not pure red cell aplasia as other cell lines are affected. 

7 December 2025 (Sunday) - Parvovirus

Parvovirus infection can seriously adversely affect erythropoiesis. I didn’t realise that. One lives and learns… through doing CPD.

Here’s an article on the matter.

7 December 2025 (Sunday) - Haptoglobin

A low haptoglobin is a good indicator of a haemolytic process…  Or so I always thought.
Perhaps not…

 

4 December 2025 (Thursday) - The Future...

The obvious way forward is to go back to how it was when I started. Don't expect people to run up massive debts in order to be able to do the job then pretend to be surprised when tehy go off and do some other job which pays better. Offer them the opportunity to get the qualifications as they work. Send them on day release (and pay for it too).

And find whoever it was who stopped the scheme which demonstrably worked and have a word with them...

 

3 December 2025 (Wednesday) - NEQAS 2507 BF

I got hold of the results of NEQAS 2507 BF today…

 

2507BF1

 

I wrote

 

Hypochromic (consensus 1^st)

Microcytic      (consensus 3^rd)

Pencil cells    (consensus 4^th)

Target cells   (consensus 2^nd)

Tear drop cells (consensus 6^th)

 

I wrote ?? Fe def. The expert opinion said “2507BF1 was the blood film from a 23-year-old woman with iron deficiency anaemia,”

 

 

25007BF2

 

Macrocytosis (consensus 4^th)

HJB

Tear drop cells (consensus 6^th)

Hypersegmented neut (consensus 1^st)

Low plts (consensus 3^rd)

 

I wrote ?? B12 def The expert opinion said “2507BF2 was the blood film from a 56-year-old man with nutritional megaloblastic anaemia”

 

I’ll take that…

 

3 December 2025 (Wednesday) - NEQAS 2504 PA

I got hold of the results of NEQAS 2504 PA today…

2504 PA1

This was “the thin blood film from a patient of unspecified age and sex and with an unknown travel history. It showed a heavy (2.1%) infestation with Plasmodium knowlesi malaria”.  

I wrote “P falciparum - rings, trophozoites & shizonts 5% parasitaemia”. I got the species wrong and overestimated the parasitaemia, but I spotted malaria.

2504 PA2

The expert opinion said “There were no parasites to see on this thick film” 

I wrote “Think it's negative. Saw one iffy thing”

 

I’ll take that…

3 December 2025 (Wednesday) - Westgard QC Update

The nice people at Wesgard QC sent out their newsletter today. You can read it by clicking here. Much of it was rather dry; much of it went over my head. But one article gave me a wry smile. A bit of a diatribe about how people are using QC terms to blag their way, safe in the knowledge that no one knows what they are talking about.

 

I’m not the only one who finds QC matters rather esoteric.

2 December 2025 (Tuesday) - Mild Neutropenia

People can be very quick to get incredibly over-excited about mild neutropenia. It can have several causes which don’t require massive over-reaction. Here’s one such:

2 December 2025 (Tuesday) - Fritsma Factor Newsletter

The Fritsma Factor newsletter appeared in my in-box today. You can see it by clicking here. This month there was quite a bit more than there usually is, Underfilled samples, anticoagulation, the PT, haemophilia…

Loads of stuff.

 

2 December 2025 (Tuesday) - Exchange Transfusions

There’s a phrase that is in common use – “exchange transfusion”. It implies that you take out all of someone’s blood because it is in some way sub-standard and exchange it for “decent” stuff. But you can’t just hoik it all out before putting in the good stuff as that would be fatal. Similarly putting the good stuff in one arm whilst taking out the bad from the other will lead to a degree of mixing.

Here’s an article examining the logistics of how it might best be done…

1 December 2025 (Monday) - BTLP-TACT Exercise

Last month I did thirteen BTLP-TACT cases, and still I’m getting emails about not doing enough… so here we go.

I was presented with one case – an eleven year old girl in ITU with burns needing two units of blood.

 

She grouped as A Rh(D) Positive with a negative antibody screen. I selected two units of A Rh(D) Positive K-Negative blood

 

I got the thumbs-up.

1 December 2025 (Monday) - Learning Monday

I won’t lie. I don’t know. It’s AML. Back in the day we’d do a Sudan Black stain and that was good enough.  Things have massively changed in the understanding and diagnosis of leukaemia.

 

Here’s the answer:

 

“Correct answers are A and B. This case illustrates a discrepancy between the two AML classification systems and underscores the complexity of diagnosis in the presence of multiple genetic alterations. An integrated diagnostic approach, including flow cytometry, cytogenetics, and molecular genetics, is necessary to reach a final diagnosis. The patient would be classified as an AML with mutated TP53 according to ICC 2022 and as an AML myelodysplasia-related according to WHO 2022. In the ICC 2022 classification, AML with mutated TP53 is recognized as a separate entity, including Pure Erythroid Leukemia, if morphologic criteria for this entity are respected.  According to WHO 2022, 5q deletion is included in the cytogenetic abnormalities defining AML-MR.  In both systems, the diagnosis of AEL (WHO 2022) or PEL (ICC 2022) requires ≥30% immature erythroid cells (proerythroblasts) and a bone marrow with erythroid predominance (≥80% of cellularity). The case of this patient doesn't comply with the criteria of the >30% proerythroblasts (he does have 45% of erythropoiesis in the BM, but not 30% or proerythroblasts)”.

 

Here’s a link to an article on the matter from an expert panel. I’ll make the observation that it wasn’t that long ago that we were all far more knowledgeable on the matter as we used to do a lot of the testing in-house and not send it off to reference labs…

27 November 2025 (Thursday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I had one case – a ninety-three year old chap who was bleeding with liver disease who needed four units of FFP

 

He grouped as B Rh(D) Positive with a negative antibody screen.

FFP is recommended for bleeding with a liver disease so I issued four units of B Rh(D) Positive FFP

 

I got it right.

26 November 2025 (Wednesday) - Competency Assessments

With pretty much a full house at work with nearly everyone in I was at something of a loose end today, so I took the opportunity to update my competencies. Over the last couple of weeks I’ve been gathering specific evidences and toady I wrote up little exercises for performing and reporting

• Blood counts
• Coagulation investigations
• D-Dimer assays
• Fibrinogen assays
• Infectious mononucleosis testing

Back in the day the boss would just blithely announce that someone was competent, or they were not and leave them to it. But today I spent a little while concentrating my mind on some of what it is that I do at work and reviewing it with a colleague.

I found it surprisingly useful…

26 November 2025 (Wednesday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today… Does it matter what ABO group of platelets you give someone? Transfusions and brain injuries, for the first time in a long time tranexamic acid wasn’t mentioned…

 ARTICLE OF THE MONTH

The effect of intravenous iron supplementation compared to oral iron supplementation during pregnancy on neonatal outcomes-a systematic review of randomized controlled trials.
Kuitunen, I., et al. (2025). European Journal of Pediatrics.
PICO SUMMARY

 

 

TOP ARTICLES

ABO matching for platelet transfusions for prevention or treatment of bleeding: a systematic review with meta-analysis.
Cain, L., et al. (2025). Transfusion Medicine Reviews. [Record in progress].

Clinical prediction models for postoperative blood transfusion after total knee arthroplasty: a systematic review and meta-analysis.
Chen, J., et al. (2025). BMC Musculoskeletal Disorders.

One versus five days of octreotide infusion for acute esophageal variceal bleeding: a randomized controlled trial.
Chirapongsathorn, S., et al. (2025). The American Journal of Gastroenterology. [Record in progress].

Rapid update and revision of: thromboelastography or rotational thromboelastometry guided algorithms in bleeding patients-an updated systematic review with meta-analysis and trial sequential analysis.
Kvisselgaard, A.D., et al. (2025). Acta Anaesthesiologica Scandinavica.

Restrictive transfusion in acute brain injury: a meta-analysis of randomized clinical trials.
Machado, M.F., et al. (2025). Journal of Critical Care. [Record in progress].  

Immunoglobulin for myasthenia gravis.
Manolopoulos, A., et al. (2025). The Cochrane Database of Systematic Reviews.

BiZact versus cold steel for post-tonsillectomy hemorrhage: a multicenter randomized trial.
M lhave, M., et al. (2025). European Archives of Oto-rhino-laryngology. [Record in progress].

Transfusion of amustaline/glutathione pathogen-reduced red blood cells in cardiac surgery: a randomized phase 3 clinical trial.
Sekela, M.E., et al. (2025). Anesthesiology. 

A pilot experimental study of cold-chain management, haemolysis and oxidative stress of packed red blood cells in early blood transfusion: toward a blood viability model in the out-of-hospital setting.
Zeenat, A., et al. (2025). Scientific Reports.

 

25 November 2025 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. 

I had one case – a sixty-four year-old woman needing group and save.

She grouped as A Rh(D) Positive with a negative antibody screen. 

I got it right…  so flushed with success I tried again. This time I was presented with a fifty-year-old chap needing two units of blood for TURP. He too grouped as A Rh(D) Positive but with an antibody screen positive in cell 2.

I performed antibody panels.

The enzyme and IAT panels were positive in cells 2 and 6 corresponding with anti-K.

I selected two units of A Rh(D) Positive K-negative blood.

I got that right too.

 
Whilst I was logged in I had a look at the performance dashboard. I am currently at over double the rate of performance it thinks I should be… I wonder how long it will be before I get another email telling me I’m not doing enough. 

 

24 November 2025 (Monday) - Frozen Platelets (!)

One criticism which is often levelled at me is that I am too flippant. Perhaps I appear that way when I tell the trainees that the golden rule of blood transfusion is “don’t kill anyone”. But as golden rules go, in my considered professional opinion I think it’s a good one. One way of not killing anyone was to make sure that platelets are stored at room temperature (between twenty and twenty-four degrees Celsius) and gently agitated. And to make sure they didn’t get cold.

Now not only is it being suggested that they might be kept in the fridge, but that they might even be kept frozen prior to use.

 

If there’s one thing I’ve found in blood transfusion is that opinion changes. What used to be absolutely a no-no becomes a possibility, and then is standard practice. 

 

23 November 2025 (Sunday) - BTLP-TACT Exercise

It’s pouring hard with rain and I’ve half an hour before I have to go to the late shift… so I might as well do a BTLP-TACT exercise, mightn’t I?

I was given two cases:

 

40336 – a seventy-five year old chap who had been over-anticoagulated who needed a group and save.

He grouped as O Rh(D) Positive with a negative antibody screen.

 

02559 – a forty-two year-old woman in the ante-natal clinic also needing group and save.

She grouped as AB Rh(D) Negative with a negative antibody screen

 

I got it right.