7 April 2025 (Monday) - BTLP-TACT Exercise

I did five BTLP-TACT exercises last month but it is still sending me emails telling me I’m not doing enough… so here’s another one.

 

I had one case – a ninety-two year-old chap in the out patient clinic needing two units of blood. He grouped as A Rh(D) Positive with a negative antibody screen. I selected two units of blood.

There was mention on the form about plasma for the following day, but no box was ticked, no amount specified… It seemed I was right not to act on that.

6 April 2025 (Sunday) - Slide Saturday Challenge

Red cell autoagglutination. Caused by IgM autoantibodies occurring in autoimmune haemolytic anaemia or can be secondary to viral infections.

Aggravated by relatively cold temperatures, the best way to get a reliable blood count is to warm the blood sample prior to analysis.

A very good way to enhance the auto agglutination is to position the blood count analyser directly below the air-con outlet whilst rudely pooh-poohing what you are being told, and then pretending to be surprised when cold agglutinins becomes a serious issue when you can’t get a sensible result no matter how much you warm the sample….

Speaking totally hypothetically of course…

4 April 2025 (Friday) - e-learning

I did some e-learning today

• Health Safety & Welfare
• Non Clinical Moving & Handling E-learning
• Safeguarding Children and Adults Level 1 Non Clinical E-learning

Bearing in mind how my back aches, the moving and handling was useful.

2 April 2025 (Wednesday) - NEQAS 2502 BF

I got hold of the results of 2502 BF today.

 

I said:

 

2502BF1

 

Lymphocytosis   (consensus 3^rd)

Bi-lobed lymphocytes (consensus 7^th)

Smear cells (consensus 1^st)

Neutropenia (consensus 5^th)

Thrombocytopenia (consensus 4th)

 

I thought this was a lymphoproliferative condition. It was CLL

 

2502BF2

 

Neutropenia (consensus 3^rd)

Reactive/atypical lymphocytes (consensus 2^nd)

Smear cells (consensus 9^th)

 

I thought this was a lymphoproliferative condition. Apparently it was glandular fever… several of us sat down with one of the consultants and we were unanimous that it wasn’t.

Just goes to show you can’t rely on morphology alone.

2 April 2025 (Wednesday) - NEQAS 2501DF

I got hold of the results of 2501DF1 today

 

Neuts           1.7 (median 0.8) 

Lymphs       14.1 (median 16.1)

Monos          1.7  (median  1.0)

 

My neuts and lymphs were a tad high, but when you consider the 2sd range for neuts was 0 – 2.6 and for monos was 0 – 5, that’s not too bad really. I suppose this illustrates the variability in manual diff counting

 

31 March 2025 (Monday) - Transfusion Evidence Alert

The nice people at Transfusion Evidence Alert sent their update today. As usual there was a lot to take in, but if I take my time reading it, some of it might soak in…

ARTICLE OF THE MONTH

Liberal vs. restrictive transfusion strategies for acute brain injury: a systematic review and frequentist-Bayesian meta-analysis.
Blot, P.L., et al. (2025). Intensive Care Medicine.
PICO SUMMARY

 

 

TOP ARTICLES

Effect of early administration of fibrinogen replacement therapy in traumatic haemorrhage: a systematic review and meta-analysis of randomised controlled trials with narrative synthesis of observational studies.
Burt, T., et al. (2025). Critical Care.

Which is the best storage temperature to preserve the haemostatic quality of non-leukoreduced whole blood units collected under a military emergency protocol - cold or room temperature?
Degueldre, J., et al. (2025). Transfusion Clinique et Biologique. [Record in progress].

Single dose intravenous iron versus oral iron for treatment of maternal iron deficiency anemia: a randomized clinical trial.
Derman, R.J., et al. (2025). American Journal of Obstetrics and Gynecology. [Record in progress].

Therapeutic plasma exchange accelerates immune cell recovery in severe COVID-19.
Guironnet-Paquet, A., et al. (2024). Frontiers in Immunology.

Direct antiglobulin test for the prediction of neonatal hyperbilirubinemia needing an intervention: a systematic review and diagnostic test accuracy meta-analysis.
Kumar Krishnegowda, V., et al. (2024). Frontiers in Pediatrics.

Enarodustat for the treatment of anemia in Chinese patients with non-dialysis chronic kidney disease: a phase 3 trial.
Liang, X.L., et al. (2025). Kidney Diseases.

Optimal dose and duration of iron supplementation for treating iron deficiency anaemia in children and adolescents: a systematic review and meta-analysis.
Rehman, T., et al. (2025). PLoS One.

Efficacy and safety of recombinant human thrombopoietin (rhTPO) on coagulation function and inflammatory factors in the treatment of patients with sepsis-related thrombocytopeni.
Wang, H., Chen, D., and He, M. (2025). Clinical and Applied Thrombosis/Hemostasis.

Transfusion of blood and blood products for the management of postpartum haemorrhage.
Williams, C.R., et al. (2025). The Cochrane Database of Systematic Reviews.

 

30 March 2025 (Sunday) - Slide Saturday Challenge

Spherocytes – a result of either a hereditary issue with the red cell membrane, or of membrane loss due to a haemolytic process.

I got it right… but not by guessing correctly.

 

I really should get off that high horse about “guessing”. I’m sure that whoever is writing these little exercises doesn’t mean that people should take pot luck in choosing an answer. They are giving me a useful bit of CPD for free… and all I can do is find fault with their choice of words. 

27 March 2025 (Thursday) - Another ASH Update

The nice people at the American Society of Hematology sent their update today. It is very clinical, and arguably not that relevant to what I do on a daily basis… but it is invaluable background reading.

 

26 March 2025 (Wednesday) - ASH Update

The latest update came in from ASH today. Much of it was clinical and went over my head, but…Arsenic to treat leukemia?  It would seem it works with nearly one hundred per cent success with relapsed acute promyelocytic leukemia.

23 March 2025 (Sunday) - BTLP-TACT Exercise

“er indoors ^TM” is asleep on the sofa. I’m a bit bored… time for a BTLP-TACT exercise. I was presented with one case – a sixty-seven year-old chap requiring group & save.

 

He grouped as O Rh(D) Positive with antibody screen positive in cells 1 and 3. I performed antibody panels.

The IAT panel was positive in cells 1, 3, 4, 6, 8 and 10. This corresponded with anti-s but didn’t exclude anti-Cw or anti-Kp(a). But the enzyme panel was negative in all cells which did exclude anti-Cw and anti-Kp(a)

 

I got the green light.

23 March 2025 (Sunday) - Not a Hairy Cell

ASH Education’s Slide Saturday Challenge was a giant platelet. It wasn’t a hairy cell as some of the people posting answers would arrogantly have had us believe. When the authors of the post asked “Did you guess correctly” they weren’t joking, were they?

It bothers me that there are those who post to these Facebook groups with such certainty but are completely wrong. It just goes to show that you really should be very careful about who you listen to on-line and who you should ignore.

21 March 2025 (Friday) - Reticulocytes

The nice people at Lablogatory sent their update today – some case studies based on reticulocyte scattergrams. In theory this sort of thing is an invaluable diagnostic tool. In practice the computer systems of most labs aren’t up to dealing with the graphical information the scattergrams provide.

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.

9 March 2025 (Sunday) - Slide Saturday Challenge

The nice people at the American Society of Hematology did another Slide Saturday Challenge. It’s a sickle cell.

But I’m not at all keen with their comment “did you guess correctly?”. This rather implies that they were expecting answers of target cell, keratocyte, blister cell, polychromasia, basophil, and pretty much everything you might find in the index of an atlas of haematology. To my mind there are two acceptable answers here.

• Sickle cell (or posh terms for the same)
• Don’t know

Perhps I’m being pedantic, but we really shouldn’t be encouraging people to guess. Perhaps the comment might be phrased differently in future.

Perhaps I should have commented on the original Facebook post?

 

5 March 2025 (Wednesday) - Atypical Lymphocytes

The nice people at the American Society of Hematology sent me this article today. A review of atypical lymphocytes.

If there’s one thing I see all the time it is atypical lymphocytes. On reflection I describe them by waving my hands in the air and using swear words. This article rather consolidates what I know and gives it some formal grounding.

Feature	Reactive	Malignant
Patient’s age	<30	>50
Lymphadenopathy	Typically absent	May be present
Absolute lymphocyte count	Usually increased	Increased, normal, or decreased
Percent lymphocytes	Usually increased	Increased, normal, or decreased
Platelets	Normal	Normal or decreased
Anemia	Absent or mild	Usually present
Cell heterogeneity	Present	Absent
Cell size	Variable but usually large	Small to medium to large
Nucleus	Irregular	Round, indented, folded, irregular
Nucleolus	Absent or inconspicuous	Absent, prominent
Cytoplasm	Abundant, radiating basophilia	Scant to moderate
Cytoplasmic projections	Absent	May be present *
Red blood cell molding	Present	Usually absent
Smudge cells	Absent	May be present **

 

4 March 2025 (Tuesday) - Fritsma Factor Newsletter

The nice people at Fritsma Factor sent their update today. Factor deficiencies, lupus, standardization of INR results… all good stuff.

4 March 2025 (Tuesday) - BTLP-TACT Exercise

I’ve walked the dogs, given them a wash, had a cuppa and got a little time before the late shift. What else might I do…

 

I was presented with two cases:

08666 – a ninety-three year-old woman awaiting surgery needing group and save.

She grouped as A Rh(D) Negative with antibody screen positive in cells 1 and 3. I requested antibody panels.

The IAT panel was positive in cells 1, 3, 6, 9 and 10 corresponding with anti-Fy(a) but not excluding anti-Cw or anti-Lu(a). But the enzyme screen was negative throughout so this did exclude them

02480 – an eighty-two year-old chap in A&E with coffee ground vomit also needing group and save.

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

 

I got it right…

2 March 2025 (Sunday) - Slide Saturday Challenge

Tear drop cells. Myelofibrosis...  myelophthisic? Thta's a new word. I wonder what it means...

2 March 2025 (Sunday) - BTLP-TACT Exercise

I’ve got an hour before I’m off to the late shift. There’s not a lot else for me to do…

 

I was presented with a nine-year-old child having a liver transplant needing FFP and cryo.

 

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

https://pmc.ncbi.nlm.nih.gov/articles/PMC2958698/ implies both FFP and cryo are indicated in liver transplants so I selected four units of FFP and two units of cryo as requested.

 

I got the thumbs-up.

28 February 2025 (Friday) - NEQAS 2501 PA

I got the results of the parasitology NEQAS exercise 2501 PA today.
 

• I didn’t see anything in sample 2501PA1 – there wasn’t anything in it.
• I saw P. vivax in sample 2501 PA2 – that was correct.

 
I’m seeing that as a result.

 

27 February 2025 (Thursday) - BTLP-TACT Exercise

 Yet another email from the people at BTLP-TACT saying

even though my manager assures me she has done no such thing. So I logged on and had a look.

Again I’m in the green for everything. But as I was logged in anyway I did another exercise. I was presented with one case – a seventy-five year-old woman in A&E with a fractured femur requiring group and save.

She grouped as O Rh(D) Positive with an antibody screen positive in cells 1 and 2. I requested antibody panels.

The IAT panel was positive in cells 2, 3, 5, 7 and 9 corresponding with anti-S, but not excluding anti-E or anti Lu(a). But the enzyme panel was negative, so that did exclude them. In this world…

I got the thumbs up. Should I have done? Bearing in mind this was *exactly* the same case as I had been given eleven days ago I just copied the answer from last time.

 

This BTLP-TACT is such a good idea in theory. In practice it is a work in progress that simply isn’t progressing very much…

I’ve got time on my hands. I’m a dab hand with computers… I wonder if I might be able to help them?