A Dull Day At Work...?: April 2025

28 April 2025 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I pressed the button and the thing told me it was unable to start. I pressed it again and it gave me two cases:

30883 – a twenty-three year-old woman in theatre having LSCS needing group & save. She grouped as O Rh(D) Positive with a negative antibody screen.
65153 – a ninety year old chap in theatre having a hernia sorted needing group & save. He also grouped as O Rh(D) Positive but with antibody screen positive in cells 1 & 3. I performed antibody panels. The IAT panel was positive in cells 1, 3, 6, 9 and 10 corresponding with anti Fy(a) but not ruling out anti-Cw or anti Lu(a). However the enzyme panel being negative throughout did rule those out.

I got the thumbs-up.

28 April 2025 (Monday) - Eosinophils Page

I created a page on eosinophils in my Atlas today. A very basic page… so basic that there’s not actually anything at all on there. But it is something… it’s a start. I shall work on it.. and work on the rest of the atlas too…

27 April 2025 (Sunday) - Slide Saturday Challenge

Hypochromic microcytic red cells – you can tell they are microcytic by comparing them with the lymphocyte.

There’s target cells too…

26 April 2025 (Saturday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – a sixty year old woman with liver disease who was bleeding and required four units of FFP

Her cell group was A, but there was no reaction in the reverse group. However both the anti-D and control were negative. That makes the ABO group uninterpretable, but the Rh(D) group negative.

The antibody screen was positive in cells 1 & 2 so I performed antibody panels. The IAT and enzyme panels were positive in cells 1, 2, 3 and 4 corresponding with anti-C and anti-D but not ruling out anti-Cw.

I selected 4 units of A FFP.

I got the green light.

25 April 2025 (Friday) - Pernicious Anaemia

I saw a case of pernicious anaemia today, so I wrote it up for my atlas. You can see that atlas by clicking here. I’ve not done much with that recently; perhaps I should…

24 April 2025 (Thursday) - BTLP-TACT Exercise

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

93489 – a thirty-two year-old chap with a bladder tumour requiring group and save.
He grouped as B Rh(D) Positive with antibody screen positive in cells 1 & 2. I performed antibody panels. The enzyme panel was negative throughout, and the IAT panel was positive in cells 2,4,5,7,8,and 10 corresponding with anti-Fy(b).
96881 – a seventy-seven year-old woman with an aortic aneurysm requiring six units of blood within two hours.
She grouped as A Rh(D) Positive with antibody screen positive in cells 2 & 3. I performed antibody panels. The IAT and enzyme panels were positive in cells 1, 3, 4, 6 and 7 corresponding with anti-Jk(a).
I went through the A and the O blood and found four units that were Jk(a) Negative and selected them.

I got the green light, which was something of a result I thought…

22 April 2025 (Tuesday) - Westgard QC Update

The nice people at Westgard QC sent their update today. Perhaps a tad heavy going, but all useful stuff…

20 April 2025 (Sunday) - Slide Saturday Challenge

Well… the question is worded rather badly. The cell is a neutrophil. One showing toxic granulation and with a Dohle body. You see these in septic conditions and when there’s a lot going on in the bone marrow – like when the patient is being treated with stimulating factors.

18 April 2025 (Friday) - ASH Update

The nice people at the American Society of Hematology sent an update about various clinical trials today. Perhaps a tad over my head, but all useful stuff…

Clinical Trials Corner

Can Abelacimab Attenuate the Risk of Bleeding in Patients With Atrial Fibrillation?

Michael Scott, MD, MHPE

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.202537

Committee Corner

Committee Corner The ASH Foundation Is a Reflection of the Society

James Labelle, MD, PhD

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.2025310

Diffusion

Better Together? Combining Teclistamab and Talquetamab in RedirecTT-1

Darren Pan, MD ; Anupama D. Kumar, MD; Jodi J. Lipof, MD; Alfred Chung, MD; Ajai Chari, MD

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.2025311

Dual BCR::ABL1 Inhibition Shows Promise in Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia

Scott Furlan, MD

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.2025312

Does 1 + 1 = 2? Combining Targeted Agents in Frontline Chronic Lymphocytic Leukemia

Tycel Phillips, MD

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.2025313

Debunking the Myth: Sickle Cell Trait and Exertion-Related Deaths — A Review of the Evidence

Chinonso Onuoha, MD ; Samuel R. Wilson, MD, MSCR; Patrick Ellsworth, MD

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.202536

Pomalidomide: A Step on the PATH Forward for Treatment of Hereditary Hemorrhagic Telangiectasia

Emily Wolf, MD; Ewa Wysokinska, MD; Surbhi Shah, MBBS, MD

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.202535

Will CAR T Cells Ever Work in Acute Myeloid Leukemia? Perhaps, If We Follow the Cytokines

Lori Muffly, MD, MS

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.202533

CRISPR-Based Diagnostic Assay for Acute Promyelocytic Leukemia

Elizabeth L. Courville, MD

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.202531

DARA to Believe: Anti-CD38 Antibody Improves Outcomes in Relapsed/Refractory Pediatric T-Cell Lymphoblastic Leukemia and Lymphoma

Zachary Graff, MD; Lauren Pommert, MD, MS

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.202534

Best in Class? DLBclass, a New Classification Tool for Diffuse Large B-Cell Lymphoma to Facilitate Development of Molecular-Based Precision Treatments

Brian T. Hill, MD, PhD

April 2025, Vol.22, . doi: 10.1182/hem.V22.3.202532

16 April 2025 (Wednesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – a forty-year-old woman in the ante-natal clinic requiring group and save.

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

I got it right

15 April 2025 (Tuesday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. Quite a bit to take in, but it pays to pay attention. I’m not quite sure how to word it… either best practice is modified by experience, or fashions change.
Back in the day whole blood transfusion was a thing. Then it became frowned upon. Now it is back in vogue.

ARTICLE OF THE MONTH

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

TOP ARTICLES

The effect of delayed cord clamping on early cardiac and cerebral hemodynamics, mortality, and severe intraventricular hemorrhage in preterm infants < 32 weeks: a systematic review and meta-analysis of clinical trials.
Aljohani, E., and Goyal, M. (2025). European Journal of Pediatrics.

A cost-effective measure to prevent hemorrhage in ultrasound-guided percutaneous liver biopsy.
Cai, Q., and Wu, X. (2025). BMC Gastroenterology.

Multicentre randomised controlled trial of a self-assembling haemostatic gel to prevent delayed bleeding following endoscopic mucosal resection (PURPLE Trial).
Drews, J., et al. (2025). Gut. [Record in progress].

Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial.
España-Cueto, S., et al. (2025). Nature Communications.

Facilitators of and barriers to blood donation among voluntary non-remunerated blood donors in sub-Saharan Africa: a scoping review.
Gondwe, A., et al. (2025). Vox Sanguinis. [Record in progress].

Early, very high-titre convalescent plasma therapy in clinically vulnerable individuals with mild COVID-19: an international, randomised, open-label trial.
Hoffmann, S., et al. (2025). EBioMedicine.

Effect of fresh whole blood donation on human performance in United States Special Forces.
Houser, A.P., et al. (2025). Journal of Special Operations Medicine.

Implementation strategies for WHO guidelines to prevent, detect, and treat postpartum hemorrhage.
Semrau, K., et al. (2025). The Cochrane Database of Systematic Reviews.

Red blood cell transfusion management for people undergoing cardiac surgery for congenital heart disease.
Wilkinson, K.L., et al. (2025). The Cochrane Database of Systematic Reviews.

14 April 2025 (Monday) - Resource Management

Here’s something interesting which appeared on the Facebook “Blood Bank Professionals” group. Although it is aimed at service users, it rather highlights the point that someone needs to keep track of a very valuable and limited resource – blood products.
How many times have we been asked to provide platelets or FFP only to find that what was needed was “just in case” rather than for actual and immediate use? How many times have we told junior medics that sometimes we use a dozen units of platelets in a day and sometimes none, and with a limited supply and short shelf-life the things aren’t stored locally but at a transfusion centre some way away.

Having found this page, I’m hoping that the parent website will prove to be a source of useful CPD.
Will it? Time will tell – it always does.

13 April 2025 (Sunday) - Slide Saturday Challenge

Gaucher cells… I won’t lie. I’d never heard of them. There are those that would blag, but I’m seeing this as a result. CPD in action. After forty-odd years in this game I’ve learned something. Which is why I’m so keen on CPD.

While primarily found in the bone marrow, Gaucher cells can also be observed in the peripheral blood, particularly in individuals with Gaucher disease. These cells are macrophages that have accumulated glucocerebroside, a fatty substance, due to a deficiency of the enzyme acid-β-glucosidase.

They are Gaucher cells in blood smears are typically large, with a small, eccentric nucleus and abundant cytoplasm that may appear fibrillar or "onionskin".

While bone marrow aspirates are often used for diagnosis, the presence of Gaucher cells in peripheral blood, along with clinical symptoms and enzyme assays, can aid in diagnosis.

It's important to note that Gaucher-like or "pseudo-Gaucher" cells can also be seen in other conditions, such as thalassemia, leukemias, and lymphomas, making accurate diagnosis crucial.

Measuring acid-β-glucosidase activity (beta-glucosidase leukocyte test) is a key diagnostic tool, as reduced or absent enzyme activity is characteristic of Gaucher disease.

In short, Gaucher cells in peripheral blood can be indicative of Gaucher disease, but their presence should be evaluated in conjunction with clinical presentation, bone marrow findings, and enzyme assays to distinguish them from pseudo-Gaucher cells seen in other conditions.