27 May 2025 (Tuesday) - BTLP-TACT

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

 

00857 – a thirty-four year-old woman needing group and save and four units of FFP for reversal of warfarin therapy

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

But FFP isn’t recommended for reversal of warfarin therapy, so I didn’t issue it.

30728 – a sixty year old woman needing group and save and four units of FFP for bleeding with a liver disease.

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

FFP is recommended for bleeding with a liver disease so I issued the requested four units.

 

I got that right… which was a result. I always find myself asking advice when asked to issue plasma…

26 May 2025 (Monday) - Transfusion Evidence Update

The nice people at the Transfusion Evidence Library sent their update today. As always there was a lot to take in. And as ever, that which seems to be showing interesting results today is totally contradicting that which was a complete no-no of ten to fifteen years ago and was standard practice thirty to forty years ago.

Transfusion science really does seem to see-saw between utterly opposed viewpoints. Whole blood transfusions? Good or bad? They can’t have been good forty years ago and good today, but totally wrong twenty years ago?

Iron tablets… how can surveys now show they don’t improve post operative anaemia these days when they always used to?

ARTICLE OF THE MONTH

Prothrombin complex concentrate vs frozen plasma for coagulopathic bleeding in cardiac surgery: the FARES-II multicenter randomized clinical trial.
Karkouti, K., et al. (2025). JAMA. [Record in progress].
PICO SUMMARY

 

 

TOP ARTICLES

The cost-effectiveness of interventions used for the screening, diagnosis and management of anaemia in pregnancy: a systematic review.
Allen, C.L., et al. (2025). PLOS Global Public Health.

Intravenous ferric carboxymaltose in heart failure with iron deficiency: the FAIR-HF2 DZHK05 randomized clinical trial.
Anker, S.D., et al. (2025). JAMA. [Record in progress].

Systematic review and meta-analysis of intravenous iron therapy for patients with heart failure and iron deficiency.
Anker, S.D., et al. (2025). Nature Medicine. [Record in progress]. 

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

Examining the role of voluntary reciprocal altruism and collectivism interventions in enhancing intentions to donate blood among young non-donors: an experimental study.
Duffy, C. and Molloy, G.J., (2025). Psychology & Health. [Record in progress].

Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis.
Gallos, I.D., et al. (2025). The Cochrane Database of Systematic Reviews.

The use of iron after surgery: a systematic review and meta-analysis.
Lim, J., et al. (2025). Anaesthesia. [Record in progress].               

How low can we go? Comparison of liberal and restrictive red cell transfusion thresholds in paediatric allogeneic haematopoietic stem cell transplantation: A randomized multicentre feasibility trial.
New, H.V., et al. (2025). British Journal of Haematology. [Record in progress].               

Pragmatic O-Positive Whole-blood RandoMizaTion in male trauma Patients (POWeR-MTP).
Strada, A.M., et al. (2025). European Journal of Trauma and Emergency Surgery: official publication of the European Trauma Society.

23 May 2025 (Friday) - Healthcare Science Bulletin

The NHS healthcare science bulletin appeared in my in-box today. You can read it by clicking here.

 

It started off with an update on the changes to the NHS management structure. Something about which I remain very cynical. The NHS has major changes to its management structure with annoying regularity. By the time any practical changes start filtering down so there is another top-down change instigated and no change ever has any time to actually take effect. No change is ever critically evaluated; every one is brought in at the whim of whoever is in a position to order the change. What the NHS needs is no change to allow the previous load of changes to take effect and be assessed.

 

There was then a paragraph about two people who had been awarded an MBE for “services to healthcare science”.

This sort of thing *really* annoys me. There are countless people up and down the country running scout groups and Women’s Institute and soup kitchens and dog socialization groups (cough cough!) who as unpaid volunteers do sterling things year-in year-out… and here’s two being given an MBE for doing the job for which they are paid.

 

AI, innovation, use of NHS data… there was actually quite a bit of stuff in this newsletter including a review of the Sullivan review which has identified a serious safeguarding risk in the current process of re-assigning gender and sex identity in medical records for children and young people. The Secretary of State for Health and Social Care has directed that the process for changing NHS numbers and gender markers for children and young people under eighteens is stopped with immediate effect.

Leaving aside the politics of the matter (which I wouldn’t want to touch with a barge pole!) this is the sort of thing I need to know – a practical directive.

22 May 2025 (Thursday) - B Platelets

From the Blood Bank Professionals group… It has been reported that bites from the Lone Star tick can cause the formation of specific IgE antibodies targeting galactose-α-1,3-galactose (α-gal). This is found in red meat and so can cause allergic reactions when you scoff any, when hitherto you’ve been shoving it down your neck like there’s no tomorrow.

Bearing in mind that there’s loads of ticks in the woods where I often walk the dogs perhaps I need to think about anti-tick treatments for myself as well as the dogs. You never know – what is good for an American tick might be good for a UK one.

 

Yes – I know… what has this got to do with CPD? Well, it turns out that this galactose-α-1,3-galactose stuff isn’t chemically unlike the B-antigen. Antibodies to galactose-α-1,3-galactose can cross-react with the B-antigen and cause a mast cell response.

 

It has been suggested that this has been seen in group B platelets which have been transfused to group O patients who’ve been suspected of having been bitten by these ticks who have received group B platelets.

Something which according to all the guidelines is perfectly acceptable.

Should we restrict the use of group B platelets?

22 May 2025 (Thursday) - BTLP-TACT Exercise

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

 

51699 – a sixty-nine year-old chap needing two units of irradiated blood tomorrow

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

 

48238 – a sixty-three year-old woman with liver disease needing group and save.

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

 

I got the green light.

 

20 May 2025 (Tuesday) - Transfusion Evidence Library

The nice people at the Transfusion Evidence Library sent their update today. Again tranexamic acid featured several times, as did the cold storage of platelets….

Top article

Topical versus intravenous tranexamic acid in patients undergoing cardiac surgery: the DEPOSITION randomized controlled trial.
Lamy, A., et al. (2024). Circulation.
PICO SUMMARY

 

Selected articles

Delayed cold-stored vs. room temperature stored platelet transfusions in bleeding adult cardiac surgery patients-a randomized multicentre pilot study (PLTS-1).
Bartoszko, J., et al. (2024). Pilot and Feasibility Studies.

Hypovolaemic phlebotomy in patients undergoing hepatic resection at higher risk of blood loss (PRICE-2): a randomised controlled trial.
Martel, G., et al. (2025). The Lancet Gastroenterology & Hepatology.

Safety and efficacy of tranexamic acid in general surgery.
Park, L.J., et al. (2025). JAMA Surgery.

A randomised controlled trial assessing the effect of tranexamic acid on post-operative blood transfusions in patient with intra-capsular hip fractures treated with hemi- or total hip arthroplasty.
Khatib, Y., et al. (2024). Archives of Orthopaedic and Trauma Surgery.

Tranexamic acid during radical cystectomy: a randomized clinical trial.
Breau, R.H., et al. (2024). JAMA Surgery.

Evaluating the safety and efficacy of a novel polysaccharide hemostatic system during surgery: a multicenter multispecialty prospective randomized controlled trial.
House, M.G., et al. (2024). Surgery Open Science.

Hospital policy of tranexamic acid to reduce transfusion in major non-cardiac surgery (TRACTION): protocol for a phase IV randomised controlled trial.
Houston, B.L., et al. (2024). BMJ Open.

The effect of perioperative sequential application of multiple doses of tranexamic acid on postoperative blood loss after PLIF: a prospective randomized controlled trial.
Dong, W., et al. (2024). International Journey of Surgery.

Tranexamic acid in patients undergoing liver resection: the HeLiX randomized clinical trial.
Karanicolas, P.J., et al. (2024). JAMA.

19 May 2025 (Monday) - IBMS Newsletter

The IBMS sent their monthly update today… you can read it by clicking here.

This one was all about Biomedical Science day… how times have changed. This month we are encouraged to post individual selfies, group photos and artistic shots to the IBMS Facebook page. And there's even a video competition for which our professional body was asking for sing-alongs and comedy shorts.

 

How times change…

 

It was only fourteen years ago when I was told that posting anything at all which was work-related to social media was bringing the NHS into disrepute, and I got a formal written warning for (supposedly) doing so when I posted a selfie at six o’clock one morning with the caption that I was tired.

I know – I’ve ranted about this before… 

18 May 2025 (Sunday) - Slide Challenge Saturday

Well… it *is* platelet satellitism… I’d spotted that. But it’s not a good example of the phenomenon really. And the photo comes from a part of the film with is too thick really.
I’m more intrigued with that neutrophil. Something’s going on there – it don’t look right.
But free CPD is always good…

15 May 2025 (Thursday) - Neutropenia

Here’s an interesting article on the treatment of symptomatic neutropenia. Reading this makes it pretty clear that genetics has moved on a lot since I was at college, and this is why I need to do CPD.

I can’t pretend to understand the article entirely, but some of it stuck.

14 May 025 (Wednesday) - BTLP-TACT Exercise

Well, I was at a bit of a loose end, so I sparked up the BTLP-TACT thingy. It gave me one case – a seventy-eight year-old chap under the medical people who had coffee ground vomiting who needed group and save.

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

 

I got the green light so, flushed with success I had another go. This time it presented me with one case – a ninety-seven year-old chap needing two units of cryo for vitamin K deficiency.

 

The control well was positive, so the entire group was invalidated. Fortunately for my nerves the antibody screen was negative.

 

https://www.sciencedirect.com/topics/nursing-and-health-professions/vitamin-k-deficiency implies cryo is indicated in cases of vitamin K deficiency, so I issued two units of AB cryo.

 

I got the thumbs down… Apparently cryo isn’t indicated in cases of vitamin K deficiency.

My mistake… now I’ve had the thumbs-down I 've realised that I was thinking of Factor V.

Mind you, I have to wonder what the nice people at Science Direct were thinking of.

13 May 2025 (Tuesday) - Horiba Newsletter

A blood film from someone with thalassaemia major, and a little review of platelets. Guess the cell (stab cell), and I got last month’s question right (positive bias).

There wasn’t *loads* in Horiba’s monthly update, but little and often works well for my poor brain…

 

12 May 2025 (Monday) - BTLP-TACT Exercise

Is it really a week since I last had a go at the BTLP-TACT thingy?  It gave me two cases:

 

50265 – a thirty year old woman in the haematology clinic needing four units of FFP for a Factor V deficiency.

Great Ormond Street say they use FFP to treat Factor V deficiency, so if it is good enough for them, it is good enough for me.

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

I issued four units of A FFP

11250 – an eighty-nine year old chap in the out patients requiring group and save

He too grouped as A Rh(D) Positive but with an 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 corresponding with anti-Jk(a)

 

I got it all right.

8 May 2025 (Thursday) - Peri-Natal Complications

One of the reasons that I don’t like being seconded to our sister laboratory is that their hospital has a maternity unit. And when pregnant ladies need the blood bank it can be quite scary for all concerned.

Here’s a little article from Blood Bytes and Beyond about managing peripartum complications in the blood bank.

 

The take-home messages are

 

·       Anticipate haemorrhagic risk in patients with placenta accreta spectrum, previa, abruption, or uterine rupture

·       Tailor MTP for obstetrics: early cryoprecipitate and TXA are critical

·       Differentiate causes of thrombocytopenia: preeclampsia/HELLP vs. TTP vs. aHUS dictates treatment

·       Monitor for DIC in any critically ill pregnant patient

·       Provide close antibody monitoring: alloantibodies may impact future pregnancies

 

I’ve not long signed up to Blood Bytes and Beyond. So far, so good…

6 May 2025 (Tuesday) - Fritsma Factor Update

The nice people at The Fritsma Factor sent their update today. You can read it by clicking here. As always there’s quite a bit of interest, and all for free.

6 May 2025 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise… I was (eventually) presented with one case – a sixty-three year-old chap needing six units of blood right away for a gunshot wound.

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

I selected six units of O Rh(D) Positive blood.

I got the thumbs-up.

 

6 May 2025 (Tuesday) - Feeling Smug

I got the results of NEQAS 2502 DM today. My notes said:
 

• Falciparum - ring forms & gametocytes
• Ovale schizonts (as fimbrillation) on red cells
• ??? exflagellation
• Unusual Wbc

 
The expert opinion said:
 
“This case shows a dual parasite infection with P. falciparum and P. ovale. Cases such as this are infrequent but certainly seen. The key is to recognise when things don’t quite match those of a single species. Present on this film are early trophozoites of P. ovale, late trophozoites of P. falciparum, and gametocytes of each species. There is a phagocyte containing malaria pigment.”
 
Well, I spotted the two species correctly, and the “unusual Wbc” I saw would be the one with the malarial pigment. Bearing how infrequently we see positive malarial smears, let alone ones with dual infestations, as Kryten 2X4B 523P would say “engage smug mode”…

5 May 2025 (Monday) - Pelger-Huet Anomaly

I saw what looked like a case of Pelger Huet anomaly last Friday. I took a rather poor photo, and then… I discovered that many years ago I started a page on my atlas on the matter but never actually published it.

So I wrote it up and published it. You can see it by clicking here and clicking on the relevant bit.

If you click there and look at the relevant bit you will see that one photo is far better than the other. Back in the day I had a camera attachment that I stuck into the microscope. I need to get another of those.

1 May 2025 (Thursday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise… I was (eventually) presented with one case – a fifty-three year-old woman needing group and save for a hernia repair.

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

I got the green light…

 

1 May 2025 (Thursday) - HCPC Update

The HCPC sent their update today. You can read it by clicking here. Like the UKAS update it’s rather dry and at first sight maybe not that relevant to my daily round. But it pays to keep abreast of things…

For example they are changing how they are taking the direct debit payments…

30 April 2025 (Wednesday) - UKAS Update

UKAS sent their update today. You can read it by clicking here. Back in the day I would have been very negative and opinionated about it. These days I’ve conceded that love it or loathe it, this is how it is, and I might as well embrace it.

If only they would actually say what their standards were and how we might practically adhere to them than I would find it much easier to get on-board with them… but there it is.

30 April 2025 (Wednesday) - Iron Deficient H.E.

An interesting case… an iron-deficient case of hereditary elliptocytosis. There’s more about it in my atlas…