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

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…

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