30 July 2025 (Wednesday) - IBMS Newsletter

The IBMS newsletter came out today… it was full of posts about how one might progress one’s career as a biomedical scientist which is laudable. I suppose it’s not really much good for me as all I want is a quiet life with full retirement in a few years’ time. But it made me think. There’s a lot more ways in which someone might advance these days… once you’ve actually got into this blood testing game.
 
Two days ago one of the trainees posted to Facebook that it was seven years since she graduated with a BSc in biomedical science. Seven years…
These days the route into this job seems to be deliberately made to deter people from becoming a professional blood tester. Back in the day I went from miserably failing “A” level year one to the (now bulldozed) Royal East Sussex Hospital where I worked for four days a week. On the fifth I went to Brighton (and later Bromley) Technical College. Admittedly the wages weren’t brilliant; mates working in the local abattoir got more money. But part of my wages were the fees of the course I was taking, the train fares to get there, the price of the fish and chips, cheesecake and pint of lager I had for lunch, and they gave me thirty quid a year to spend on text books too. So after four years I got my qualifications and having been working for those four years I could work unsupervised right away, and my first night shift was one week later.
 
Perhaps we might revisit the old day release scheme? Mind you, I say “we”… it’s not me who might revisit.

 

29 July 2025 (Tuesday) - 2503DM

 

I got the results of 2503DM today. At the time (30 June) I wrote “Well, there’s malaria there. I’d go with a mixed infestation. P.vivax and P. malariae”.

I was right in that there was malaria there. But I was wrong in that it wasn’t mixed. It was just P. malariae. However I’m taking that as a result. I spotted the malaria which is the important part. Speciation is something that I would sent off to the reference lab anyway, and I don’t think I’ve ever actually seen P. malariae outside of a EQA slide.


28 July 2025 (Monday) - BTLP-TACT Exercise

I’ve been writing up one or two CPD thingies… I might as well do a BTLP-TACT whilst I’m at it, mightn’t I?
I was presented with two cases:
 

50116 – a twenty-nine year-old woman with PPH needing four units of blood.

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

 

86778 – a thirty-three year-old woman with sickle cell disease needing two units for top up transfusion.

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

 
I got the green light.

27 July 2025 (Sunday) - Slide Saturday Challenge

Smear cells... I see I've not mentioned them in my atlas. Perhaps I should....

27 July 2025 (Sunday) - Anti-U


The U antigen is part of the MNS blood group system and is a high incidence antigen being found in approximately 99% of Black individuals and virtually 100% of Caucasians. Consequently having a patient with anti-U who needs blood is, as my grandson would say, a pain in the glass.

I came in to the early shift today to find one such case. With a haemoglobin of 45 g/L the patient was symptomatic. Blood had been requested yesterday… we had been told that frozen blood was available. But it was frozen and was actually in Liverpool three hundred miles away.

There’s all sorts of talk about learning from these incidents and there is a lot to be learned. What do you do in a situation like this? Give blood which may well be detrimental, or wait until the blood is available… the waiting being detrimental.

I’m glad it’s not a decision I have to make.

24 July 2025 (Thursday)- BTLP-TACT Exercise

Being at something of a loose end I did another BTLP-TACT exercise. I was presented with one case – a thirty-three year-old woman in ITU needing group and save.
Her ABO group was indeterminant; a cell group of B, but the reverse group giving positive reactions with A cells and B cells. One for NHSBT... if not a "cold" antibody such as anti-M or anti-P1.
However her Rh(D) group was negative.
 
Her antibody screen was negative
 
I got the green light, which is always a result.

23 July 2025 (Wednesday) - Wiskott-Aldrich Syndrome

I saw a diagnosis today - Wiskott–Aldrich syndrome. I couldn’t remember that much about it... so I looked it up.
 
As always, people might sneer at it, but Wikipedia is a good place to start. There's a more detailed review here.
These days there's a genetic marker which is considered definitive for the condition
There never used to be genetic markers back in the day.

22 July 2025 (Tuesday) - Westgard QC Update

The Westgard QC newsletter arrived today. It is rather dry, but rather useful. There were a couple of interesting articles in it which showed how some people either don’t understand how statistics work, or have found how easy it is to blind people with science.

You can read it by clicking here.

 

22 July 2025 (Tuesday) - Transfusion Evidence Library Update

The Transfusion Evidence Update arrived in my in-box today. Reviews of transfusion strategies in cases of brain injury and PPH, platelet transfusion, and tick-bourne conditions…

All useful stuff.

ARTICLE OF THE MONTH

A randomized trial of acute normovolemic hemodilution in cardiac surgery.
Monaco, F., et al. (2025). The New England Journal of Medicine. [Record in progress].
PICO SUMMARY

TOP ARTICLES

Pre-emptive TIPS for gastric variceal bleeding in patients with cirrhosis (GAVAPROSEC): an open-label randomised clinical trial.
Cervoni, J.P., et al. (2025). The Lancet. Gastroenterology & Hepatology.

Comparison of intravenous carbetocin (100 Mcg) and intravenous oxytocin (10 IU) for the prevention of postpartum hemorrhage following emergency cesarean section.
Chowdary, V.K., et al. (2025). Cureus.

Oxidative stress markers and tissue iron overload after 12-months vitamin E supplementation for children with transfusion-dependent β-thalassemia on different iron chelators: a randomized placebo-controlled trial.
ElLaboudy, M.A., et al. (2025). Clinical Nutrition.

Efficacy and safety of hetrombopag versus thrombopoietin in promoting platelet engraftment after allogeneic hematopoietic stem cell transplantation: a prospective, multicenter, randomized controlled clinical trial.
Feng, Y., et al. (2025). American Journal of Hematology. [Record in progress].

The clinical use of platelet transfusions: a systematic literature review and meta-analysis on behalf of the International Collaboration for Transfusion Medicine Guidelines.
Jug, R., et al. (2025). Transfusion.

Seroprevalence of tick-borne infections in blood donors in Europe: a systematic review.
Mathys, S., et al. (2025). New Microbes and New Infections.

Postoperative 20% albumin infusion and acute kidney injury in high-risk cardiac surgery patients: the ALBICS AKI randomized clinical trial.
Shehabi, Y., et al. (2025). JAMA Surgery. [Record in progress].

Liberal vs restrictive transfusion strategy for acute brain injury: a meta-analysis with trial sequential analysis of randomized clinical trials.
Tsai, W.W., et al. (2025). Anaesthesia, Critical Care & Pain Medicine. [Record in progress].

Effects of combinations of diagnostic and treatment strategies for postpartum haemorrhage: a network meta-analysis.
Yunas, I., et al. (2025). The Cochrane Database of Systematic Reviews.

21 July 2025 (Monday) - Getting the BTLP-TACT Wrong


 Time for a BTLP-TACT exercise. I was presented with two scenarios:
 
47434 – an eighty year old woman who has had a CVA requiring group and save.
She grouped as O Rh(D) Positive with a negative antibody screen.
 
98077 – a twenty-two year old woman in A&E requiring six units of blood having received gun shot wounds.
She grouped as A Rh(D) Positive with antibody screen positive in all three cells. Just what you want in a case like this, eh? I requested antibody panels.
 
The IAT panel was positive in cells 1, 2, 3, 5, 6, 7, 9 and 10 corresponding with anti-K and anti-Fy(a) but not excluding anti-Cw or anti-Lu(a)
The enzyme panel was negative throughout… that was a pain. In this simulator it thinks anti-K works by enzyme… doesn’t it?
I selected six units of A Rh(D) Positive K-negative Fy(a)-negative.
 
I got the thumbs-down. I missed a possible anti-S

20 July 2025 (Sunday) - Slide Saturday Challenge

Bipolar villous lymphocytes in blood films are indicative of splenic marginal zone lymphoma. There’s a case study and literature review that can be seen by clicking here

19 July 2025 (Saturday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise. I was presented with two scenarios:
 

00064 – a thirty-seven year old woman in A&E needing two units of blood for an above knee amputation.

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

09281 – a ninety year old chap in the cardiac unit needing group and save.

He grouped as A Rh(D) Positive; albeit a weak reaction in the anti-D. In reality this would go to NHSBT, but in this simulator? I can remember falling foul of this before, but I couldn’t remember what the simulator wanted me to say. I called the RH group indeterminate.

The antibody screen was negative.

 
I was right to call the weak Rh group indeterminate.

18 July 2025 (Friday) - UKAS Update

The nice people at UKAS sent their update today. You can read it by clicking here. I have… At the risk of appearing cynical there was a lot of “blah blah blah” and very little tangible actually useful information about how their standards are applied in a practical sense to my daily round.
The nice people at UKAS might be better advised to state one of their standards and then give a few examples of exactly how that standard might be met in a variety of practical situations. However their standards remain a closely guarded secret; known only to those prepared to pay good money to see them.
Back in the day we all knew what the CPA standards were. We could understand why we were told to do this, that and the other, and could offer informed suggestions on how we might improve the service we offer…

17 July 2025 (Thursday) - Chief Scientific Officer's Update

The Office of the Chief Scientific Officer sent out their update today. You can read it by clicking here.
There was quite a bit about near patient testing which is probably the way forward, but…
I know I’m an old reactionary but all the verbals about the government’s 10 Year Health Plan for England… 
We all know that despite it being what the country probably needs,  whatever plan any government has for healthcare will be in place for less than a year before it is scrapped and replaced by another in the desperate hope of short term political gain, don’t we?

17 July 2025 (Thursday) - FFP Again

On Monday the nice people at Blood, Bytes and Beyond put out a little guide about plasma transfusions.
They’re added a few more:
A guide to using FFP
When not to use FFP
What to use instead.
 
A very useful set of refreshers…

 

15 July 2025 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with two cases:
 
79165 – a thirty-one year-old woman needing six units of blood following a stabbing. The date of birth on the sample was wildly different to that on the paperwork, so I rejected it. Despite the urgency of the case I’d rather operate without a blood sample than having one from the wrong patient.
 
20599 – a ninety-seven year-old chap needing two units of blood following burns.
He grouped as A Rh(D) Positive with a negative antibody screen. I selected two units of A Rh(D) Positive blood
 
I got the thumbs-up

14 July 2025 (Monday) - Plasma Transfusions

The nice people at Blood Bytes Beyond sent a rather good little review of plasma transfusions today. You can read it by clicking here.

It was a very useful refresher…


12 July 2025 (Saturday) - Slide Saturday Challenge


Well, they are Howell-Jolly bodies. I mentioned them in my atlas some time ago
.

10 July 2025 (Thursday) - HCPC Newsletter

The HCPC sent their newsletter today… It was all very “corporate”. It invited my opinion on the future direction of the HCPC.
I gave it. How on Earth does someone’s rantings on social media in any way affect their ability to do their job?
I might just get struck off…

7 July 2025 (Monday) - Fritsma Factor Update


 Fibrinolysis, haemophilia, DIC, mixing studies… the Fritsma Factor newsletter is always a useful thing to have. And it’s free too.

4 July 2025 (Friday) - Iatrogenic Anaemia

One thing that has wound me up over the years is that every so often I hear or see or read something which is presented as news… when I actually first heard about whatever it is at about the time that the person making the announcement was busy being born.
 
Take today’s missive from Blood Bytes Beyond. How many duplicate samples do we see in the lab? If a patient is known to have problem antibodies requiring referral to NHSBT, why send routine group and save on a daily basis? Babies in SCBU had notices on their cots saying that blood should only be drawn on consultant advice only forty years ago. It stands to reason that the more blood you take for someone, the more likely they are to need a transfusion.
 
Today’s missive from Blood Bytes Beyond is a rather good review of the situation.

3 July 2025 (Thursday) - BTLP-TACT Exercise

On the last day of last month (three days ago) I wrote on here: “That’s eight BTLP-TACT exercises I’ve done this month… I bet I get an email whinging about my low involvement by the end of the week”. That email came at two o’clock this afternoon…
 

So here we go again. I was presented with one case – a sixty-two year-old woman needing four units of blood right away for a GI bleed.

The ABO group was indeterminate. The cell group was B; the serum group AB. But the Rh group was negative. That’s one for NHSBT.

The antibody panel was positive in cells 1 and 2 so I requested antibody panels. The IAT and enzyme panels were positive in cells 1, 2 and 3 corresponding with anti-D but not excluding anti Cw

I issued four units of O Rh(D) Negative blood.

 
I got it right.

1 July 2025 (Tuesday) - Competency Assessment

I was asked if I might produce a series of slides for competency assessments. I was rather happy to do so… it’s easier said than done though.
How many slides do we need? I went for twenty, but at five minutes per slide that’s going to take two hours per assessment.
What cases should we cover? What cases have we got in the teaching slides… Has anyone sorted the teaching slides for a while?
Back in the day I compiled a series of teaching slides by sticking what I considered to be an interesting case into a slide tray with a plan to sort it later… and I would forget about it. So consequently when I came to sort the myriad of slides I’d piled up I had a few dozen cases of iron deficient anaemia, a few dozen cases of CLL, and a few dozen slides with frankly horrific looking blast cells. All of which were rather faded.
Fortunately we had quite a variety of cases in the teaching slides. I’ve managed to get eight different slides which are predominantly red cell issues, eight which are predominantly white cell issues, one thrombocytosis, one thrombocytopenia, one with clumps, and one unremarkable one.
Getting a selection was tricky. Now I’ve got to come up with standard (correct) answers…
I quite like making myself useful like this…