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

30 September 2025 (Tuesday) - Transfusion Evidence Library Update

Again my poor brain overloaded when I got the latest update from the nice people at the Transfusion Evidence Library sent their monthly update.

And yes – it again mentioned tranexamic acid.

It might be better for my poor brain if these updates came in smaller amounts on a weekly basis, but something for nothing is not to be sniffed at.

ARTICLE OF THE MONTH

Prophylactic strategies for prevention of postpartum haemorrhage in caesarean delivery: a systematic review and Bayesian network meta-analysis of randomised controlled trials. Amaral, S., et al. (2025). The Lancet. Global Health.
PICO SUMMARY

TOP ARTICLES

Intravenous versus oral iron after gastrointestinal bleeding: a systematic review and meta-analysis of randomized controlled trials.
Abuelazm, M., et al. (2025). JGH Open.

Pilot pragmatic clinical trial of iron therapy in children with anemia of chronic kidney disease (FeTCh-CKD).
Baqai, K., et al. (2025). Pediatric Nephrology. [Record in progress].

The effect of intravenous albumin administration before exchange transfusion in infants with hyperbilirubinemia: a meta-Analysis.
Kamyab, R., et al. (2025). Health Science Reports.

Intravenous ferric carboxymaltose in heart failure with iron deficiency (FAIR-HF2 DZHK05 trial): sex-specific outcomes.
Karakas, M., et al. (2025). European Journal of Heart Failure. [Record in progress].

Timing of intravenous iron for treatment of anaemia in surgical patients: a systematic review and network meta-analysis.
Liu, C., et al. (2025). EClinicalMedicine.

Non-targeted immunosuppressive and immunomodulatory therapies for idiopathic inflammatory myopathies.
Raaphorst, J., et al. (2025). The Cochrane Database of Systematic Reviews.

Efficacy and safety of human fibrinogen concentrate (BT524) in patients with major haemorrhage undergoing major orthopaedic or abdominal surgery (AdFIrst): a randomised, active-controlled, multicentre, partially blinded, phase 3 non-inferiority trial.
Rahe-Meyer, N., et al. (2025). EClinicalMedicine.

Efficacy and safety of different treatments in chemotherapy-induced thrombocytopenia: a systematic review and network meta-analysis.
Yang, H., et al. (2025). Frontiers in Pharmacology.

Comparative efficacy and safety of different tranexamic acid administration in spine surgery: a network meta-analysis.
Zheng, B., et al. (2025). European Spine Journal. [Record in progress].

30 September 2025 (Tuesday) - The Mislabelled Specimen

I always felt https://themislabeledspecimen.com was just some odd Facebook page. It isn’t. There’s quite a bit to it.

Take this link for example. An on-line morphology quiz. And it is different every time I’ve tried it.

29 September 2025 (Monday) NEQAS 2504 DM

I got the results of NEQAS 2504 DM today. I can’t remember anything about it, but my notes said “Neutropenia, thrombocytopenia, blast cells, promyelocytes, myelocytes, folded nuclei... ? Sezary”

The expert opinion said:

“Acute promyelocytic leukaemia with many cells resembling the typical hypogranular form of the disorder; but notice also the variable forms present that reflect orientation of cells on the slide, but also the slightly varying maturation of the abnormal cells that is typical of the disorder”.

Well… I got that wrong. Or did I? I spotted the salient features and would have referred it urgently.

It’s interesting that the expert commentary didn’t mention the folded nuclei…

29 September 2025 (Monday) - Platelets...

Big platelets… not many of them… is this Bernard Soulier Syndrome? Or Von WIllebrands?

The other day I mentioned that I need to refresh myself on specialist leukaemia testing. It would seem that whilst I wasn’t looking there’s been great strides made in the genetics of platelet diseases.

There’s a list here which at first sight meant absolutely nothing to me. But half the battle of CPD is realizing what I need to develop…

28 September 2025 (Sunday) - BTLP-TACT Exercise

Having only done five BTLP exercises this month, the software thinks I’m slacking as I’m getting emails about low levels of participation (again).

So here goes…

I was presented with one case – a fifty-nine year-old chap with ITP needing group and save. He grouped as A Rh(D) Positive with a negative antibody screen.

I got it right…

28 September 2025 (Sunday) - Slide Saturday Challenge

They are megakaryoblasts... Parhaps a tad small?

26 September 2025 (Friday) - A Meeting

I had a little meeting with the bosses today to talk about how I might help with the trainees. One positive was that everyone agreed with my theory that scheduling and actually having regular formal meetings with them is a good idea.

One negative thing was my realization of just how much I’ve forgotten about the diagnostic testing that gets sent to reference centres.

But what is CPD for if not to address those shortcomings.

25 September 2025 (Thursday) - More Specialist Portfolio Website

I spent a little while carrying on updating my specialist portfolio website today.
Hopefully the trainees will find it of some use.

24 September 2025 (Wednesday) - Parasitology Tutorial

The boss asked if I would spend some time with one of the trainees going over blood-borne parasites. I’m always quite happy to do so… but I can rabbit on and “blood-borne parasites” is a lot to cover… So I suggested that the pair of us looked after the microscopy bench, and periodically we’d break off and have a little training session. Little and often so as not to overload with information.

It worked surprisingly well.

Session One – 9am

We downloaded a PowerPoint presentation I’d prepared and had a little overview of blood-borne parasites that infest humans.

We then examined some films containing microfilaria

Session Two – 10am

We looked at some pictures of P. falciparum on the American Society of Hematology’s website, discussed them and looked down the twin microscope at thick and thin films containing P. falciparum

Session Three – 11am

We looked at some pictures of P. vivax and P. ovale on the American Society of Hematology’s website and other websites, discussed them and looked down the twin microscope at thick and thin films containing both.

Session Four – 2 pm

We looked at some pictures of P. malariae and P. knowlsei on the Scientists Against Malaria’s website, discussed them and looked down the twin microscope thin films containing P. knowlesi

Session Five – 3.30 pm

We looked at some pictures of trypanosomes and babesiosis on Google images and discussed them.

23 September 2025 (Tuesday) - Specialist Portfolio Revisited

I’ve been asked to help with the trainees.

If I’m going to do this, I want to do it properly and with some sort of structure.

In the past I would sit with the trainee and assign them a portfolio module to get on with.

A month later we sit together again, review progress and either make a plan to address any shortcomings or move on to the next module.

And so we continue with each trainee getting a formal meeting once a month (as well as any help or assistance as they need it).

The idea was that they would pretty much get on with it themselves, To help them along we would give them the portfolio together with presentations and links to useful websites in the form of a website.

The old website I made to do this was well out of date, so I thought I might bring it in line with the latest IBMS portfolio.

http://mankybadger.co.uk/test/index.htm is still very much a work in progress, but (if nothing else) re-building this will be CPD for me.

23 September 2025 (Tuesday) - IBMS Morphology Quiz

Here’s a little morphology quiz.

I slipped up on Q3 mistaking the Chediak Higashi syndrome for Dohle bodies, and Q6 was the Alder Reilly Syndrome.
But a little reminder of obscure things is always useful…

From left to right – Chediak Higashi Syndrome, Dohle bodies, Alder Reilly sundrome.

23 September 2025 (Tuesday) - Westgard QC Update

The nice people at Westgard QC sent their update today. You can see it by clicking here. It was useful, but a tad dry and a tad American. That’s no insult to our cousins over the pond, but you really need to be careful with any article which purports to be a guide to the rules, regulations and legislations… You need to know precisely which rules, regulations and legislations you are being guided round.

22 September 2025 (Monday) - BTLP-TACT Exercise

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

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

I got it right…

21 Septmeber 2025 (Sunday) - Slide Saturday Challenge

As I said, it's a Sezary cell...

20 September 2025 (Saturday) - BTLP-TACT Exercise

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

32477 – an eighty-five year old chap with liver disease who was bleeding who needed four units of FFP.

FFP is recommended for bleeding with a liver disease, but seeing how the labelling on the sample bore no relation to that on the accompanying paperwork I rejected the request.

91691 – a seventy-six year-old chap who’d been involved in an RTA and needed four units of blood right away.

His group came up positive in every well and so was utterly uninterpretable. Fortunately the antibody screen was negative so I issued four units of O Rh(D) Negative blood.

I got it wrong… but the software showed everything I’d done as having a green tick. What was that all about?

18 September 2025 (Thursday) - UKAS Update

The nice people at UKAS sent their update today. I make a point of reading it every month. Again I found it utterly unrelated to what I do on a daily basis.

I did a course on Quality Management a while ago, and the lecturer on the course said that many quality management systems are instigated by people who’ve not been taught quality management but the best tutors. Perhaps whoever it is that writes the UKAS update might consider producing something that will improve the daily round of its reader rather than trying to impress with big words.

I know – I’m just an old reactionary…

17 September 2025 (Wednesday) - HCPC Update

The nice people at the HCPC sent their update today. To be honest I didn’t think there was much of relevance to my daily round, but as it will be them assessing this CPD blog (if it ever gets assessed) one should bear in mind the thirty-third Rule of Acquisition.

“It never hurts to suck up to the boss”

17 September 2025 (Wednesday) - One or Two?

The nice people at the Transfusion Evidence Library sent their update today. As ever there were a load of articles, but one caught my eye…

Effect of single-unit transfusion in patients treated for haematological disease including acute leukemia: a multicenter randomized controlled clinical trial.
Chantepie, S.P., et al. (2023). Leukemia Research. [Link opens in Transfusion Evidence Library].

A comparison was made between people receiving two-unit blood transfusions as opposed to single unit transfusions. Back in the day it was common knowledge that the hazards of a single unit transfusion outweighed the benefits of that transfusion.

More recently this has been thrown out as being about as true as the flat earth theory…

However this trial has found that a single unit transfusion policy is not inferior to a double unit transfusion policy.

However, the single unit transfusion policy did not reduce the total number of units transfused per stay. Presumably people just have smaller transfusions more often.

Is that good or bad? Presumably this reduces TACO?

17 September 2025 (Wednesday) - Mentoring

I spent quite a bit of time helping with the competency assessment of a colleague today. Not so much teaching as showing how I do a job, and checking that I agreed with what he'd done.
Of course I did... but it made me think. In many ways there is no right and wrong to the reporting in microscopy - as I explained how I do it, I found myself wondering if I might do it better... or at least differently...

15 September 2025 (Monday) - NEQAS 2505 BF

I got hold of the results of NEQAS 2505BF today…In my notes for BF1 I wrote

Rbc

NRBCs
Howell Jolly Bodies
echinocytes
anisopoikilocytosis

Wbc

Lymphocytosis
Hypersegmented neuts

Plts

Thrombocytosis

I spotted the salient features (if the consensus view was correct) but I am shouting “I Told You So!!” very loudly as the expert opinion started off by saying “There is a problem with this case as there is a lack of clinical information” and then went on to list no end of possible diagnoses.

I’ve always said that asking us to give a diagnosis on the strength of incredibly limited information is very unreasonable, and the expert opinion would seem to be agreeing with me.

For BF2 I said:

Rbc

NRBCs
Polychromasia
Target cells
Blister cells

Wbc

Neutrophilia
myelocytes
blast cells

Plts

thrombocytopenia

The blister cells had me thinking of a G6PD deficiency, but what were the blast cells all about?
The expert opinion felt this was either G6PD or an unstable haemoglobin. Bearing in mind that unstable haemoglobin is into rocking horse poo territory, I’m claiming that as a result.

15 September 2025 (Monday) - BTLP-TACT Exercise

I took my car for MOT this morning… it needs its brakes doing, so whilst the nice man does the brakes I thought I might do a BTLP-TACT exercise.

I had one case – an eighty-one year-old woman needing group and save for a hernia repair.

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

I got it right…

14 September 2025 (Sunday) - Slide Saturday Challenge

Erythroblasts - I said so !!

11 September 2025 (Thursday) - ASH Update

The nice people at the American Society of Hematology sent their update today. Much of it was very clinical; much of it went over my head. But some of it stuck… and if nothing else I now know that which I don’t know and need to find out about.

Reality bites: allocating gene therapy for hemoglobinopathies

Venée N. Tubman; Titilope A. Fasipe

Blood Adv September 2025, Vol.9, 4500-4501. doi: 10.1182/bloodadvances.2025016943

“Optimizing” HLH diagnoses in patients with lymphoma

Joseph M. Rocco; William T. Johnson

Blood Adv September 2025, Vol.9, 4513-4514. doi: 10.1182/bloodadvances.2025017104

Multifaceted cfDNA profiling in mantle cell lymphoma

Brian J. Sworder; Alex F. Herrera

Blood Adv September 2025, Vol.9, 4526-4527. doi: 10.1182/bloodadvances.2025017086

10 September 2025 (Wednesday) - NEQAS Parasitology Result

I got hold of the results of NEQAS survey 2503 PA today.

2503 PA1 – I wasn’t convinced. I didn't say negative… but I’ve never found thick films easy. When I was first taught malaria identification over forty years ago I was told how difficult it is to distinguish between genuine parasites mangled by the cell lysis and cell debris mangled by the cell lysis.

There was actually P. falciparum in there – I shall have another look.

2503 PA2 – I saw P. falciparum. I was right. I estimated a 1% parasitaemia; a parasitaemia wasn’t reported

I'll take that .

10 September 2025 (Wednesday) - BTLP-TACT Exercise

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

11220 – a forty-eight year-old woman in maternity who having had a PPH needed four units of blood tomorrow within the next hour (!)
She grouped as O Rh(D) Positive with a negative antibody screen. I issued four units of O Rh(D) Positive K negative blood.
12195 – an eighty-one year-old chap with a fractured shaft of femur needing two units of blood tomorrow within the next hour (!)
He grouped as A Rh(D) Positive with a negative antibody screen. I issued two units of A Rh(D) Positive blood.

I got the thumbs-up

4 September 2025 (Thursday) - Fritsma Factor Newsletter

The Fritsma Factor newsletter appeared in my in-box this morning. You can read it by clicking here.

One article made me think – measurement of uncertainty.. it’s always been an issue in haemostatic investigations, hasn’t it? The very nature of that for which we are testing means that any issues in collecting a sample can give a dubious result. I can remember doing my IBMS Special Examination in 1987 when I was asked about dealing with a prolonged APTT. The first line of approach was to ask for a repeat sample…

3 September 2025 (Wednesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. Despite having done seven last month it is still sending me snarky emails telling me I’ve not done enough. So here we go… (whilst on a week off)

It presented me with two cases:

76576 – a fifty-five year-old chap needing group and save for a cystectomy.
He grouped as B Rh(D) Positive with a negative antibody screen.
01627 – a thirty-six year-old woman needing group and save for surgery for a bladder tumour.
She grouped as A Rh(D) Positive also with a negative antibody screen.