31 October 2025 (Friday) - BTLP-TACT Exercise

I’ve done six separate BTLP-TACT exercises (ten individual cases) this month and *still* I’m getting emails saying “you may need to complete further TACT participations to improve your engagement target with the system”. So I logged in again…
I was presented with two more cases:
 

51898 – an eighty-nine year old chap with beta thalassaemia needing two units of blood

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

 

54334 – a twenty-six year old woman needing two units of irradiated blood prior to a stem cell transplant. She grouped as O Rh(D) Positive, but with a weak D reaction. In this world that counts as indeterminate.

The antibody screen was positive in cell 2 so I performed antibody panels.

The IAT panel was positive in cells 2, 3, 5 and 6 corresponding to anti-E and anti-K

The enzyme panel was strongly positive in cells 3 and 5 corresponding with anti-E, and it was weaker with cells 2 and 6 corresponding with anti-K. I selected two units of O Rh(D) Negative K-Neg E-Neg irradiated blood

 
I got it right…

30 October 2025 (Thursday) - Westgard QC Update

The nice people at Westgard QC sent their update today. You can read it by clicking here, but be warned – it’s not an easy read.

There was an interesting line in there – Are CLIA labs better than ISO 15189 labs?

The answer is… they didn’t actually give a straight answer. As there probably isn’t one.

29 October 2025 (Wednesday) - Post Transfusion Purpura

Here’s an interesting (if rather obscure) condition – post transfusion purpura.

28 October 2025 (Tuesday) - Transfusion Training Hub

A colleague was talking about a case study in a podcast which she had been watching on the National Blood Transfusion Committee’s Transfusion Training Hub.

I’d not heard of that one – you can access it by clicking here. It looks rather useful. The trouble is that having made a mention today, time will pass and I will forget it… I shall add it to my “Sources of CPD” page listed at the top of this page…

It needed updating…

28 October 2025 (Tuesday) - Trivia Tuesday

 

27 October 2025 (Monday) - BTLP-TACT Exercise

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

79360 – a thirty-three year-old woman with sepsis requiring group and save.

The ABO group was A, but the RH group wasn’t as clear-cut as it might be, so I’m calling in indeterminate and would send it to NHSBT.

The antibody screen was weakly positive in cells 2 and 3 so I performed panels.

The IAT panel was weakly positive in cells 3, 4, 5, 6, 7, 8. 9 and 10 corresponding with anti-c abut nor excluding anti-E, anti-Lu(a) or anti-Kp(a). The enzyme panel was positive in the same cells giving the same interpretation.

 

55590 – a ninety-seven year-old chap needing two units of blood for a fractured shaft of femur.

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

 
I got it right.

26 October 2025 (Sunday) - Slide Saturday Challenge

Hairy cell leukaemia. I can remember when I first heard of the condition and thought that the chap mentioning it was making it up.

 

Here’s an overview https://pmc.ncbi.nlm.nih.gov/articles/PMC11394659/

23 October 2025 (Thursday) - BTLP-TACT Exercise

I had yet another email saying that my BTLP-TACT participation wasn’t what it might be, so I sparked up the lap-top and had a go at the fifth one of this month. I had one case – an eighty-eight year old chap with AAA needing six units of blood.

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

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

I got the green light.

22 October 2025 (Wednesday) - UKAS Update

The UK Accreditation Service sent their update today. You can see it by clicking here.

As I have said (many times) before UKAS is such a brilliant idea in theory, but sadly fails to deliver in practice.

To me “quality improvement” means striving for a higher standard of what I and my colleagues do on a daily basis. I’m all for that. I wouldn’t be on here several times a week doing CPD and spending time with the trainees if I wasn’t, would I?

But to UKAS “quality improvement” seems to mean “generating irrelevant unexplained paperwork because they can”.

And who is going to go out on a limb and tell UKAS which of their edicts are applicable to their daily round and which are irrelevant.

21 October 2025 (Tuesday) - NEQAS 2505 DM

I got the results of NEQAS 2505DM today. The case gave me a blood film and said:

 

“A 72 year old man attended the Emergency Department overnight with symptoms of a chest infection. An initial blood count showed a normal haemoglobin, neutrophil count and platelet count. However, the white cell count was significantly elevated with a marked lymphocytosis.

The analyser suggested the lymphocytes may be neoplastic. You are asked to examine the film and see if there are any immediate clinical concerns. What is your view?”

 

I can’t remember much about it, but my notes were:

 

“The neutrophils, platelets and red cells all look OK to me.

The lymphocytes are pleomorphic (all different) with smear cells.

This is CLL and should be referred to the consultant, but not with any immediate urgency”.

 

The expert opinion was:

 

“Making a definite diagnosis of chronic lymphocytic leukaemia can be tricky, especially during the night, but having the confidence to offer that reassurance to clinicians can make a big difference that prevents concern about other diagnoses. In this case, the normal haemoglobin, neutrophil and platelet counts are very reassuring, and the morphological features are fairly typical of the disorder. Faced with these decisions, it is important to look at the overall features rather than focusing too strongly on occasional cells that might not fit perfectly with your opinion. Particularly when the normal cells are well represented, it is often appropriate to give your preferred diagnosis even when waiting for formal confirmation the next morning. CLL can have varied morphology, but the appearances shown in this case are fairly typical”.

 

I’m taking that as a result…

21 October 2025 (Tuesday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. As ever there was a lot to take in, and a lot of it was very clinical. But that is a good thing; being able to advice on the efficacity of any proposed transfusions can only be a good thing.

I just hope that what I intend to be offered as help and advice to patient care is seen in that context.

ARTICLE OF THE MONTH

Ferritin-guided iron supplementation as an alternative or complement to prolonged blood donation intervals (FORTE): a double-blind, randomised, controlled trial.
Karregat, J.H.M., et al. (2025). The Lancet. Haematology.
PICO SUMMARY

 

 

TOP ARTICLES

Impact of thrombopoietin receptor agonists on platelet transfusion requirements in myelodysplastic syndromes: an updated systematic review and meta-analysis.
Aziz, N., et al. (2025). Clinical Lymphoma, Myeloma & Leukemia. [Record in progress].

Restrictive vs. liberal transfusion strategy in critically ill patients with acute brain injury: a systematic review and meta-analysis.
Boutrik, A., et al. (2025). Neurocritical Care. [Record in progress].

Meta-analysis of the safety and efficacy of fresh frozen plasma exchange in the treatment of organophosphate pesticide poisoning.
Cai, B., et al. (2025). Critical Reviews in Toxicology.

Evaluating economic and clinical impacts of anaemia management strategies: a systematic review of the evidence from the UK perspective.
Farabi, H., et al. (2025). EJHaem.

The effect of plasma donation frequency on total serum protein, immunoglobulin G and donor safety: a non-inferiority randomized controlled trial.
Haugen, M., et al. (2025). Vox Sanguinis. [Record in progress].

Viscoelastic testing in postpartum obstetric hemorrhage: a scoping review commissioned by the Patient-Centered Outcomes Research Institute (PCORI).
Janzen, C., et al. (2025). International Journal of Obstetric Anesthesia.

Clotting factor concentrates for preventing bleeding and bleeding-related complications in previously untreated or minimally treated children with hemophilia A or B.
Razmpoosh, E., et al. (2025). The Cochrane Database of Systematic Reviews.

Cord red blood cell transfusions for severe retinopathy in preterm neonates in Italy: a multicenter randomized controlled trial.
Teofili, L., et al. (2025). EClinicalMedicine.

Pilot-optimizing transfusion therapy in critically ill children with anemia: a pilot multicenter electronic health record-enabled randomized controlled trial on red blood cell transfusion in critically ill children.
Tucci, M., et al. (2025). Pediatric Critical Care Medicine.

20 October 2025 (Monday) - Jaundice

Here’s an interesting case study. Massive jaundice… Bearing in mind that I never wanted to do haematology and I wanted to be a biochemist you’d think that after all these years some basic chemistry would have sunk through my skull. But every time I see a case study with chemistry results I have to seriously think about what they mean and look up the reference ranges…

20 October 2025 (Monday) - Learning Monday

It’s Learning Monday and the European Hematology Association have a puzzler for us as they so often do on a Monday… 

Looks like a case of TTP to me… 

It was.

Here’s the first of the references, and here’s the second.

18 October 2025 (Saturday) - Pelger-Huet Anomaly

18 October 2025 (Saturday) - Haematinics

I spent a couple of hours reviewing the essays a couple of the trainees had written about haematinics.
They’ve obviously worked very hard… I hope they see my comments as constructive and not as being negative…
I actually learned quite a bit myself…
 
Here’s a link… https://www.annualreviews.org/content/journals/10.1146/annurev-nutr-120524-043056

 

17 October 2025 (Friday) - On-Line Morphology

I spent a little while reviewing the morphology abilities of one of the trainees today. The chap did rather well (I thought) but…

 

Back in the day analysers didn’t do white cell differential counts. We did them. And so we looked at hundreds of blood films that today we wouldn’t look at, and consequently we soon built up a mental image of what “normal” looked like. Automation means we look at far fewer blood films these days and so it takes a lot longer to build up experience.

I always tell every trainee that they need to make a point of looking at a dozen blood films every day… but I’m not the boss (any more… which I see as a result) and the real boss has other tasks that they want the trainees to be doing.

 

But back in the day wasn’t half-way through the third decade of the twenty-first century. If they haven’t got time to look down the microscope at work they can find ten minutes a day to peer into the Internet (if I can, anyone can) and look at some films on-line. Here’s a few useful websites I found today whilst I was waiting for my trainee to decide what he thought about the films I’d given him.

 

·       The Sysmex Academy Cellspotting Quiz

·       The MedSchool Blood Film Quiz

·       From the University of Utah

·       From Yale University

 

I’ve added this list on the right hand side of this blog together with other useful links. It might not be the same as peering down a microscope but it’s better than nothing…

 

16 October 2025 (Thursday) - Anti-D? Who Knows...

You have a patient with an antibody.
You identify the antibody and find it is anti-D.
You check the patient’s blood group.
You find the patient is D-positive.
You cry (well, I do)
 
Here’s a rather good article explaining what happens in this all too common situation.

 

16 October 2025 (Thursday) - Morphology Quiz

I did The Mislabelled Specimen's on-line morphology quiz again.
https://themislabeledspecimen.com/fun-games/fun-quiz-hematology-cell-identification 

Being different every time I can do it whenever I like...
I got it right.

16 October 2025 (Thursday) - BTLP-TACT Exercise

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

 

93705 – an eighty-seven year-old chap needing two units of blood due to bleeding during TURP

The chap grouped as A Rh(D) Positive… but a weak Rh(D) Positive. That goes as .

The antibody screen was negative, as was the IAT panel I requested by mistake

I issued two units of O Rh(D) Negative blood

 

55384 – an eighty-eight year-old chap requiring group and save prior to a fem-pop bypass

The chap grouped as A Rh(D) Positive with antibody screen positive in all three cells. I requested antibody panels.

The IAT panel was positive in cells 1, 3, 5, 6, 9 and 10 corresponding with anti-Fy(a) and anti-E but not excluding anti Cw or anti-Lu(a)

The enzyme panel was positive in cells 3 and 5 corresponding with anti-E and excluding anti Cw and anti-Lu(a)

 

I got it right.

14 October 2025 (Tuesday) - Hb Koln (!)

The American Society of Hematology had a post on their Facebook page today. You can see it by clicking here.

A lifelong chromic haemolytic anaemia which is clearly hereditary…

Membrane abnormalities are most common in my part of the world… I have seen cases of G6PD and PK deficiencies (but not many), but Haemoglobin Koln? That’s rather obscure.

There’s an article on the matter here.

14 October 2025 (Tuesday) - IBMS Newsletter

The IBMS sent their newsletter today; you can see it by clicking here.

Sadly as is so often the case, very little of what my professional body had to say had much to do with my daily round; I actually rolled my eyes when I saw there was to be yet another country-wide review of pathology.

Now I’m not against any reviews… if they are done sensibly. But reviews is entirely the problem which has been besetting the NHS for the forty-four years I’ve been working for it.

What happens is that there is a review. Something or other is suggested. But before whatever has been suggested is fully implemented, something else is suggested. That which had been started is immediately abandoned and the something else is implemented. But before that something else is fully implemented, yet another idea is suggested.

No idea is ever given long enough to take effect. No idea is ever evaluated to see whether it was good or bad. Every idea is brought in on the whim of whichever politician is calling the shots at the time.

And I’m breaking no confidences in saying this. Just read the news and the political histories of the last few decades…

What the NHS needs is one over-arching review, and the recommendations of that review to be put in place and tested over a period of a year or so before reviewing and improving. Not reviewing and effectively starting again from scratch.

 

And the IBMS has released an update to its Good Professional Practice and Conduct in Biomedical Science. I suppose that we need such a document… but I realise I’m an old reactionary in feeling sadness that we need such a document to state the patently obvious.

13 October 2025 (Monday) - Unexplained Erythrocytosis

Well… presumably the chap is not unwell? The Hb of 18.4 isn’t especially high…

The JAK2 being negative pretty much rules out polycythaemia rubra vera (or polycythaemia Rupert Bear as I once heard it called).

Erythropoetin receptor mutations usually result in low levels of EPO so that is pretty much ruled out too.

EPO levels are typically higher in individuals with pulmonary diseases.

My gut feeling is that this would be a relative erythrocytosis until I saw the P50 was low.

 

This might be a haemoglobinopathy with a high affinity haemoglobin…  A haemoglobinopathy was the correct answer. I got it right... but this would be *very* obscure.

 

Here’s an article on erythrocytosis with several useful links.

12 October 2025 (Sunday) - Flower Cells

Flower cells are petal-shaped nuclei seen in adult T-cell leukemia, often HTLV-1-induced, and may be seen in asymptomatic carriers of HTLV-1.

There’s more about them here

https://imagebank.hematology.org/image/12563/flower-cells-of-leukemia

12 October 2025 (Sunday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise.

I was presented with two cases:

 

41096  – a fifty-eight year-old chap with factor VIII deficiency needing two units of cryo

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

https://www.utmb.edu/bloodbank/cryoprecipitate says “Cryo should not be used for patients with Hemophilia A (Factor VIII deficiency) unless other recombinant and/or virally inactivated factor VIII preparations are not available” so I didn’t issue any.

  

64441 – a forty-seven year-old woman needing two units of irradiated blood prior to stem cell transplant.

She grouped as B Rh(D) Positive with antibody screen positive in cell 1. I performed antibody panels. The IAT and enzyme panels were positive in cells 2, 4, 5, 8, 9 and 10 corresponding with anti- Jk(b) but not excluding anti Lu(a)

I issued the only unit of O Rh(D) Positive blood that was Jk(b) Negative

 

I got the green light.

10 October 2025 (Friday) - Morphology Quiz

I had another go at the Mislabelled specimen’s morphology quiz.

I got it right..

7 October 2025 (Tuesday) - Plasma Replacements

Here’s an interesting article… when doing plasma exchanges, there’s a lot to exchange, and a lot of different things to exchange.

“Albumin replacement also removes the clotting proteins that plasma would otherwise supply. Each albumin-only exchange removes about 60% of plasma fibrinogen, and hepatic synthesis restores only about 60% of that loss over 48 hours. Two daily albumin exchanges in a row can easily drive fibrinogen below 100 mg/dL, the level where bleeding risk becomes clinically relevant“.

Seriously worth bearing in mind… back in the day we used to issue one unit of FFP after ever four units of blood transfused for this very reason.

 

7 October 2025 (Tuesday) - BTLP-TACT Exercise

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

49272 – a twenty-two year-old woman with renal failure requiring group and save. She grouped as AB but with an indeterminate Rh group but the antibody screen was negative.

08570 – a seventy-six year-old chap with iron deficiency anaemia also requiring group and save. He grouped as O Rh(D) Positive with a negative antibody screen

I got this one right…

7 October 2025 (Tuesday) - NEQAS 2506 BF

I got the results of NEQAS 2506 BF today…

 

2506 BF1 was in my opinion unremarkable. It was the blood film from a healthy 53-year-old woman who had a full blood count as part of pre-operative assessment before routine elective surgery. The numerical parameters of the full blood count were all within normal limits, as were the blood film appearances.

2506 BF2 I said:

 

Fragments (Consensus finding #1)

Thrombocytopenia (Consensus finding #2)

Acanthocytes (Consensus finding #4)

Hypochromic/polychromatic (Consensus finding #3) 

Spherocytes (Consensus finding #6)

 

This was the blood film from a 57-year-old man with a Thrombotic microangiopathy (TMA) – i.e. the combination of a microangiopathic haemolytic anaemia (MAHA) and thrombocytopenia.

 

One needed action, one didn’t. I spotted the salient features. I’m claiming that as a result.

6 October 2025 (Monday) - A Morphology Quiz

I had another go at The Mislabelled Specimen’s morphology quiz. I got two wrong…

 

The one on the left is a rubricyte. No – I’d never heard of it either. Apparently in some schools of thought red cells progress from rubriblast through prorubricyte, rubricyte and metarubricyte to erythrocyte.

There’s several stages of what I would can a nucleated red cell. I suppose that makes sense.

And the one of the right was my usual error of mistaking a promyelocyte for a myelocyte.

This is a mistake I’ve made before…  

 

But I’ve learned something…

 

2 October 2025 (Thursday) - Fritsma Factor Newsletter

Quality management, AI and platelet counts, case studies… again the Fritsma Factor newsletter is a little gem.

 

2 October 2025 (Thursday) - Digital Footprint

I’ve signed up for (and started) another Coursera course. Digital Footprint…"the data you leave behind when you go online”.

So what does this have to do with CPD?

 

The CPD rules say that we have to do CPD, but how we record it is up to the individual.

Back in the day when I first started recording my CPD in the form of a blog, the management where I used to work was unanimous in their disdain of it.

Possibly because I wasn’t using the templates that they’d spent months arguing about.

Possibly because it was an idea I’d had, and I was never flavour of the month with them.

Possibly fear of the Internet… as one of them once told me “You never know who’s reading what you write”.

Which is why I am rather cautious about exactly what it is that I write on here. But for all that the title up above says “anonymous biomedical scientist who works somewhere in the south of England” it wouldn’t take anyone with any IT skills more than a couple of minutes to work out who I am and where I work, would it?

 

As someone who has been all over the Internet pretty much since it started my digital footprint is quite immense. Have you ever Googled yourself? I have. If you peer into the Internet there’s photos of me holding snakes, looking through telescopes, drinking far too much, in Star Trek costumes, in a mankini, with cub scouts, flying kites, fishing, walking through the countryside, with dogs, geocaching, and even occasionally performing a blood test…

That’s the kind of guy I am.

But I know that whenever I post anything to the Internet it is there for keeps.

That’s why this diary is incredibly dull, and my personal diary (see the “other biomedical blogs of note” section) is far more of a hagiography (look it up!) than a biography.

 

It would seem that quite a few people are ashamed of who they used to be and are frightened about what they might be perceived to be…

Like all Coursera courses, this one is rather interesting. It’s reminded me to be circumspect in what I post on here, and I’m hoping to learn one or two new things.

I’ve passed the first module, so here’s hoping.

2 October 2025 (Thursday) - Seriously?

I’ve had yet another email about my “need to complete further TACT participations to improve your engagement target with the system”. So let’s review my “engagement with the system” last month.

I logged into the system on six different occasions, and as you can see, everything is in the green and I got absolutely nothing wrong…. Even though it failed me for not issuing plasma on a mislabelled request on September 20^th.

So, bearing in mind that the system is still very much a work in progress I pressed the “Start new scenario” button and wondered what might happen.

 

It presented me with one case – a forty-five year-old woman with post operative anaemia needing two units of blood as soon as possible tomorrow (Have I ever mentioned that I suspect the system leaves a little to be desired?)

 

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

I selected two units of AB Rh(D) Positive K Negative blood

 

I got it wrong… but I’ve worked out how to call up the pictures of completed exercises. This Rh(D) group is supposedly uninterpretable…

Seriously?