Time for another BTLP-TACT exercise. I
had one case – a ninety-three year old chap who was bleeding with liver disease
who needed four units of FFP
He grouped as B Rh(D) Positive with a negative antibody screen.
I got it right.
This is (supposed to be) a reflective diary by a (not very) anonymous biomedical scientist who works somewhere in the south of England. One day this diary may well be submitted to the Health and Care Professions Council as evidence of ongoing continual professional development....
27 November 2025 (Thursday) - BTLP-TACT Exercise
26 November 2025 (Wednesday) - Competency Assessments
With pretty much a full house at work
with nearly everyone in I was at something of a loose end today, so I took the
opportunity to update my competencies. Over the last couple of weeks I’ve been
gathering specific evidences and toady I wrote up little exercises for performing
and reporting
- Blood counts
- Coagulation investigations
- D-Dimer assays
- Fibrinogen assays
- Infectious mononucleosis testing
Back in the day the boss would just blithely
announce that someone was competent, or they were not and leave them to it. But
today I spent a little while concentrating my mind on some of what it is that I
do at work and reviewing it with a colleague.
I found it surprisingly useful…
26 November 2025 (Wednesday) - Transfusion Evidence Library Update
The nice people at the Transfusion
Evidence Library sent their update today… Does it matter what ABO group of
platelets you give someone? Transfusions and brain injuries, for the first time
in a long time tranexamic acid wasn’t mentioned…
ARTICLE OF THE MONTH
The effect of intravenous iron supplementation compared to oral iron supplementation during pregnancy on neonatal outcomes-a systematic review of randomized controlled trials.
Kuitunen, I., et al. (2025). European Journal of Pediatrics.
PICO SUMMARY
TOP ARTICLES
ABO matching for platelet transfusions for prevention or treatment of bleeding: a systematic review with meta-analysis.
Cain, L., et al. (2025). Transfusion Medicine Reviews. [Record in progress].
Clinical prediction models for postoperative blood transfusion after total knee arthroplasty: a systematic review and meta-analysis.
Chen, J., et al. (2025). BMC Musculoskeletal Disorders.
One versus five days of octreotide infusion for acute esophageal variceal bleeding: a randomized controlled trial.
Chirapongsathorn, S., et al. (2025). The American Journal of Gastroenterology. [Record in progress].
Rapid update and revision of: thromboelastography or rotational thromboelastometry guided algorithms in bleeding patients-an updated systematic review with meta-analysis and trial sequential analysis.
Kvisselgaard, A.D., et al. (2025). Acta Anaesthesiologica Scandinavica.
Restrictive transfusion in acute brain injury: a meta-analysis of randomized clinical trials.
Machado, M.F., et al. (2025). Journal of Critical Care. [Record in progress].
Immunoglobulin for myasthenia gravis.
Manolopoulos, A., et al. (2025). The Cochrane Database of Systematic Reviews.
BiZact versus cold steel for post-tonsillectomy hemorrhage: a multicenter randomized trial.
M lhave, M., et al. (2025). European Archives of Oto-rhino-laryngology. [Record in progress].
Transfusion of amustaline/glutathione pathogen-reduced red blood cells in cardiac surgery: a randomized phase 3 clinical trial.
Sekela, M.E., et al. (2025). Anesthesiology.
A pilot experimental study of cold-chain management, haemolysis and oxidative stress of packed red blood cells in early blood transfusion: toward a blood viability model in the out-of-hospital setting.
Zeenat, A., et al. (2025). Scientific Reports.
25 November 2025 (Tuesday) - BTLP-TACT Exercise
Time for another BTLP-TACT exercise.
I had one case – a sixty-four year-old woman needing group and save.She grouped as A Rh(D) Positive with a negative antibody screen.
I got it right… so flushed with success I tried again. This time I was presented with a fifty-year-old chap needing two units of blood for TURP. He too grouped as A Rh(D) Positive but with an antibody screen positive in cell 2.I performed antibody panels.The enzyme and IAT panels were positive in cells 2 and 6 corresponding with anti-K.I selected two units of A Rh(D) Positive K-negative blood.I got that right too.
Whilst I was logged in I had a look at the performance dashboard. I am currently at over double the rate of performance it thinks I should be… I wonder how long it will be before I get another email telling me I’m not doing enough.
24 November 2025 (Monday) - Frozen Platelets (!)
One criticism which is often levelled at
me is that I am too flippant. Perhaps I appear that way when I tell the
trainees that the golden rule of blood transfusion is “don’t kill anyone”.
But as golden rules go, in my considered professional opinion I think it’s a
good one. One way of not killing anyone was to make sure that platelets are
stored at room temperature (between twenty and twenty-four degrees Celsius)
and gently agitated. And to make sure they didn’t get cold.
Now not only is it being suggested that
they might be kept
in the fridge, but that they might even be kept frozen
prior to use.
If there’s one thing I’ve found in blood
transfusion is that opinion changes. What used to be absolutely a no-no becomes a possibility,
and then is standard practice.
23 November 2025 (Sunday) - BTLP-TACT Exercise
It’s pouring hard with rain and I’ve
half an hour before I have to go to the late shift… so I might as well do a
BTLP-TACT exercise, mightn’t I?
I was given two cases:
40336 – a seventy-five year old chap who had been over-anticoagulated who needed a group and save.He grouped as O Rh(D) Positive with a negative antibody screen.02559 – a forty-two year-old woman in the ante-natal clinic also needing group and save.She grouped as AB Rh(D) Negative with a negative antibody screen
I got it right.
21 November 2025 (Friday) - UKAS Update
The nice people at the UK Accreditation
service sent their update today. You can read it by
clicking here. I always do. Some people have criticized me for not taking the
whole UKAS thing seriously, which is unfair. I take it very seriously as doing
so is a legal requirement. However I question how any of its requirements
improve what I do on a daily basis. I can remember asking the same question
about its predecessor organisations Clinical Pathology Accreditation and
Investors in People.
I am very open to being shown the error
of my ways. I wish I could be shown the error of my ways; clearly thousands of
people feel the entire accreditation process to be a very worthwhile endeavour.
It’s just that every single person with whom I’ve spoken about it approaches accreditation
from the perspective of “doing accreditation” for its own sake.
I’m sure I’m missing something. I *wish*
I knew what.
20 November 2025 (Thirsday) - BTLP-TACT Exercise
Time for another BTLP-TACT exercise.
I was given two cases:
24870 – a thirty-four
year-old woman in the maternity unit needing group and save.
She grouped as O Rh(D) Negative with
antibody screen positive in cells 1 and 2. I performed antibody panels.
The enzyme and IAT panels were positive in
cells 1, 2, 3 and 5 corresponding with anti-D and anti-E but not excluding anti-Cw
90078 – an eighty
year old woman in the medical out-patients also needing group and save.
She grouped as A Rh(D) Positive with antibody
screen positive in cells 1 and three. I performed antibody panels.
The IAT panel was positive in cells 1,
3, 6, 9 and 10 corresponding with anti Fy(a)
The enzyme panel was negative throughout.
I got it right…
20 November 2025 (Thursday) - T.A.C.O.
Back in the day it was widely accepted
that the potential hazards of the transfusion of a single unit of blood greatly
outweighed the advantages, and so it would be at least two units of blood or
nothing.
Back in the day pretty much everyone
would be transfused until their haemoglobin level was over 10 (or 100 in new
currency).
And back in the day a lot of people
would get pneumonia whilst in hospital for no adequately explored reason.
Nowadays we are more aware of
transfusion associated circulatory overload, and today (despite being on a
day off) I tuned in to a rather interesting talk on the subject presented
over Microsoft Teams.
I listened to a couple of very interesting
case studies… and found myself wondering just what can you do for the best.
Someone’s anaemia is causing fluid retention, but trying to alleviate the
anaemia by transfusing blood is just giving more fluid…
17 November 2025 (Monday) - Getting the BTLP-TACT Wrong (again)
Time for another BTLP-TACT exercise…
I was presented with two cases:
57466 – a forty-two year-old woman needing group and save for a PV bleed.She grouped as O Rh(D) Negative with a negative antibody screen.24369 – a sixty-eight year-old chap with hypofibrinogenaemia needing two units of cryo as he was bleeding.He grouped as A Rh(D) Positive with antibody screen positive in all three cells. I performed antibody panels. The IAT panel was positive in cells 1, 2, 3, 5, 6, 7, 9 and 10 but the enzyme panel was negative throughout. Ideally I’d want to send this off, but from what I could see this was probably anti- S with anti-Fy(a) but I couldn’t exclude anti-K
I got the thumbs down… supposedly a clinically
significant antibody was masked by not noted… I’d love to know what it was.
12 November 2025 (Wendesday) - HCPC Update
The HCPC sent their monthly update
today. You can read it by
clicking here.
It started off by trying to attract new people
to its council. That can only be a good thing; it is so easy for such vital
positions to become an “in-crowd”.
Three was also talk about the importance
of retention – one in ten of all registrants (across all the HCPC’s professions)
less last than four years before packing up.
Sadly I can’t say I blame them… and
sadly the HCPC doesn’t seem to have any suggestions to encourage people to
stay.
11 November 2025 (Tuesday) - IBMS Update
Every month I make mention of the thing;
every month I am very disparaging about it… and sadly there’s no change this
month.
It started off by asking for nominations
for its annual awards. There’s loads of us who do all sorts of sterling things
every day, and singling one out for praise (in my honest opinion) lessens
the efforts of everyone else.
There was then talk about a statement on
quality assurance which had been issued. A vital aspect of our everyday round;
such a shame the focus of our professional body isn’t on what is required but what
committees will quarrel about it.
The rest followed in much the same vein…
really good ideas strangled by committee.
I find fault with it every month… I don’t know what I want
from my professional body, but it isn’t this.
10 November 2025 (Monday) - Warm AIHA
I got that right…not that I will ever be
deciding on the therapies, but it really helps if I know what the drugs are,
what conditions they are for, and how they work.
Here’s the first reference, and
here’s the second.
10 November 2025 (Monday) - BTLP-TACT Exercise
It’s pouring hard; the dog walk was a
washout, and so with not a lot else on the agenda I thought I might as well do
a BTLP-TACT exercise.
I was presented with one case – a thirty-eight
year-old woman in theatre with a ruptured ectopic pregnancy needing six units
of blood. She grouped as A Rh(D) Positive with a negative antibody screen. I
selected six units of A Rh(D) Positive K Negative blood
I got it right.
6 November 2025 (Thursday) - BTLP-TACT Exercise
I suppose I should really do a BTLP-TACT
exercise…
I had one case – a seventy year old woman
supposedly needing FFP for reversal of warfarin therapy.
Her ABO group was indeterminate (cell
group A, no reaction in reverse group) but her Rh(D) group was negative.
The antibody screen was weakly positive
in cells 1 and 2 so I performed antibody panels.
The IAT and enzyme panels were positive
in cells 1, 2 and 3 corresponding with anti-D but not excluding anti-Cw.
Bearing in mind warfarin
isn’t recommended for the reversal of warfarin therapy, I didn’t issue any.
I got it right this time…
5 November 2025 (Wednesday) - TACO-Related Fever
Here’s something
to think about… back in the day transfusion trigger limits were a *lot*
higher than they are these days. We’d give three or four units of blood where
these days we’d only give one. And back in the day we were investigating quite
a few alleged transfusion reactions which were characterized by post
transfusion fevers. We’d do blood cultures… but nothing ever grew.
Were we seeing fevers related to transfusion associated circulatory overload?
4 November 2025 (Tuesday) - Fritsma Factor Newsletter
The Fritsma
Factor newsletter appeared in my in-box this morning. As always it’s a
rather useful source of information on matters haemostatic…
4 November 2025 (Tuesday) - Information Governance
I did my e-learning on information
governance today. Governance… it’s a simple concept really. I have access to
confidential information. I only discuss it with those who have a bona-fide
reason to know what I know, and I keep my trap shut to everyone else. I make
sure that no one could accidentally find out what I know… simple, really.
3 November 2025 (Monday) - A.P.L.
Acute promyelocytic leukaemia… There’s some
pictures here and an article about how the condition is
best treated here.
Oh… Statements 1, 3, and 4 are correct.
The images given show dumbbell-shaped
blasts consistent with acute promyelocytic leukemia (APL), a subtype of AML
known for its aggressive presentation and high risk of bleeding and/or
thrombosis due to coagulopathy. Unlike other AML variants, APL often leads to
disseminated intravascular coagulation (DIC), supported by lab findings such as
elevated INR, prolonged aPTT, low fibrinogen, and high D-dimer.
Despite its favorable long-term
prognosis, APL is a hematologic emergency requiring urgent treatment. The coagulopathy in APL is primarily driven
by tissue factor (TF) released during promyelocyte destruction,
triggering excessive activation of the coagulation cascade. With the advent of
all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) as frontline therapy,
APL has become the most curable AML subtype. APL blasts are typically negative
for HLA-DR and CD34, distinguishing them from other AML variants.
2 November 2025 (Sunday) - Slide Saturday Challenge
Strange-looking cells…. Obviously derived
from basophils… or are they? The nuclei aren’t right.
This is a case of systemic mastocytosis.
Here’s some information
on the condition.
2 November 2025 (Sunday) - BTLP-TACT Exercise
It’s raining, I’m sulking… Might as well
do another BTLP-TACT exercise until the rain stops.
I was presented with two cases:
76896 – a fifty-one year old chap needing four units of FFP for bleeding varices.The control well was weakly positive so the entire group was invalidated and would need referral to NHSBT. The antibody screen was negative.FFP is NOT recommended for bleeding varices https://pubmed.ncbi.nlm.nih.gov/33969607/ so I didn’t issue any.45944 – a seventy-five year old chap with beta thalassemia needing two units of bloodHe grouped as A Rh(D) Positive with antibody screen positive in cells 2 and 3, so I performed antibody panels. The IAT and enzyme panels were positive in cells 2, 3, 7, 8 and 9 corresponding with anti-Le(b) but not excluding anti-Lu(a) or anti-Kp(a)https://pmc.ncbi.nlm.nih.gov/articles/PMC11747971/ says anti-Le(b) is not clinically significant, and bearing in mind that there were no units available which were Le(b)-negative I treated it as not significant. But there wasn’t any units at all that were Kp(a) negative so I didn’t issue any.
I got the thumbs down. Apparently anti-Lu(a)
and anti-Kp(a) could be excluded…
I’d like to know how.
1 November 2025 (Saturday) - Daratumumab - Remember That Stuff?
Seven years ago I wrote something on here about daratumumab and how it gives false positive results in antibody screening, and what we do about it. Somewhat ironic that the entire matter slipped my mind and I wasted a couple of hours messing around on completely unnecessary antibody panels this evening…
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