A Dull Day At Work...?: 2026

14 April 2026 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with two cases:

78080 – a thirty year old woman in the haematology clinic needing two units of irradiated blood.
The sample label had no NHS number or hospital number so I rejected it.

33345 – an eighty-nine year old chap in out-patients needing group and save.
He 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 4 corresponding with anti-C and anti-D but not excluding anti-Cw

I got the thumbs-up

12 April 2026 (Sunday) - A Giant Platelet

Well, there’s a giant platelet but you get them in all sorts of conditions.
Here’s a few words about Bernard-Soulier syndrome.

12 April 2026 (Sunday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise I suppose… I was presented with one sample – a ninety-five year old chap with beta thalassaemia needing two units of blood.

He grouped as A Rh(D) Positive with antibody screen positive in cells 1 and 3. 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 selected two units of A Rh(D) Positive Fy(a) negative blood

I got the green light…

10 April 2026 (Friday) - Iron

I found this picture on one of the work-related Facebook groups I follow…

9 April 2026 (Thursday) - Infection Control e-learning

I did my infection control e-learning today. Infection control, health and safety, it’s all a load of old tosh, isn’t it…

I can remember being told (by a senior biochemist) to sharpen my pencil with a scalpel blade, and chopping a lump off of my finger.

I can remember watching senior staff charging round the (now bulldozed) biochemistry department chasing each other with water pistols filled with Schiff’s reagent.

I can remember senior staff playing cricket in the (now bulldozed) microbiology department and sending petri dishes flying.

I can remember when I first started as an apprentice blood tester being told to seriously consider not joining the works pension scheme as I was told that (at that time) the average blood tester died three years before collecting their pension.

And I can remember the face of a friend who died from a rather rare type of brain tumour… the lab where she worked used to make thromboplastin from human brain. Four of them in the same lab died of the very same type of tumour within a few weeks of each other…

I sometimes take a deep breath when the trainees put on their gloves and goggles, but they are right to do so.

For all that I grumble about recent changes in the workplace, some have been for the better.

7 April 2026 (Tuesday) - Fritsma Factor Update

The Fritsma Factor newsletter arrived today. As always it is a very useful source of CPD…

6 April 2026 (Monday) - Granulocyte Transfusions

Granulocyte transfusions – good or bad? I’d never experienced them in practice until a few years ago…
It would seem that the jury is still out on their efficacity

5 April 2026 (Sunday) - Pay Attention (!)

Look closely in a blood film – it’s easy to overlook the early signs…

4 April 2026 (Saturday) - A Useful Lilttle Refresher

I found this useful...

2 April 2026 (Thursday) - NEQAS 2602 BF

I got the results of NEQAS morphology survey 2602BF today…

2602BF1 I said:

Hypochromia (consensus 4^th)

Target cells (consensus 1^st)

Large plts (consensus 2^nd)

Neutropenia (consensus 14^th)

I wrote “? thal ? SC disease”. The expert opinion said: “These features are all suggestive of Hb SC disease and this was confirmed on HPLC though the degree of microcytosis should lead to the consideration of a coexistent alpha thalassemia trait”

2602BF2 I said:

Hypochromia (consensus 1^st)

Microcytosis (consensus 2nd)

Pencil cells (consensus 3^rd)

Tear drop cells (consensus 5^th)

^ plts (consensus 4^th)

I thought this was a case of iron deficiency. It was.

31 March 2026 (Tuesday) - IBMS Update

The IBMS sent their update today – you can read it by clicking here. I must admit I’m quite a critic of the IBMS but this was one of their better offerings.

I did like the article about infections in feature films… I was reminded of an episode nearly thirty years ago when I wrote to the BBC. A rather poor doctor in the TV show “Casualty” was told that they would be lucky to end up in a path lab. The BBC replied saying that they were sorry for any offence caused, and they acknowledged that the average path lab worked is educated to postgraduate standards. But what they were striving for was dramatic effect.

Nothing has changed in the meantime…

30 March 2026 (Monday) - AML

Back in the day we’d just judge on what we saw down the microscope. Didn’t I comment on that the other day?

30 March 2026 (Monday) - BTLP-TACT Exercise

I’ve had another email from the nice people at BTLP-TACT telling me that I’m not doing enough exercises. So here we go…

I was presented with one case – a fifty-seven year-old woman in the haematology out-patients clinic needing two units of blood.

She grouped as AB Rh(D) Positive but with a weak(ish) reaction in the D. I’d call that positive because she’s over fifty and it is positive, but BTLP-TACT don’t like that. So UI it is…

The antibody screen was negative.

So… what do I issue?

Personally I’d have given AB Rh(D) Positive because she *is* AB Rh(D) Positive.

But having said the Rh(D) group is uninterpretable (even though it is) I should give Rh(D) Negative blood.

My question is that having said the Rh(D) group is uninterpretable, should I give O Rh(D) Negative (for no reason that I could actually fathom) rather than AB Rh(D) Negative?

There’s one way to find out… I went with two units of AB Rh(D) Negative

I got the green light.

30 March 2026 (Monday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. As always there was so much as to boggle my poor brain, but the second to last article made me think. It is very easy to think that blood science is what I do, and that it probably happens in a few hospitals nearby.

It’s world-wide and what happens in other parts of the world can be very different. In over forty years I’ve only ever heard of one case of malaria being transmitted by blood transfusion… in some parts of Africa nearly one donor in five has malaria…

ARTICLE OF THE MONTH

Preventive interventions for vasovagal reactions in whole blood donors: a cluster-randomised, stepped-wedge, crossover trial of 73 sites involving 1·4 million donors in England.
Kaptoge, S., et al. (2026). The Lancet. Haematology.
PICO SUMMARY

TOP ARTICLES

N-acetylcysteine reduces incidence and duration of linezolid-associated thrombocytopenia in critically ill patients: a randomized controlled trial.
Abdeltawab, M., et al. (2026). Environmental Toxicology and Pharmacology.

Interventions to prevent intraventricular haemorrhage in preterm neonates: an umbrella review of systematic reviews and meta-analyses.
Bhanushali, M., et al. (2026). Neonatology. [Record in progress].

Recombinant factor VIIa versus placebo for spontaneous intracerebral haemorrhage within 2 h of symptom onset (FASTEST): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial.
Broderick, J.P., et al. (2026). Lancet.

Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders.
Champaneria, R., et al. (2026). The Cochrane Database of Systematic Reviews.

Use of albumin in patients with hepatic encephalopathy: a systematic review and meta-analysis of randomized controlled studies with trial sequential analysis.
Coan, A.C.C., et al. (2026). Hepatology Forum.

Comparative efficacy of prehospital resuscitation strategies on mortality for patients with major trauma: a network meta-analysis.
Hsu, C.W., et al. (2026). European Journal of Emergency. [Record in progress].

Randomized, sham-controlled trial of intraoperative ticagrelor removal to reduce perioperative bleeding.
Mack, M.J., et al. (2026). The Journal of Thoracic and Cardiovascular Surgery. [Record in progress].

Global burden of asymptomatic malaria among blood donors: systematic review and meta-analysis.
Malede, B., et al. (2026). BMC Infectious Diseases.

Comparison of safety and efficacy of liberal versus restrictive red blood cell transfusion thresholds on the quality of life in patients with myelodysplastic syndromes: a systematic review and meta-analysis.
Mandal, S., et al. (2026). Annals of Hematology.

29 March 2026 (Sunday) - Slide Saturday Challenge

Here’s some info on the condition. There are those who turn their noses up at Wikipedia… they can write their own CPD journals. Bet they won’t.

25 March 2026 (Tuesday) - Nil Desperandum

I had another little session testing the new works computer today. I had a *lot* of frustration with in. In retrospect it worked perfectly doing exactly what it should. The problem was “operator error”, but I learned a lot…

I think Lionel Jeffries summed it all up over fifty years ago…

24 March 2026 (Tuesday) - Haemochromatosis

Here’s a little update on hereditary haemochromatosis. It’s a useful little bit of revision…

23 March 2026 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with one case – a sixty-one yar-old chap having a pancreatectomy and needing four units of blood.

The ABO group was uninterpretable but the RH(D) group was Positive. The antibody screen was positive in cells 1 and 3 so I performed antibody panels.

The IAT panel was positive in cells 1, 3, 6, 9 and 10 corresponding with anti- Fy(a)

however the enzyme panel was negative throughout.

I tried to select four units of O Rh(D) Negative blood which was Fy(a) negative but there was only two. So… what next. We’ve got a male who’s over fifty… I selected two more units of Fy(a) negative blood; these being O Rh(D) Positive.

Either the software would like it or it wouldn’t…

It did…

23 March 2026 (Monday) - Increasing Workload

Yesterday’s post has made me think… Yesterday I mentioned about how the microscopy of yesteryear has been replaced with more modern technology which is much less subjective and much more objective.

And that’s partly answered a question I’ve been pondering for some time…

When I first started as a Junior (Grade "A") medical laboratory scientific officer in September 1981 the (now demolished) Royal East Sussex Hospital had one consultant haematologist. She would see out-patients in the morning... sometimes as many as six patients in one morning.

Occasionally some patients were ill enough to be hospitalized... she had up to four beds in the (also now demolished) St Helen's Hospital in which these patients would stay, and she had an arrangement with one of the consultant physicians that she might avail herself of the services of the medical SHO *if* they weren't too busy with their own work.

Three years later I moved to a nearby hospital where the consultant haematologist had the use of pretty much all of the isolation ward and had two dedicated SHOs of his own... Two. I counted them.

I Googled where I currently work... The most recent information publicly availably says that we have nine consultant haematologists, two specialist registrars and four SHOs.

Why so many? What has changed in the meantime...

Here’s a couple of articles which give the answer:

https://pmc.ncbi.nlm.nih.gov/articles/PMC10188596/

https://www.bloodcancerstoday.com/post/cancer-mortality-rate-declines-yet-cancer-incidence-increases-among-women-and-younger-adults

Fewer people are dying from preventable infections. Fewer people are dying from heart disease and pulmonary conditions. Smoking and drinking are in decline. Is that why over the past thirty years (globally) cases of hematologic malignancies have been increasing?

But whether or not it is the reason, the death rates for all types of hematologic malignancies has been declining.

We are getting better at what we do.

We’ve a lot more haematologists because we need them.

22 March 2026 (Sunday) - Getting It Right

Well, I was confident that it was something malaria-ous and (quite frankly) that’s good enough. I spotted the issue and was confident about the next steps… tell the clinician and the London School of Tropical Medicine.

As for the species… I won’t say “that’s anyone’s guess” but I will say “look at the last NEQAS parasitology result”. Out of nearly four hundred and fifty participants, over ninety-nine point five per cent of the participants saw something there that shouldn’t have been. However less than half of the participants got the species right… I say “right”. Perhaps “agreed with the expert opinion” might be a better phrasing.

I find myself thinking back to the good old days when leukaemias were typed according to what they looked like down the microscope, and there being as many opinions as there were people working that day at the (now demolished) haematology lab of the Royal East Sussex Hospital.

Nowadays microscopy is just an add-on to flow cytometry and cytogenetics.

How long will it be before speciating will be done by something less subjective than saying “I think it looks like…”

20 March 2026 (Friday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with one case – a ninety-five year-old chap who was up for an autologous stem cell harvest (at that age?) who needed two units of blood.

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

I got the thumbs-up.

19 March 2026 (Thursday) - UKAS Update

The UK Accreditation Service sent their update today... I make a point of reading it because I don’t think many people actually do, and there is a load of misunderstanding and misinformation spread about the thing – in the past I knew of a manager who would get his own way by insisting that any way but his would go against MHRA requirements, safe in the knowledge that no one knew what MHRA required. Much the same is probably true of the UKAS…

But look at their update. How can I as a professional blood-tester be held to the same standards as someone operating a sexual assault referral centre? I really don’t know how, but I am. And that’s why I read the updates…

16 March 2026 (Monday) - I.T. Training

We’re getting a new computer system soon. Today I had some training on the thing. A bit of an introduction to show me the basics. The new one is rather different to what I’m used to; different enough to make my head spin.

Many years ago I did a post graduate certificate on distance based learning. Part of it focused on how people learn. I didn’t actually realise that I’m not very good at being taught anything new as I have the attention span of a gnat and my poor brain needs time to process new information.

I’m having another session on the computer tomorrow. Hopefully by then what I’ve learned will have percolated through my thick head…

15 March 2026 (Sunday) - I Disagree...

Well… I wouldn’t have said that was hypersegmented. I would have said that was a botryoid neutrophil.
I think the take-home message here is not to judge on the strength of just one cell…

12 March 2026 (Thursday) - BTLP-TACT

Well I’ve made a few mistakes with the BTLP-TACT recently, so let’s try again…

It presented me with two cases:

22286 – a ninety-six year-old chap with bleeding varices needing four units of FFP. He grouped s A Rh(D) Positive with a negative antibody screen.
However FFP is NOT recommended for bleeding varices so I didn’t issue any.

26881 – a fifty-one year-old chap in ITU needing two units of blood. He also 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. Bearing in mind I’ve had the thumbs-down for three of the last four I saw that as something of a result.

10 March 2026 (Tuesday) - The RDW

Here’s something I found randomly on my Facebook feed – a rather useful little dissertation on a much-overlooked blood count parameter; the RDW.

9 March 2026 (Monday) - NEQAS 2601DM

I got the results of 2601DM this morning. I did it a month ago when I was presented with an image of a blood film and this statement:

“A 60-year-old man had commenced treatment for a serious haematological disorder. His white cell count was raised, and platelet count reduced. He then became increasingly anaemic with changed blood film features. You are asked for your opinion. The film arrives outside of normal hours”

In my notes I wrote “Well, there’s a bit of everything in this film, isn’t there. The red cells show echinocytes, microspherocytes, blister cells, nucleated red cells, Howell Jolly bodies, rec cell fragments.

The white cells are a bit of a disaster – cerebriform/flower type lymphocytes, toxic granulation, vacuoles in monocytes and neutrophils, smear cells, target cells, pyknotic neutrophils, eosinophilia.
The platelet appeared reduced, but we were told that anyway.

I didn’t fiddle about trying to get the observations in order… time was pressing.
As this arrived out of normal hours I would put it for the consultant to review in the morning… they don’t thank us for being bothered about this sort of thing… this sort of thing being a patient of which they are already well aware”.

The expert opinion was rather odd… it waxed on as it so often does but seemed to completely overlook the fact that this was in a patient with a known haematological condition.

But I spotted that which needed spotting and made the right decision

8 March 2026 (Sunday) - Crigler-Naijar Syndrome

Crigler-Najjar syndrome? No – I’d never heard of it either. Here’s a little write-up on the subject. As I always say, a day when you learn nothing is a day wasted.

8 March 2026 (Sunday) - Neutrophil Clumping

I have seen this... but it's not common.

7 March 2026 (Saturday) - BTLP-TACT Exercise

I had a go at the BTLP-TACT thingy today. It presented me with one case – a twenty-nine year-old woman in theatre having an above-knee amputation and needing two units of blood.

She grouped as O Rh(D) Positive with antibody screen positive in all three cells. I requested antibody panels.

The IAT panel was positive in cells 1, 2, 3, 5, 6, 7, 9 and 10 corresponding with anti-S and anti-Fy(a) but not excluding anti-K.

The enzyme panel was negative throughout which excluded quite a bit..

I selected two units of O Rh(D) Positive S-negative Fy(a)-negative K-negative

I got the thumbs-down. Apparently there was a clinically significant antibody masked but not noted. I’d love to know what it was.

This is a major failing of the BTLP-TACT simulator. You can’t learn anything from your mistakes.

5 March 2026 (Thursday) - NEQAS 2601 BF

I got the results of NEQAS morphology 2601BF today

2601 BF1

302 Thrombocytopenia (consensus 1^st)
212 Blast cells (consensus 2^nd)
012 Red cell fragments (consensus 3^th)
213 Promyelocytes (consensus 4^th)
022 NRBC (consensus 5^th)

I said ?? acute promyelocytic leukaemia. It was.

2601 BF2

212 Blast cells (consensus 1^st)
224 Basophilia (consensus 2^nd)
022 NRBC (consensus 3^th)
301 Thrombocytosis (consensus 4^th)
213 Promyelocytes (consensus 8^th)

I said ?? CML transforming. It was certainly something transforming, but the expert opinion was rather vague as to what.