A Dull Day At Work...?: January 2026

28 January 2026 (Wednesday) - Levetiracetam

I saw an interesting case today. Clearly an iron-deficiency anaemia. They are quite common. But this one was in someone who was on Levetiracetam. It’s an anticonvulsant which whilst supposedly not causing iron deficiency, it is recommended that people on that medication should take iron supplements.

I’ve updated my atlas to include this case, and here’s some expert opinion on the matter

27 January 2026 (Tuesday) - BTLP-TACT Exercise

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

77343 – a ninety-eight year-old chap with sickle cell disease needing two units of blood

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

I selected two units of O Rh(D) Positive HbS negative blood

61659 – a twenty-eight year-old woman with ITP needing group and save

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

I got the green light.

26 January 2026 (Monday) - Transfusion Evidence Alert Update

The nice people at the Transfusion Evidence Alert sent their update today. Again there was talk of frozen platelets. It would seem they aren’t as good as fresh ones, but fresh ones are only good for five days; frozen ones keep for two years…

ARTICLE OF THE MONTH

Cryopreserved vs liquid-stored platelets for the treatment of surgical bleeding: the CLIP-II randomized noninferiority clinical trial.
Reade, M.C., et al. (2025). JAMA. [Record in progress].
PICO SUMMARY

TOP ARTICLES

Engasertib versus placebo for bleeding in hereditary hemorrhagic telangiectasia.
Al-Samkari, H., et al. (2025). The New England Journal of Medicine.

Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birthweight infants.
Andersen, C., et al. (2025). The Cochrane Database of Systematic Reviews.

Red cell physiologic stress results in lower quality transfusions: a randomized trial in adults with sickle cell disease.
Karafin, M.S., et al. (2025). Blood Red Cells Iron.

Safety and pharmacodynamics of the ferroportin inhibitor vamifeport in patients with non-transfusion-dependent β-thalassemia: results from a randomized phase 2a study.
Kattamis, A., et al. (2025). Orphanet Journal of Rare Diseases.

The efficacy and safety of thrombopoietin receptor agonists in solid tumors with chemotherapy-induced thrombocytopenia: a systematic review and network meta-analysis of randomized controlled trials.
Lai, Y., et al. (2025). Frontiers in Pharmacology.

Effect of multidisciplinary team-based refined nursing on outcomes in elderly patients with liver cirrhosis and upper gastrointestinal bleeding.
Li, S., et al. (2025). Journal of Visualized Experiments: JoVE.

A standard blood bank donation improves cardiometabolic health of donors: a double-blind randomised controlled trial.
Mora-Gonzalez, D., et al. (2025). British Journal of Haematology. [Record in progress].

Risk assessment tools for predicting transfusion in surgery: a systematic review and meta-analysis.
Seyahian, A., et al. (2025). Health Technology Assessment. [Record in progress].

Liberal versus restrictive red blood cell transfusion thresholds in acute acquired brain injury: a systematic review and meta-analysis.
Sud, S., et al. (2025). BMJ Open.

23 January 2026 (Friday) - UKAS Update

The nice people at the UK Accreditation Service sent their update today. You can read it by clicking here. I read it because making sure that I operate within the scope of their rules is a major part of what I do every day.

But…

This update covered the accreditation of bodies involved with event management, railway supply chains, water management and announced the launch of an accreditation for A.I. management systems…

I try not to be a cynical old reactionary. I realise that what I do needs some sort of oversight. But how can any supervisory body with such a wide-ranging remit do much more than check the paperwork that the bosses fill in?

20 January 2026 (Tuesday) - Lymphopenia

Lymphopenia is something that I see from time to time...

20 January 2026 (Tuesday) - HCPC Update

The HCPC sent its update today. You can see it by clicking here. I was rather interested to see mention of the upcoming CPD Week, but sadly (at the risk of appearing to be a cynical old reactionary) it is CPD week for the sort of people who sit in offices and come up with CPD Week. I was hoping to see talk about the latest developments in what I do on a daily basis…

I suppose that, as my son once told his teacher over thirty years ago, if you want a job done, do it yourself. Maybe I might volunteer to organise something for them rather than just sitting on my bum and finding fault

20 January 2026 (Tuesday) - NEQAS 2506DM

I finally got the results of NEQAS 2506DM forty-two days after it closed. At the time (8 December 2025) I said “Well, there’s something haemolytic going on, isn’t there? Schistocytes, red cell fragments, nucleated red cells, polychromasia, ghost cells, spherocytes and were there some occasional odd red cell inclusions?

The platelet count was down (well, we were told that) and there were some large platelets.

There was one myelocyte and a couple of dysplastic neutrophils”

It turns out this was a case of TTP; I spotted that which I needed to spot. Interestingly the expert opinion made no mention of the myelocyte or dysplastic neutrophils.

As time goes by I find myself getting more and more frustrated with NEQAS morphology. Bearing in mind they know what the cases are when they go live there is absolutely no reason at all why we should have to wait six weeks for feedback on something about which I have by now totally forgotten…

19 January 2026 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – a seventy-nine year-old woman in theatre having a revision of her hip replacement who needed four units of blood. She grouped as B Rh(D) Positive with a negative antibody screen.

I selected four units of B Rh(D) Positive blood.

I got it right…

18 January 2026 (Sunday) - Toxic Granulation

16 January 2026 (Friday) - Sub Types of A

Here’s an interesting little read about sub-types of the A blood group which got me thinking. Back in the day sub-types of the A blood group were a big thing. We’d often find the weak reacting A₂ with the anti-A₁. We hardly see them any more because the anti-A reagents are far better these days, and because the buildings we work in now correspond to more stringent building regulations and aren’t anywhere near cold enough for the cold-reacting anti-A₁ to show itself.

Those sub-types are still there… we just don’t notice them anywhere near as often as we used to. Is that an issue? Demonstrably not.

15 January 2026 (Thursday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – an eighty-six year old chap having a liver transplant needing group and save, four units of FFP and two units of cryo.

The sample had no NHS number or hospital number and so was not acceptable.

I had another go. I was presented with two cases:

32854 – a fifty three year old chap having a revision of a THR who needed four units of blood.
He grouped as B Rh(D) Positive with antibody screen positive in cells 1 and 2. I performed antibody panels. The IAT panel was positive in cells 2, 3, 5, 7 and 9 whilst the enzyme panel was negative throughout. This would correspond with anti – S

I selected four units of O Rh(D) Positive S-negative blood.

75659 – a twenty-five year-old woman in the maternity department needing group and save.
She grouped as O Rh(D) Positive with antibody screen positive in cell 2. I performed antibody panels. The IAT panel and enzyme panels were positive in cells 2 and 6 corresponding with anti-K.

I got it right.

13 January 2026 (Tuesday) - Pseudo Pelger Huet Anomaly

An interesting case today… a massive neutrophilia with some Pelger Huet cells…

I’ve updated the page in my atlas – click here, and then look for “Pelger Huet Anomaly” in the links on the left hand side…

12 January 2026 (Monday) - T.A.M.O.F. (wassat then?)

No massive bleeding. No dramatic hypotension. But test results drifting in a direction that feels wrong: platelets falling, creatinine creeping, LDH elevated, hemoglobin sliding just enough to notice.

Organ dysfunction without a single unifying explanation…

Here’s a condition that is new to me. Thrombocytopenia-associated multiple organ failure (TAMOF)

Here’s a little write-up about it.

As I always say, a day when you learn nothing is a day wasted.

11 January 2026 (Sunday) - Marking Specialist Portfolio Work

I spent a couple of hours marking trainees’ portfolio work today. Iron, morphology, malaria… Over the years I’ve learned quite a bit and I’m only too happy to share my experience. Even if I do have just a tad of imposter syndrome and wonder just who am I to be commenting on post-graduate level scripts.

The trainees all see me as Methuselah’s grandad and think that if I can’t comment, who can?

11 January 2026 (Sunday) - APML

APML… Promyelocytes might look vaguely “lymphy” at first glance but that’s because of the cytoplasm which (for the most part) lacks granules. But look at the nucleus. A lymphoid nucleus is generally sounder and more regular. The myeloid nucleus has lumps and bumps (albeit rounded).

I’m particularly prompted by the bit about “while morphology can strongly suggest this diagnosis…” for many years that was all that could suggest any diagnosis. It’s such a shame that cytogenetic and molecular testing are the purview of specialist testing centres.

But that’s what CPD is all about, isn’t it?

8 January 2026 (Thursday) - BTLP-TACT Exercise

I did another BTLP-TACT exercise. I was presented with one case – a seventy-one year-old woman in theatre needing four units of blood.

She grouped as AB Rh(D) Negative with antibody screen positive in cells 1 and 2. I performed antibody panels.

The IAT and enzyme panels were positive in cells 1, 2, 3 and 6 corresponding to anti-D and anti-K but not excluding anti-Cw

I selected four units of A Rh(D) Negative blood that were K Negative and got the thumbs-up.

7 January 2026 (Wednesday) - Protein Z (?!)

The Fritsma Factor update arrived in my in-box today. You can read it by clicking here.

As always there is loads of useful stuff. Some on what you might call “routine” haemostasis, and some rather more esoteric… and talk about Protein Z. What on Earth is that? Well, here’s an introduction, but as far as I’m concerned, it’s something new. And a day when I don’t learn anything new is a day wasted…

7 January 2026 (Wednesday) - Atlas Update

The rules say that if and when I get called up for audit, only CPD work done in the last two years will be assessed. Which is something of a nuisance because I’ve put a load of effort into a personal atlas of things I’ve seen over the years.

Is it cheeky to do a major overhaul of the thing and claim that as recent CPD? That’s been my CPD project for the last few days… I’ve found that the formatting isn’t what it might be, and some of the references now go to dead links.

Well… I shall claim it as CPD… what’s the worst that can happen? An assessor will say that it isn’t current and I’ll have to submit something else…

6 January 2026 (Tuesday) - NEQAS 2508 BF

I got hold of the results for NEQAS 2508BF today…

2508 BF1

I said:

Lymphocytosis (consensus 3^rd)
smear cells (consensus 4^th)
Thrombocytopenia (consensus 1^st)
Abnormal Lymphs (consensus 6th)

I felt this was CLL – it was.

2508 BF2

I said:

Myelocytes (consensus 3^rd)
Promyelocytes (consensus 4th)
Nrbc (consensus 2^nd)
Blast cells (consensus 5th)
Thrombocytopenia (consensus 1^st)

I felt this was CML. The expert opinion was uncertain. Had this appeared in real life I would have referred it anyway…

5 January 2026 (Monday) - BTLP-TACT Exercise

I did another BTLP-TACT exercise. I was presented with two cases

65114 – a six year old lad in ITU with burns needing two units of blood.
He grouped as A Rh(D) Positive with a negative antibody screen.
I issued two units of A Rh(D) Positive

70158 – a sixty-one year-old woman in theatre needing six units of blood for gunshot wounds.
She grouped as O Rh(D) Positive with a negative antibody screen
I issued six units of O Rh(D) Positive

I got it right

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