19 February 2026 (Thursday) - The ESR

I’ve just marked a trainee’s portfolio work on ESR.

The erythrocyte sedimentation rate is quite possibly the first blood test that was ever invented. You just suck some blood up a tube and see how much it settles out in an hour. The more it settles, the more ill the patient.

 

Professional blood testers laugh at it because it is so non-specific. In these days of high-tech diagnostics, those who know about high-tech diagnostics look down their nose at a test which is so non-specific.

However for a GP this is absolutely brilliant. With a limited time to spend with the patient, the GP has to determine if the patient is genuinely ill or malingering. The ESR tells him that. It don’t say what is wrong with the patient, but in the first instance it don’t need to.

All the GP needs to know in the first instance is does he need to spend more time with the patient, or can he tell them to clear off with a clear conscience.

 

Here’s a proper article about it.

19 February 2026 (Thursday) - Getting the BTLP-TACT Wrong (again)

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

 

41032 – a forty year old woman needing four units of CMV-negative blood for a case of placenta accrecia

The control well was positive and so the entire group was uninterpretable. The antibody screen was negative though. I issued the only three units of O Rh(D)-negative, K-negative, CMV-negative blood

53832 – a twenty year oldwoman needing two units of blood for a haematemesis

Again the control well was positive and so the entire group was uninterpretable. The antibody screen was negative. I issued two units of O Rh(D)-negative, K-negative blood.

 

I got it wrong. Somehow the thing didn’t realise that I’d actually selected blood for the first patient and issued it all to the second…

18 February 2026 (Wednesday) - Red Cell Membrane Issues

I was talking with one of the trainees about the good old days… I’m sure they think I used to run the path lab on Noah’s Ark… We got talking about tests for red cell membrane abnormalities and I felt I might benefit from a little refresher on the subject. So here’s what I found.

 

Given a blood count with unexplained high MCHC (that doesn’t correct on warming) and reticulocytosis you have a look at the blood film.

 

If there’s lots of spherocytes we would do a direct antiglobulin test to rule out autoimmune haemolytic anaemia.

Back in the day we used to perform the osmotic fragility test but that is “so last century”. These days we use flow cytometry to look for eosin-5-malemide (EMA) which, being a structural red cell protein, is reduced in people with hereditary spherocytosis.

 

If there’s lots of elliptocytes we used to say “that’s hereditary elliptocytosis” and move on. These days there’s all sorts of molecular tests that can be done.

 

I found out that I wasn’t really that out of touch, but I am now rather inexperienced… mainly because these tests are only done in specialist centres these days.

17 February 2026 (Tuesday) - Westgard QC Update

The nice people Westgard QC sent their update today. You can read it by clicking here. As always a lot of it is hard going, but mathematics often is (I’ve got a degree in the stuff – I know!) But there was an interesting article about how some labs are using AI to review their IQC… and the AI is getting it wrong.

AI does that… Look at this piccie – it is my current Facebook profile picture which was created by AI. It looks rather good doesn’t it? Until you actually look at it.

The walking stick somehow supports itself.

I’ve got three dogs but four dog leads.

One of the dogs isn’t on a lead at all.

There’s a hole in my left thigh.

 

Don’t use AI to review your IQC, eh?

 

15 February 2026 (Sunday) - Acanthocytes

 Click here and click on “spiky cells” to see my take on the matter...

12 February 2026 (Thursday) - Horiba Newsletter

The nice people at Horiba sent their update today. You can read it by clicking here.

A case study of myeloproliferative disorder / chronic eosinophilic leukaemia, and an update about their latest technology… Something about which I'm getting increasingly out of touch.

 

Back in the day the reps used to come round at least twice a year to give us all lunchtime presentations about their latest machines… and they would give us all sandwiches and free pens and stuff… how times have changed.

 

11 February 2026 (Wednesday) - BTLP-TACT Exercise

After yesterday’s debacle I thought I’d better try again.  It presented me with two cases:

 

62453 – a sixty-eight year-old chap with hypofibrinogenaemia who needed two units of cryoprecipitate.

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

According to https://pubmed.ncbi.nlm.nih.gov/34127586/ cryoprecipitate *is*recommended  for hypofirinogenaemia  so I issued two units of the stuff.

 

 

27497 – a twenty-two year-old woman needing four units of FFP for factor V deficiency.

She grouped as A Rh(D) Positive, but the Rh reaction was weak so I called it indeterminate as that is what has worked in the past. The antibody screen was negative.

FFP is suitable for Factor V deficiency according to https://www.ncbi.nlm.nih.gov/books/NBK580494/  and https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/factor-v-deficiency/  so I issued four units of it.

 

I got this one right…

 

10 February 2026 (Tuesday) - IBMS Newsletter

The IBMS sent out their monthly newsletter today. You can read it by clicking here. I read it; it is the official communication of my professional body. And (as I say every month) either it or I am out of touch with the profession…

 

There was talk about the IBMS’s new president; I have heard of her before. She works in the University of Brighton (the old Brighton poly). There were several management/HR initiatives being discussed. There was talk about the “Harvey’s Gang” scheme, but that’s not really what we do on a daily basis.

And there was talk about elections to the board that runs the IBMS. I’ve done nothing but moan about the IBMS for years. Maybe I should stand for one of the positions on their council?

I suspect I’d be wasting my time. The trouble I have with the IBMS is that for all that I’m completely convinced they are going in the wrong direction, I don’t know what the right direction is.

10 February 2026 (Tuesday) - BTLP-TACT Exercise

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

 

12309 – a twenty-five year-old woman in theatre needing six units of blood for a stab wound.

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

I issued six units of A Rh(D) Positive K-Negative blood

 

45555 – a ninety-eight year-old chap having a liver transplant needing four units of FFP and two units of cryo.

His blood group was completely indeterminate with cell group AB and serum group O, and the control failed as well.

The antibody screen was positive in cells 2 and 3 so I performed antibody panels. The enzyme and IAT panels were positive in cells 1, 3, 4, 6 and 7 corresponding with anti-Jk(a) but not excluding anti-E.

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC2958698/ implies both FFP and cryo are indicated in liver transplants

I selected two units of AB FFP (because that was all there was) and two units of AB cryo.

 

I got it wrong… Apparently in case 45555 there wasn’t any anti-E. I had another look. There wasn’t. So why did I think there had been? Oh well… if nothing else I wouldn’t have done any harm had I given E-negative products…

 

8 February 2026 (Sunday) - Wassat?

 I’ve mentioned this before. See by clicking here…

5 February 2026 (Thursday) - Thermal Amplitude and anti-A1

Here’s a rather interesting dissertation on anti-A₁.

 

I first heard about anti-A₁ in 1982 when I was working at the (now demolished) Royal East Sussex Hospital. But I never saw an example of it until I left the place and worked somewhere else.

That “somewhere else” had more cases of anti-A1 that my gran ever had cups of tea. At least one a day… until there was a huge laboratory refurbishment and re-build. The cases of anti-A1 stopped overnight, and in twenty more years there I never saw another case. Nor did I see any in the place where I worked from 2011 to 2017, nor in the place where I’ve worked ever since.

So what was going on in the late 1980s?

 

Looking back we used to do blood groups in tubes and all the testing done at room temperature was left on the drafty windowsills to incubate. Where it was cold.

And that’s where the term “thermal amplitude” comes into play. The week before the laboratory refurbishment I had a case of anti P₁ which the boss couldn’t detect because I was incubating my room temperature tubes on the drafty windowsill whereas he was doing his on the bench. We got out the thermometer…  the bench was just under 20^oC, the windowsill was 6^oC.

5 February 2026 (Thursday) - Yuk (!)

I updated my atlas with something I saw down the microscope yesterday. Click here, then click on loa loa

5 February 2026 (Thursday) - BTLP-TACT

Yet another email saying “Your manager has identified that you may need to complete further TACT participations to improve your engagement target with the system. Please visit TACT and log in at your earliest convenience”

Even though my manager denies all knowledge of this…

But it’s raining outside, it’s half an hour before “Four In A Bed” is on telly, I’m up to date on marking trainee portfolio work… so here we go.

 

I was presented with two cases:

 

12328 – a sixty-eight year-old chap in the haematology clinic needing group and save.

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

 

63393 – a forty-six year-old woman with PPH needing four units of blood within two hours.

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

I selected four units of O Rh(D) Positive K-Negative blood

 

I got the thumbs-up

 

3 February 2026 (Tuesday) - Trivia Tuesday

 Leucocytosis is not uncommon in pregnancy… but a leucocyte alkaline phosphatase… does anyone still do those?

3 February 2026 (Tuesday) - Fritsma Factor Newsletter

The Fritsma Factor newsletter appeared in my in-box this morning. You can see it by clicking here. As always it was rather useful, and this month it had quite a lot more in it than usual…

2 February 2026 (Monday) - Learning Monday

 

It’s not Immune thrombocytopenia. The platelet count is too high and the patient would have had bruising and other symptoms which would have come to light before any surgery.

It’s not Wiskott-Aldrich syndrome as that has small platelets.

It’s not DIC as the clotting isn’t outside the normal range.

 

Large and pale platelets – grey platelet syndrome…

29 January 2026 (Thursday) - IBMS Newsletter

The IBMS sent their newsletter today. You can see it by clicking here. In the past I’ve been less than complimentary about it… and I am again today. Again there’s absolutely nothing of interest to me in it. And I’ll make the observation that back in the day (before the Internet) people only joined the IBMS because their magazine was *the* place where jobs in this line of work were advertised.

There’s only one job advert in this month’s newsletter (I counted)…