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.

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…

 

26 September 2025 (Friday) - A Meeting

I had a little meeting with the bosses today to talk about how I might help with the trainees. One positive was that everyone agreed with my theory that scheduling and actually having regular formal meetings with them is a good idea.

One negative thing was my realization of just how much I’ve forgotten about the diagnostic testing that gets sent to reference centres.

But what is CPD for if not to address those shortcomings.

24 September 2025 (Wednesday) - Parasitology Tutorial

The boss asked if I would spend some time with one of the trainees going over blood-borne parasites. I’m always quite happy to do so… but I can rabbit on and “blood-borne parasites” is a lot to cover… So I suggested that the pair of us looked after the microscopy bench, and periodically we’d break off and have a little training session. Little and often so as not to overload with information.

It worked surprisingly well. 

 

Session One – 9am 

 

We downloaded a PowerPoint presentation I’d prepared and had a little overview of blood-borne parasites that infest humans. 

We then examined some films containing microfilaria 

 

Session Two – 10am  

 

We looked at some pictures of P. falciparum on the American Society of Hematology’s website, discussed them and looked down the twin microscope at thick and thin films containing P. falciparum  

 

Session Three – 11am 

 

We looked at some pictures of P. vivax and P. ovale on the American Society of Hematology’s website and other websites, discussed them and looked down the twin microscope at thick and thin films containing both. 

 

Session Four – 2 pm 

 

We looked at some pictures of P. malariae and P. knowlsei on the Scientists Against Malaria’s website, discussed them and looked down the twin microscope thin films containing P. knowlesi 

 

Session Five – 3.30 pm 

 

We looked at some pictures of trypanosomes and babesiosis on Google images and discussed them. 

17 September 2025 (Wednesday) - Mentoring

I spent quite a bit of time helping with the competency assessment of a colleague today. Not so much teaching as showing how I do a job, and checking that I agreed with what he'd done.
Of course I did... but it made me think. In many ways there is no right and wrong to the reporting in microscopy - as I explained how I do it, I found myself wondering if I might do it better... or at least differently...

 

28 November 2019 (Thursday) - MCV

One of the trainees spotted this today. A patient’s MCV had changed by about ten per cent overnight. Whilst it was a “normal” result, it shouldn’t do that.

We had a really good chat about why this might have been. Did we have the right sample? Had the wrong patient been bled? Were the analysers working properly?

It turned out the sample was over a day old.

I quite like these little ad-hoc teaching sessions.

17 October 2019 (Thursday) - Mentoring

I spent a few minutes on the late shift chatting with one of the newly qualified chaps. He wasn’t sure about whether he could authorise some blood counts, so we sat and talked them all through. Reactive neutrophilias in people just arrived in A&E, relative thrombocytopenias in people with ongoing liver disease… the sorts of things that you get to understand with experience.

I enjoyed the session. Sometimes I miss being  a formal trainer

20 June 2017 (Tuesday) - Reviewing Blood Films

I was asked to sit with one of the trainees today and discuss some blood films with him.

He did well; he spotted the salient features in cases of iron deficiency, sickle cell disease, megaloblastic anaemia and CLL. However he was a tad weak on Howell-Jolly bodies. As was I back in the day.

It was good to be able to teach and mentor again. It is about the only part of my old life that I miss…