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…