30 September 2026 (Wednesday) - BTLP-TACT Exercise

As it is the end of the month I thought I might as well do a BTLP-TACT exercise if only to keep the engagement level up.

I had one case – a ninety-two year-old chap needing four units of blood prior to surgery. 

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

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

 

I got it right. Having done six exercises this month the software says I’m currently meeting my engagement targets… I wonder why it keeps sending me emails saying that I’m not…

29 September 2026 (Tuesday) - IBMS Newsletter

It was with something of a sense of frustration that I received the IBMS newsletter today. Having received it in four different emails, the works IT refused to open it as it originated from outside its own domain.

I eventually got the thing open – you can read it by clicking here (hopefully). Much of it was irrelevant to me, but two items made me think.

There was an article about embracing automation… This is clearly the way forward, but when I first started people were fighting tooth and nail against automation. There was supposedly some merit by doing everything in the most laborious, time consuming, expensive and imprecise way possible (or so it was ranted at me by so many people).

But I saw red when I read about “Pathology Transformation: Building a sustainable workforce”. This is a standard management catchphrase which has been trotted out ever since we as a profession decided not to build a sustainable workforce but to hope to have a workforce educate and train itself, and then pretended to be surprised when in the large part it didn’t work. (I’ve ranted about this before).

24 September 2026 (Thursday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – a twenty-eight year-old woman with a ruptured ectopic pregnancy needing six units of blood.
 

She grouped as B Rh(D) Negative with a negative antibody screen.

I selected two units of B Rh(D) Negative and four units of O Rh(D) Negative

 
I got the thumbs-up.

 

23 September 2026 (Wednesday) - Westgard QC Update

The nice people at Westgard QC sent their update today. It was rather heavy going, but that’s the nature of the subject…

 

22 September 2026 (Tuesday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. Tranexamic acid and keeping platelets in the fridge featured again…

ARTICLE OF THE MONTH

Cold and room-temperature platelets in cardiac surgery: the CHIPS randomized clinical trial.
Spinella, P.C., et al. (2026). JAMA. [Record in progress].
PICO SUMMARY

 

 

TOP ARTICLES

Subcutaneous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy.
Bus, S.R., et al. (2026). The Cochrane Database of Systematic Reviews.

Perioperative albumin versus other fluids to prevent cardiac surgery-associated kidney injury: a systematic review and meta-analysis of randomized trials.
Darlison, P.R., et al. (2026). Critical Care Science.

AI and blood banking: predicting transfusion demand - a systematic review of forecasting approaches.
Engelke, M., et al. (2026). Transfusion Medicine and Hemotherapy. [Record in progress].

All-trans retinoic acid plus eltrombopag for refractory/relapsed immune thrombocytopenia.
Fu, H., et al. (2026). NEJM Evidence.

Recombinant human thrombopoietin reduces the need for platelet transfusion in patients with chronic liver disease and thrombocytopenia.
Han, Y., et al. (2026). American Journal of Hematology.

Eltrombopag plus cyclosporine A for moderate aplastic anemia (EMAA): a placebo-controlled, double-blind, phase 3 trial.
Höchsmann, B., et al. (2026). Blood. [Record in progress].

Impact of tranexamic acid on outcomes in early-admitted patients with aneurysmal subarachnoid hemorrhage: a systematic review and bayesian meta-analysis of randomized controlled trials.
Łajczak, P., et al. (2026). Journal of Thrombosis and Thrombolysis. [Record in progress].

Intravenous iron to treat anaemia before cardiac surgery (ITACS): international, double blind, placebo controlled randomised trial.
Myles, P.S., et al. (2026). BMJ.

Early red blood cell transfusion strategy in septic shock among patients with cancer: the TRANSPORT randomized controlled trial.
Pène, F., et al. (2026). Intensive Care Medicine. [Record in progress].

Larger versus smaller red blood cell volume per transfusion in hospitalized adults, children and preterm neonates.
Roumeliotis, N., et al. (2026). The Cochrane Database of Systematic Reviews.

Albumin for people with liver cirrhosis and bacterial infections.
Simonetti, R.G., et al. (2026). The Cochrane Database of Systematic Reviews.

 

 

21 September 2026 (Monday) - Hb D Punjab

 

The correct answer is option 1. HPLC of the husband should be advised.  

HbD Punjab is a structural hemoglobin variant that is usually clinically benign in the heterozygous state (HbAD). Therefore, identification of HbD Punjab in the mother alone is not an indication for termination of pregnancy. However, HbD Punjab is important because it can be inherited by the fetus, may interact with other haemoglobin variants, and can result in clinically significant disease when combined with certain hemoglobinopathies.  

The important next step is to evaluate the husband for an underlying hemoglobinopathy, particularly HbS or β-thalassaemia, as compound heterozygosity in the offspring may result in a clinically significant hemoglobin disorder. Based on the husband's results, the couple should receive appropriate genetic counselling and, if indicated, prenatal diagnostic testing. 

Although HbD Punjab is generally clinically silent, it can become clinically significant when inherited alongside other hemoglobin variants, such as sickle haemoglobin (HbS) or β-thalassaemia. In particular, HbSD Punjab disease can present with manifestations similar to sickle cell disease, including vaso-occlusive complications, while HbD Punjab/β-thalassaemia may produce a variable clinical phenotype ranging from mild to moderately severe anaemia 

Reference:

• Torres Lde S, Okumura JV, Silva DG, Bonini-Domingos CR. Hemoglobin D-Punjab: origin, distribution and laboratory diagnosis. Rev Bras Hematol Hemoter. 2015 Mar-Apr;37(2):120-6. 

I got that right...

20 September 2026 (Sunday) - Hedging Your Bets

 

Well… the initial Slide Saturday Challenge (yesterday) asked: “How would you describe the atypical cell in the centre of the field and what diagnosis would you consider”.
I see that the American Society of Hematology was as reluctant to commit themselves as I was…