12 August 2026 (Wednesday) - BTLP-TACT Exercise

It’s too hot outside. I’ll do a BTLP-TACT exercise… I was presented with one case – a forty-nine year-old woman who claimed to be tired all the time. A group and save was required.

 

She grouped as A Rh(D) Positive, but it was one of those supposedly weak reactions so I called it A Rh indeterminate with the proviso that I would send it to NHSBT.

The antibody screen was positive in cell 2 so I performed antibody panels.

 

The enzyme panel was 2+ in cells 2 and 6 corresponding to anti-K, and 4+ in cells 3 and five corresponding to anti-E.

The IAT panel was 2+ in cells 2, 3, 5 and 6 corresponding to anti-K and anti-E

 

I got the thumbs-up.

9 August 2026 (Sunday) - Slide Saturday Challenge

 

Well, it’s hereditary elliptocytosis, isn’t it? This one looks particularly extreme with a lot of very bizarre red cells.

Clinically this one would be severe, some not so bad. I always remember discovering a case of H.E. in an eighty year old chap who had an infection after a prostatectomy. Morphologically loads of elliptocytes, clinically not a problem… he’d lived eighty years before anyone had any cause to put his blood under a microscope… and even then it wasn’t actually because of his red cells.

 

Here’s an article on the matter… 

7 August 2026 (Friday) - ABO Groups

ABO groups aren’t quite as straightforward as we might like them to be…

Here’s a little article on the subject…

4 August 2026 (Tuesday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise. I had two cases:

 

15626 – a fifty-six year-old chap needing two units of cryo to treat Factor VIII deficiency.

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

According to https://pmc.ncbi.nlm.nih.gov/articles/PMC4627369 Cryo is not recommended for Factor VIII deficiency  so I didn’t issue any

 

73726 – a seventy-eight year old chap needing four units of FFP for a pre-operative reversal of warfarin.

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

According to https://pmc.ncbi.nlm.nih.gov/articles/PMC9362864/ FFP is not the treatment of choice for the reversal of warfarin pre-operatively so I didn’t issue any.

 

I got it right.

4 August 2026 (Tuesday) - Fritsma Factor Newsletter

 

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

There was quite a bit to take in…

3 August 2026 (Monday) - Learning Monday

 The correct answer is option 3. Mixed phenotype acute leukemia with KMT2A rearrangement  

Immunophenotypic properties of MPAL can change over time: both variable proportions of different lineages and phenotypic alterations have been described as lineage switch. Most cases of lineage change involve a switch from ALL to AML. A retrospective review can often reveal the presence of an unrecognized or underappreciated malignant subclonal population present in the initial specimen. This may represent a minor population which displayed more chemoresistance and emerged after eradication of the chemosensitive dominant clone. This kind of lineage switch is most common in MPALs with KMT2A rearrangement where a small myeloid/monocytic population can be difficult to appreciate due to hyperleukocytosis with a dominant B-precursor population at diagnosis.

Reference: 

Weinberg OK, Arber DA, Döhner H, et al. The International Consensus Classification of acute leukemias of ambiguous lineage. Blood. 2023;141(18):2275-2277. 

2 August 2026 (Sunday) - Something New

Emperipolesis – that’s a new one on me… apparently it’s a rare biological process where an intact, living cell enters and moves inside the cytoplasm of another cell without getting harmed or destroyed. It differs from phagocytosis because the engulfed cell stays alive and can leave and does…

Here’s a reference about it.