15 October 2026 (Thursday) - It Knows, You Know

I’ve got bored with the dull picture I’ve been using for BTLP-TACT exercise so got Microsoft Copilot to generate a new one - a fun piccie of me at work in the blood bank.

In order to personalise it somewhat I asked it to include a poster featuring the two rules I always tell the trainees (which it did).

 

When I thanked Microsoft Copilot for this picture it commented: “I have to say, the final blood bank version with the "Two Rules. Don't balls it up. Don't kill no one" poster made me laugh. It feels exactly like the sort of unofficial quality-management statement that every transfusion laboratory secretly operates under, despite hundreds of pages of SOPs saying the same thing in a much more complicated way”.

 

Seeing it has this level of understanding is why I always thank it for anything I ask it to do.

 

15 October 2026 (Thursday) - BTLP-TACT Exercise

Bearing in mind I stuffed up on Monday (and also bearing in mind I’ve been playing with Microsoft Copilot) I thought I’d do another BTLP-TACT exercise…

 

I was presented with two cases:

 

18718 – a fifty year old woman in ITU needing two units of blood

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

I selected two units of B Rh(D) Positive blood for her.

 

37802 – a thirty-six year old woman in the haematology clinic needing two units of irradiated blood

She grouped as O Rh(D) Positive with antibody screen positive in cells 1 and 3.

I performed antibody panels. The IAT panel was positive in cells 1, 3, 6, 9 and 10 corresponding with anti-Fy(a) whilst the enzyme panel was negative throughout.

I selected two irradiated units of O (one Rh(D) Positive and one Rh(D) Negative) Fy(a) Negative which were also K-Negative.

I got the red light as it felf there were more antibodies there… I’d love to know which ones. Possibly anti-Kp(a)?

Rather ironic what with my new piccie courtesy of Microsoft Copilot, eh?

13 October 2026 (Tuesday) - NEQAS 2604DM

 

I got hold of the results of 2604DM today. When I looked at it I said:

 

• Neutrophilia – mature cells
• Howell Jolly Bodies
• Sickle cells
• Target cells
• Polychromasia
• Some Large platelets

 

Was this someone with sickle cell disease with some sort of myeloproliferation?

 

The expert final comment that I read today was:

 

“This film showed a G-CSF-induced neutrophilia in a patient with sickle cell disease (who was recovering from chemotherapy).

It is often easy to overlook a second disorder when there is a dominant abnormal feature on a blood film. In this case, there were clues to a red cell element: red cell appearances were very abnormal and nucleated red cells and Howell-Jolly bodies were present, but most of all there were clear sickle cells on the film. If you missed these, have another look.

Could you have known the neutrophilia was caused by G-CSF administration? Probably not, but given the high neutrophil count, it would be unusual for an infective cause not to have marked toxic features in the neutrophils! A chronic neutrophilic leukaemia could be considered if G-CSF had not been administered”.

 

Well, I spotted the salient features, but my final comment might not appear very professional, but what a load of bollox. It is utterly inconceivable that a patient with sickle cell disease who was receiving G-CSF following chemotherapy would be unknown to the haematology laboratory.

For these exercises to have any validity they need to have al least a passing relationship with reality.

13 October 2026 (Tuesday) - IBMS Update

The IBMS sent their update today – you can read it by clicking here. There wasn’t a lot that was directly relevant to me, but it did mention the recent publication of certain national standards to do with microbiology and sepsis.

That’s a step in the right direction.

There was still a lot of stuff about what individual committee members had been getting up to, but perhaps we are moving away from that sort of thing to what our professional body should be doing

(or what a semi-retired out of date old reactionary thinks it should be doing. A subtle difference…)

12 October 2026 (Monday) - BTLP-TACT Exercise

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

51761 – a seventy-two year-old chap needing group and save

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

98771 – a fifty-nine year-old woman also needing group and save

She also grouped as O Rh(D) Positive but with antibody screen weakly positive in cells 2 & 3. I performed antibody panels. Both the enzyme and IAT panels were negative in cells 1 & 2 and positive in all other cells corresponding with anti-c, but I was unable to exclude anti – Lu(a) as it doesn’t feature on the antigram of the screen, and also unable to exclude anti-Kp(a)

 
I got the thumbs down… anti-E was also masked… I saw that - why didn't I write it down?

10 October 2026 (Saturday) - Platelet Refractoriness

Platelet transfusions don’t always do the trick. You gave a full adult dose, ABO-compatible, straight off the agitator, room temperature the whole way, and the post-transfusion count looks almost identical to the pre-transfusion count. So do you carry on stuffing in more platelets?

Here’s a treatise on the matter.

 

6 October 2026 (Tuesday) - Fritsma Factor Update

The latest update from the nice people at the Fritsma Factor arrived in my in-box today.

As always there was quite a bit of useful stuff.

Haemophilia in women… we don’t often think about that…