5 November 2026 (Thursday) - BTLP-TACT Exercise

 I got another snarky email saying I’m not doing enough BTLP-TACT exercises so I thought I’d better do one…

It gave me two cases:

 

44549 – a forty-six year-old woman in maternity needing group and save.

She grouped as O Rh(D) Negative with antibody screen weakly positive in cells 1 & 2 so I performed antibody panels. The enzyme and IAT panels were positive in cells 1, 2 & 3 corresponding with anti-D but not excluding anti-Cw

74466 – a seventy-six year-old woman needing four units of blood for a revision of THR.

She grouped as O Rh(D) Positive with a negative antibody screen. I selected four units of O Rh(D) Positive blood.

 

I got the thumbs up

5 November 2026 (Thursday) - UKAS Update

The nice people at UKAS sent their incomprehensible gibberish today. Am I being cynical? Click here and judge for yourself.

I then copied the entire lot into Microsoft CoPilot and asked for an English translation. And again starting off with what really was a load of incomprehensible gibberish I ended up with something rather more sensible.

As I’ve said before, quality management would be taken far more seriously if it wasn’t couched in such silly words. 

3 November 2026 (Tuesday) - Fritsma Factor Update

The Fritsma Factor newsletter appeared in my in-box today. This one does get published as a website to which I can link… so here’s the link. I like thinks I can link to – it’s evidence that I’m not just making it up.

 

There’s quite a bit of technical stuff in this month’s update. Bearing in mind that I finished formal training in 1987 and Factor V Leiden was first described in 1994, I personally find the Fritsma Factor update invaluable.

2 November 2026 (Monday) - The Blood Project

A while ago I signed up to the mailing list of “The Blood Project”. As I said to the boss last week, I sign up to pretty much every work-related mailing list there is. I was going to say “most turn out to be a load of rubbish” but that’s rather unfair. To be honest what I do is rather specialized and so most medical mailing lists are incredibly useful to those at whom they are aimed, but just a tad irrelevant to me.

The October newsletter arrived today (in November!). I would give a link to it, but this is just an email… it’s rather clinical but that’s not necessarily a bad thing. Thalassemia, haemophilia… all useful stuff. It would just be nice to have some technical stuff in amongst the clinical.

 

2 November 2026 (Monday) - Learning Monday

 

The correct answer: is 3.

Thromboembolism occurs one in every five patients with myeloproliferative neoplasms (MPNs). The incidence of splanchnic vein thrombosis (SVT) in patients varies and can affect mortality and morbidity. Active gastrointestinal bleeding occurring as a result of portal hypertension and or with anticoagulant therapy in these patients requires immediate stabilization and control of the bleeding source. The timing of anticoagulation resumption or initiation must account for hemostasis, rebleeding risk, thrombus extent and progression, and the patient's overall clinical condition. Cytoreductive therapy does not replace anticoagulation when anticoagulation is indicated. Long-term anticoagulation is frequently needed due to the risk of recurrent thrombosis and the other risk factors for thrombosis. Discontinuing anticoagulation can still be a difficult decision. There is no universally applicable time point for restarting anticoagulation after acute variceal bleeding in every patient with MPN-SVT. The decision requires multidisciplinary assessment, often involving hematology, hepatology and gastroenterology.  

References:  

1. Demirci U, Baysal M, Aksoy E, et al. Evaluation of the frequency, risk factors, and outcomes of splanchnic vein thrombosis in myeloproliferative neoplasms: a retrospective cohort study. J Thromb Thrombolysis. 2026 Aug 7. doi: 10.1007/s11239-026-03363-8. 

2. Baysal M, Bayrak M, Eşkazan AE. Current evidence on the use of direct oral anticoagulants in patients with myeloproliferative neoplasm: a systematic review. Expert Rev Hematol. 2023 Feb;16(2):131-140. 

3. How C, Chrysafi P, Ko A, et al. Anticoagulation Management of Splanchnic Vein Thrombosis in Myeloproliferative Neoplasms: A Global Abdominal/Splanchnic Thrombosis Retrospective Observational Study in 486 MPN Patients (GASTRO-MPN). Blood. Volume 144, 2024, Page 16.  

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1 November 2026 (Sunday) - BTLP-TACT Exercise

Bearing in mind I’ve had yet another whinging email about how few BTLP-TACT exercises I’ve done (only six last month!!) I thought I might see if I could get ahead of the curve this month.

I was presented with two cases:

 

90063 – a forty-five year-old woman in the haematology clinic with sickle cell disease needing a two unit top up.

She grouped as O Rh(D) Positive with a negative antibody screen. I selected two units of O Rh(D) Positive K-Negative HbS-Negative blood for her.

 

06929 – a fifty-nine year-old chap with PR bleed needing group and save.

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

 

I got it right, which was a result.

1 November 2026 (Sunday) - ITP

Here’s an interesting little overview of the state of treatment of ITP. Back in the mid-eighties I used to go to the haematology clinic of a satellite hospital on a Friday morning where I would do a couple of dozen (manual) platelet counts. We had many patients with ITP whose platelet counts were often in single figures. I can remember may of those people being one big bruise.

How times have changed…