3 July 2025 (Thursday) - BTLP-TACT Exercise

On the last day of last month (three days ago) I wrote on here: “That’s eight BTLP-TACT exercises I’ve done this month… I bet I get an email whinging about my low involvement by the end of the week”. That email came at two o’clock this afternoon…

 

So here we go again. I was presented with one case – a sixty-two year-old woman needing four units of blood right away for a GI bleed.

The ABO group was indeterminate. The cell group was B; the serum group AB. But the Rh group was negative. That’s one for NHSBT.

The antibody panel was positive in cells 1 and 2 so I requested antibody panels. The IAT and enzyme panels were positive in cells 1, 2 and 3 corresponding with anti-D but not excluding anti Cw

I issued four units of O Rh(D) Negative blood.

 

I got it right.

1 July 2025 (Tuesday) - Competency Assessment

I was asked if I might produce a series of slides for competency assessments. I was rather happy to do so… it’s easier said than done though.

How many slides do we need? I went for twenty, but at five minutes per slide that’s going to take two hours per assessment.

What cases should we cover? What cases have we got in the teaching slides… Has anyone sorted the teaching slides for a while?

Back in the day I compiled a series of teaching slides by sticking what I considered to be an interesting case into a slide tray with a plan to sort it later… and I would forget about it. So consequently when I came to sort the myriad of slides I’d piled up I had a few dozen cases of iron deficient anaemia, a few dozen cases of CLL, and a few dozen slides with frankly horrific looking blast cells. All of which were rather faded.

Fortunately we had quite a variety of cases in the teaching slides. I’ve managed to get eight different slides which are predominantly red cell issues, eight which are predominantly white cell issues, one thrombocytosis, one thrombocytopenia, one with clumps, and one unremarkable one.

Getting a selection was tricky. Now I’ve got to come up with standard (correct) answers…

I quite like making myself useful like this…

30 June 2025 (Monday) - BTLP-TACT Exercise

It’s a day off work. There’s no end of stuff I might be doing but there’s a heatwave. It’s over thirty degrees outside so I’m staying where it is relatively cool. And to pass the time I’m doing a BTLP-TACT exercise.

I was presented with two cases:

 

93507 – a twenty-six year-old woman requiring group and save following a miscarriage.

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

 

24778 – an eighty-five year-old chap with haemophilia also requiring group and save.

He also grouped as A Rh(D) Positive but with antibody screen positive in all three cells. I requested antibody panels.

The IAT panel was positive in cells 1, 3, 5, 6 9 and 10 corresponding to anti-E and anti-Fy(a) but not ruling out anti-Cw or anti Lu(a).

The enzyme panel was positive in cells 3 and 5 corresponding to anti-E and ruling out anti-Cw and anti Lu(a).

 

I got the green light. That’s eight BTLP-TACT exercises I’ve done this month… I bet I get an email whinging about my low involvement by the end of the week.,

 

30 June 2025 (Monday) - NHS Elect

 

I’ve signed up to NHS Elect; I had this idea that it might be a source of CPD… As I logged in the form asked me my interests. It listed such diverse topics as

 

• Career planning

• Communication and engagement

• Customer care

• Leadership training

• Management fundamentals

• Quality improvement

• Strategy and systems

• Wellbeing

 

Am I being hopelessly naïve in expecting to have seen topics such as “blood tests” or “doing an X-ray” or “giving a bed bath”? Perhaps NHS Elect might have some useful stuff?

The trouble with me is that I am a hopeless old reactionary and I am too dismissive of anything which I might describe as “management nonsense”. Am I being *that* unreasonable in hoping that they might offer a comprehensive series of webinars suited to the haematology BMS?

 

One of the courses they offer is on “growing your social media following”, and that always gets me going. Many years ago I posted a selfie to Facebook at six o’clock in the morning whilst on a night shift and commented that I was tired. I received a formal written warning for doing so. During the hearing I was formally told by a senior manager that there was a formal policy that any mention on social media whatsoever of where I worked at the time was seen as bringing it into disrepute. Whether or not it said good, bad or indifferent things about the place.

And now we are being encouraged to grow our professional following on-line on that same social media.

How times have changed

Was there a formal policy? Somehow I doubt it. I should really let it go…

 

Shortly after that episode the fellow who gave me the formal written warning had the cheek to add me as a Facebook friend…

29 June 2025 (Sunday) - Infection Control e-learning

I did my infection control e-learning today. All a tad dull, all a tad basic… all incredibly important. It’s so easy to belittle this sort of thing. I’m reminded of an old English teacher who fifty years ago insisted we all learned proverbs. One of them was “familiarity breeds contempt”. Something of which I should be aware.

29 June 2025 (Sunday) - Platelet Clumps

Not sure about the calculation though... it presupposes that the clumps are distributed evenly across the film.
Which they aren't.

27 June 2025 (Friday) - BTLP-TACT Exercise

Yet another email whinging about my low engagement with BTLP. I’m doing one a week on average. How many more do they want me to do?

Still… here we go…

 

I had one case – a sixty year old chap needing four units of FFP and two units of cryo prior to liver transplant.

He grouped as B Rh(D) Positive with antibody screen positive in cell 2. I requested antibody panels. The IAT and enzyme panels were positive in cells 3 and 5 corresponding with anti-E.

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC2958698/ implies both FFP and cryo are indicated in liver transplants so I issued both.

 

I got the thumbs up.