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…

18 September 2026 (Friday) - BTLP-TACT Exercise

 Time for another BTLP-TACT exercise. I had one case – a twenty-five year-old woman with sickle cell disease needing eight units of blood for an exchange transfusion.

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

I selected all the O Rh(D) Negative K Negative HbS Negative units I could scrape up.. two of them.

 

I got the green light, but I hardly got it right, did I? I supplied a quarter of what was required. In reality I would have got on to NHSBT and had more supplies sent.

But I got the green light and that was a result.

16 September 2026 (Wednesday) - Inspections

This appeared on one of the satirical work-related Facebook pages that I follow… but it illustrates something I’ve been banging on about for years. Back in the day the old CPA standards were for most people unobtainable for most of the time.

Everyone knew this, and everyone accepted this.

Back in the day when I was in charge our lab passed with only three (very) minor findings, but it was the result of a lot of hard work to reach a standard for one day which was frankly beyond anyone’s ability to maintain for more than a day. We would put on a show, breathe a sigh of relief when the inspectors went home, and put our feet up for the next four years. After four years we would get plenty of notice of our next inspection, and would again move heaven and Earth to be ready on the day.

The late Duke of Edinburgh unknowingly summed up the old CPA standards when he once remarked that everywhere he went smelled of paint. And the current ISO standards are in much the same vein.

 

As a lad our Boys Brigade entered a team into the fire brigade’s fire safety quiz competition. There we learned about industrial and commercial fire safety standards which were manageable and obtainable…  but the fire brigade would turn up unannounced to check that all was in order.

 

Surely we would be far better off with such a system. Manageable and achievable objectives which are inspected without prior notice.

14 September 2026 (Monday) - Hairy Cells

 

Looks like hairy cell leukaemia to me...

The correct answer is option 3. Hairy cell leukemia. 
The combination of neutropenia, thrombocytopenia, marked monocytopenia, splenomegaly, absence of lymphadenopathy, and a dry bone marrow aspirate is highly suggestive of classic hairy cell leukemia (HCL).
Cytopenias result from bone marrow infiltration and fibrosis, which commonly causes a dry tap. Marked monocytopenia is particularly characteristic of HCL, while splenomegaly without significant lymphadenopathy is a typical clinical pattern. Diagnosis should be confirmed by bone marrow biopsy, flow cytometry, and BRAF V600E testing. The presence of a BRAF V600E mutation supports the diagnosis of classic HCL and helps distinguish it from several HCL-like disorders. 
CLL is unlikely in the absence of lymphocytosis, whereas myelodysplastic syndrome and T-cell large granular lymphocytic leukemia do not typically produce this combination of findings.

Reference:

• Zent CS, et al. Updated consensus guidelines for the diagnosis and management of patients with HCL and HCL variant. Blood. 2026 Jul 2;148(1):31-42.
• Falini B, Tiacci E. Hairy-Cell Leukemia. N Engl J Med. 2024 Oct 10;391(14):1328-1341.
• Wotherspoon A, et al. Bone marrow and splenic histology in hairy cell leukaemia. Best Pract Res Clin Haematol. 2015 Dec;28(4):200-7.

10 September 2026 (Thursday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I had one case – a seventy year old woman needing six units of blood for an aortic aneurysm.

 

Her ABO group was indeterminate, but her Rh(D) group was negative.

The antibody screen was negative.

I selected six units of O Rh(D) Negative.

 

I got it right.

7 September 2026 (Monday) - NEQAS 2603 PA

I got the results of NEQAS 2603 PA today…

 

2603PA1

 

I saw some things that made me look twice, but nothing convincing. It was probably debris; certainly wasn’t a parasite.I don’t like thick films at the best of times.

The slide was actually negative and that’s what I said.

 

2603PA2

 

I saw some small worm-things. Was it  Leishmania donovani?

The expert opinion was that this was amastigotes of Leishmania. Bearing in mind I’ve never seen this outside of a NEQAS exercise I think I’m justified in saying “Go me” (!)