19 August 2026 (Wednesday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. I know I keep banging on about the stuff, but tranexamic acid really is *the* stuff, isn’t it?
Two more mentions…

ARTICLE OF THE MONTH

Avatrombopag versus placebo for persistent chemotherapy-induced thrombocytopenia in GI cancers: the phase II ACT-GI trial.
Al-Samkari, H., et al. (2026). Journal of Clinical Oncology. [Record in progress].
PICO SUMMARY

 

 

TOP ARTICLES

Barriers and enablers to non-remunerated plasma donation: a meta-synthesis of the qualitative literature using the theoretical domains framework.
Etherington, C., et al. (2026). Vox Sanguinis. [Record in progress].

The efficacy of tranexamic acid for the prevention of postpartum hemorrhage among women at high risk of postpartum hemorrhage undergoing cesarean section: a meta-analysis.
Gao, Q., et al. (2026). BMC Pregnancy and Childbirth. [Record in progress].

Optimal route of tranexamic acid administration in total knee arthroplasty: a Bayesian network meta-analysis with decision-analytic cost evaluation.
Hershfeld, B.E., et al. (2026). The Journal of Arthroplasty. [Record in progress].

Efficacy and safety of different doses of intravenous immunoglobulin combined with phototherapy in neonatal hemolytic disease: a systematic review and meta-analysis.
Huang, M., et al. (2026). European Journal of Pediatrics.

HLA selected red cell transfusions to prevent HLA sensitisation: a prospective, double-blinded, randomised controlled trial.
McComish, J.S., et al. (2026). Transplant Immunology.

Mortality effect of albumin fluid resuscitation in adults with septic shock: a systematic review and dual frequentist-bayesian meta-analysis of randomised trials.
Mendes, H., et al. (2026). Critical Care.

Adjuvant intravenous immunoglobulin in elderly sepsis: a randomized controlled study of mortality, organ function, and inflammation.
Miao, X., et al. (2026). Frontiers in Medicine.

Effect of blood donation in the glycemic control of prediabetic donors: a blinded randomized controlled trial.
Mora-Gonzalez, D., et al. (2026). Endocrine Practice. [Record in progress].             

Comparative efficacy of intranasal, intramuscular, and intravenous vitamin B12 therapy for hematological recovery in vitamin B12 deficiency anemia: a randomized controlled trial.
Singh, S.K., et al. (2026). American Journal of Hematology.

Diagnostic accuracy of reticulocyte haemoglobin content in detecting iron deficiency without anaemia in blood donors: a systematic review and meta-analysis.
Yanyiam, P., et al. (2026). Vox Sanguinis. [Record in progress].

 

 

19 August 2026 (Wednesday) - NEQAS 2603DM

I finally got the result of 2603DM today…  “a 43-year-old man who regularly attends Haematology outpatients. The blood film was prepared after new features were noticed in his blood count. Your opinion is requested”.

 

I can’t remember it at all, but at the time I said: “I’d say he regularly attends haematology outpatients because of a haemoglobinopathy. There’s target cells, sickle cells, nucleated red cells, polychromasia and Howell-Jolly bodies there.

And there’s blast cells and smear cells.

And there’s  an eosinophilia too.

 

The platelet count is down as well

 

I’d say this is someone with sickle cell disease (possibly HbSC or with a co-existing thalassaemia because of the target cells) who has suddenly developed leukaemia”.

 

The expert opinion was “This is a case of sickle cell disease (HbSS) with typical red cell features including sickle cells, boat-shaped cells, hyposplenic features and nRBCs. However, in this case there are also blast cells which should not be present and indicate the additional presence of an acute leukaemia. The important principle here is to recognise that we like to consolidate all features of a diagnostic blood film into a single diagnosis (e.g. sickle cell anaemia with reactive/hyposplenic features, or an acute leukaemia or myelofibrosis with associated red cell change). The key is sometimes to focus on the really key findings – in this case the blast cells, thrombocytopenia and typical sickle cells. Then ask whether this is really compatible with a single disorder”.

 

So… I’d spotted all the salient features. I got it right. 

 

18 August 2026 (Tuesday) - QC on the TOP

 

Still sulking about the BTLP-TACT debacle I had a look at the Werfen academy.

I had a go at one of the courses – “ACL TOP Family 50 Series - Running QC”.

I passed. That cheered me up a bit…

18 August 2026 (Tuesday) - Getting the BTLP Wrong (Again)

I had a little time on my hands this morning so I did a BTLP-TACT exercise.

I was presented with two cases:

 

47778 – a ninety-nine year-old woman in out patients needing group and save prior to hip replacement surgery.

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

 

36230 – a twenty-nine year-old woman in the maternity unit needing group and save prior to induction of labour.

She grouped as A Rh(D) Negative with antibody screen positive in all three cells. I performed antibody panels.

The enzyme panel was negative throughout.

The IAT panel was positive in cells 1, 2, 3, 5, 6, 7, 9 and 10 corresponding with anti-S and anti-Fy(a)

 

I got it wrong. Apparently anti-K could not be excluded. I’m not happy about this. In previous exercises I was told that a negative reaction in the enzyme panel *did* rule out anti-K in the simulator (I know it don't in real life).

 

17 August 2026 (Monday) - Sounds Like Sezary's Syndrome...

 The LEAST recommended diagnostic test is option 1. Bone marrow aspirate and biopsy

The patient shows the typical clinical picture of Sézary syndrome (cutaneous T-cell lymphoma, likely stage T4NxB2M0), characterized by erythroderma (erythema involving >80% of the body surface area), generalized lymphadenopathy and lymphocytosis with a TCR rearrangement shared between the skin and the blood. Skin biopsies, PET-CT and lymph node biopsies are indicated for diagnosis and staging. In the absence of unexplained cytopenia, a bone marrow study is generally not necessary. 

First-line therapies include low-dose methotrexate, extracorporeal photopheresis, retinoids and interferon. Mogamulizumab (an anti-CCR4 monoclonal antibody) is the treatment of choice for relapsed/refractory disease. Allogeneic transplantation should be considered in selected cases.

Reference: 

• Dummer R, et al. Cutaneous T cell lymphoma. Nat Rev Dis Primers. 2021;7(1):61. Published 2021 Aug 26. 

• Latzka J, et al. EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome - Update 2023. Eur J Cancer. 2023;195:113343. 

• Olsen E, et al. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood. 2007;110(6):1713-1722. 

16 August 2026 (Sunday) - I've Heard Of It...

 

Well, I’ve heard of Chediak-Higashi syndrome, but don’t think I’ve actually seen it in real life.. Here’s as good a place as any to start with it.

It’s not restricted to humans…

15 August 2026 (Saturday) - DOAC

I finally got round to signing up to the Werfen Academy today, and got full marks on my first course “Introduction to Direct Oral Anticoagulants (DOACs)”.

Go me…