19 February 2026 (Thursday) - The ESR

I’ve just marked a trainee’s portfolio work on ESR.

The erythrocyte sedimentation rate is quite possibly the first blood test that was ever invented. You just suck some blood up a tube and see how much it settles out in an hour. The more it settles, the more ill the patient.

 

Professional blood testers laugh at it because it is so non-specific. In these days of high-tech diagnostics, those who know about high-tech diagnostics look down their nose at a test which is so non-specific.

However for a GP this is absolutely brilliant. With a limited time to spend with the patient, the GP has to determine if the patient is genuinely ill or malingering. The ESR tells him that. It don’t say what is wrong with the patient, but in the first instance it don’t need to.

All the GP needs to know in the first instance is does he need to spend more time with the patient, or can he tell them to clear off with a clear conscience.

 

Here’s a proper article about it.

19 February 2026 (Thursday) - Getting the BTLP-TACT Wrong (again)

Time for another BTLP-TACT exercise…I was presented with two cases:

 

41032 – a forty year old woman needing four units of CMV-negative blood for a case of placenta accrecia

The control well was positive and so the entire group was uninterpretable. The antibody screen was negative though. I issued the only three units of O Rh(D)-negative, K-negative, CMV-negative blood

53832 – a twenty year oldwoman needing two units of blood for a haematemesis

Again the control well was positive and so the entire group was uninterpretable. The antibody screen was negative. I issued two units of O Rh(D)-negative, K-negative blood.

 

I got it wrong. Somehow the thing didn’t realise that I’d actually selected blood for the first patient and issued it all to the second…

18 February 2026 (Wednesday) - Red Cell Membrane Issues

I was talking with one of the trainees about the good old days… I’m sure they think I used to run the path lab on Noah’s Ark… We got talking about tests for red cell membrane abnormalities and I felt I might benefit from a little refresher on the subject. So here’s what I found.

 

Given a blood count with unexplained high MCHC (that doesn’t correct on warming) and reticulocytosis you have a look at the blood film.

 

If there’s lots of spherocytes we would do a direct antiglobulin test to rule out autoimmune haemolytic anaemia.

Back in the day we used to perform the osmotic fragility test but that is “so last century”. These days we use flow cytometry to look for eosin-5-malemide (EMA) which, being a structural red cell protein, is reduced in people with hereditary spherocytosis.

 

If there’s lots of elliptocytes we used to say “that’s hereditary elliptocytosis” and move on. These days there’s all sorts of molecular tests that can be done.

 

I found out that I wasn’t really that out of touch, but I am now rather inexperienced… mainly because these tests are only done in specialist centres these days.

17 February 2026 (Tuesday) - Westgard QC Update

The nice people Westgard QC sent their update today. You can read it by clicking here. As always a lot of it is hard going, but mathematics often is (I’ve got a degree in the stuff – I know!) But there was an interesting article about how some labs are using AI to review their IQC… and the AI is getting it wrong.

AI does that… Look at this piccie – it is my current Facebook profile picture which was created by AI. It looks rather good doesn’t it? Until you actually look at it.

The walking stick somehow supports itself.

I’ve got three dogs but four dog leads.

One of the dogs isn’t on a lead at all.

There’s a hole in my left thigh.

 

Don’t use AI to review your IQC, eh?

 

15 February 2026 (Sunday) - Acanthocytes

 Click here and click on “spiky cells” to see my take on the matter...

12 February 2026 (Thursday) - Horiba Newsletter

The nice people at Horiba sent their update today. You can read it by clicking here.

A case study of myeloproliferative disorder / chronic eosinophilic leukaemia, and an update about their latest technology… Something about which I'm getting increasingly out of touch.

 

Back in the day the reps used to come round at least twice a year to give us all lunchtime presentations about their latest machines… and they would give us all sandwiches and free pens and stuff… how times have changed.

 

11 February 2026 (Wednesday) - BTLP-TACT Exercise

After yesterday’s debacle I thought I’d better try again.  It presented me with two cases:

 

62453 – a sixty-eight year-old chap with hypofibrinogenaemia who needed two units of cryoprecipitate.

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

According to https://pubmed.ncbi.nlm.nih.gov/34127586/ cryoprecipitate *is*recommended  for hypofirinogenaemia  so I issued two units of the stuff.

 

 

27497 – a twenty-two year-old woman needing four units of FFP for factor V deficiency.

She grouped as A Rh(D) Positive, but the Rh reaction was weak so I called it indeterminate as that is what has worked in the past. The antibody screen was negative.

FFP is suitable for Factor V deficiency according to https://www.ncbi.nlm.nih.gov/books/NBK580494/  and https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/factor-v-deficiency/  so I issued four units of it.

 

I got this one right…