1 March 2026 (Sunday) - Beware What You Read...

 Well, it’s intracellular yeast…  The original question had people confidently saying green crystals of death, dohle bodies…

The take-home message here is to be *very* careful about what you read on Facebook haematology groups…

27 February 2026 (Friday) - UKAS Update

The nice people at the UK Accreditation Service sent their update today. You can read it by clicking here. And again I clicked there and read it.

I’ve made no secret that I struggle to see how this stuff is relevant to improve what I actually do on a daily basis, and whoever wrote the newsletter didn’t help by starting off with “Learning as an investment in capability delivers long-term benefits for individuals and organisations by strengthening professional judgement and helping individuals respond confidently to new or complex situations”.

What does that actually mean? Why don’t they write these things in understandable everyday English?

A few less management catch-phrases and a little more comprehensibility all round would help everyone.

 

I’m reminded of my days as a manager when if I ever wanted to get my way in a meeting against a majority decided against me, I would say that my way was the only way that didn’t have serious governance issues. And because very few people knew what a “governance issue” was, most people would back down. And if anyone didn’t, I would scare them off with equally incomprehensible talk of “MHRA requirements”.

26 February 2026 (Thursday) - More Change

And so it all gets changed again... 

24 February 2026 (Tuesday) - IBMS Update

The IBMS sent their update today. You can read it by clicking here. I must admit the only bit which was of any relevance to me was the bit about major hemorrhage protocols… and if there is one thing I would say about blood bankers (apart from how much they love meetings!) is that they provide loads of CPD through all sorts of other outlets.

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.