24 September 2026 (Thursday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – a twenty-eight year-old woman with a ruptured ectopic pregnancy needing six units of blood.
 

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

I selected two units of B Rh(D) Negative and four units of O Rh(D) Negative

 
I got the thumbs-up.

 

23 September 2026 (Wednesday) - Westgard QC Update

The nice people at Westgard QC sent their update today. It was rather heavy going, but that’s the nature of the subject…

 

22 September 2026 (Tuesday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. Tranexamic acid and keeping platelets in the fridge featured again…

ARTICLE OF THE MONTH

Cold and room-temperature platelets in cardiac surgery: the CHIPS randomized clinical trial.
Spinella, P.C., et al. (2026). JAMA. [Record in progress].
PICO SUMMARY

 

 

TOP ARTICLES

Subcutaneous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy.
Bus, S.R., et al. (2026). The Cochrane Database of Systematic Reviews.

Perioperative albumin versus other fluids to prevent cardiac surgery-associated kidney injury: a systematic review and meta-analysis of randomized trials.
Darlison, P.R., et al. (2026). Critical Care Science.

AI and blood banking: predicting transfusion demand - a systematic review of forecasting approaches.
Engelke, M., et al. (2026). Transfusion Medicine and Hemotherapy. [Record in progress].

All-trans retinoic acid plus eltrombopag for refractory/relapsed immune thrombocytopenia.
Fu, H., et al. (2026). NEJM Evidence.

Recombinant human thrombopoietin reduces the need for platelet transfusion in patients with chronic liver disease and thrombocytopenia.
Han, Y., et al. (2026). American Journal of Hematology.

Eltrombopag plus cyclosporine A for moderate aplastic anemia (EMAA): a placebo-controlled, double-blind, phase 3 trial.
Höchsmann, B., et al. (2026). Blood. [Record in progress].

Impact of tranexamic acid on outcomes in early-admitted patients with aneurysmal subarachnoid hemorrhage: a systematic review and bayesian meta-analysis of randomized controlled trials.
Łajczak, P., et al. (2026). Journal of Thrombosis and Thrombolysis. [Record in progress].

Intravenous iron to treat anaemia before cardiac surgery (ITACS): international, double blind, placebo controlled randomised trial.
Myles, P.S., et al. (2026). BMJ.

Early red blood cell transfusion strategy in septic shock among patients with cancer: the TRANSPORT randomized controlled trial.
Pène, F., et al. (2026). Intensive Care Medicine. [Record in progress].

Larger versus smaller red blood cell volume per transfusion in hospitalized adults, children and preterm neonates.
Roumeliotis, N., et al. (2026). The Cochrane Database of Systematic Reviews.

Albumin for people with liver cirrhosis and bacterial infections.
Simonetti, R.G., et al. (2026). The Cochrane Database of Systematic Reviews.

 

 

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.