23 March 2026 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with one case – a sixty-one yar-old chap having a pancreatectomy and needing four units of blood.

The ABO group was uninterpretable but the RH(D) group was Positive. The antibody screen was positive in cells 1 and 3 so I performed antibody panels.

 

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

however the enzyme panel was negative throughout.

I tried to select four units of O Rh(D) Negative blood which was Fy(a) negative but there was only two. So… what next. We’ve got a male who’s over fifty… I selected two more units of Fy(a) negative blood; these being O Rh(D) Positive.

Either the software would like it or it wouldn’t…

It did…

 

23 March 2026 (Monday) - Increasing Workload

Yesterday’s post has made me think… Yesterday I mentioned about how the microscopy of yesteryear has been replaced with more modern technology which is much less subjective and much more objective.

And that’s partly answered a question I’ve been pondering for some time…

 

When I first started as a Junior (Grade "A") medical laboratory scientific officer in September 1981 the (now demolished) Royal East Sussex Hospital had one consultant haematologist. She would see out-patients in the morning... sometimes as many as six patients in one morning.

Occasionally some patients were ill enough to be hospitalized... she had up to four beds in the (also now demolished) St Helen's Hospital in which these patients would stay, and she had an arrangement with one of the consultant physicians that she might avail herself of the services of the medical SHO *if* they weren't too busy with their own work.

 

Three years later I moved to a nearby hospital where the consultant haematologist had the use of pretty much all of the isolation ward and had two dedicated SHOs of his own... Two. I counted them.

 

I Googled where I currently work... The most recent information publicly availably says that we have nine consultant haematologists, two specialist registrars and four SHOs.

Why so many? What has changed in the meantime...

 

Here’s a couple of articles which give the answer:

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC10188596/

 

https://www.bloodcancerstoday.com/post/cancer-mortality-rate-declines-yet-cancer-incidence-increases-among-women-and-younger-adults

 

Fewer people are dying from preventable infections. Fewer people are dying from heart disease and pulmonary conditions. Smoking and drinking are in decline. Is that why over the past thirty years (globally) cases of hematologic malignancies have been increasing?

But whether or not it is the reason, the death rates for all types of hematologic malignancies has been declining.

We are getting better at what we do.

We’ve a lot more haematologists because we need them.

22 March 2026 (Sunday) - Getting It Right

 Well, I was confident that it was something malaria-ous and (quite frankly) that’s good enough. I spotted the issue and was confident about the next steps… tell the clinician and the London School of Tropical Medicine.

As for the species… I won’t say “that’s anyone’s guess” but I will say “look at the last NEQAS parasitology result”. Out of nearly four hundred and fifty participants, over ninety-nine point five per cent of the participants saw something there that shouldn’t have been. However less than half of the participants got the species right… I say “right”. Perhaps “agreed with the expert opinion” might be a better phrasing.

 

I find myself thinking back to the good old days when leukaemias were typed according to what they looked like down the microscope, and there being as many opinions as there were people working that day at the (now demolished) haematology lab of the Royal East Sussex Hospital.

Nowadays microscopy is just an add-on to flow cytometry and cytogenetics.

How long will it be before speciating will be done by something less subjective than saying “I think it looks like…”

20 March 2026 (Friday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with one case – a ninety-five year-old chap who was up for an autologous stem cell harvest (at that age?) who needed two units of blood.

 

He grouped as A Rh(D) Negative with a negative antibody screen. I selected two units of A Rh(D) Negative irradiated blood

 

I got the thumbs-up.

 

19 March 2026 (Thursday) - UKAS Update

The UK Accreditation Service sent their update today... I make a point of reading it because I don’t think many people actually do, and there is a load of misunderstanding and misinformation spread about the thing – in the past I knew of a manager who would get his own way by insisting that any way but his would go against MHRA requirements, safe in the knowledge that no one knew what MHRA required. Much the same is probably true of the UKAS…

But look at their update. How can I as a professional blood-tester be held to the same standards as someone operating a sexual assault referral centre? I really don’t know how, but I am. And that’s why I read the updates…

16 March 2026 (Monday) - I.T. Training

We’re getting a new computer system soon. Today I had some training on the thing. A bit of an introduction to show me the basics. The new one is rather different to what I’m used to; different enough to make my head spin.

Many years ago I did a post graduate certificate on distance based learning. Part of it focused on how people learn. I didn’t actually realise that I’m not very good at being taught anything new as I have the attention span of a gnat and my poor brain needs time to process new information.

I’m having another session on the computer tomorrow. Hopefully by then what I’ve learned will have percolated through my thick head…

15 March 2026 (Sunday) - I Disagree...

 Well… I wouldn’t have said that was hypersegmented. I would have said that was a botryoid neutrophil.
I think the take-home message here is not to judge on the strength of just one cell…