21 April 2026 (Tuesday) - BTLP-TACT

Being at a bit of a loose end I thought I mihght do a BTLP-TACT exercise. I was pesented with one case – a seventy-eight year-old chap needing two units of cryo for factor VIII deficiency.

 

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

 

Is the cryo actually indicated in Factor VIII deficiency?  Well, https://pmc.ncbi.nlm.nih.gov/articles/PMC4627369/ says that it is rich in the stuff and has historically been used as a treatment for haemophilia A. But it potentially carries pathogens… The reference says that it is a second-line treatment.

I’m going to say that it *is* indicated and either way I will learn something.

 

So I issued two units and got the thumbs down. Apparently “Selection of any plasma components was inappropriate for this clinical condition”. One lives and learns…

20 April 2026 (Monday) - UKAS Update

The nice people at UKAS sent their update today. You can see it by clicking here.

There was a potentially interesting article about how UKAS and the Academy for Healthcare Science (AHCS) are working together… it was dull, but I’ve signed up with the Academy for Healthcare Science. You never know – I might learn something…

20 April 2026 (Monday) - NEQAS 2505DM

I got the results of NEQAS 2502DM today…

 

“This film was prepared from the blood of a 73-year-old man who attended the Emergency Department after experiencing increasing tiredness, then more recently bleeding from his gums. His white cell count was found to be elevated, and a blood film was prepared. What is your opinion of the blood film appearances?”

 

Bleeding from gums immediately makes me think “thrombocytopenia”  but that isn’t the case. There’s platy of platelets. Some are clumped and some rather large.

The red cells are on the whole rather dull. There’s a Howell-Jolly body and a target cell there.

But it’s the white cells that are odd here. Too many of them, and precious few of them “normal”. There’s smear cells, dysplastic neutrophils, vacuolated monocytes, and blasty-looking things.

Is this a case of MDS?

I pressed the button before I could comment…

 

The expert opinion said CLL…  seriously?

 

19 April 2026 (Sunday) - I Got That Wrong...

 I won’t lie… I thought it was hairy cell leukaemia. They do look similar, but are very different diseases. Flow cytometry comes into play… as the article says.

14 April 2026 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with two cases:

 

78080 – a thirty year old woman in the haematology clinic needing two units of irradiated blood.

The sample label had no NHS number or hospital number so I rejected it.

 

33345 – an eighty-nine year old chap in out-patients needing group and save.

He grouped as O Rh(D) Negative with antibody screen positive in cells 1 and 2. I performed antibody panels.

The enzyme and IAT panels were positive in cells 1, 2, 3 and 4 corresponding with anti-C and anti-D but not excluding anti-Cw

 

I got the thumbs-up

12 April 2026 (Sunday) - A Giant Platelet

Well, there’s a giant platelet but you get them in all sorts of conditions.
Here’s a few words about Bernard-Soulier syndrome.
 

12 April 2026 (Sunday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise I suppose… I was presented with one sample – a ninety-five year old chap with beta thalassaemia needing two units of blood.

He grouped as A Rh(D) Positive with antibody screen positive in cells 1 and 3. I performed antibody panels.

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

The enzyme panel was negative throughout.

 

I selected two units of A Rh(D) Positive Fy(a) negative blood

 

I got the green light…