30 March 2026 (Monday) - BTLP-TACT Exercise

I’ve had another email from the nice people at BTLP-TACT telling me that I’m not doing enough exercises. So here we go…

I was presented with one case – a fifty-seven year-old woman in the haematology out-patients clinic needing two units of blood.

 

She grouped as AB Rh(D) Positive but with a weak(ish) reaction in the D. I’d call that positive because she’s over fifty and it is positive, but BTLP-TACT don’t like that. So UI it is…  

The antibody screen was negative.

So… what do I issue?

Personally I’d have given AB Rh(D) Positive because she *is* AB Rh(D) Positive.

But having said the Rh(D) group is uninterpretable (even though it is) I should give Rh(D) Negative blood.

My question is that having said the Rh(D) group is uninterpretable, should I give O Rh(D) Negative (for no reason that I could actually fathom) rather than AB Rh(D) Negative?

 

There’s one way to find out… I went with two units of AB Rh(D) Negative

I got the green light.

30 March 2026 (Monday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. As always there was so much as to boggle my poor brain, but the second to last article made me think. It is very easy to think that blood science is what I do, and that it probably happens in a few hospitals nearby.

It’s world-wide and what happens in other parts of the world can be very different. In over forty years I’ve only ever heard of one case of malaria being transmitted by blood transfusion… in some parts of Africa nearly one donor in five has malaria…

   ARTICLE OF THE MONTH

Preventive interventions for vasovagal reactions in whole blood donors: a cluster-randomised, stepped-wedge, crossover trial of 73 sites involving 1·4 million donors in England.
Kaptoge, S., et al. (2026). The Lancet. Haematology.
PICO SUMMARY

 

 

TOP ARTICLES

N-acetylcysteine reduces incidence and duration of linezolid-associated thrombocytopenia in critically ill patients: a randomized controlled trial.
Abdeltawab, M., et al. (2026). Environmental Toxicology and Pharmacology.

Interventions to prevent intraventricular haemorrhage in preterm neonates: an umbrella review of systematic reviews and meta-analyses.
Bhanushali, M., et al. (2026). Neonatology. [Record in progress].            

Recombinant factor VIIa versus placebo for spontaneous intracerebral haemorrhage within 2 h of symptom onset (FASTEST): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial.
Broderick, J.P., et al. (2026). Lancet.

Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders.
Champaneria, R., et al. (2026). The Cochrane Database of Systematic Reviews.

Use of albumin in patients with hepatic encephalopathy: a systematic review and meta-analysis of randomized controlled studies with trial sequential analysis.
Coan, A.C.C., et al. (2026). Hepatology Forum.

Comparative efficacy of prehospital resuscitation strategies on mortality for patients with major trauma: a network meta-analysis.
Hsu, C.W., et al. (2026). European Journal of Emergency. [Record in progress].

Randomized, sham-controlled trial of intraoperative ticagrelor removal to reduce perioperative bleeding.
Mack, M.J., et al. (2026). The Journal of Thoracic and Cardiovascular Surgery. [Record in progress].

Global burden of asymptomatic malaria among blood donors: systematic review and meta-analysis.
Malede, B., et al. (2026). BMC Infectious Diseases.

Comparison of safety and efficacy of liberal versus restrictive red blood cell transfusion thresholds on the quality of life in patients with myelodysplastic syndromes: a systematic review and meta-analysis.
Mandal, S., et al. (2026). Annals of Hematology.

29 March 2026 (Sunday) - Slide Saturday Challenge

Here’s some info on the condition. There are those who turn their noses up at Wikipedia… they can write their own CPD journals. Bet they won’t.

25 March 2026 (Tuesday) - Nil Desperandum

I had another little session testing the new works computer today. I had a *lot* of frustration with in. In retrospect it worked perfectly doing exactly what it should. The problem was “operator error”, but I learned a lot…

I think Lionel Jeffries summed it all up over fifty years ago…

24 March 2026 (Tuesday) - Haemochromatosis

Here’s a little update on hereditary haemochromatosis. It’s a useful little bit of revision… 
 

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.