Monday 20 July 2026 (Monday) - 3000 !!

Well… here we are at the three thousandth entry to this blog. I started it as a record of what CPD activities I do. Whilst is it in no way secret, I’ve never really tried to attract a following, but through the wonders of modern science I can see that has quite a following. In the last three weeks it has had over two hundred visits.

Why not leave a comment to say hello, and to answer a question.

 

I’ve a plan that I might set up a little CPD sharing on-line community… would you like to take part?

20 July 2026 (Monday) - Transfusion Evidence Library Update

Tranexamic acid again !!

The article about alloimmunization in sickle cell patients was interesting. In the study a third of them had formed antibodies. Clearly people on long-term transfusions should have blood matched as closely as possible…

I’m reminded of a thread I saw on one of the work-related Facebook pages which was talking about artificial oxygen carriers. If ever there was a cohort of patients that could use them…

ARTICLE OF THE MONTH

Hospital policy of tranexamic acid to reduce transfusion in major noncardiac surgery. Houston, B.L., et al. (2026). The New England Journal of Medicine.
PICO SUMMARY

 

 

TOP ARTICLES

Global prevalence of alloimmunization in adults with sickle cell disease receiving red blood cell transfusions: a systematic review and meta-analysis.
Alsalman, M., et al. (2026). Journal of Clinical Medicine.

Effect of continuous non-invasive hemoglobin monitoring on blood transfusion and mortality in hip surgeries: a randomized controlled study.
Dinçer Yeşilnacar, M.E., et al. (2026). Journal of Clinical Practice and Research.

Oral or parenteral iron supplementation to reduce deferral, iron deficiency and/or anaemia in blood donors.
Geneen, L.J., et al. (2026). The Cochrane Database of Systematic Reviews.

Clinical trial: predicting response to iron therapy in patients with active inflammatory bowel disease using hepcidin and functional iron indices: a multicentre randomised trial.
Koppelman, L.J.M., et al. (2026). Alimentary Pharmacology & Therapeutics.

Clinical efficacy of different blood purification modes on severe acute pancreatitis: a systematic review and network meta-analysis.
Li, P., et al. (2026). Frontiers in Medicine.

Effect of tranexamic acid for acute spontaneous intracerebral haemorrhage: a systematic review and individual patient data meta-analysis.
Menon, C.S., et al. (2026). Journal of Neurology, Neurosurgery, and Psychiatry. [Record in progress].

Artificial Intelligence-based predictive models for adverse blood donor reactions: a systematic review of immediate and delayed events and clinical data approaches.
ShojaeiBaghini, M., et al. (2026). BMC Medical Informatics and Decision Making. [Record in progress].

The effect of active warming and conventional body temperature management on perioperative blood loss and coagulation function in patients undergoing scoliosis correction: a multicenter randomized controlled trial.
Yan, W., et al. (2026). European Spine Journal. [Record in progress].

 

 

19 July 2026 (Sunday) - Disagree (!)

 

Seriously? I always thought that platelets were much larger in May-Hegglin anomaly.

Personally what with the rather echinocytic red cells and the lack of distinct lobulation in the neutrophil I would have said this was an example of a blood film having been made on an old blood sample.

17 July 2026 (Friday) - Circulating Microplastics

It’s been claimed that plasma exchange treatment can remove the amount of microplastics in the circulation.

Apparently this claim isn’t quite what it might be.

No that anyone has ever asked me to perform a plasma exchange to lower the amount of microplastics in a patient’s circulation…

16 July 2026 (Thursday) - ASH Update

The nice people at the American Society of Hematology sent their update today. You can read it by clicking here.

They send these updates every week or so, and just lately I’ve not been bothering with them. They are very clinically oriented and I can’t pretend to understand much of what they are saying. But the fact that I don’t understand much of it is the very reason why I should be reading it and trying to understand.

I shall try harder…

16 July 2026 (Thursday) - Learning Monday (three days ago...)

 

The correct answer is option 4. Heatstroke 

The cells depicted are neutrophils (A-D), lymphocytes (E) and monocytes (F) with botryoid nuclei, characterized by hypersegmented nuclei with a radial arrangement. These were first seen in 1980 in six patients with heatstroke and were named after the Greek term “botrys,” which translates onto “bunch of grapes” because of their resemblance. Since then, they have been described in other conditions causing severe hyperthermia, such as cocaine and methamphetamine abuse, autoimmune limbic encephalitis, sepsis, drug rash with eosinophilia and systemic symptoms (DRESS) and neuroleptic malignant syndrome. These nuclear changes have been hypothesized to be early stages of oncotic (karyolysis) and apoptotic (karyorhexis and pyknosis) cell death because of extreme heat.

Reference: 

• Verdú G, Vallvé M, San-José P, Molina A, Merino A. Diagnostic Value of Botryoid Nuclei as a Biomarker of Severe Hyperthermia and  Systemic Inflammation in Heatstroke and Neuroleptic Malignant Syndrome: A Challenge of Climate Change. Int J Lab Hematol. May 2025. doi:10.1111/ijlh.14500 

• Chiriac R, Pourchet V. Noyaux botryoïdes des leucocytes induits par le syndrome de DRESS. Ann Biol Clin (Paris). 2025;83(2):220-222. doi:10.1684/abc.2025.1961 

14 July 2026 (Tuesday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise. I had one case – a seventy-seven year-old woman needing two units of blood for a haematemesis. She grouped as B Rh(D) Positive with antibody screen positive in cells 2 & 3. I performed antibody panels.

The enzyme and IAT panels were positive in cells 1, 3, 4, 6 & 7 corresponding with anti Jk(a). I selected two unts of blood that were Jk(A) negative (one O Rh(D) Pos, one B Rh(D) Pos)

I got it right.