29 July 2026 (Wedneday0 - UKAS Update

The nice people at UKAS sent their update today. You can read it by clicking here. I did, and struggled, as did the colleagues with whom I discussed it. I often whinge about the UKAS newsletter, but this time I’ve done something more than whinge. I’ve emailed them… Here’s what I wrote:

 

“Dear sir or madam

I just received your latest newsletter. I was intrigued to hear about the Pathology Transformation Review 2026 but when I clicked on the link I found the article incomprehensible.

The article in question is https://www.ukas.com/resources/latest-news/ukas-welcomes-the-pathology-transformation-review-2026/

I showed it to some colleagues, and none of us understand what it means. I don’t want to appear confrontational or reactionary. I seriously want to understand what is going on with my profession and its regulator… But I don't.

Could one of your experts paraphrase it in such a way that a semi-retired old dinosaur could understand it… (sorry)”

 

I wonder if they will get a reply? My request is a serious one. Despite having done a formal course of study in quality management I didn’t understand any of what that article was saying.

 

27 July 2026 (Monday) - Myeloma Treatment

 

I thought option 3 and I said so. I was told: The correct answer is option 3. The patient remains biologically high-risk despite achieving MRD negativity. 

Achieving MRD negativity at a sensitivity of 10⁻⁶ is an excellent treatment outcome and is strongly associated with improved progression-free and overall survival in multiple myeloma. While MRD negativity reflects how effectively treatment has reduced the disease burden, cytogenetic abnormalities provide important information about the underlying biology of the myeloma clone. 

In this patient, the presence of both t(4;14) and gain(1q) identifies biologically aggressive disease. Although deep responses such as MRD negativity can substantially improve outcomes, current evidence suggests that they do not completely eliminate the adverse prognostic impact of multiple high-risk cytogenetic abnormalities. Data from studies have shown that patients with ultra-high-risk disease can achieve high rates of MRD negativity, yet their long-term outcomes remain inferior to those of patients with standard-risk disease achieving the same depth of response. 

Therefore, the most accurate interpretation is that this patient remains at increased risk of relapse despite achieving MRD negativity. 

26 July 2026 (Sunday) - Slide Saturday Challenge

 Hypochromic microcytic blood film with pronounces anisopoikilocytosis. Target cells and nucleated red cells. No pencil cells…

Thalassemia major…

24 July 2026 (Saturday) - Letrozole

I had a neutropenic patient today. Perfectly fine a month ago, a neutrophil count of 0.6 today. Diagnosis “on letrozole”.

I looked that one up. A common side effect is neutropenia. Here’s an article on the matter.

One lives and learns…

 

23 July 2026 (Thursday) - HCPC Update

The HCPC sent their update today. You can read it by clicking here. There’s no denying it was on the dull side. However I see they are asking for applications for the role of head honcho.

I have absolutely no intention of applying… and consequently I have no right to whinge that I think they are making a fundamental mistake by getting all bogged down in management-speak rather than focusing on what I feel should be their core business (i.e. acting in the best interests of the professions they represent). On reflection I suppose that they feel that they *are* acting in the best interests of the professions they represent. But their way of doing it is different to mine.

Mind you for all that I can’t really whinge when I have no intention of putting my money where my mouth is, I expect I will still whinge.

I wonder who would take on the role of head honcho? There’s plenty of people who love the entire “meetings thing”.

 

23 July 2026 (Thursday) - Pappenheimer Bodies

I saw some Pappenheimer bodies last week, so I took photos, and have updated my little atlas with the piccies. To see it click on this link and then click on “Pappenheimer bodies” in the list on the left hand side.

 

I’ve used a new page format for this entry… if only to make it look like the thing is a work in progress (which it actually is!)

 

22 July 2026 (Wednesday) - Von WIllebrand's Disease

Here’s a rather good set of web pages about Von Willebrand’s disease courtesy of The Blood Project.

I never really understood what that was all about when I was at college… I rather suspect that the one lecturing us on the matter didn’t either. I’m a little clearer now.