2 June 2026 (Tuesday) - BTLP-TACT Exercise

I’m always getting prompts to do more BTLP-TACT exercises, I’ve walked the dogs, and it is raining outside anyway…
 
I was given two cases:
 

33586 – a thirty-year-old woman with appendicitis needing group and save.

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

 

15253 – an eight-one-year-old woman needing four units of blood for a pancreatectomy.

She grouped as B Rh(D) Positive with an 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) but not excluding anti-Cw.

I scared up four units of various compatible ABO and RH groups that were Jk(a) Negative

 
I got it wrong…
Anti-Cw *could* have been excluded from the screening panel. Dur !!! 
But if that was the only hiccup I’m content. Better to err on the side of caution, eh?

1 June 2026 (Monday) - VEXAS Syndrome

I saw a diagnosis today: VEXAS syndrome. A new one on me – it is an adult-onset, severe autoinflammatory and blood disorder caused by a random, acquired mutation in the UBA1 gene. It primarily affects men over fifty. The name is an acronym outlining its core characteristics:

 

·  Vacuoles in bone marrow cells

·  E1 enzyme malfunction

·  X-linked genetic origin

·  Autoinflammation (immune system attacking healthy tissue)

·  Somatic mutation (not inherited)

 

Here’s a link about it.

31 May 2026 (Sunday) - Slide Saturday Challenge

 At first sight I agreed with the people who’d said it was some sort of haemoglobinopathy… OK there were target cells there. But in a haemoglobinopathy the red cells are a tad more uniform. These ones are all over the place. Massive anisopoikilocytosis with cell fragments, tear drop cells, spherocytes…

That’s some sort of microangiopathic haemolytic condition…

27 May 2026 (Wednesday) - Westgard QC Update

The nice people at Wesgard QC sent their update today. You can read it by clicking here. I did. I’d suggest you do to, but I’ve got a degree in maths and I found it heavy going.

The headline “Has hematology quality bled out?” caught my eye, but has it? I’d have to take Mr. Westgard’s word for it if he says it has. The British Prime Minister Benjamin Disraeli was believed to have ranted about "Lies, damned lies, and statistics" when describing the deceptive power of numbers to bolster weak arguments. He might have a point here, he might not. I don’t know.

 

Looking back in time to yesterday I think I might have made my own (albeit informal) Westgard rule… due to a minor problem the details of which are irrelevant here we had to leave non-urgent blood films over the bank holiday weekend, and yesterday I spent the afternoon catching up. A few patients who were clinically stable had blood films made every day (the reasons for which are irrelevant here), and as I reviewed the blood films I noticed that the results didn’t change much from day to day. That’s not a bad QC measure, is it?

27 May 2026 (Wednesday) - BTLP-TACT Exercise

I’ve got half an hour before I need to go to the late shift…

I was presented with two cases:

 

37192 – a twenty-one year-old woman in maternity needing group and save

Her ABO group was indeterminate, but she was Rh(D) Positive with a negative antibody screen

 

46614 – a ninety-six year-ol d chap needing four untits of FFP for bleeding varices.

He grouped as O Rh(D) Positive with antibody screen positive on cells 1 & 3. I performed antibody panels.

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

 

FFP is NOT recommended for bleeding varices https://pubmed.ncbi.nlm.nih.gov/33969607/ so I didn’t issue any

 

I got the green light…

25 May 2026 (Monday) - Found on the Internet

I found this on one of the Facebook groups I follow this morning… It’s not bad really…

22 May 2026 (Friday) - UKAS Update

The nice people at UKAS sent their update today. You can read it by clicking here. I always do as I struggle to understand exactly what UKAS actually does, and how what it does is relevant to my daily round.

One thing they do is to charge various employers for their services… and it would seem that some of that money has been spent on buying three hundred and fifty trees which have been planted by UKAS staff who’ve been given a day’s leave to do so.

I’m even more mystified…