9 November 2026 (Monday) - BTLP-TACT Exercise

Can you believe it - I got yet another snarky email saying I’m not doing enough BTLP-TACT exercises so here we go again…

I was presented with two cases:

 

86241 – a seventy-three year-old chap with alcoholic liver disease needing group and save.

He grouped as O Rh(D) Positive with antibody screen positive in all three cells. I performed antibody screens. The enzyme screen was positive in cells 3 and 5 corresponding with anti-E, and the IAT screen was positive in cells 1, 3, 5, 6, 9 & 10 corresponding with anti Fy(a).

 

76686 – a forty-one year-old chap with sepsis also needing group and save.

He grouped as Rh(D) Positive but the ABO group was indeterminate. With a cell group of A but a reverse group of O, this is one for NHSBT.

His antibody screen was negative though.

 

I got the thumbs-up…

 

9 November 2026 (Monday) - PNH (?)

Well, let’s apply a process of elimination…

The patient is older than me (and I’m ancient) so any condition is unlikely to be a hereditary one.

Having a bone marrow aspiration is traumatic (I’ve seen it done)

So that leaves flow cytometry and cytogenetics.

Bearing in mind from the symptoms it looks like the patient has PNH, the standard test would be flow cytometry to evaluate CD55 and CD59 levels…

The correct answer is 2
Paroxysmal nocturnal hemoglobinuria is an acquired clonal disorder caused by somatic mutations of the PIGA gene that result in impaired production of the glycosylphosphatidylinositol (GPI) anchor on blood cells. The resulting GPI-anchor deficiency can affect multiple haematopoietic lineages. Clinically, patients present with complement-mediated intravascular hemolysis, thrombosis, and bone marrow failure. Diagnosis is established by flow cytometry demonstrating populations of GPI-deficient blood cells.  

Reference:
Fattizzo B, Marchetti M, Cannizzo E, et al. Expert Consensus on the Diagnosis and Monitoring of Paroxysmal Nocturnal Hemoglobinuria (PNH): An Algorithmic Approach in an Era of New Treatments. European Journal of Haematology. 2026. 

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8 November 2026 (Sunday) - Slide Saturday Challenge

 They are hairy cells... aren't they?
(Apparently not called that any more in the twenty-first century!!!)

7 November 2026 (Saturday) - Neutropenic?

For a long time it has been common knowledge that “people of African origin” have lower neutrophil counts than the general UK public. It would seem that this isn’t strictly true… it is actually people with the Duffy-null phenotype.

New reference ranges have been drawn up for neutrophil counts for these people. There’s an article on it here.

However this begs the question of how do we know where and when to apply this reference range? Should we be performing Duffy phenotyping as part of a chronic neutropenia screen?

 

5 November 2026 (Thursday) - BTLP-TACT Exercise

 I got another snarky email saying I’m not doing enough BTLP-TACT exercises so I thought I’d better do one…

It gave me two cases:

 

44549 – a forty-six year-old woman in maternity needing group and save.

She grouped as O Rh(D) Negative with antibody screen weakly positive in cells 1 & 2 so I performed antibody panels. The enzyme and IAT panels were positive in cells 1, 2 & 3 corresponding with anti-D but not excluding anti-Cw

74466 – a seventy-six year-old woman needing four units of blood for a revision of THR.

She grouped as O Rh(D) Positive with a negative antibody screen. I selected four units of O Rh(D) Positive blood.

 

I got the thumbs up

5 November 2026 (Thursday) - UKAS Update

The nice people at UKAS sent their incomprehensible gibberish today. Am I being cynical? Click here and judge for yourself.

I then copied the entire lot into Microsoft CoPilot and asked for an English translation. And again starting off with what really was a load of incomprehensible gibberish I ended up with something rather more sensible.

As I’ve said before, quality management would be taken far more seriously if it wasn’t couched in such silly words. 

3 November 2026 (Tuesday) - Fritsma Factor Update

The Fritsma Factor newsletter appeared in my in-box today. This one does get published as a website to which I can link… so here’s the link. I like thinks I can link to – it’s evidence that I’m not just making it up.

 

There’s quite a bit of technical stuff in this month’s update. Bearing in mind that I finished formal training in 1987 and Factor V Leiden was first described in 1994, I personally find the Fritsma Factor update invaluable.