31 January 2022 (Monday) - BTLP-TACT Excercise

Time for another BTLP-TACT exercise. I was presented with a sample from a sixty-two year-old woman in the A&E department with a GI bleed requiring four units of blood within two hours. 

She grouped as A Rh(D) Positive with a negative antibody screen so I selected four units of A Rh(D) positive blood, and got the green light for which I was grateful.

28 January 2022 (Friday) - 2106 DM

I had a look at NEQAS digital morphology exercise 2106 DM on 16 November and was presented with: 

 “This is an image from a blood film prepared from a 67-year-old female known to have mild anaemia and an enlarged spleen. At a routine clinic follow up she was found to have a rising white cell count. You are asked your opinion. This case has complex morphology so you may wish to look at our help pages” 

Well… the red cells were horrible. Anisopoikilocytosis with echinocytes, tear drop cells, red cell fragments. Spherocytes and nucleated red cells with polychromasia. 
The white cells were equally yuk, with degenerate neutrophils, myelocytes and blast cells. Odd-looking monocytes, smear cells and what I can only call “bi-lobed strange things”. One might have been a Pelger-Huet neutrophil. but the others looked lymphoid.

There were giant platelets and grey platelets  and were a couple of the odd things megakaryocytes?

As for the clinical condition… I would hazard a guess at myelodysplasia considering transforming into leukaemia… but that’s just a guess. Quite frankly if this appears down the microscope it gets referred to the haematology consultant whose patient it already is. 

 The results were available to me today. 

This is a leucoerythroblastic picture with marked red cell abnormalities and tear drops cells in a 67 year old female with splenomegaly.  The original diagnosis was of JAK2 positive PRV but the features are much too abnormal to support this as a sole diagnosis. In fact, at the time of this film the disease was transforming to myelofibrosis (the presence of tear drop forms, early erythroid progenitor cells, a bare megakaryocyte nucleus are suggestive of this transformation). The primitive cells present on the film may be a reflection of the advanced fibrosis, but in this case were found on bone marrow examination to reflect an additional transformation to an acute leukaemia,

Leukaemic transformation… I got that right.

26 January 2022 (Wednesday) - Transfusion News Update

The nice people at “Transfusion News” sent their update today. I was a tad vague on what the first article was about, but the article on the use of convalescent plasma was intriguing, if only because opinion seems to be utterly divided on the matter right now…

RBCeq: A Novel, User-Friendly, Algorithm for Genetic Blood Typing

January 26, 2022 About 85 million units of red blood cells (RBCs) are transfused globally, and some patients requiring multiple transfusions are at a high risk of alloimmunization. Currently, serology is the gold standard for RBC phenotyping and matching. Recently, molecular methods utilizing DNA microarrays and single nucleotide polymorphism (SNP) genotyping have enabled large-scale typing, but these methods are incapable of identifying novel blood groups. [Read More]


Covid 19 Convalescent Plasma in the Omicron Era

Join Transfusion News Associate Editors Daniela Hermelin MD and Monica Pagano MD on Twitter Space this Friday January 28 from 11:00-11:30 AM EST for the first ever #Blooducation Baristas live event. Dr. Hermelin and Dr. Pagano will be serving up piping hot Transfusion News along with Evan Bloch MD, Claudia Cohn MD, and BJ Grossman MD. [Set a reminder to join us]


Variable Transfusion Practices for Bleeding ICU Patients Globally

January 19, 2022 Approximately 40-50% of patients in the intensive care unit (ICU) receive blood transfusions. Many studies have focused on bleeding in trauma patients who are usually healthy. Patients in the ICU, however, more often have multiple comorbidities and may require a more nuanced transfusion approach. [Read More]


Plasma Exchange for Hypertriglyceridemic Acute Pancreatitis

January 11, 2022 Acute pancreatitis can be caused by many etiologies including high levels of plasma triglycerides. Hypertriglyceridemic acute pancreatitis (HTGAP) can cause life-threatening complications such as multi-organ failure. While plasma exchange is used to quickly lower plasma triglyceride concentrations, the benefits of this treatment are not clear. [Read More]


21 January 2022 (Friday) - HDN

Whilst I wasn’t looking, Clare’s done more science… A particularly good case study of a case of haemolytic disease of the newborn. You can see it by clicking here