21 December 2023 (Thursday) - Swearing at the BTLP-TACT

Time for a BTLP-TACT exercise… I had two cases:


79396 – A thirty-eight year-old chap in the haematology clinic requiring eight units of blood for an exchange transfusion (do they still happen?) for sickle cell disease

He grouped as A Rh(D) Positive with a weak D. With absolutely no idea what the “less than perfect(!)” software was expecting I called it indeterminate. But this is crap isn’t it (to be blunt). Given a patient in the haematology clinic known to have sickle cell disease requiring exchange transfusion, how likely is it that this dubious D group wouldn’t have been encountered and investigated years ago?

The antibody screen was negative, for which I was grateful.

I selected eight units of A Rh(D) Negative blood knowing full well the software wouldn’t be happy. 

16094 – A thirty-three year-old woman needing four units of blood for surgery.

She too was a pain in the glass (as my grandson would say). An indeterminate ABO group but was Rh (D) Negative, and a positive antibody screen (in cells 1 & 2). I selected panels…

The IAT and enzyme panels were positive in cells 1, 2. 3. and 5 corresponding with anti-D and anti-E but not excluding anti-Cw

I selected four units of O Rh(D) Negative which were also E and Cw negative

Needless to say I got the thumbs down. I’m not quite sure why though. Apparently I got the group bits right but selected the wrong blood components. But why I’d done that… It wouldn’t tell me. It has to be said that as a learning tool the blood transfusion simulator leaves a lot to be desired in that it seems to work in a way which is at odds to reality, and when you get it wrong it won’t tell you why.

19 December 2023 (Tuesday) - Transfusion Evidence Alert Update

PCC or FFP?  And tranexamic acid yet again!!! The regular update from the nice people at the Transfusion Evidence Alert is always worth having.


Restrictive or liberal transfusion strategy in myocardial infarction and anemia.Carson, J.L., et al. (2023). The New England Journal of Medicine. [Record in progress].PICO Summary available



Thalidomide for recurrent bleeding due to small-intestinal angiodysplasia.Chen, H., et al. (2023). The New England Journal of Medicine.

Tranexamic acid for traumatic injury in the emergency setting: a systematic review and bias-adjusted meta-analysis of randomized controlled trials.Fouche, P.F., et al. (2023). Annals of Emergency Medicine. [Record in progress].

Comparative efficacy of early TIPS, non-Early TIPS, and standard treatment in patients with cirrhosis and acute variceal bleeding: a network meta-analysis.Huang, Y., et al. (2023). International Journal of Surgery. [Record in progress].

Randomized trial of hyperimmune globulin for congenital CMV infection - 2-year outcomes.Hughes, B.L., et al. (2023). The New England Journal of Medicine.

Erythropoiesis-stimulating agents and cardiovascular mortality: a systematic review and meta-analysis of 17 studies and 372,156 hemodialysis patients.Karimi, Z., et al. (2023). International Journal of Cardiology. Cardiovascular Risk and Prevention.

Next generation sequencing of red blood cell antigens in transfusion medicine: systematic review and meta-analysis.Matosinho, C.G.R., et al. (2023). Transfusion Medicine Reviews. [Record in progress].

Effects of plasmapheresis frequency on health status and exercise performance in men: a randomized controlled trial.Mortier, A., et al. (2023). Vox Sanguinis. [Record in progress].

Can a checklist facilitate recognition of a transfusion-associated adverse event by prelicensure nursing students?Scott, S.S., et al. (2023). Nurse Educator. [Record in progress].

Prothrombin complex concentrate versus fresh frozen plasma in adult patients undergoing cardiac surgery: a systematic review and meta-analysis.Viana, P., et al. (2023). Journal of Chest Surgery. [Record in progress].


13 December 2023 (Thursday) - HCPC Update

The HCPC sent their update today. You can read it by clicking here. I read it as I rather feel obliged to do so, and in all honesty didn’t find anything I felt was relevant to me… but this left me rather thoughtful. Bearing in mind it is a professionally produced document, either the person being paid to produce it is the wrong person, or I’m missing the point entirely.
I wonder which it is. I suspect the latter.

12 December 2023 (Tuesday) - BTLP-TACT Exercise

I thought I’d try another BTLP-TACT exercise…
I had one case – an eighty-four year-old chap in A&E requiring group & save. He grouped as O Rh(D) Positive with a negative antibody screen
I got the green light… Bearing in mind the debacle of last time I took screen shots every step of the way today. I can delete them all now.

12 December 2023 (Tuesday) - Westgard QC Update

The nice people at Westgard sent their update today. Perhaps a tad dull and dry, but useful stuff applicable to my daily round. We all need more of this…

11 December 2023 (Monday) - ESR

Here’s something about a new ESR analyser that came via the nice people at the Medical Laboratory Observer. There are those who are incredibly scathing about the ESR. There are those who call it a totally non-specific test and had long since been superseded by all sorts of other tests.
However I can remember my old GP singing the praises of the ESR. He told me he had a few minutes with a patient. Were they ill? Were they looking to get a sick note? He told me that given a high ESR he knows he has to investigate further, but given a normal result, he can tell the patient to clear off with a clear conscience.
In the hospital setting the ESR is of limited use (at best), but for the GP it is invaluable. And that’s why we keep on doing them.

10 December 2023 (Sunday) - BTLP-TACT

I’ve not done a BTLP-TACT exercise for ages… I was presented with two cases:

13485 – a ninety-two year-old chap in out patients requiring two units of blood within the hour

He grouped as A Rh(D) Positive with ntibody screen positive in cell 2.

I performed panels.

The enzyme and IAT panels were positive in cells 2 and 6 which was consistent with anti-K

I selected two units of A Rh(D) Positive which were K Negative


99315 – a fifty-eight year-old woman in A&E requiring group and save.

She grouped as A Rh(D) Negative with antibody screen positive in cell 3.

I performed panels.

The enzyme and IAT panels were positive in cell 8 which was consistent with anti-Kp(a)

I got the thumbs down. It claimed that the D group of the first one was uninterpretable.
Well, it wasn’t. I’m claiming shenanigans on this one

7 December 2023 (Thursday) - Medical Laboratory Observer

I’ve signed up to the mailing list of the Medical Laboratory Observer. You can do so by clicking here.
The first update I got mentioned screening tests for multiple sclerosis and race-related reference ranges for PSA…
This might be a useful resource. Time will tell; it always does.

6 December 2023 (Wednesday) - NEQAS 2304 PA

The results of NEQAS parasitology 2304PA became available today…
2304 PA1
I saw T. cruzei… so did everyone else.
2304 PA2
I’m going to argue this one. I saw the P. falciparum. However I also saw what I thought were completely different parasites. I thought these were P. vivax, as did over a hundred other participants. You’d think that the scheme organisers would address this… what were we all seeing?

6 December 2023 (Wednesday) - NEQAS 2307 BF

The results of NEQAS morphology 2307BF became available today…
2307 BF1
Hypochromic (consensus 8th) 
Lymphocytosis (some spiky?)  (consensus 1st)
smear cells (consensus 7th)
low plts (consensus 2nd)
? CLL (it was)
2307 BF2
burr cells (consensus 6th)
nrbc (consensus 1st)
lymphocytosis / blasts (consensus 2nd)
smear cells (consensus 4th)
low plts (consensus 3rd)
? lymphoma (it was)
I got that right

5 December 2023 (Tuesday) - Fritsma Factor Newsletter

The Fritsma Factor newsletter arrived in my in-box today… Perhaps I’m being unfair to compare it tl last week’s update from Stago, but this one wasn’t one of the better ones.

That’s rather ungrateful of me, isn’t it?

4 December 2023 (Monday) - Transfusion Evidence Alert Update

The nice people at the Transfusion Evidence Library sent quite a few articles today. The COVID plasma debate rages on – is it any good or not? And one unit transfusions are supposedly as good as two units…

Top Article

Selected Articles

Effect of donor sex on recipient mortality in transfusion.Chasse, M., et al. (2023). The New England Journal of Medicine.

Effect of single-unit transfusion in patients treated for haematological disease including acute leukemia: a multicenter randomized controlled clinical trial.Chantepie, S.P., et al. (2023). Leukemia Research.

Pathogen inactivation methods to prevent transfusion-transmissible arboviruses.Giménez-Richarte, Á., et al. (2023). Tropical Medicine & International Health

Prehospital tranexamic acid for severe trauma.Gruen, R. L., et al. (2023). The New England Journal of Medicine.

Convalescent plasma for people with COVID-19: a living systematic review.Iannizzi, C., et al. (2023). The Cochrane Database of Systematic Reviews.

Comparison of quantitative and calculated postpartum blood loss after vaginal delivery.Madar, H., et al. (2023). American Journal of Obstetrics & Gynecology.

Two-year outcomes following a randomised platelet transfusion trial in preterm infants.Moore C.M., et al. (2023). Archives of Disease in Childhood. Fetal and Neonatal Edition.

Men who have sex with men and risk for transfusion-transmissible infections in blood donors in Western countries: a systematic review update.Schroyens, N., et al. (2023). Vox Sanguinis.

Platelet transfusion before CVC placement in patients with thrombocytopenia.Van Baarle, F.L.F., et al. (2023). The New England Journal of Medicine.

30 November 2023 (Thursday) - Stago Newsletter

The nice people at Stago sent their update today. You can read it by clicking here.
Quite a useful thing to have – whilst the corporate stuff about their latest analysers was only of passing interest to me (realistically I am never going to use them) the stuff about QC and INR was rather good.


27 November 2023 (Monday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Alert sent their update today. Again tranexamic acid featured… that stuff really is one of the wonders of our age.
Personally I liked the talk about not taking such a great volume of blood from patients for various testing… surely it stands to reason that the more you exsanguinate a patient, the more transfusions they will need?


Effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions: A randomized controlled trial.Badr, E. A., et al. (2023). Journal of Pediatric Nursing. [Record in progress].

Cerebral and intestinal oxygen saturation of different volumes of red blood cell transfusion in preterm infants.Chen, R., et al. (2023). Transfusion and Apheresis Science. [Record in progress].

Tranexamic acid for percutaneous nephrolithotomy.Cleveland, B., et al. (2023). The Cochrane Database of Systematic Reviews.

Haemostatic therapies for stroke due to acute, spontaneous intracerebral haemorrhage.Eilertsen, H., et al. (2023). The Cochrane Database of Systematic Reviews.

Intravenous iron administration before cardiac surgery reduces red blood cell transfusion in patients without anaemia.Friedman, T., et al. (2023). British Journal of Anaesthesia.

Effect of red blood cell storage time in pediatric cardiac surgery patients: a subgroup analysis of a randomized controlled trial.Martin, S. M., et al. (2023). JTCVS Open.

Convalescent plasma for Covid-19-Induced ARDS in mechanically ventilated patients.Misset, B., et al. (2023). The New England Journal of Medicine.

Small-volume blood collection tubes to reduce transfusions in intensive care: the STRATUS randomized clinical trial.Siegal, D. M., et al. (2023). JAMA.

Allogeneic serum eye drops: a randomized clinical trial to evaluate the clinical effectiveness of two drop sizes.Vermeulen, C., et al. (2023). Ophthalmology and Therapy.

26 November 2023 (Sunday) - Sign of the Times?

Back in the day if you stuffed something up and made a serious mistake you found yourself up before the regulator and had conditions of practice put upon you. The stress of the process made you lose five stones in weight and gave you nightmares for years after the event.
Nowadays you write the thing up as a PowerPoint presentation for the world to download, and have no qualms about writing “Malaria was missed by BMS and consultant staff”.
Not that I'm in any way bitter...

21 November 2023 (Tuesday) - BTLP-TACT Exercise

I’m just about to go to bed for the afternoon before a night shift… time for a BTLP-TACT exercise.
I had one case – an eighty-three year old chap in the haematology clinic needing group & save. He grouped as A Rh(D) Negative with antibody screen positive in cells 1 and 2. I requested antibody panels.
The IAT and enzyme panels were positive in cells 1, 2 and 3 which was consistent with anti-D but didn’t rule out anti-Cw.
I got the green light…

20 November 2023 (Monday) - XBarM Analysis

Clare’s done some more science…  XbarM analysis… for the most part tells you that the blood samples going through your analyser now are from a different clinic to those that went through half an hour ago…
Clare explains it in more detail here.