31 July 2023 (Monday) - BTLP-TACT Exercise

Having stuffed up the BTLP-TACT that I did last week I thought I’d better have another go; if only to deter the emails telling me to get on with it…
The thingy gave me two cases:

26112 – a sixty-four year old chap needing group and save. 
He grouped as O 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 is consistent with anti-D but does not exclude anti-Cw 

03367 – a twenty-one year old chap needing two units of irradiated blood with two hours. 
He grouped as A Rh(D) Positive with a negative antibody screen 
I selected two units of A Rh(D) Pos K Neg irradiated blood

I got the green light.

28 July 2023 (Friday) - 2303 DM


The results of 2303 DM became available today. The patient had a transfusion dependent beta thalassaemia major with splenectomy. Without copying and pasting ad nauseum I spotted the salient features…
I feel I have to question the point of this exercise… how likely is if for this sort of patient to turn up unannounced?

28 July 2023 (Friday) - A Book on Morphology


I found this book of morphology on-line today. It’s rather useful…

27 July 2023 (Thursday) - BTLP-TACT Exercise


I’ve not done a BTLP-TACT exercise for a while and I’ve been getting snarky emails about it. So here goes…
I had two cases:

49863 – a fifteen year old lad with beta thalassaemia needing two units of blood today.

He grouped as O with an indeterminate Rh control, and a negative antibody screen.

I selected two units of O Rh(D) Negativeblood fir him


93572 – a thirty-one year old chap with haematemesis needing two units of blood urgently. 

He grouped as A Rh (D) Positive with a negative antibody screen.

I selected two units of A Rh(D) Positive blood for him.

I got the thumbs-down. It seems the control being positive invalidates the entire group. I am SURE!!!!!! that previously in this simulator the control only applied to the Rh group.

26 July 2023 (Wednesday) - XbarM


Here’s an interesting article from the Sysmex Academy. The XbarM control program.
In theory it is a brilliant idea… the average result of all the samples going through the lab should remain unchanged over time.
It probably does… from one week to the next. However all the time patient samples from specific clinics arrive together there are going to be biases. And so XbarM is of arguable relevance. The trouble is that because the analyser comes with this tool, people will use it. With no regard to how it is being used. And so the old maxim comes into play – “if you look for trouble, you will find it”.

25 July 2023 (Tuesday) - NEQAS 2304BF


I got hold of the results of NEQAS 2304 BF today. Rather than copying and pasting loads (the formatting of which is problematical) I’ll summarise:
I said “Leucoerythroblastic ? CML”. It was… 
I said “? AML”. It was…

25 July 2023 (Tuesday) - NEQAS 2302 DF


I got hold of the results of NEQAS 2302 DF today
Neut     36.5  32.5
Lymph  4.0     4.0
Mono    0.5     1.0
Eos       7.0     9.5
Baso     27.0   22.0
Meta      1.0    3.2
Myelo     10.5    11.0
Blast      12.0     10.0
NRBC    5.0     4.0
C-Wbc    64.7   64
That’ll do…

25 July 2023 (Tuesday) - Transfusion Evidence Library Update


The people at Transfusion Evidence Alert sent their update… far too much for my poor brain to process in one sitting. But yet again tranexamic acid features…


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



The impact of the Safe Delivery Application on knowledge and skills managing postpartum haemorrhage in a low resource setting: a cluster randomized controlled trial in West Wollega region, Ethiopia.Christiansen, A.H., et al. (2023). Reproductive Health. 

Desmopressin for patients with spontaneous intracerebral haemorrhage taking antiplatelet drugs (DASH): a UK-based, phase 2, randomised, placebo-controlled, multicentre feasibility trial.Desborough, M.J.R., et al. (2023). The Lancet. Neurology. 

Risk of thrombotic events in immune thrombocytopenia patients treated with thrombopoietic agents: a systematic review and meta-analysis.Dong, Y., et al. (2023). Thrombosis Journal. 

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures.Gibbs, V.N., et al. (2023). The Cochrane Database of Systematic Reviews.

Interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews.Lewis, S.R., et al. (2023). The Cochrane Database of Systematic Reviews.

Factors that influence the administration of tranexamic acid (TXA) to trauma patients in prehospital settings: a systematic review. Nicholson, H., et al. (2023). BMJ Open.

Eltrombopag for low-risk myelodysplastic syndromes with thrombocytopenia: interim results of a phase-II, randomized, placebo-controlled clinical trial (EQOL-MDS).Oliva, E. N., et al. (2023). Journal of Clinical Oncology. [Record in progress]. 

Efficacy and safety of luspatercept versus epoetin alfa in erythropoiesis-stimulating agent-naive, transfusion-dependent, lower-risk myelodysplastic syndromes (COMMANDS): interim analysis of a phase 3, open-label, randomised controlled trial.Platzbecker, U., et al. (2023). Lancet. [Record in progress].

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. [Record in progress]. 

20 July 2023 (Thursday) - Oncology Central Update


The nice people at Oncology Central broke with tradition this month and rather than sending very technical scientific stuff which went over my head, they sent stuff about what I might be doing in ten years’ time.

Realistically I expect to be retired by then, but you never know…

Design of SERENA-6, a Phase III switch trial with camizestrant in ESR1-mutant breast cancer during first-line treatment

Future Oncology, our partner journal, has recently published a Clinical Trial Protocol, which details the design of the SERENA-6 breast cancer trial.

Latest news

How are patients being put first in a new era of ‘common sense oncology’?

A comment published in The Lancet Oncology calls for a recalibrated approach to oncology care, where patient needs are put to the forefront and decisions to pursue research options are not influenced by an organization's profit motive.

Everyone in the UK with symptoms of colorectal cancer set to receive an at-home test

NICE’s diagnostic advisory committee has recently recommended the use of quantitative fecal immunochemical tests for all individuals suspected of colorectal cancer.  

Could lung cancer prognosis be predicted from a drop of blood?

A blood-based protein panel combined with a prediction model shows potential to lower lung cancer death rate(?) by identifying individuals who need CT screening.