1 March 2024 (Friday) - BTLP-TACT Exercise

It has to be said that I get rather frustrated with the BTLP-TACT simulator. It could be such a good thing but it is most definitely a work in progress on which all work seems to have stopped. As was illustrated today.
But I had a go… It gave me one case – a nineteen year old woman with factor VIII deficiency needing cryoprecipitate tomorrow.
She grouped as O Rh(D) Positive with a negative antibody screen.
But section 5.5.3 of the latest guidelines says “For patients with hemophilia, cryoprecipitate is not recommended due to concerns about the safety and quality… The use of cryoprecipitate can only be justified in situations where clotting factor concentrates are not available as there is no proven advantage for their use over CFCs. It is strongly encouraged that viral-inactivation procedures be used, if available”.
So bearing in mind the stuff wasn’t needed until tomorrow I didn’t issue cryoprecipitate. Plenty of time to get the proper stuff.
But how was I supposed to put this onto the exercise? I chose not to select the issue at all as I’ve not seen any option to cancel it once requested. In reality we would have a conversation with the requestor.

It would seem not requesting the stuff was the right option as I got the green light.

29 February 2024 (Thursday) - UKAS Update

The UK Accreditation Service sent their update today… You can see it here. Am I being incredibly cynical in wondering if they might benefit from taking that quality management course I did recently?

26 February 2024 (Tuesday) - Transfusion Evidence Alert Update

The people at Transfusion Evidence Alert sent their update today. In a novel break with tradition there was no mention of tranexamic acid…


Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis.Gibbs, V.N., et al. (2024). The Cochrane Database of Systematic Reviews.PICO Summary available



Standard of care versus octreotide in angiodysplasia-related bleeding (the OCEAN study): a multicenter randomized controlled trial.Goltstein, L., et al. (2023). Gastroenterology. [Record in progress].Long-term outcomes of plasma exchange versus intravenous immunoglobulin for the treatment of Guillain-Barré Syndrome: a double-blind, randomized clinical trial.Haridy, N.A., Shehab, M.M., and Khedr, E.M., (2024). Restorative Neurology and Neuroscience.

Iron and erythropoietin to heal and recover after intensive care (ITHRIVE): a pilot randomised clinical trial.Litton, E., et al. (2023). Critical Care and Resuscitation.

Prevention strategies for vasovagal reaction in whole blood donors: a quadri-armed randomised control trial.Meher, R., et al. (2024). Transfusion Medicine. [Record in progress].Efficacy and cost-effectiveness of darbepoetin alfa once every 4 weeks versus continuous erythropoietin receptor activator once every 4 weeks for anemia correction in patients with chronic kidney disease not on dialysis.Park, G.N., et al. (2024). Kidney Research and Clinical Practice. [Record in progress].

Effective management of foetal anaemia in Rh(D) alloimmunised pregnant women with intrauterine transfusion: a systematic review.Prescott, B. and D.E. Jackson (2023). Hematology, Transfusion and Cell Therapy. [Record in progress].

Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes.Stangl, S., et al. (2024). Systematic Reviews.

Desmopressin to reduce periprocedural bleeding and transfusion: a systematic review and meta-analysis.Wang, C., et al. (2024). Perioperative Medicine.

Effects of albumin and crystalloid priming strategies on red blood cell transfusions in on-pump cardiac surgery: a network meta-analysis. Wang, T., et al. (2024). BMC Anesthesiology.


23 February 2024 (Friday) - Oncology Central Update

The nice people at Oncology Central sent their update today. All a bit over my head, but stuff I need to be aware of…

Uncovering the link between cancer disparities and climate change


What disparities exist in cancer screening and how does this impact patient outcomes? Listen to our latest podcast episode with Dr Kilan Ashad-Bishop from the American Cancer Society to find out.


Real-world clinical scenarios during introduction of trastuzumab biosimilar for HER2-positive breast cancer in the European Union

Trastuzumab-anns is a biosimilar to trastuzumab, which is approved by the EMA and US FDA for treatment of HER2+ early and metastatic breast cancer. Read about its use in seven clinical oncology practices in the EU.

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BIPOC involvement in oncological research: insights from Future Oncology

In this special edition of editor’s highlights, Michael Bell Managing Editor, looks at three articles published over the last 12 months in Future Oncology, concerning greater engagement and representation for Black, Indigenous and People of Colour (BIPOC) people in oncological research.

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P-REALITY X: prolonging metastatic breast cancer survival by adding palbociclib to an aromatase inhibitor

Find out details of a real-world database analysis exploring how adding palbociclib to an aromatase inhibitor could prolong the life of people with metastatic HR+/HER2– breast cancer in routine clinical practice. 

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20 February 2024 (Tuesday) - Westgard QC Update

The nice people at Westgard sent out their update today. All perhaps a tad dull, but this is the sort of thing which is relevant to my daily round. The article on the measurement of uncertainty was rather useful. A shame that not everyone who needs to read it will read it.

19 February 2024 (Monday) - European Hematology Association Update

On the one hand following the European Hematology Association’s Facebook feed is a good move as they send out things like this. On the other hand what with the vagaries of Facebook, there’s very little point in doing a morphology quiz on-line as when the answer comes out, the Facebook algorithms will decide to show me pictured of Lego or dogs instead…

In this instance platelet clumping should warrant performing  blood count on a citrated sample.

15 February 2024 (Thursday) - Horiba update

The nice people at Horiba sent their monthly morphology update today. There were loads of answers to previous quizzes… not that I can remember having seen any previous quizzes. I wonder if I’m missing something here…

14 February 2024 (Wednesday) - Getting the BTLP-TACT Wrong. Again.

Time for another BTLP-TACT exercise… It gave me two cases.
00403 – a fifty-eight year-old woman needing group & save for a hernia repair.
Her blood group was indeterminate as a positive result in the control tube invalidated the entire blood group. Apparently.
Fortunately the antibody screen was negative.
92445 – a seventy-six year old woman needing four units of FFP for reversal of warfarin therapy. Personally I wouldn’t have used FFP for reversal of warfarin therapy, but presumably the nice people at BTLP-TACT had already had that argument.
She grouped as A Rh(D) Negative with antibody panel positive in cell 3. I requested antibody panels. The IAT and enzyme panels were positive in cell 8 corresponding with anti-Kp(a)
I issued two units of A Rh(D) Negative FFP, and two units of A Rh(D) Positive FFP as there was no more A Rh(D) Negative FFP or any AB Rh(D) Negative FFB
I got the thumbs-down. I wasn’t supposed to issue any plasma at all. Well, I know that. But when I said “presumably the nice people at BTLP-TACT had already had that argument”, clearly they hadn’t.
I’m getting fed up trying to second-guess this software…


13 February 2024 (Tuesday) - Eighty Four Point Five Per Cent

I started this quality management course three weeks ago when I said “I’ve always considered “Quality Management” to be a load of blah-blah-blah that gets in the way of doing my job, and for years I’ve been wondering just what I’m missing. I must be missing something.
So far the course has been nothing but blah-blah-blah, and all it is doing is confirming my preconceptions.
I finished the course today and got eighty four point five per cent. I’ve clearly learned something during this time, but it has to be said there was a *lot* of “blah-blah-blah”. It really could have done with a whole lot less general theoretical and a whole lot more specific practical examples.
But eighty four point five per cent is eighty four point five per cent, isn’t it? There’s something tangible I can stick in a CPD audit should the need arise.
The course I’ve just done made it quite clear that a CPD audit of the sort I’m talking about here in no way contributes to workplace quality. And that’s why I’m still cynical.

8 February 2024 (Thursday) - MDS

The nice people at Oncology Central sent their update today. As always, much of it went over my head, but there was one rather interesting article about the diagnosis of myelodysplastic syndrome.

Back in the day MDS was something of a catch-all labelling of pre-leukaemic conditions. Things are getting a tad more specific these days

7 February 2024 (Wednesday) - Placental Growth Factor

The future? Here’s an article about a quick, accurate new blood test for pre-eclampsia which is contributing to safer pregnancies and better outcomes for tens of thousands of women and their unborn babies every year.

How long will it be before I’m performing placental growth factor assays?

6 February 2024 (Tuesday) - Fritsma Factor Newsletter

Cryoprecipitate, platelet function tests… again the Fritsma Factor newsletter comes up trumps.
You can read it by clicking here. There’s not lots, but what there is, is good.

3 February 2024 (Saturday) - More Quality Management

Having identified a problem... is it really a problem? Was there an error that came to light? Has there been a complaint? Or is there something in the workplace that could be changed easily and that would be used to tick a quality management box?
Having identified a real (as opposed to imagined or made up for a paperwork exercise) problem, is this one that can be readily rectified? And exactly how can we be sure that what changes we make actually eliminate or reduce the percieved problem?

An example was given from a well-known manucaturer of office equipment who felt they were paying far too much in transport costs when getting stuff in from their suppliers. At the end of the process they cut a list of three thousand suppliers down to three hundred; thereby eliminating the transport and administration costs of dealing with two thousand seven hundred companies. 

Suddenly quality management is all making sense.

2 February 2024 (Friday) - Haemostasis Update

The Journal of Thrombosis and Haemostasis sent its update today. Some interesting articles…

I’m always interested in haemostatic articles – when you think about it, there is such a fine line between our bodies bleeding out and clotting into one solid lump.