16 March 2025 (Sunday) - Slide Saturday Challenge

Slide Saturday Challenge – target cells.  These form when there's an increased surface area to volume ratio in red blood cells leading to a distinctive "bullseye" appearance.

This is often seen in liver disease, iron deficiency and haemoglobinopathies; particularly thalassemias, and HbC and E.

14 March 2025 (Friday) - BTLP-TACT Exercise

I’m at something of a loose end, so why not do another BTLP-TACT exercise? I was presented with one case – an eighty-three year-old woman in theatre needing group & save.

She grouped as O Rh(D) Positive with antibody screen positive in cells 2 & 3.

I requested antibody panels.

The IAT and enzyme panels were positive in cells 1, 3, 4, 6 and 7 which corresponded with anti Jk(a)

 

I got it right. That’s four this month (and it is only the 14^th). I checked my performance dashboard; all is in the green.

So why am I still getting emails badgering me about “need to complete further TACT participations to improve your engagement target with the system”?

13 March 2025 (Thursday) - ASH Update

The nice people at the American Society of Hematology sent their update today. You can read it by clicking here. Much of it went over my head, but some of it made sense, some of it was a useful update, and something for nothing is always a bargain.

11 March 2025 (Tuesday) - NEQAS 2501DM

I got the results of NEQAS 2501DM today.

 

“You are asked your opinion of this blood film that was prepared from a 64-year old female who had attended her GP complaining of tiredness. The automated analyser had reported a lymphocytosis with a flag indicating the possible presence of blast cells”.

 

I saw

 

Rbc

 

Rouleaux

 

Wbc

 

Lymphocytes with blebbing

Lymmphocytes with Burkett-like vacuoles

Smear cells

Blast cells

Dysplastic neutrophils

Toxic granulation

 

Plt

 

Giant platelets

 

I felt this was something lymphoproliferative.

 

The expert opinion said ”The abnormal cells are variable. However, most cells have a mature appearance, and the preservation of neutrophil and platelet numbers makes a diagnosis of acute leukaemia less likely. Furthermore, the overall nuclear and cytoplasmic features are not typical of either circulating blast cells. Making a morphological diagnosis of MCL can be difficult and we can rarely (if ever) be confident of the diagnosis using morphology alone. However, MCL is a potentially aggressive disorder, so it is important not to simply report the appearances as reactive. Features to look for include – marked variability between malignant cells with some cells looking quite mature and others more aggressive; a variable but often abundant and basophilic cytoplasm; and nuclear complexity, classically indented but often quite variable. Confirmation can then be made using marker studies and molecular testing.”

 

Which (quite frankly) means that I’d spotted the salient features and gone about as far as I could with a microscope. I’ll take that as a success.

11 March 2025 (Tuesday) - e-learning

Today I was tasked with supervising one of the trainees… well, not so much supervising as being there if he needed me. As he cracked on (very competently) I took the opportunity to catch up on my e-learning. I got quite a bit done:

 

• Sexual misconduct in the Workplace
• Resus training
• NHS Counter Fraud, Bribery and Corruption Training
• Equality & diversity

 

I got 100% on sexual misconduct in the Workplace… is that good or bad?

10 March 2025 (Monday) - BTLP-TACT Exercise

Well.. I’ve done six exercises in the last month and still I’m getting emails saying that I need to “improve my engagement target” even though when I call up my participation history all is in the green.

But… here goes again.

I was presented with two cases:

58214 – a forty-five year old woman in the ante-natal clinic needing group and save. The label on her blood sample was blank. I rejected it. That might have come from absolutely anyone.

65191 – a thirty-one year-old woman requiring group and save prior to a splenectomy. She grouped as O Rh(D) Positive with a negative antibody screen.

 

I got the thumbs-up.

9 March 2025 (Sunday) - Slide Saturday Challenge

The nice people at the American Society of Hematology did another Slide Saturday Challenge. It’s a sickle cell.

But I’m not at all keen with their comment “did you guess correctly?”. This rather implies that they were expecting answers of target cell, keratocyte, blister cell, polychromasia, basophil, and pretty much everything you might find in the index of an atlas of haematology. To my mind there are two acceptable answers here.

• Sickle cell (or posh terms for the same)
• Don’t know

Perhps I’m being pedantic, but we really shouldn’t be encouraging people to guess. Perhaps the comment might be phrased differently in future.

Perhaps I should have commented on the original Facebook post?

 

5 March 2025 (Wednesday) - Atypical Lymphocytes

The nice people at the American Society of Hematology sent me this article today. A review of atypical lymphocytes.

If there’s one thing I see all the time it is atypical lymphocytes. On reflection I describe them by waving my hands in the air and using swear words. This article rather consolidates what I know and gives it some formal grounding.

Feature	Reactive	Malignant
Patient’s age	<30	>50
Lymphadenopathy	Typically absent	May be present
Absolute lymphocyte count	Usually increased	Increased, normal, or decreased
Percent lymphocytes	Usually increased	Increased, normal, or decreased
Platelets	Normal	Normal or decreased
Anemia	Absent or mild	Usually present
Cell heterogeneity	Present	Absent
Cell size	Variable but usually large	Small to medium to large
Nucleus	Irregular	Round, indented, folded, irregular
Nucleolus	Absent or inconspicuous	Absent, prominent
Cytoplasm	Abundant, radiating basophilia	Scant to moderate
Cytoplasmic projections	Absent	May be present *
Red blood cell molding	Present	Usually absent
Smudge cells	Absent	May be present **

 

4 March 2025 (Tuesday) - Fritsma Factor Newsletter

The nice people at Fritsma Factor sent their update today. Factor deficiencies, lupus, standardization of INR results… all good stuff.

4 March 2025 (Tuesday) - BTLP-TACT Exercise

I’ve walked the dogs, given them a wash, had a cuppa and got a little time before the late shift. What else might I do…

 

I was presented with two cases:

08666 – a ninety-three year-old woman awaiting surgery needing group and save.

She grouped as A Rh(D) Negative with antibody screen positive in cells 1 and 3. I requested antibody panels.

The IAT panel was positive in cells 1, 3, 6, 9 and 10 corresponding with anti-Fy(a) but not excluding anti-Cw or anti-Lu(a). But the enzyme screen was negative throughout so this did exclude them

02480 – an eighty-two year-old chap in A&E with coffee ground vomit also needing group and save.

He grouped as A Rh(D) Positive with antibody screen positive in cell 2. I requested antibody panels. The IAT and enzyme panels were positive in cells 2 and 6 corresponding with anti-K

 

I got it right…

2 March 2025 (Sunday) - Slide Saturday Challenge

Tear drop cells. Myelofibrosis...  myelophthisic? Thta's a new word. I wonder what it means...

2 March 2025 (Sunday) - BTLP-TACT Exercise

I’ve got an hour before I’m off to the late shift. There’s not a lot else for me to do…

 

I was presented with a nine-year-old child having a liver transplant needing FFP and cryo.

 

He grouped as O Rh(D) Negative with a negative antibody screen.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2958698/ implies both FFP and cryo are indicated in liver transplants so I selected four units of FFP and two units of cryo as requested.

 

I got the thumbs-up.

28 February 2025 (Friday) - NEQAS 2501 PA

I got the results of the parasitology NEQAS exercise 2501 PA today.
 

• I didn’t see anything in sample 2501PA1 – there wasn’t anything in it.
• I saw P. vivax in sample 2501 PA2 – that was correct.

 
I’m seeing that as a result.