A Dull Day At Work...?: June 2025

17 June 2025 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with two cases

98137 – a thirty-one year-old woman in outpatients with “maternal alloantibody” requiring group and save
She grouped as A Rh(D) Positive with a negative antibody screen. Bearing in mind the diagnosis of “maternal alloantibody” this might warrant further investigation to find just how long ago this “maternal alloantibody” was identified.
47220 – a nineteen year old woman in theatre requiring group and save.
Her ABO group was indeterminate; cell group A, reverse group AB. But the Rh group was negative. This should be referred to NHSBT, but given that she was having a baby this would probably be a known case.
The antibody screen was negative.

I got it right.

16 June 2025 (Monday) - NEQAS 2502 PA

The results of NEQAS 2502 PA became available today. It gas to be said that I wasn’t overly confident on that survey.

2502 PA1 was a thick film. I said “Parasites present”. There were – P. Knowlesi. The expert opinion said “It is optimistic to hope to distinguish between different species of Plasmodium on a thick film unless you are working in a high prevalence area or have extensive experience”.

For 2502 PA2 I said “ring forms” and there was. The expert opinion said “This is an example of babesiosis, most likely due to Babesia microti. It was a difficult film to interpret. B. microti is mainly seen as small rings, so it is easily confused with Plasmodium sp”.

In both cases I spotted parasites present. Obscure ones that I rarely, if ever (never), see in practice. But I spotted them. Had this happened in reality the case would be referred to a specialist lab.

I’m taking this as a success

15 June 2025 (Sunday) - Slide Saturday Challenge

Babesia... carried by ticks. I've piulled a few of those off of the dogs over the last few months...

13 June 2025 (Friday) - BTLP-TACT Exercise

Having stuffed up the BTLP-TACT in the week I thought I’d best have another go. It presented me with two cases:

05245 – a thirty-one year-old woman needing four units of FFP for pre-operative reversal of warfarin therapy.
She grouped as O Rh(D) Positive with antibody screen positive in cell 2. I requested antibody panels. The IAT and enzyme panels were positive in cells 3 & 5 corresponding with anti-E.
PCC would be better than FFP for reversal of warfarin therapy, so I didn’t issue any

71170 – a thirty year old woman needing two units of cryo for factor VIIII deficiency.
She grouped as O Rh(D) Positive with a negative antibody screen.
Factor VIII concentrate would be a far better treatment, so I didn’t issue cryo.

I got it right… which was a result.

12 June 2025 (Thursday) - ASH Update

The American Society of Hematology sent their update today. You can read it by clicking here.

There’s a lot to take in, and I can’t pretend to understand very much of it… but te more of this sort of thing I read, the more of is seeps through my thick head…

11 June 2025 (Wednesday) - Getting the BTLP-TACT Wrong

Time for a BTLP-TACT exercise. It gave me two cases:

52493 – a fifty-two year-old chap in theatre needing four units of blood for a GI bleed

He grouped as A Rh(D) Positive with a negative antibody screen.
The software had presented me with IAT Ab ID which was negative throughout. What was that all about?

I issued four units of A Rh(D) Positive K Negative blood

72993 – a sixty-two year-old chap in out-patients with thalassaemia needing two units of blood tomorrow.

He grouped as B Rh(D) Positive with a negative antibody screen.
The software had also presented me with IAT Ab ID which was negative throughout. What was that all about?

I issued two units of B Rh(D) Positive K Negative blood

I got the thumbs-down. It claimed the D group of the second case was uninterpretable. Was it? Bearing in mind I can’t call it up, I’ll have to trust it… Possibly my attention was on the unwanted IAT screens it had randomly generated? It pays to stay alert…

9 June 2025 (Monday) - XbarM Analysis

The XbarM alarm is in theory an absolutely brilliant idea. Given that the population with which we are dealing remains constant then the average result of any given blood parameter will also remain constant. And so any serious change in the average of the measurements of that parameter will tell us (me!) that there’s something causing that result to change.

However there is one big assumption in there… if we take the day’s workload and compare it to yesterday’s or tomorrow’s then the population with which we are dealing probably does remain constant. However we aren’t comparing on a daily basis. We are comparing batches of twenty patients. And bearing in mind that the various clinics batch up their work and sent it to us in job lots, XbarM analysis effectively ends up comparing twenty ante-natal patients with twenty oncology patients.

And so the alarm goes off.

There’s an interesting article from Sysmex on the matter which you can read by clicking here.

8 June 2025 - Buffy Coats?

Intracellular bacteria... What I found interesting was the concept of preparing a buffy coat to examine. In this day and age this is exacttly the sort of thing from which we are moving away.

7 June 2025 (Saturday) - NEQAS 2503 BF

I got the results of NEQAS 2503BF today.

For NEQAS 2503 BF1 I felt the red cells were unremarkable. The white cells showed blast cells, folded nuclei, cytoplasmic blebbing/hairy cells and neutropenia. The platelet count was reduced.

I spotted the salient features – the patient had AML.

For NEQAS 2503 BF2 I felt the red cells showed anisopoikilocytosis with nucleated red cells, target cells and burr cells seen. The white cells showed neutrophilia and monocytosis (with vacuolation). Some cells showed cleft nuclei and clover leaf nuclei. I spent a while before deciding these were not Sezary cells. There were also smear cells there.

The platelet count was reduced.

I spotted the salient features – the patient had CMML.

6 June 2025 (Friday) - UKAS Update

The United Kingdom Accreditation Service sent their update today. You can read it by clicking here.

This time they were talking about how “training supports professional development in the conformity assessment sector”. However, as is always the case, they seemed to be talking in riddles. It is all very well referring to how something or other does or doesn’t fit in with their standards. But all the time you have to spend serious money to see what their standards actually are, there’s a large amount of guesswork going on.

I’m reminded of my days as a manager when another manager would always get his way by insisting that whatever he wanted was “an MHRA requirement”. As no one in the meetings ever knew what MHRA required, his demands were always met without argument.

Perhaps if the UKAS people were more open about their standards we might all learn something. After all their predecessor was quite open about what their standards were.

6 June 2025 (Friday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – a forty-nine year-old woman needing four units of blood for a surgical procedure.

She grouped as O Rh(D) Positive with a negative antibody screen.

I selected four units of O Rh(D) Positive K – negative blood.

I got the thumbs-up.

4 June 2025 (Wednesday) - Warm Autoantibodies

Back in the day when presented with a patient who has warm-acting autoantibodies we would crossmatch half a dozen units and give those which seemed to be least incompatible.

These days we sent samples to NHSBT.

Here’s a little article on the matter.

3 June 2025 (Tuesday) - Fritsma Factor Newsletter

The Fritsma Factor newsletter appeared in my in-box today. You can read it by clicking here. As always it has some useful snippets… but bleeding time and whole blood clotting time? Seriously?

3 June 2025 (Tuesday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. I was presented with one case – a twenty-nine year-old woman in the haematology clinic needing two units of cryo for Factor VIII deficiency

Their ABO group was indeterminate but the Rh(D) group was positive.

Their antibody screen was negative.

The guidelines say that cryo is NOT indicated when virus-inactivated factor concentrates are available.

And in my world they are.

So I didn’t issue any.

I got it right…

29 May 2025 (Thursday) - Oncology Central Update

The nice people at Oncology Central sent their update today. Much of it went over my head; much of it usually does. But just occasionally something sticks…

29 May 2025

OC - 2024 - Q1 - AstraZeneca vis Arc Bio - interview - LB

ASCO 2025 guide: breaking news and key themes

The world’s largest clinical oncology conference, the ASCO Annual Meeting (May 30–June 3, IL, USA), begins tomorrow! To help you maximise your experience at ASCO, we have compiled breaking news headlines and key conference themes in one handy article.