25 March 2026 (Tuesday) - Nil Desperandum

I had another little session testing the new works computer today. I had a *lot* of frustration with in. In retrospect it worked perfectly doing exactly what it should. The problem was “operator error”, but I learned a lot…

I think Lionel Jeffries summed it all up over fifty years ago…

24 March 2026 (Tuesday) - Haemochromatosis

Here’s a little update on hereditary haemochromatosis. It’s a useful little bit of revision… 
 

23 March 2026 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with one case – a sixty-one yar-old chap having a pancreatectomy and needing four units of blood.

The ABO group was uninterpretable but the RH(D) group was Positive. The antibody screen was positive in cells 1 and 3 so I performed antibody panels.

 

The IAT panel was positive in cells 1, 3, 6, 9 and 10 corresponding with anti- Fy(a)

however the enzyme panel was negative throughout.

I tried to select four units of O Rh(D) Negative blood which was Fy(a) negative but there was only two. So… what next. We’ve got a male who’s over fifty… I selected two more units of Fy(a) negative blood; these being O Rh(D) Positive.

Either the software would like it or it wouldn’t…

It did…

 

23 March 2026 (Monday) - Increasing Workload

Yesterday’s post has made me think… Yesterday I mentioned about how the microscopy of yesteryear has been replaced with more modern technology which is much less subjective and much more objective.

And that’s partly answered a question I’ve been pondering for some time…

 

When I first started as a Junior (Grade "A") medical laboratory scientific officer in September 1981 the (now demolished) Royal East Sussex Hospital had one consultant haematologist. She would see out-patients in the morning... sometimes as many as six patients in one morning.

Occasionally some patients were ill enough to be hospitalized... she had up to four beds in the (also now demolished) St Helen's Hospital in which these patients would stay, and she had an arrangement with one of the consultant physicians that she might avail herself of the services of the medical SHO *if* they weren't too busy with their own work.

 

Three years later I moved to a nearby hospital where the consultant haematologist had the use of pretty much all of the isolation ward and had two dedicated SHOs of his own... Two. I counted them.

 

I Googled where I currently work... The most recent information publicly availably says that we have nine consultant haematologists, two specialist registrars and four SHOs.

Why so many? What has changed in the meantime...

 

Here’s a couple of articles which give the answer:

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC10188596/

 

https://www.bloodcancerstoday.com/post/cancer-mortality-rate-declines-yet-cancer-incidence-increases-among-women-and-younger-adults

 

Fewer people are dying from preventable infections. Fewer people are dying from heart disease and pulmonary conditions. Smoking and drinking are in decline. Is that why over the past thirty years (globally) cases of hematologic malignancies have been increasing?

But whether or not it is the reason, the death rates for all types of hematologic malignancies has been declining.

We are getting better at what we do.

We’ve a lot more haematologists because we need them.

22 March 2026 (Sunday) - Getting It Right

 Well, I was confident that it was something malaria-ous and (quite frankly) that’s good enough. I spotted the issue and was confident about the next steps… tell the clinician and the London School of Tropical Medicine.

As for the species… I won’t say “that’s anyone’s guess” but I will say “look at the last NEQAS parasitology result”. Out of nearly four hundred and fifty participants, over ninety-nine point five per cent of the participants saw something there that shouldn’t have been. However less than half of the participants got the species right… I say “right”. Perhaps “agreed with the expert opinion” might be a better phrasing.

 

I find myself thinking back to the good old days when leukaemias were typed according to what they looked like down the microscope, and there being as many opinions as there were people working that day at the (now demolished) haematology lab of the Royal East Sussex Hospital.

Nowadays microscopy is just an add-on to flow cytometry and cytogenetics.

How long will it be before speciating will be done by something less subjective than saying “I think it looks like…”

20 March 2026 (Friday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. It presented me with one case – a ninety-five year-old chap who was up for an autologous stem cell harvest (at that age?) who needed two units of blood.

 

He grouped as A Rh(D) Negative with a negative antibody screen. I selected two units of A Rh(D) Negative irradiated blood

 

I got the thumbs-up.

 

19 March 2026 (Thursday) - UKAS Update

The UK Accreditation Service sent their update today... I make a point of reading it because I don’t think many people actually do, and there is a load of misunderstanding and misinformation spread about the thing – in the past I knew of a manager who would get his own way by insisting that any way but his would go against MHRA requirements, safe in the knowledge that no one knew what MHRA required. Much the same is probably true of the UKAS…

But look at their update. How can I as a professional blood-tester be held to the same standards as someone operating a sexual assault referral centre? I really don’t know how, but I am. And that’s why I read the updates…

16 March 2026 (Monday) - I.T. Training

We’re getting a new computer system soon. Today I had some training on the thing. A bit of an introduction to show me the basics. The new one is rather different to what I’m used to; different enough to make my head spin.

Many years ago I did a post graduate certificate on distance based learning. Part of it focused on how people learn. I didn’t actually realise that I’m not very good at being taught anything new as I have the attention span of a gnat and my poor brain needs time to process new information.

I’m having another session on the computer tomorrow. Hopefully by then what I’ve learned will have percolated through my thick head…

15 March 2026 (Sunday) - I Disagree...

 Well… I wouldn’t have said that was hypersegmented. I would have said that was a botryoid neutrophil.
I think the take-home message here is not to judge on the strength of just one cell…

12 March 2026 (Thursday) - BTLP-TACT

Well I’ve made a few mistakes with the BTLP-TACT recently, so let’s try again…

It presented me with two cases:

 

22286 – a ninety-six year-old chap with bleeding varices needing four units of FFP. He grouped s A Rh(D) Positive with a negative antibody screen.

However FFP is NOT recommended for bleeding varices so I didn’t issue any.

 

 

26881 – a fifty-one year-old chap in ITU needing two units of blood. He also grouped as A Rh(D) Positive with a negative antibody screen.

I issued two units of A Rh(D) Positive blood

 

I got the thumbs-up. Bearing in mind I’ve had the thumbs-down for three of the last four I saw that as something of a result.

 

10 March 2026 (Tuesday) - The RDW

Here’s something I found randomly on my Facebook feed – a rather useful little dissertation on a much-overlooked blood count parameter; the RDW.

 

9 March 2026 (Monday) - NEQAS 2601DM

 

I got the results of 2601DM this morning. I did it a month ago when I was presented with an image of a blood film and this statement:

 

“A 60-year-old man had commenced treatment for a serious haematological disorder. His white cell count was raised, and platelet count reduced. He then became increasingly anaemic with changed blood film features. You are asked for your opinion. The film arrives outside of normal hours”

 

In my notes I wrote “Well, there’s a bit of everything in this film, isn’t there. The red cells show echinocytes, microspherocytes, blister cells, nucleated red cells, Howell Jolly bodies, rec cell fragments.

The white cells are a bit of a disaster – cerebriform/flower type lymphocytes, toxic granulation, vacuoles in monocytes and neutrophils, smear cells, target cells, pyknotic neutrophils, eosinophilia. 

The platelet appeared reduced, but we were told that anyway.

 

I didn’t fiddle about trying to get the observations in order… time was pressing.

As this arrived out of normal hours I would put it for the consultant to review in the morning… they don’t thank us for being bothered about this sort of thing… this sort of thing being a patient of which they are already well aware”.

 

The expert opinion was rather odd… it waxed on as it so often does but seemed to completely overlook the fact that this was in a patient with a known haematological condition.

But I spotted that which needed spotting and made the right decision

8 March 2026 (Sunday) - Crigler-Naijar Syndrome

Crigler-Najjar syndrome? No – I’d never heard of it either. Here’s a little write-up on the subject. As I always say, a day when you learn nothing is a day wasted.

 

8 March 2026 (Sunday) - Neutrophil Clumping

 I have seen this... but it's not common.

7 March 2026 (Saturday) - BTLP-TACT Exercise

I had a go at the BTLP-TACT thingy today. It presented me with one case – a twenty-nine year-old woman in theatre having an above-knee amputation and needing two units of blood.

She grouped as O Rh(D) Positive with antibody screen positive in all three cells. I requested antibody panels.

The IAT panel was positive in cells 1, 2, 3, 5, 6, 7, 9 and 10 corresponding with anti-S and anti-Fy(a) but not excluding anti-K.

The enzyme panel was negative throughout which excluded quite a bit..

 

I selected two units of O Rh(D) Positive S-negative Fy(a)-negative K-negative

 

I got the thumbs-down. Apparently there was a clinically significant antibody masked but not noted. I’d love to know what it was.

This is a major failing of the BTLP-TACT simulator. You can’t learn anything from your mistakes. 

5 March 2026 (Thursday) - NEQAS 2601 BF

I got the results of NEQAS morphology 2601BF today
 
2601 BF1
 
302   Thrombocytopenia (consensus 1^st)
212      Blast cells (consensus 2^nd)
012   Red cell fragments (consensus 3^th)
213   Promyelocytes (consensus 4^th)
022   NRBC (consensus 5^th)
 
I said ?? acute promyelocytic leukaemia. It was.
 
2601 BF2
 
212      Blast cells (consensus 1^st)
224   Basophilia (consensus 2^nd)
022   NRBC (consensus 3^th)
301   Thrombocytosis (consensus 4^th)
213   Promyelocytes (consensus 8^th)
 
I said ?? CML transforming. It was certainly something transforming, but the expert opinion was rather vague as to what.

 

5 March 2026 (Thursday) - NEQAS 2601 PA

I got the results of NEQAS parasitology 2601PA today
 
2601 PA1
 
I said this was P Falciparum with trophozoites and a parasitaemia of 0.5%
I got the species and the parasitaemia right
 
2602 PA2
I said this was Microfilaria (loa loa)
It was.

3 March 2026 (Tuesday) - Fritsma Factor Update

 

The Fritsma Factor newsletter appeared in my in-box this evening. There was quite a bit to take in, but I’m very grateful for this update. It’s effectively my only way of keeping up with current developments in haemostasis.

3 March 2026 (Tuesday) - Extended DAT Panel (wassat?)

Here’s an interesting case study prompted by a conversation in the lab today… Extended DAT panel… what's that all about?

2 March 2026 (Monday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. Keeping platelets cold eh? I wonder how long it will be before I’m doing that myself?

ARTICLE OF THE MONTH

Intravenous iron for non-anaemic iron deficiency in pregnancy: a multicentre, two-arm, randomised controlled trial.
Wasim, T., et al. (2026). The Lancet. Haematology.
PICO SUMMARY

 

 

TOP ARTICLES

Efficacy of desmopressin for post-kidney biopsy bleeding complications prevention: a systematic review with frequentist and Bayesian meta-analysis.
Chen, J.J., et al. (2026). Nephrology.

Study of centrifugal therapeutic plasma exchange and membrane therapeutic plasma exchange; a comparative study.
Elghoneimy, H.A., et al. (2025). Therapeutic Apheresis and Dialysis. [Record in progress].

Effects of rhEPO-Fc on chronic renal anemia in Chinese patients undergoing maintenance hemodialysis: a multicenter, randomized, open-label, and phase 3 study.
Gan, L., et al. (2025). Renal Failure.

Risk prediction models for blood transfusion in patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis.
Liu, X., et al. (2026). Annals of Medicine.

Daprodustat vs recombinant human erythropoietin for anemia and cardiovascular safety in dialysis-dependent and non-dialysis-dependent CKD patients - a systematic review and meta-analysis.
Mishra, H.P., et al. (2026). Current Reviews in Clinical and Experimental Pharmacology. [Record in progress].

Effectiveness of closed blood-sampling devices in critically ill adults: a feasibility trial.
Raurell-Torredà, M., et al. (2026). Nursing in Critical Care.

Liberal versus restrictive blood transfusion strategies in neurocritical care: a systematic review and meta-analysis of randomized controlled trials.
Shaukat, A., et al. (2026). Critical Care Research and Practice.

The effect of online education on cardiovascular intensive care nurses' self-efficacy in blood transfusion: a randomized controlled trial conducted in Turkey.
Songül, A. and Bahar, A. (2025). Transfusion and Apheresis Science.

A pilot trial of long-distance shipped, extended- and cold-stored platelets in 100% plasma for cardiothoracic surgical bleeding.
Stolla, M., et al. (2026). Transfusion. [Record in progress].

1 March 2026 (Sunday) - Beware What You Read...

 Well, it’s intracellular yeast…  The original question had people confidently saying green crystals of death, dohle bodies…

The take-home message here is to be *very* careful about what you read on Facebook haematology groups…

27 February 2026 (Friday) - UKAS Update

The nice people at the UK Accreditation Service sent their update today. You can read it by clicking here. And again I clicked there and read it.

I’ve made no secret that I struggle to see how this stuff is relevant to improve what I actually do on a daily basis, and whoever wrote the newsletter didn’t help by starting off with “Learning as an investment in capability delivers long-term benefits for individuals and organisations by strengthening professional judgement and helping individuals respond confidently to new or complex situations”.

What does that actually mean? Why don’t they write these things in understandable everyday English?

A few less management catch-phrases and a little more comprehensibility all round would help everyone.

 

I’m reminded of my days as a manager when if I ever wanted to get my way in a meeting against a majority decided against me, I would say that my way was the only way that didn’t have serious governance issues. And because very few people knew what a “governance issue” was, most people would back down. And if anyone didn’t, I would scare them off with equally incomprehensible talk of “MHRA requirements”.

26 February 2026 (Thursday) - More Change

And so it all gets changed again... 

24 February 2026 (Tuesday) - IBMS Update

The IBMS sent their update today. You can read it by clicking here. I must admit the only bit which was of any relevance to me was the bit about major hemorrhage protocols… and if there is one thing I would say about blood bankers (apart from how much they love meetings!) is that they provide loads of CPD through all sorts of other outlets.

19 February 2026 (Thursday) - The ESR

I’ve just marked a trainee’s portfolio work on ESR.

The erythrocyte sedimentation rate is quite possibly the first blood test that was ever invented. You just suck some blood up a tube and see how much it settles out in an hour. The more it settles, the more ill the patient.

 

Professional blood testers laugh at it because it is so non-specific. In these days of high-tech diagnostics, those who know about high-tech diagnostics look down their nose at a test which is so non-specific.

However for a GP this is absolutely brilliant. With a limited time to spend with the patient, the GP has to determine if the patient is genuinely ill or malingering. The ESR tells him that. It don’t say what is wrong with the patient, but in the first instance it don’t need to.

All the GP needs to know in the first instance is does he need to spend more time with the patient, or can he tell them to clear off with a clear conscience.

 

Here’s a proper article about it.

19 February 2026 (Thursday) - Getting the BTLP-TACT Wrong (again)

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

 

41032 – a forty year old woman needing four units of CMV-negative blood for a case of placenta accrecia

The control well was positive and so the entire group was uninterpretable. The antibody screen was negative though. I issued the only three units of O Rh(D)-negative, K-negative, CMV-negative blood

53832 – a twenty year oldwoman needing two units of blood for a haematemesis

Again the control well was positive and so the entire group was uninterpretable. The antibody screen was negative. I issued two units of O Rh(D)-negative, K-negative blood.

 

I got it wrong. Somehow the thing didn’t realise that I’d actually selected blood for the first patient and issued it all to the second…

18 February 2026 (Wednesday) - Red Cell Membrane Issues

I was talking with one of the trainees about the good old days… I’m sure they think I used to run the path lab on Noah’s Ark… We got talking about tests for red cell membrane abnormalities and I felt I might benefit from a little refresher on the subject. So here’s what I found.

 

Given a blood count with unexplained high MCHC (that doesn’t correct on warming) and reticulocytosis you have a look at the blood film.

 

If there’s lots of spherocytes we would do a direct antiglobulin test to rule out autoimmune haemolytic anaemia.

Back in the day we used to perform the osmotic fragility test but that is “so last century”. These days we use flow cytometry to look for eosin-5-malemide (EMA) which, being a structural red cell protein, is reduced in people with hereditary spherocytosis.

 

If there’s lots of elliptocytes we used to say “that’s hereditary elliptocytosis” and move on. These days there’s all sorts of molecular tests that can be done.

 

I found out that I wasn’t really that out of touch, but I am now rather inexperienced… mainly because these tests are only done in specialist centres these days.

17 February 2026 (Tuesday) - Westgard QC Update

The nice people Westgard QC sent their update today. You can read it by clicking here. As always a lot of it is hard going, but mathematics often is (I’ve got a degree in the stuff – I know!) But there was an interesting article about how some labs are using AI to review their IQC… and the AI is getting it wrong.

AI does that… Look at this piccie – it is my current Facebook profile picture which was created by AI. It looks rather good doesn’t it? Until you actually look at it.

The walking stick somehow supports itself.

I’ve got three dogs but four dog leads.

One of the dogs isn’t on a lead at all.

There’s a hole in my left thigh.

 

Don’t use AI to review your IQC, eh?

 

15 February 2026 (Sunday) - Acanthocytes

 Click here and click on “spiky cells” to see my take on the matter...

12 February 2026 (Thursday) - Horiba Newsletter

The nice people at Horiba sent their update today. You can read it by clicking here.

A case study of myeloproliferative disorder / chronic eosinophilic leukaemia, and an update about their latest technology… Something about which I'm getting increasingly out of touch.

 

Back in the day the reps used to come round at least twice a year to give us all lunchtime presentations about their latest machines… and they would give us all sandwiches and free pens and stuff… how times have changed.

 

11 February 2026 (Wednesday) - BTLP-TACT Exercise

After yesterday’s debacle I thought I’d better try again.  It presented me with two cases:

 

62453 – a sixty-eight year-old chap with hypofibrinogenaemia who needed two units of cryoprecipitate.

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

According to https://pubmed.ncbi.nlm.nih.gov/34127586/ cryoprecipitate *is*recommended  for hypofirinogenaemia  so I issued two units of the stuff.

 

 

27497 – a twenty-two year-old woman needing four units of FFP for factor V deficiency.

She grouped as A Rh(D) Positive, but the Rh reaction was weak so I called it indeterminate as that is what has worked in the past. The antibody screen was negative.

FFP is suitable for Factor V deficiency according to https://www.ncbi.nlm.nih.gov/books/NBK580494/  and https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/factor-v-deficiency/  so I issued four units of it.

 

I got this one right…

 

10 February 2026 (Tuesday) - IBMS Newsletter

The IBMS sent out their monthly newsletter today. You can read it by clicking here. I read it; it is the official communication of my professional body. And (as I say every month) either it or I am out of touch with the profession…

 

There was talk about the IBMS’s new president; I have heard of her before. She works in the University of Brighton (the old Brighton poly). There were several management/HR initiatives being discussed. There was talk about the “Harvey’s Gang” scheme, but that’s not really what we do on a daily basis.

And there was talk about elections to the board that runs the IBMS. I’ve done nothing but moan about the IBMS for years. Maybe I should stand for one of the positions on their council?

I suspect I’d be wasting my time. The trouble I have with the IBMS is that for all that I’m completely convinced they are going in the wrong direction, I don’t know what the right direction is.

10 February 2026 (Tuesday) - BTLP-TACT Exercise

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

 

12309 – a twenty-five year-old woman in theatre needing six units of blood for a stab wound.

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

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

 

45555 – a ninety-eight year-old chap having a liver transplant needing four units of FFP and two units of cryo.

His blood group was completely indeterminate with cell group AB and serum group O, and the control failed as well.

The antibody screen was positive in cells 2 and 3 so I performed antibody panels. The enzyme and IAT panels were positive in cells 1, 3, 4, 6 and 7 corresponding with anti-Jk(a) but not excluding anti-E.

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC2958698/ implies both FFP and cryo are indicated in liver transplants

I selected two units of AB FFP (because that was all there was) and two units of AB cryo.

 

I got it wrong… Apparently in case 45555 there wasn’t any anti-E. I had another look. There wasn’t. So why did I think there had been? Oh well… if nothing else I wouldn’t have done any harm had I given E-negative products…