19 August 2026 (Wednesday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. I know I keep banging on about the stuff, but tranexamic acid really is *the* stuff, isn’t it?
Two more mentions…

ARTICLE OF THE MONTH

Avatrombopag versus placebo for persistent chemotherapy-induced thrombocytopenia in GI cancers: the phase II ACT-GI trial.
Al-Samkari, H., et al. (2026). Journal of Clinical Oncology. [Record in progress].
PICO SUMMARY

 

 

TOP ARTICLES

Barriers and enablers to non-remunerated plasma donation: a meta-synthesis of the qualitative literature using the theoretical domains framework.
Etherington, C., et al. (2026). Vox Sanguinis. [Record in progress].

The efficacy of tranexamic acid for the prevention of postpartum hemorrhage among women at high risk of postpartum hemorrhage undergoing cesarean section: a meta-analysis.
Gao, Q., et al. (2026). BMC Pregnancy and Childbirth. [Record in progress].

Optimal route of tranexamic acid administration in total knee arthroplasty: a Bayesian network meta-analysis with decision-analytic cost evaluation.
Hershfeld, B.E., et al. (2026). The Journal of Arthroplasty. [Record in progress].

Efficacy and safety of different doses of intravenous immunoglobulin combined with phototherapy in neonatal hemolytic disease: a systematic review and meta-analysis.
Huang, M., et al. (2026). European Journal of Pediatrics.

HLA selected red cell transfusions to prevent HLA sensitisation: a prospective, double-blinded, randomised controlled trial.
McComish, J.S., et al. (2026). Transplant Immunology.

Mortality effect of albumin fluid resuscitation in adults with septic shock: a systematic review and dual frequentist-bayesian meta-analysis of randomised trials.
Mendes, H., et al. (2026). Critical Care.

Adjuvant intravenous immunoglobulin in elderly sepsis: a randomized controlled study of mortality, organ function, and inflammation.
Miao, X., et al. (2026). Frontiers in Medicine.

Effect of blood donation in the glycemic control of prediabetic donors: a blinded randomized controlled trial.
Mora-Gonzalez, D., et al. (2026). Endocrine Practice. [Record in progress].             

Comparative efficacy of intranasal, intramuscular, and intravenous vitamin B12 therapy for hematological recovery in vitamin B12 deficiency anemia: a randomized controlled trial.
Singh, S.K., et al. (2026). American Journal of Hematology.

Diagnostic accuracy of reticulocyte haemoglobin content in detecting iron deficiency without anaemia in blood donors: a systematic review and meta-analysis.
Yanyiam, P., et al. (2026). Vox Sanguinis. [Record in progress].

 

 

19 August 2026 (Wednesday) - NEQAS 2603DM

I finally got the result of 2603DM today…  “a 43-year-old man who regularly attends Haematology outpatients. The blood film was prepared after new features were noticed in his blood count. Your opinion is requested”.

 

I can’t remember it at all, but at the time I said: “I’d say he regularly attends haematology outpatients because of a haemoglobinopathy. There’s target cells, sickle cells, nucleated red cells, polychromasia and Howell-Jolly bodies there.

And there’s blast cells and smear cells.

And there’s  an eosinophilia too.

 

The platelet count is down as well

 

I’d say this is someone with sickle cell disease (possibly HbSC or with a co-existing thalassaemia because of the target cells) who has suddenly developed leukaemia”.

 

The expert opinion was “This is a case of sickle cell disease (HbSS) with typical red cell features including sickle cells, boat-shaped cells, hyposplenic features and nRBCs. However, in this case there are also blast cells which should not be present and indicate the additional presence of an acute leukaemia. The important principle here is to recognise that we like to consolidate all features of a diagnostic blood film into a single diagnosis (e.g. sickle cell anaemia with reactive/hyposplenic features, or an acute leukaemia or myelofibrosis with associated red cell change). The key is sometimes to focus on the really key findings – in this case the blast cells, thrombocytopenia and typical sickle cells. Then ask whether this is really compatible with a single disorder”.

 

So… I’d spotted all the salient features. I got it right. 

 

18 August 2026 (Tuesday) - QC on the TOP

 

Still sulking about the BTLP-TACT debacle I had a look at the Werfen academy.

I had a go at one of the courses – “ACL TOP Family 50 Series - Running QC”.

I passed. That cheered me up a bit…

18 August 2026 (Tuesday) - Getting the BTLP Wrong (Again)

I had a little time on my hands this morning so I did a BTLP-TACT exercise.

I was presented with two cases:

 

47778 – a ninety-nine year-old woman in out patients needing group and save prior to hip replacement surgery.

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

 

36230 – a twenty-nine year-old woman in the maternity unit needing group and save prior to induction of labour.

She grouped as A Rh(D) Negative with antibody screen positive in all three cells. I performed antibody panels.

The enzyme panel was negative throughout.

The IAT panel was positive in cells 1, 2, 3, 5, 6, 7, 9 and 10 corresponding with anti-S and anti-Fy(a)

 

I got it wrong. Apparently anti-K could not be excluded. I’m not happy about this. In previous exercises I was told that a negative reaction in the enzyme panel *did* rule out anti-K in the simulator (I know it don't in real life).

 

17 August 2026 (Monday) - Sounds Like Sezary's Syndrome...

 The LEAST recommended diagnostic test is option 1. Bone marrow aspirate and biopsy

The patient shows the typical clinical picture of Sézary syndrome (cutaneous T-cell lymphoma, likely stage T4NxB2M0), characterized by erythroderma (erythema involving >80% of the body surface area), generalized lymphadenopathy and lymphocytosis with a TCR rearrangement shared between the skin and the blood. Skin biopsies, PET-CT and lymph node biopsies are indicated for diagnosis and staging. In the absence of unexplained cytopenia, a bone marrow study is generally not necessary. 

First-line therapies include low-dose methotrexate, extracorporeal photopheresis, retinoids and interferon. Mogamulizumab (an anti-CCR4 monoclonal antibody) is the treatment of choice for relapsed/refractory disease. Allogeneic transplantation should be considered in selected cases.

Reference: 

• Dummer R, et al. Cutaneous T cell lymphoma. Nat Rev Dis Primers. 2021;7(1):61. Published 2021 Aug 26. 

• Latzka J, et al. EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome - Update 2023. Eur J Cancer. 2023;195:113343. 

• Olsen E, et al. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood. 2007;110(6):1713-1722. 

16 August 2026 (Sunday) - I've Heard Of It...

 

Well, I’ve heard of Chediak-Higashi syndrome, but don’t think I’ve actually seen it in real life.. Here’s as good a place as any to start with it.

It’s not restricted to humans…

15 August 2026 (Saturday) - DOAC

I finally got round to signing up to the Werfen Academy today, and got full marks on my first course “Introduction to Direct Oral Anticoagulants (DOACs)”.

Go me…

 

14 August 2026 (Friday) - Seriously?

I’m not quite old enough to remember the first Moon landings, but I remember the Apollo 13 disaster and Skylab. I remember Dolly (the first cloned sheep) and Louise Brown (the first test-tube baby).

I had such high hopes for the future… it turned out to be such a disappointment.

 

12 August 2026 (Wednesday) - BTLP-TACT Exercise

It’s too hot outside. I’ll do a BTLP-TACT exercise… I was presented with one case – a forty-nine year-old woman who claimed to be tired all the time. A group and save was required.

 

She grouped as A Rh(D) Positive, but it was one of those supposedly weak reactions so I called it A Rh indeterminate with the proviso that I would send it to NHSBT.

The antibody screen was positive in cell 2 so I performed antibody panels.

 

The enzyme panel was 2+ in cells 2 and 6 corresponding to anti-K, and 4+ in cells 3 and five corresponding to anti-E.

The IAT panel was 2+ in cells 2, 3, 5 and 6 corresponding to anti-K and anti-E

 

I got the thumbs-up.

9 August 2026 (Sunday) - Slide Saturday Challenge

 

Well, it’s hereditary elliptocytosis, isn’t it? This one looks particularly extreme with a lot of very bizarre red cells.

Clinically this one would be severe, some not so bad. I always remember discovering a case of H.E. in an eighty year old chap who had an infection after a prostatectomy. Morphologically loads of elliptocytes, clinically not a problem… he’d lived eighty years before anyone had any cause to put his blood under a microscope… and even then it wasn’t actually because of his red cells.

 

Here’s an article on the matter… 

7 August 2026 (Friday) - ABO Groups

ABO groups aren’t quite as straightforward as we might like them to be…

Here’s a little article on the subject…

4 August 2026 (Tuesday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise. I had two cases:

 

15626 – a fifty-six year-old chap needing two units of cryo to treat Factor VIII deficiency.

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

According to https://pmc.ncbi.nlm.nih.gov/articles/PMC4627369 Cryo is not recommended for Factor VIII deficiency  so I didn’t issue any

 

73726 – a seventy-eight year old chap needing four units of FFP for a pre-operative reversal of warfarin.

He grouped as O Rh(D) Positive with anegative antibody screen.

According to https://pmc.ncbi.nlm.nih.gov/articles/PMC9362864/ FFP is not the treatment of choice for the reversal of warfarin pre-operatively so I didn’t issue any.

 

I got it right.

4 August 2026 (Tuesday) - Fritsma Factor Newsletter

 

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

There was quite a bit to take in…

3 August 2026 (Monday) - Learning Monday

 The correct answer is option 3. Mixed phenotype acute leukemia with KMT2A rearrangement  

Immunophenotypic properties of MPAL can change over time: both variable proportions of different lineages and phenotypic alterations have been described as lineage switch. Most cases of lineage change involve a switch from ALL to AML. A retrospective review can often reveal the presence of an unrecognized or underappreciated malignant subclonal population present in the initial specimen. This may represent a minor population which displayed more chemoresistance and emerged after eradication of the chemosensitive dominant clone. This kind of lineage switch is most common in MPALs with KMT2A rearrangement where a small myeloid/monocytic population can be difficult to appreciate due to hyperleukocytosis with a dominant B-precursor population at diagnosis.

Reference: 

Weinberg OK, Arber DA, Döhner H, et al. The International Consensus Classification of acute leukemias of ambiguous lineage. Blood. 2023;141(18):2275-2277. 

2 August 2026 (Sunday) - Something New

Emperipolesis – that’s a new one on me… apparently it’s a rare biological process where an intact, living cell enters and moves inside the cytoplasm of another cell without getting harmed or destroyed. It differs from phagocytosis because the engulfed cell stays alive and can leave and does…

Here’s a reference about it.

29 July 2026 (Wednesday) - UKAS Update

The nice people at UKAS sent their update today. You can read it by clicking here. I did, and struggled, as did the colleagues with whom I discussed it. I often whinge about the UKAS newsletter, but this time I’ve done something more than whinge. I’ve emailed them… Here’s what I wrote:

 

“Dear sir or madam

I just received your latest newsletter. I was intrigued to hear about the Pathology Transformation Review 2026 but when I clicked on the link I found the article incomprehensible.

The article in question is https://www.ukas.com/resources/latest-news/ukas-welcomes-the-pathology-transformation-review-2026/

I showed it to some colleagues, and none of us understand what it means. I don’t want to appear confrontational or reactionary. I seriously want to understand what is going on with my profession and its regulator… But I don't.

Could one of your experts paraphrase it in such a way that a semi-retired old dinosaur could understand it… (sorry)”

 

I wonder if they will get a reply? My request is a serious one. Despite having done a formal course of study in quality management I didn’t understand any of what that article was saying.

 

27 July 2026 (Monday) - Myeloma Treatment

 

I thought option 3 and I said so. I was told: The correct answer is option 3. The patient remains biologically high-risk despite achieving MRD negativity. 

Achieving MRD negativity at a sensitivity of 10⁻⁶ is an excellent treatment outcome and is strongly associated with improved progression-free and overall survival in multiple myeloma. While MRD negativity reflects how effectively treatment has reduced the disease burden, cytogenetic abnormalities provide important information about the underlying biology of the myeloma clone. 

In this patient, the presence of both t(4;14) and gain(1q) identifies biologically aggressive disease. Although deep responses such as MRD negativity can substantially improve outcomes, current evidence suggests that they do not completely eliminate the adverse prognostic impact of multiple high-risk cytogenetic abnormalities. Data from studies have shown that patients with ultra-high-risk disease can achieve high rates of MRD negativity, yet their long-term outcomes remain inferior to those of patients with standard-risk disease achieving the same depth of response. 

Therefore, the most accurate interpretation is that this patient remains at increased risk of relapse despite achieving MRD negativity. 

26 July 2026 (Sunday) - Slide Saturday Challenge

 Hypochromic microcytic blood film with pronounces anisopoikilocytosis. Target cells and nucleated red cells. No pencil cells…

Thalassemia major…

24 July 2026 (Saturday) - Letrozole

I had a neutropenic patient today. Perfectly fine a month ago, a neutrophil count of 0.6 today. Diagnosis “on letrozole”.

I looked that one up. A common side effect is neutropenia. Here’s an article on the matter.

One lives and learns…

 

23 July 2026 (Thursday) - HCPC Update

The HCPC sent their update today. You can read it by clicking here. There’s no denying it was on the dull side. However I see they are asking for applications for the role of head honcho.

I have absolutely no intention of applying… and consequently I have no right to whinge that I think they are making a fundamental mistake by getting all bogged down in management-speak rather than focusing on what I feel should be their core business (i.e. acting in the best interests of the professions they represent). On reflection I suppose that they feel that they *are* acting in the best interests of the professions they represent. But their way of doing it is different to mine.

Mind you for all that I can’t really whinge when I have no intention of putting my money where my mouth is, I expect I will still whinge.

I wonder who would take on the role of head honcho? There’s plenty of people who love the entire “meetings thing”.

 

23 July 2026 (Thursday) - Pappenheimer Bodies

I saw some Pappenheimer bodies last week, so I took photos, and have updated my little atlas with the piccies. To see it click on this link and then click on “Pappenheimer bodies” in the list on the left hand side.

 

I’ve used a new page format for this entry… if only to make it look like the thing is a work in progress (which it actually is!)

 

22 July 2026 (Wednesday) - Von WIllebrand's Disease

Here’s a rather good set of web pages about Von Willebrand’s disease courtesy of The Blood Project.

I never really understood what that was all about when I was at college… I rather suspect that the one lecturing us on the matter didn’t either. I’m a little clearer now.

21 July 2026 (Tuesday) - BTLP-TACT Exercise

Well… here we are at the three thousandth and first entry to this blog. Despite having been read several times, no one has replied to my suggestion about sharing CPD resources. Such a shame.

 

In the meantime I shall carry on undaunted. I had a go at the BTLP-TACT which presented me with one case – a ninety-seven year-old chap needing group and save following ahead injury.

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

 

I got it right.

 

Monday 20 July 2026 (Monday) - 3000 !!

Well… here we are at the three thousandth entry to this blog. I started it as a record of what CPD activities I do. Whilst is it in no way secret, I’ve never really tried to attract a following, but through the wonders of modern science I can see that has quite a following. In the last three weeks it has had over two hundred visits.

Why not leave a comment to say hello, and to answer a question.

 

I’ve a plan that I might set up a little CPD sharing on-line community… would you like to take part?

20 July 2026 (Monday) - Transfusion Evidence Library Update

Tranexamic acid again !!

The article about alloimmunization in sickle cell patients was interesting. In the study a third of them had formed antibodies. Clearly people on long-term transfusions should have blood matched as closely as possible…

I’m reminded of a thread I saw on one of the work-related Facebook pages which was talking about artificial oxygen carriers. If ever there was a cohort of patients that could use them…

ARTICLE OF THE MONTH

Hospital policy of tranexamic acid to reduce transfusion in major noncardiac surgery. Houston, B.L., et al. (2026). The New England Journal of Medicine.
PICO SUMMARY

 

 

TOP ARTICLES

Global prevalence of alloimmunization in adults with sickle cell disease receiving red blood cell transfusions: a systematic review and meta-analysis.
Alsalman, M., et al. (2026). Journal of Clinical Medicine.

Effect of continuous non-invasive hemoglobin monitoring on blood transfusion and mortality in hip surgeries: a randomized controlled study.
Dinçer Yeşilnacar, M.E., et al. (2026). Journal of Clinical Practice and Research.

Oral or parenteral iron supplementation to reduce deferral, iron deficiency and/or anaemia in blood donors.
Geneen, L.J., et al. (2026). The Cochrane Database of Systematic Reviews.

Clinical trial: predicting response to iron therapy in patients with active inflammatory bowel disease using hepcidin and functional iron indices: a multicentre randomised trial.
Koppelman, L.J.M., et al. (2026). Alimentary Pharmacology & Therapeutics.

Clinical efficacy of different blood purification modes on severe acute pancreatitis: a systematic review and network meta-analysis.
Li, P., et al. (2026). Frontiers in Medicine.

Effect of tranexamic acid for acute spontaneous intracerebral haemorrhage: a systematic review and individual patient data meta-analysis.
Menon, C.S., et al. (2026). Journal of Neurology, Neurosurgery, and Psychiatry. [Record in progress].

Artificial Intelligence-based predictive models for adverse blood donor reactions: a systematic review of immediate and delayed events and clinical data approaches.
ShojaeiBaghini, M., et al. (2026). BMC Medical Informatics and Decision Making. [Record in progress].

The effect of active warming and conventional body temperature management on perioperative blood loss and coagulation function in patients undergoing scoliosis correction: a multicenter randomized controlled trial.
Yan, W., et al. (2026). European Spine Journal. [Record in progress].