6 Juny 2026 (Monday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise. I had one case – a twenty-one year-old woman from the ante-natal clinic needing group and save.

She grouped as B Rh(D) Positive… was that supposed to be a weak reaction with the D? Bearing in mind the issues I’ve had with BTLP-TACT in the past I erred on the side of caution and called it inconclusive and said I would send it to NHSBT.

The antibody panel was negative though. 

I got it right - that was supposed to be a weak reaction.

5 July 2026 (Sunday) - NEQAS 2603 BF

I got the results of NEQAS 2603BF today.
 

For 2603 BF1 I said

 

Hairy cells  (consensus 1^st)

Lymphocytosis (consensus 4^th)

low plts (consensus 3rd)

Neutropenia (consensus 5th)

NRBC (consensus 2^nd)

 

I thought it was hairy cell leukaemia. It was.

 
For 2603 BF2 I said
 

Neutropenia (consensus 4^th)

low plts (consensus 1^st)

Blast cells (consensus 2^nd)

“iffy” lymphocytes (consensus 6^th)

Rouleaux (consensus 5^th)

 

I thought it was “???”. It could have been any of a wide range of conditions. The expert opinion said “In essence the morphology, in isolation, suggests a wide differential diagnosis”.

 

I’ll take that…

 

5 July 2026 (Sunday) - NEQAS 2602 PA

I got the results of NEQAS 2602PA today.
 
2602PA1: Microfilaria of Loa Loa
2602PA2: Negative for malaria

 

That’s what I said.

1 July 2026 (Wednesday) - Cladribine

I had a patient with an unexplained neutropenia today. The diagnosis was “multiple sclerosis on cladribine”.

Taken orally as Mavenclad, it is prescribed for adults with active relapsing-remitting multiple sclerosis to reduce the frequency and severity of relapses. However Cladribine is also used in lymphoid neoplasms. It mimics the nucleoside deoxyadenosine but resists breakdown by the enzyme adenosine deaminase, causing it to accumulate inside lymphocytes and interfere with DNA synthesis and repair.

Common side effects include a reduced white blood cell count and an increased risk of viral infections such as shingles or oral herpes.

And it can cause neutropenia too.

 

30 June 2026 (Tuesday) - Fritsma Factor Update

The nice people at the Fritsma Factor sent out their newsletter today. You can read it by clicking here. There was quite a bit to take in. Sickle cell, lupus, Von Willebrands….

It’s a rather good source of CPD…

30 June 2026 (Tuesday) - Westgard QC Update

The nice people at Westgard QC sent out their update today. You can read it by clicking here. It was rather scathing of certain analysers… I wonder if the manufacturers of those analysers are happy to be publicly lambasted?

 

26 June 2026 (Friday) - BTLP-TACT Exercise

It’s too hot outside to do anything. I’m bored… and I’ve not done a BTLP-TACT for three weeks (and I got that one wrong)…

I had two cases today:

59319 – a twenty-nine year-old woman with anaemia needing group and save. She grouped as A RH(D) Negative with a negative antibody screen

88558 – a seventy-seven year-old chap in A&E also needing group and save. He grouped as B Rh(D) Positive also with a negative antibody screen

I got it right…

25 June 2025 (Thursday) - UKAS Update

The nice people at UKAS sent their update today. When asked about how to do CPD I always suggest that you sign up for absolutely every work-related mailing list you can find. Every day I get at least half a dozen emails from these mailing lists. Most of them don’t make the cut (as they aren’t actually very relevant to me) but I *always* read the UKAS one, and *always* mention it on here.

Take the current update… you can read it by clicking here. Do read it… and if you understand it, please explain it to me. It seems to say a lot without saying anything. When I read this sort of thing I’m reminded of a colleague who always got his way at management meetings. No matter what the subject under discussion he would maintain that his way was the only way because of MHRA requirements. And because no one knew (let alone understood) what an MHRA requirement was, he went unchallenged.

 

Don’t get me wrong – I’m not saying that the UKAS regulations are a load of tripe. I’m just saying that if they were written in English rather than gibberish, more people would understand them. And if people understood them, people might appreciate them rather then resent them…

25 June 2026 (Thursday) - Transfusion Evidence Library

The nice people at the Transfusion Evidence Library sent their update today. A couple of articles caught my eye…

The use of blood transfusions in trauma cases before hospital admission didn’t seem to have much of an effect on final outcome… I suppose that if someone is in such desperate need of a transfusion that we can skip all of the safety protocols they aren’t going to be likely to survive the trauma.

But what really made me think was the article about the transportation and large-scale long-distance airdrops of blood. These days we document every single thing that every happens to a unit of blood. Back in the day things weren’t quite so tight… it would seem that things weren’t as bad then as we’ve now been led to believe…

ARTICLE OF THE MONTH

Prehospital resuscitation with type O whole blood for trauma and hemorrhage.
Sperry, J.L., et al. (2026). The New England Journal of Medicine.
PICO SUMMARY

 

 

TOP ARTICLES

Early erythropoiesis-stimulating agents in preterm or low-birthweight infants.
Anarna, K., et al. (2026). The Cochrane Database of Systematic Reviews.

Clinical outcomes of intravenous albumin administration after acute variceal hemorrhage in patients with cirrhosis: an open-label, randomized controlled trial.
Biswas, S., et al. (2026). Digestive Diseases and Sciences.

Platelet transfusion thresholds for thrombocytopenic infants.
Chotas, W., et al. (2026). The Cochrane Database of Systematic Reviews.

A prospective, randomized, multicenter trial comparing lactated Ringer's alone or with 5% albumin for resuscitation of large burns The Acute Burn ResUscitation Multicenter Prospective Trial 2 (ABRUPT2).
Greenhalgh, D.G., et al. (2026). Annals of Surgery. [Record in progress].

The clinical use of cryoprecipitate and fibrinogen concentrate: a scoping review.
Hess, A.S., et al. (2026). Transfusion. [Record in progress].

Convalescent plasma for people with COVID-19.
Iannizzi, C., et al. (2026). The Cochrane Database of Systematic Reviews.

Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding.
Kvisselgaard, A.D., et al. (2026). The Cochrane Database of Systematic Reviews.

A study on the impact of blood large-scale long-distance airdrop on storage quality of suspended red blood cells.
Liu, L., et al. (2026). Transfusion. [Record in progress].

Efficacy and safety of albumin combined with endovascular therapy in the treatment of patients with acute ischemic stroke: a randomized clinical trial.
Liu, Y., et al. (2026). Nature Communications.

Approaches to guide red blood cell transfusion in patients with subarachnoid hemorrhage: a systematic review and meta-analysis.
Pinedo-Avila, J.B., et al. (2026). Journal of Intensive Care Medicine. [Record in progress].

Impact of Rh five-antigen-matched transfusion on alloimmunization and clinical outcomes in patients requiring repeated red blood cell transfusions: a prospective randomized controlled study.
Xie, X., et al. (2026). Frontiers in Medicine.

Prophylactic tranexamic acid for the prevention of postpartum haemorrhage in women with placenta praevia: multicentre, double blind, randomised, placebo controlled, phase 3 trial.
Zhang, L., et al. (2026). BMJ.

24 June 2026 (Wednesday) - Some Training

I had some formal training today. Like buses, nothing for ages and then two loads come at once.

This morning with an IT specialist learning about the new blood transfusion system which is coming. It looks to be rather good compared with that which I’ve used before.

And this afternoon with a product specialist learning about apixaban and rivaroxaban and anti-Xa assays.

 

I learned a lot, but I will make the observation that back in the day these reps used to come with loads of goodies, a free lunch and cake…

 

21 June 2026 (Sunday) - Still Waiting

Here’s food for thought – During my first week in this job I spend a day in each of the various laboratories. One of my most vivid memories was from Friday 18 September 1981 when the chief in the microbiology laboratory went off on a major rant about how the science of blood transfusion was dead. Apparently there were dogs in Japan being kept alive on cell-free haemoglobin-based oxygen carriers, and this chap was adamant that they would be used in humans in only a few short months, and the traditional hospital blood bank would be gone.

There was a *lot* of inter-departmental animosity (outright hatred) at the now-demolished Royal East Sussex Hospital, and the subject of artificial blood was never far from anyone’s lips back then.

Forty-five years later and the stuff still hasn’t delivered…

 

20 June 2026 (Saturday) - End of an Era?

I’ve not written anything here for two weeks – I’ve been on holiday. And whilst I wasn’t looking one of my major sources of CPD has gone belly-up.

Every so often there would be a work-related post appearing on the Lablogatory blog which I could sometimes use here on my personal continuing professional development. Naively I always thought the site was created by volunteers. It turns out that those producing material for the site were being paid to do so, and the money has dried up. My CPD blog is open to all, and a surprising amount of people seem to refer to it. Am I wrong in providing this for free? Personally I don’t think so.

2 June 2026 (Tuesday) - Fritsma Factor Newsletter

 The nice people at the Fritsma Factor sent their update today. This time there’s quite a bit of stuff which went over my head. Perhaps it shouldn’t… which is why I do CPD…

2 June 2026 (Tuesday) - BTLP-TACT Exercise

I’m always getting prompts to do more BTLP-TACT exercises, I’ve walked the dogs, and it is raining outside anyway…
 
I was given two cases:
 

33586 – a thirty-year-old woman with appendicitis needing group and save.

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

 

15253 – an eight-one-year-old woman needing four units of blood for a pancreatectomy.

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

I performed antibody panels.

The enzyme and IAT panels were positive in cells 1, 3, 4, 6 & 7 corresponding with anti Jk(a) but not excluding anti-Cw.

I scared up four units of various compatible ABO and RH groups that were Jk(a) Negative

 
I got it wrong…
Anti-Cw *could* have been excluded from the screening panel. Dur !!! 
But if that was the only hiccup I’m content. Better to err on the side of caution, eh?

1 June 2026 (Monday) - VEXAS Syndrome

I saw a diagnosis today: VEXAS syndrome. A new one on me – it is an adult-onset, severe autoinflammatory and blood disorder caused by a random, acquired mutation in the UBA1 gene. It primarily affects men over fifty. The name is an acronym outlining its core characteristics:

 

·  Vacuoles in bone marrow cells

·  E1 enzyme malfunction

·  X-linked genetic origin

·  Autoinflammation (immune system attacking healthy tissue)

·  Somatic mutation (not inherited)

 

Here’s a link about it.

31 May 2026 (Sunday) - Slide Saturday Challenge

 At first sight I agreed with the people who’d said it was some sort of haemoglobinopathy… OK there were target cells there. But in a haemoglobinopathy the red cells are a tad more uniform. These ones are all over the place. Massive anisopoikilocytosis with cell fragments, tear drop cells, spherocytes…

That’s some sort of microangiopathic haemolytic condition…

27 May 2026 (Wednesday) - Westgard QC Update

The nice people at Wesgard QC sent their update today. You can read it by clicking here. I did. I’d suggest you do to, but I’ve got a degree in maths and I found it heavy going.

The headline “Has hematology quality bled out?” caught my eye, but has it? I’d have to take Mr. Westgard’s word for it if he says it has. The British Prime Minister Benjamin Disraeli was believed to have ranted about "Lies, damned lies, and statistics" when describing the deceptive power of numbers to bolster weak arguments. He might have a point here, he might not. I don’t know.

 

Looking back in time to yesterday I think I might have made my own (albeit informal) Westgard rule… due to a minor problem the details of which are irrelevant here we had to leave non-urgent blood films over the bank holiday weekend, and yesterday I spent the afternoon catching up. A few patients who were clinically stable had blood films made every day (the reasons for which are irrelevant here), and as I reviewed the blood films I noticed that the results didn’t change much from day to day. That’s not a bad QC measure, is it?

27 May 2026 (Wednesday) - BTLP-TACT Exercise

I’ve got half an hour before I need to go to the late shift…

I was presented with two cases:

 

37192 – a twenty-one year-old woman in maternity needing group and save

Her ABO group was indeterminate, but she was Rh(D) Positive with a negative antibody screen

 

46614 – a ninety-six year-ol d chap needing four untits of FFP for bleeding varices.

He grouped as O Rh(D) Positive with antibody screen positive on cells 1 & 3. I performed antibody panels.

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

 

FFP is NOT recommended for bleeding varices https://pubmed.ncbi.nlm.nih.gov/33969607/ so I didn’t issue any

 

I got the green light…

25 May 2026 (Monday) - Found on the Internet

I found this on one of the Facebook groups I follow this morning… It’s not bad really…

22 May 2026 (Friday) - UKAS Update

The nice people at UKAS sent their update today. You can read it by clicking here. I always do as I struggle to understand exactly what UKAS actually does, and how what it does is relevant to my daily round.

One thing they do is to charge various employers for their services… and it would seem that some of that money has been spent on buying three hundred and fifty trees which have been planted by UKAS staff who’ve been given a day’s leave to do so.

I’m even more mystified…

22 May 2026 (Friday) - BTLP-TACT Exercise

 

At the beginning of the week I was whinging that it was raining. Today it’s rather hot. But the end result is the same. I’d rather not be outside, so I might as well do a BTLP-TACT exercise.

 

I was presented with one case – a thirty-two year-old woman with sickle cell disease needing a two unit top up transfusion.

 

Her ABO group was indeterminate with reactions in everything, but she was clearly Rh(D) Positive.

The antibody screen was negative.

 

I selected two units of HbS-negative O Rh(D) Negative blood. If nothing else that would stuff up the Rh group next time…

 

I got it right…

21 May 2026 (Thursday) - Transfusion Evidence Library Update

The nice people at the Transfusion Evidence Library sent their update today. As always there was too much to take in at one sitting:

ARTICLE OF THE MONTH

Intravenous ferric carboxymaltose versus oral ferrous sulphate for the treatment of moderate-to-severe postpartum anaemia in Nigerian women (IVON-PP): an open-label, randomised controlled trial.
Afolabi, B.B., et al. (2026). The Lancet. Global Health.
PICO SUMMARY

 

 

TOP ARTICLES

Angio-Seal plug-based versus dual ProGlide for transfemoral hemostasis in transcatheter aortic valve replacement: a systematic review and meta-analysis.
Alnomani, Y.R., et al. (2026). Journal of Thrombosis and Thrombolysis. [Record in progress].

Low-dose vs. standard care Iv human albumin during large-volume paracentesis in patients with liver cirrhosis: a systematic review.
Bot, K., et al. (2026). Liver International.

The efficacy of interactive communication interventions for motivating blood donation: a systematic review.
Boult, L., et al. (2026). Vox Sanguinis. [Record in progress].        

Red blood cell transfusion in neurocritical patients: an updated systematic review and meta-analysis.
Fu, Y., et al. (2026). BMC Anesthesiology.

Effect of donor exclusion criteria on blood safety and volume of donations: a systematic review of modelling studies.
Mosselmans, L., et al. (2026). Bulletin of the World Health Organization.

Blood donation and subjective wellbeing: a cross-sectional survey and a randomized trial.
Ou-Yang, J., et al. (2026). Frontiers in Psychology.

Therapeutic plasma exchange improves short-term survival in patients with acute-on-chronic liver failure: a randomized controlled trial.
Swaroop, S., et al. (2026). Hepatology. [Record in progress].           

The effect of stress ball and music on anxiety, distress, and pain levels during platelet apheresis donation: randomized controlled trial.
Urtekin, D., et al. (2026). Transfusion Medicine Reviews. [Record in progress].

18 May 2026 (Monday) - BTLP-TACT Exercise

I had planned to mow the lawn, but it’s raining… so here we go. I was given one case – an eighty-two year-old chap with PR blood needing group and save.

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

I got it right.

15 May 2026 (Friday) - Religion (!)

Here’s an interesting post from the nice people at Blood Bytes Beyond. How do you proceed if someone has a religious objection to having a blood transfusion.

I find I have to stop myself and take a deep breath when it comes to deeply held religious views as I used to have them. Back in the day I was a Steward in the Methodist Church. I was one of a committee of four that hired and fired the vicar. And one day I suddenly realized that I didn’t believe a word of the nonsense that I was professing; I just desperately hoped that it was true as the alternative of a godless universe was rather scary.

 

Part of my religious life was a bible study class every Thursday evening in which we would read what appeared to be stark nonsense and try to rationalize it. It clearly says in the Bible that we should abstain from blood (Genesis 9:4; Leviticus 17:10; Deuteronomy 12:23; Acts 15:28, 29) but that means abstain from eating animal blood… which is possibly not a bad thing to do as uncooked animal blood can give you tapeworms. But I doubt very much if anyone writing the Bible all those years ago had blood transfusions in mind.

I’ve had this argument with Jehovah’s Witnesses who’ve come banging on my door. In my experience there are two types of Jehovah’s Witnesses…  

Those who feel that blood transfusions are utterly evil and sinful.

Those whose lives have been saved by them who take great pains to explain that scripture is open to interpretation.

 

And that’s where I fall out with religion. It is all so open to interpretation. Until such time as God leans over a cloud and bellows out instructions it is all guesswork, isn’t it? And the less evidence someone has for a religious standpoint, the more convinced they are that they are right.

 

15 May 2026 (Friday) - Horiba Update

The nice people at Horiba sent their update today. They sent a rather interesting case study… however the case study was rather biased towards people using their blood counters. Which isn’t entirely unreasonable of them, is it?

Keeping abreast of other technologies is never a bad thing though, is it? When I first started in this line of work no one in the UK did a blood count on anything other than a device made by the Coulter corporation. Then the H1 was released. I can remember the rep telling me that he’d been given a target of selling five across the South-East in one year and in a few months he’d shifted seventeen. And then the Sysmex XE came along…

Perhaps Horiba’s day will come. I just wonder if I will see it?

11 May 2026 (Monday) - BTLP-TACT Exercise

 

I’ve got backache and it’s raining. I might as well do a BTLP-TACT exercise, mightn’t I?

It gave me two cases:

 

44156 – a forty-two year-old woman with liver disease and bleeding needing four units of FFP.

The control well failed so the group was uninterpretable.

The antibody screen was negative.

I issued two units of AB FFP as there was only two units there.

 

34387 – an eighty-four year-old chap in A&E also with liver disease just requiring group and save.

He grouped as O Rh(D) Negative with antibody screen positive in wells 1 & 3 so I performed antibody panels.

The enzyme panel was negative throughout.

The IAT panel was positive in cells 1, 3, 4, 6, 8 and 10 corresponding with anti- s but not excluding anti-Kp(a)

 I got the green light.