And with my poor brain already overloaded so the Fritsma Factor Newsletter arrived in my in-box.
This is (supposed to be) a reflective diary by a (not very) anonymous biomedical scientist who works somewhere in the south of England. One day this diary may well be submitted to the Health and Care Professions Council as evidence of ongoing continual professional development....
5 May 2026 (Tuesday) - Transfusion Evidence Library Update
The nice people at the Transfusion
Evidence Library sent their update today. As always it boggled my poor brain.
It was a lot to take in…
ARTICLE OF THE MONTH
Prehospital whole blood in traumatic hemorrhage - a randomized controlled trial.
Smith, J.E., et al. (2026). The New England Journal of Medicine. [Record in progress].
PICO SUMMARY
TOP ARTICLES
Romiplostim versus placebo for chemotherapy-induced thrombocytopenia.
Al-Samkari, H., et al. (2026). The New England Journal of Medicine.
Impact of feeding strategies during red blood cell transfusion on cerebral and splanchnic oxygenation in preterm infants: randomized pilot study.
Aslan Tuncay, S., et al. (2026). Journal of Neonatal-Perinatal Medicine. [Record in progress].
Erythropoiesis-stimulating agents to reduce heart failure hospitalization: a systematic review and meta-analysis.
Bunting, K.V., et al. (2026). European Journal of Heart Failure.
Substantial international variation in the cost of blood group and save and crossmatch: a systematic review.
Fabiano, G., et al. (2026). British Journal of Haematology.
Statistically significant results favored in abstracts of platelet rich plasma treatment of knee osteoarthritis: a systematic review and spin analysis.
Fullano, G.D., et al. (2026). Arthroscopy.
Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis.
Kimber, C., et al. (2026). BMC Neurology.
Blood donation practices and behavioral intentions: a scoping review using the theory of planned behavior.
Lakew, G., et al. (2026). PLoS One.
Prophylactic haemostatic treatment to control iatrogenic bleeding during endobronchial biopsy (PROTECT study): a multicentre, randomised, single-blind, placebo-controlled study.
Li, B., et al. (2026). Chest. [Record in progress].
Artificial intelligence implementation in transfusion medicine: addressing the challenges of clinical adoption.
Maynard, S., et al. (2026). Transfusion Medicine Reviews.
Albumin replacement therapy in septic shock: a randomized clinical trial.
Sakr, Y., et al. (2026). JAMA Network Open.
3 May 2026 (Sunday) - Babeosis
I’ve (so far) never seen a case
of babeosis, but it can only be a matter of time.
Apparently severe cases are treated with exchange transfusions
Forewarned is forearmed…
Apparently severe cases are treated with exchange transfusions
Forewarned is forearmed…
3 May 2026 (Sunday) - Slide Saturday Challenge
Flame cells… I don’t think I’ve ever actually seen them in real life…
2 May 2026 (Saturday) - Unexpected Thrombocytosis
I was sitting in the garden enjoying the Bank Holiday sunshine when my
phone beeped. A colleague wanted my opinion on a blood film…
A sample taken in the community had been somehow left in the sunshine,
the red cells had cooked and broken up, and the analyser had counted the fragments
as platelets.
1 May 2026 (Friday) - HCPC Update
The HCPC sent out their newsletter today. You can read
it by clicking here. As always I wish it was of more direct relevance to me…
I
must admit I was interested by the updated guidance on fitness
to practice. Dishonesty for example… is being a tad cheeky with evading
paying for parking really a striking off offence? And the bit on sexually
motivated misconduct… back in the day I used to joke with the younger trainees…
these days I’m terrified to even say hello.
30 April 2026 (Thursday) - BTLP-TACT Exercise
Time for another BTLP-TACT exercise. I
was presented with one case – an eighty year old chap in A&E with coffee
ground vomit needing group and save.
He grouped as AB Rh(D) Positive with
antibody screen positive in cell 3.
I performed antibody panels. The IAT and
enzyme panels were both positive in cell 8 corresponding with anti Kp(a)
I got it right.
28 April 2026 (Tuesday) - Westgard QC Update
The nice people at Westgard QC sent their update today. It was rather heavy going, but statistical stuff often is.
21 April 2026 (Tuesday) - BTLP-TACT
Being at a bit of a loose end I thought
I mihght do a BTLP-TACT exercise. I was pesented with one case – a seventy-eight
year-old chap needing two units of cryo for factor VIII deficiency.
He grouped as O Rh(D) Positive with a
negative antibody screen.
Is the cryo actually indicated in Factor
VIII deficiency? Well, https://pmc.ncbi.nlm.nih.gov/articles/PMC4627369/
says that it is rich in the stuff and has historically been used as a treatment
for haemophilia A. But it potentially carries pathogens… The reference says that
it is a second-line treatment.
I’m going to say that it *is*
indicated and either way I will learn something.
So I issued two units and got the thumbs
down. Apparently “Selection of any plasma components was inappropriate for
this clinical condition”. One lives and learns…
20 April 2026 (Monday) - UKAS Update
The nice people at UKAS sent their update today. You can see it by
clicking here.
There was a potentially interesting article about how UKAS and the Academy for Healthcare Science (AHCS) are
working together… it was dull, but I’ve signed up with the Academy for
Healthcare Science. You never know – I might learn something…
20 April 2026 (Monday) - NEQAS 2505DM
I got the results of NEQAS 2502DM today…
“This film was prepared from the blood of
a 73-year-old man who attended the Emergency Department after experiencing
increasing tiredness, then more recently bleeding from his gums. His white cell
count was found to be elevated, and a blood film was prepared. What is your
opinion of the blood film appearances?”
Bleeding from gums immediately makes me think
“thrombocytopenia” but that isn’t the case. There’s platy of platelets.
Some are clumped and some rather large.
The red cells are on the whole rather dull. There’s a
Howell-Jolly body and a target cell there.
But it’s the white cells that are odd here. Too many of
them, and precious few of them “normal”. There’s smear cells, dysplastic
neutrophils, vacuolated monocytes, and blasty-looking things.
Is this a case of MDS?
I pressed the button before I could comment…
The expert opinion said CLL… seriously?
19 April 2026 (Sunday) - I Got That Wrong...
I won’t lie… I thought it was hairy cell leukaemia. They do look similar, but are very different diseases. Flow cytometry comes into play… as the article says.
14 April 2026 (Tuesday) - BTLP-TACT Exercise
Time for another BTLP-TACT exercise. It presented me with two cases:
78080 – a thirty year old woman in the haematology clinic needing two units of irradiated blood.The sample label had no NHS number or hospital number so I rejected it.33345 – an eighty-nine year old chap in out-patients needing group and save.He grouped as O Rh(D) Negative with antibody screen positive in cells 1 and 2. I performed antibody panels.The enzyme and IAT panels were positive in cells 1, 2, 3 and 4 corresponding with anti-C and anti-D but not excluding anti-Cw
I got the thumbs-up
12 April 2026 (Sunday) - A Giant Platelet
Well, there’s a giant platelet but you get them in all sorts of
conditions.
Here’s a few words about Bernard-Soulier syndrome.
Here’s a few words about Bernard-Soulier syndrome.
12 April 2026 (Sunday) - BTLP-TACT Exercise
Time for a BTLP-TACT exercise I suppose… I was presented with one sample –
a ninety-five year old chap with beta thalassaemia needing two units of blood.
He grouped as A Rh(D) Positive with antibody screen positive in cells 1
and 3. I performed antibody panels.
The IAT panel was positive in cells
1, 3, 6, 9 and 10 corresponding with anti-Fy(a)
The enzyme panel was negative throughout.
I selected two units of A Rh(D) Positive Fy(a) negative blood
I got the green light…
10 April 2026 (Friday) - Iron
I found this picture on one of the work-related Facebook groups I follow…
9 April 2026 (Thursday) - Infection Control e-learning
I did my infection control e-learning today. Infection control, health and
safety, it’s all a load of old tosh, isn’t it…
I can remember being told (by a senior biochemist) to sharpen my
pencil with a scalpel blade, and chopping a lump off of my finger.
I can remember watching senior staff charging round the (now bulldozed)
biochemistry department chasing each other with water pistols filled with Schiff’s
reagent.
I can remember senior staff playing cricket in the (now bulldozed)
microbiology department and sending petri dishes flying.
I can remember when I first started as an apprentice blood tester being
told to seriously consider not joining the works pension scheme as I was told
that (at that time) the average blood tester died three years before
collecting their pension.
And I can remember the face of a friend who died from a rather rare type
of brain tumour… the lab where she worked used to make thromboplastin from
human brain. Four of them in the same lab died of the very same type of tumour
within a few weeks of each other…
I sometimes take a deep breath when the trainees put on their gloves and
goggles, but they are right to do so.
For all that I grumble about recent changes in the workplace, some have
been for the better.
6 April 2026 (Monday) - Granulocyte Transfusions
Granulocyte transfusions – good or bad? I’d never experienced them in
practice until a few years ago…
It would seem that the jury is still out on their efficacity
It would seem that the jury is still out on their efficacity
5 April 2026 (Sunday) - Pay Attention (!)
Look closely in a blood film – it’s easy to overlook the early signs…
2 April 2026 (Thursday) - NEQAS 2602 BF
I got the results of NEQAS morphology survey 2602BF today…
2602BF1 I said:
Hypochromia (consensus 4th)
Target cells (consensus 1st)
Large plts (consensus 2nd)
Neutropenia (consensus 14th)
I wrote “? thal ? SC disease”. The expert opinion
said: “These features are all suggestive
of Hb SC disease and this was confirmed on HPLC though the degree of
microcytosis should lead to the consideration of a coexistent alpha thalassemia
trait”
2602BF2 I said:
Hypochromia (consensus 1st)
Microcytosis (consensus 2nd)
Pencil cells (consensus 3rd)
Tear drop cells (consensus 5th)
^ plts (consensus 4th)
I thought this was a case of iron deficiency. It was.
31 March 2026 (Tuesday) - IBMS Update
The IBMS sent their update today – you can read it by
clicking here. I must admit I’m quite a critic of the IBMS but this was one
of their better offerings.
I did like the article about infections in feature films… I was reminded
of an episode nearly thirty years ago when I wrote to the BBC. A rather poor
doctor in the TV show “Casualty” was
told that they would be lucky to end up in a path lab. The BBC replied saying
that they were sorry for any offence caused, and they acknowledged that the
average path lab worked is educated to postgraduate standards. But what they
were striving for was dramatic effect.
Nothing has changed in the meantime…
30 March 2026 (Monday) - AML
Back in the day we’d just judge on what we saw down the microscope. Didn’t
I comment on that the other day?
30 March 2026 (Monday) - BTLP-TACT Exercise
I’ve had another email from the nice
people at BTLP-TACT telling me that I’m not doing enough exercises. So here we
go…
I was presented with one case – a fifty-seven
year-old woman in the haematology out-patients clinic needing two units of
blood.
She grouped as AB Rh(D) Positive but
with a weak(ish) reaction in the D. I’d call that positive because she’s
over fifty and it is positive, but BTLP-TACT don’t like that. So UI it is…
The antibody screen was negative.
So… what do I issue?
Personally I’d have given AB Rh(D)
Positive because she *is* AB Rh(D) Positive.
But having said the Rh(D) group is
uninterpretable (even though it is) I should give Rh(D) Negative blood.
My question is that having said the
Rh(D) group is uninterpretable, should I give O Rh(D) Negative (for no reason
that I could actually fathom) rather than AB Rh(D) Negative?
There’s one way to find out… I went with
two units of AB Rh(D) Negative
I got the green light.
30 March 2026 (Monday) - Transfusion Evidence Library Update
The nice people at the Transfusion
Evidence Library sent their update today. As always there was so much as to
boggle my poor brain, but the second to last article made me think. It is very
easy to think that blood science is what I do, and that it probably happens in
a few hospitals nearby.
It’s world-wide and what happens in
other parts of the world can be very different. In over forty years I’ve only
ever heard of one case of malaria being transmitted by blood transfusion… in
some parts of Africa nearly one donor in five has malaria…
ARTICLE OF THE MONTH
Preventive interventions for vasovagal reactions in whole blood donors: a cluster-randomised, stepped-wedge, crossover trial of 73 sites involving 1·4 million donors in England.
Kaptoge, S., et al. (2026). The Lancet. Haematology.
PICO SUMMARY
TOP ARTICLES
N-acetylcysteine reduces incidence and duration of linezolid-associated thrombocytopenia in critically ill patients: a randomized controlled trial.
Abdeltawab, M., et al. (2026). Environmental Toxicology and Pharmacology.
Interventions to prevent intraventricular haemorrhage in preterm neonates: an umbrella review of systematic reviews and meta-analyses.
Bhanushali, M., et al. (2026). Neonatology. [Record in progress].
Recombinant factor VIIa versus placebo for spontaneous intracerebral haemorrhage within 2 h of symptom onset (FASTEST): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial.
Broderick, J.P., et al. (2026). Lancet.
Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders.
Champaneria, R., et al. (2026). The Cochrane Database of Systematic Reviews.
Use of albumin in patients with hepatic encephalopathy: a systematic review and meta-analysis of randomized controlled studies with trial sequential analysis.
Coan, A.C.C., et al. (2026). Hepatology Forum.
Comparative efficacy of prehospital resuscitation strategies on mortality for patients with major trauma: a network meta-analysis.
Hsu, C.W., et al. (2026). European Journal of Emergency. [Record in progress].
Randomized, sham-controlled trial of intraoperative ticagrelor removal to reduce perioperative bleeding.
Mack, M.J., et al. (2026). The Journal of Thoracic and Cardiovascular Surgery. [Record in progress].
Global burden of asymptomatic malaria among blood donors: systematic review and meta-analysis.
Malede, B., et al. (2026). BMC Infectious Diseases.
Comparison of safety and efficacy of liberal versus restrictive red blood cell transfusion thresholds on the quality of life in patients with myelodysplastic syndromes: a systematic review and meta-analysis.
Mandal, S., et al. (2026). Annals of Hematology.
29 March 2026 (Sunday) - Slide Saturday Challenge
Here’s some info on the condition. There are those who turn their noses up at Wikipedia… they can write their own CPD journals. Bet they won’t.
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…
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:
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.
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