A Dull Day At Work...?: 2026

12 January 2026 (Monday) - T.A.M.O.F. (wassat then?)

No massive bleeding. No dramatic hypotension. But test results drifting in a direction that feels wrong: platelets falling, creatinine creeping, LDH elevated, hemoglobin sliding just enough to notice.

Organ dysfunction without a single unifying explanation…

Here’s a condition that is new to me. Thrombocytopenia-associated multiple organ failure (TAMOF)

Here’s a little write-up about it.

As I always say, a day when you learn nothing is a day wasted.

11 January 2026 (Sunday) - Marking Specialist Portfolio Work

I spent a couple of hours marking trainees’ portfolio work today. Iron, morphology, malaria… Over the years I’ve learned quite a bit and I’m only too happy to share my experience. Even if I do have just a tad of imposter syndrome and wonder just who am I to be commenting on post-graduate level scripts.

The trainees all see me as Methuselah’s grandad and think that if I can’t comment, who can?

11 January 2026 (Sunday) - APML

APML… Promyelocytes might look vaguely “lymphy” at first glance but that’s because of the cytoplasm which (for the most part) lacks granules. But look at the nucleus. A lymphoid nucleus is generally sounder and more regular. The myeloid nucleus has lumps and bumps (albeit rounded).

I’m particularly prompted by the bit about “while morphology can strongly suggest this diagnosis…” for many years that was all that could suggest any diagnosis. It’s such a shame that cytogenetic and molecular testing are the purview of specialist testing centres.

But that’s what CPD is all about, isn’t it?

8 January 2026 (Thursday) - BTLP-TACT Exercise

I did another BTLP-TACT exercise. I was presented with one case – a seventy-one year-old woman in theatre needing four units of blood.

She grouped as AB Rh(D) Negative with antibody screen positive in cells 1 and 2. I performed antibody panels.

The IAT and enzyme panels were positive in cells 1, 2, 3 and 6 corresponding to anti-D and anti-K but not excluding anti-Cw

I selected four units of A Rh(D) Negative blood that were K Negative and got the thumbs-up.

7 January 2026 (Wednesday) - Protein Z (?!)

The Fritsma Factor update arrived in my in-box today. You can read it by clicking here.

As always there is loads of useful stuff. Some on what you might call “routine” haemostasis, and some rather more esoteric… and talk about Protein Z. What on Earth is that? Well, here’s an introduction, but as far as I’m concerned, it’s something new. And a day when I don’t learn anything new is a day wasted…

7 January 2026 (Wednesday) - Atlas Update

The rules say that if and when I get called up for audit, only CPD work done in the last two years will be assessed. Which is something of a nuisance because I’ve put a load of effort into a personal atlas of things I’ve seen over the years.

Is it cheeky to do a major overhaul of the thing and claim that as recent CPD? That’s been my CPD project for the last few days… I’ve found that the formatting isn’t what it might be, and some of the references now go to dead links.

Well… I shall claim it as CPD… what’s the worst that can happen? An assessor will say that it isn’t current and I’ll have to submit something else…

6 January 2026 (Tuesday) - NEQAS 2508 BF

I got hold of the results for NEQAS 2508BF today…

2508 BF1

I said:

Lymphocytosis (consensus 3^rd)
smear cells (consensus 4^th)
Thrombocytopenia (consensus 1^st)
Abnormal Lymphs (consensus 6th)

I felt this was CLL – it was.

2508 BF2

I said:

Myelocytes (consensus 3^rd)
Promyelocytes (consensus 4th)
Nrbc (consensus 2^nd)
Blast cells (consensus 5th)
Thrombocytopenia (consensus 1^st)

I felt this was CML. The expert opinion was uncertain. Had this appeared in real life I would have referred it anyway…

5 January 2026 (Monday) - BTLP-TACT Exercise

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

65114 – a six year old lad in ITU with burns needing two units of blood.
He grouped as A Rh(D) Positive with a negative antibody screen.
I issued two units of A Rh(D) Positive

70158 – a sixty-one year-old woman in theatre needing six units of blood for gunshot wounds.
She grouped as O Rh(D) Positive with a negative antibody screen
I issued six units of O Rh(D) Positive

I got it right

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