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…

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.