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.
 

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.

7 April 2026 (Tuesday) - Fritsma Factor Update

 The Fritsma Factor newsletter arrived today. As always it is a very useful source of CPD…

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

5 April 2026 (Sunday) - Pay Attention (!)

Look closely in a blood film – it’s easy to overlook the early signs…

4 April 2026 (Saturday) - A Useful Lilttle Refresher

 I found this useful...

2 April 2026 (Thursday) - NEQAS 2602 BF

I got the results of NEQAS morphology survey 2602BF today…

 

2602BF1 I said:

 

Hypochromia (consensus 4^th)

Target cells  (consensus 1^st)

Large plts (consensus 2^nd)

Neutropenia (consensus 14^th)

 

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 1^st)

Microcytosis (consensus 2nd)

Pencil cells (consensus 3^rd)

Tear drop cells (consensus 5^th)

^ plts (consensus 4^th)

 

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?