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.

11 May 2026 (Monday) - Iffy Valves

 

Looks like an iffy heart valve to me. The correct answer was:

 

“The correct answer is option 3. Revision of prosthetic valve. 

Mechanical hemolysis may results from malfunctioning prosthetic valves. Hemolysis is intravascular and may give rise to iron deficiency due to hemoglobinuria. Treatment is by correcting the valve malfunction”. 

 

Go me!!!

8 May 2026 (Friday) - BTLP-TACT Exercise

It can be no surprise to anyone that I’ve had yet another email from the nice people at BTLP-TACT whinging that I’m not doing enough exercises. So here we go again…

 

I was presented with two cases:

 

93449 – a sixty-nine year-old chap with sickle cell disease needing two units of blood

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

I selected two units of O Rh(D) Positive.

62030 – a sixty-eight year-old chap needing group and save for a fem-pop bypass.

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

 

I got it right… I must admit I was amazed. The connection to the server dropped out several times…

7 May 2026 (Thursday) - Horiba Update

The nice people at Horiba sent their update today. I’ll say one thing for their update – its format seems to change from month to month.

This month featured Sezary syndrome, G6PD, and a quiz which was MAHA.

This is the sort of thing I want for CPD…

5 May 2026 (Tuesday) - Fritsma Factor Newsletter

And with my poor brain already overloaded so the Fritsma Factor Newsletter arrived in my in-box.

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…

 

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.

Here’s my (updated) take on the matter…

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.