29 July 2026 (Wedneday0 - UKAS Update

The nice people at UKAS sent their update today. You can read it by clicking here. I did, and struggled, as did the colleagues with whom I discussed it. I often whinge about the UKAS newsletter, but this time I’ve done something more than whinge. I’ve emailed them… Here’s what I wrote:

 

“Dear sir or madam

I just received your latest newsletter. I was intrigued to hear about the Pathology Transformation Review 2026 but when I clicked on the link I found the article incomprehensible.

The article in question is https://www.ukas.com/resources/latest-news/ukas-welcomes-the-pathology-transformation-review-2026/

I showed it to some colleagues, and none of us understand what it means. I don’t want to appear confrontational or reactionary. I seriously want to understand what is going on with my profession and its regulator… But I don't.

Could one of your experts paraphrase it in such a way that a semi-retired old dinosaur could understand it… (sorry)”

 

I wonder if they will get a reply? My request is a serious one. Despite having done a formal course of study in quality management I didn’t understand any of what that article was saying.

 

27 July 2026 (Monday) - Myeloma Treatment

 

I thought option 3 and I said so. I was told: The correct answer is option 3. The patient remains biologically high-risk despite achieving MRD negativity. 

Achieving MRD negativity at a sensitivity of 10⁻⁶ is an excellent treatment outcome and is strongly associated with improved progression-free and overall survival in multiple myeloma. While MRD negativity reflects how effectively treatment has reduced the disease burden, cytogenetic abnormalities provide important information about the underlying biology of the myeloma clone. 

In this patient, the presence of both t(4;14) and gain(1q) identifies biologically aggressive disease. Although deep responses such as MRD negativity can substantially improve outcomes, current evidence suggests that they do not completely eliminate the adverse prognostic impact of multiple high-risk cytogenetic abnormalities. Data from studies have shown that patients with ultra-high-risk disease can achieve high rates of MRD negativity, yet their long-term outcomes remain inferior to those of patients with standard-risk disease achieving the same depth of response. 

Therefore, the most accurate interpretation is that this patient remains at increased risk of relapse despite achieving MRD negativity. 

26 July 2026 (Sunday) - Slide Saturday Challenge

 Hypochromic microcytic blood film with pronounces anisopoikilocytosis. Target cells and nucleated red cells. No pencil cells…

Thalassemia major…

24 July 2026 (Saturday) - Letrozole

I had a neutropenic patient today. Perfectly fine a month ago, a neutrophil count of 0.6 today. Diagnosis “on letrozole”.

I looked that one up. A common side effect is neutropenia. Here’s an article on the matter.

One lives and learns…

 

23 July 2026 (Thursday) - HCPC Update

The HCPC sent their update today. You can read it by clicking here. There’s no denying it was on the dull side. However I see they are asking for applications for the role of head honcho.

I have absolutely no intention of applying… and consequently I have no right to whinge that I think they are making a fundamental mistake by getting all bogged down in management-speak rather than focusing on what I feel should be their core business (i.e. acting in the best interests of the professions they represent). On reflection I suppose that they feel that they *are* acting in the best interests of the professions they represent. But their way of doing it is different to mine.

Mind you for all that I can’t really whinge when I have no intention of putting my money where my mouth is, I expect I will still whinge.

I wonder who would take on the role of head honcho? There’s plenty of people who love the entire “meetings thing”.

 

23 July 2026 (Thursday) - Pappenheimer Bodies

I saw some Pappenheimer bodies last week, so I took photos, and have updated my little atlas with the piccies. To see it click on this link and then click on “Pappenheimer bodies” in the list on the left hand side.

 

I’ve used a new page format for this entry… if only to make it look like the thing is a work in progress (which it actually is!)

 

22 July 2026 (Wednesday) - Von WIllebrand's Disease

Here’s a rather good set of web pages about Von Willebrand’s disease courtesy of The Blood Project.

I never really understood what that was all about when I was at college… I rather suspect that the one lecturing us on the matter didn’t either. I’m a little clearer now.

21 July 2026 (Tuesday) - BTLP-TACT Exercise

Well… here we are at the three thousandth and first entry to this blog. Despite having been read several times, no one has replied to my suggestion about sharing CPD resources. Such a shame.

 

In the meantime I shall carry on undaunted. I had a go at the BTLP-TACT which presented me with one case – a ninety-seven year-old chap needing group and save following ahead injury.

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

 

I got it right.

 

Monday 20 July 2026 (Monday) - 3000 !!

Well… here we are at the three thousandth entry to this blog. I started it as a record of what CPD activities I do. Whilst is it in no way secret, I’ve never really tried to attract a following, but through the wonders of modern science I can see that has quite a following. In the last three weeks it has had over two hundred visits.

Why not leave a comment to say hello, and to answer a question.

 

I’ve a plan that I might set up a little CPD sharing on-line community… would you like to take part?

20 July 2026 (Monday) - Transfusion Evidence Library Update

Tranexamic acid again !!

The article about alloimmunization in sickle cell patients was interesting. In the study a third of them had formed antibodies. Clearly people on long-term transfusions should have blood matched as closely as possible…

I’m reminded of a thread I saw on one of the work-related Facebook pages which was talking about artificial oxygen carriers. If ever there was a cohort of patients that could use them…

ARTICLE OF THE MONTH

Hospital policy of tranexamic acid to reduce transfusion in major noncardiac surgery. Houston, B.L., et al. (2026). The New England Journal of Medicine.
PICO SUMMARY

 

 

TOP ARTICLES

Global prevalence of alloimmunization in adults with sickle cell disease receiving red blood cell transfusions: a systematic review and meta-analysis.
Alsalman, M., et al. (2026). Journal of Clinical Medicine.

Effect of continuous non-invasive hemoglobin monitoring on blood transfusion and mortality in hip surgeries: a randomized controlled study.
Dinçer Yeşilnacar, M.E., et al. (2026). Journal of Clinical Practice and Research.

Oral or parenteral iron supplementation to reduce deferral, iron deficiency and/or anaemia in blood donors.
Geneen, L.J., et al. (2026). The Cochrane Database of Systematic Reviews.

Clinical trial: predicting response to iron therapy in patients with active inflammatory bowel disease using hepcidin and functional iron indices: a multicentre randomised trial.
Koppelman, L.J.M., et al. (2026). Alimentary Pharmacology & Therapeutics.

Clinical efficacy of different blood purification modes on severe acute pancreatitis: a systematic review and network meta-analysis.
Li, P., et al. (2026). Frontiers in Medicine.

Effect of tranexamic acid for acute spontaneous intracerebral haemorrhage: a systematic review and individual patient data meta-analysis.
Menon, C.S., et al. (2026). Journal of Neurology, Neurosurgery, and Psychiatry. [Record in progress].

Artificial Intelligence-based predictive models for adverse blood donor reactions: a systematic review of immediate and delayed events and clinical data approaches.
ShojaeiBaghini, M., et al. (2026). BMC Medical Informatics and Decision Making. [Record in progress].

The effect of active warming and conventional body temperature management on perioperative blood loss and coagulation function in patients undergoing scoliosis correction: a multicenter randomized controlled trial.
Yan, W., et al. (2026). European Spine Journal. [Record in progress].

 

 

19 July 2026 (Sunday) - Disagree (!)

 

Seriously? I always thought that platelets were much larger in May-Hegglin anomaly.

Personally what with the rather echinocytic red cells and the lack of distinct lobulation in the neutrophil I would have said this was an example of a blood film having been made on an old blood sample.

17 July 2026 (Friday) - Circulating Microplastics

It’s been claimed that plasma exchange treatment can remove the amount of microplastics in the circulation.

Apparently this claim isn’t quite what it might be.

No that anyone has ever asked me to perform a plasma exchange to lower the amount of microplastics in a patient’s circulation…

16 July 2026 (Thursday) - ASH Update

The nice people at the American Society of Hematology sent their update today. You can read it by clicking here.

They send these updates every week or so, and just lately I’ve not been bothering with them. They are very clinically oriented and I can’t pretend to understand much of what they are saying. But the fact that I don’t understand much of it is the very reason why I should be reading it and trying to understand.

I shall try harder…

16 July 2026 (Thursday) - Learning Monday (three days ago...)

 

The correct answer is option 4. Heatstroke 

The cells depicted are neutrophils (A-D), lymphocytes (E) and monocytes (F) with botryoid nuclei, characterized by hypersegmented nuclei with a radial arrangement. These were first seen in 1980 in six patients with heatstroke and were named after the Greek term “botrys,” which translates onto “bunch of grapes” because of their resemblance. Since then, they have been described in other conditions causing severe hyperthermia, such as cocaine and methamphetamine abuse, autoimmune limbic encephalitis, sepsis, drug rash with eosinophilia and systemic symptoms (DRESS) and neuroleptic malignant syndrome. These nuclear changes have been hypothesized to be early stages of oncotic (karyolysis) and apoptotic (karyorhexis and pyknosis) cell death because of extreme heat.

Reference: 

• Verdú G, Vallvé M, San-José P, Molina A, Merino A. Diagnostic Value of Botryoid Nuclei as a Biomarker of Severe Hyperthermia and  Systemic Inflammation in Heatstroke and Neuroleptic Malignant Syndrome: A Challenge of Climate Change. Int J Lab Hematol. May 2025. doi:10.1111/ijlh.14500 

• Chiriac R, Pourchet V. Noyaux botryoïdes des leucocytes induits par le syndrome de DRESS. Ann Biol Clin (Paris). 2025;83(2):220-222. doi:10.1684/abc.2025.1961 

14 July 2026 (Tuesday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise. I had one case – a seventy-seven year-old woman needing two units of blood for a haematemesis. She grouped as B Rh(D) Positive with antibody screen positive in cells 2 & 3. I performed antibody panels.

The enzyme and IAT panels were positive in cells 1, 3, 4, 6 & 7 corresponding with anti Jk(a). I selected two unts of blood that were Jk(A) negative (one O Rh(D) Pos, one B Rh(D) Pos)

I got it right.

 

6 July 2026 (Monday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise. I had one case – a twenty-one year-old woman from the ante-natal clinic needing group and save.

She grouped as B Rh(D) Positive… was that supposed to be a weak reaction with the D? Bearing in mind the issues I’ve had with BTLP-TACT in the past I erred on the side of caution and called it inconclusive and said I would send it to NHSBT.

The antibody panel was negative though. 

I got it right - that was supposed to be a weak reaction.

5 July 2026 (Sunday) - NEQAS 2603 BF

I got the results of NEQAS 2603BF today.
 

For 2603 BF1 I said

 

Hairy cells  (consensus 1^st)

Lymphocytosis (consensus 4^th)

low plts (consensus 3rd)

Neutropenia (consensus 5th)

NRBC (consensus 2^nd)

 

I thought it was hairy cell leukaemia. It was.

 
For 2603 BF2 I said
 

Neutropenia (consensus 4^th)

low plts (consensus 1^st)

Blast cells (consensus 2^nd)

“iffy” lymphocytes (consensus 6^th)

Rouleaux (consensus 5^th)

 

I thought it was “???”. It could have been any of a wide range of conditions. The expert opinion said “In essence the morphology, in isolation, suggests a wide differential diagnosis”.

 

I’ll take that…

 

5 July 2026 (Sunday) - NEQAS 2602 PA

I got the results of NEQAS 2602PA today.
 
2602PA1: Microfilaria of Loa Loa
2602PA2: Negative for malaria

 

That’s what I said.

1 July 2026 (Wednesday) - Cladribine

I had a patient with an unexplained neutropenia today. The diagnosis was “multiple sclerosis on cladribine”.

Taken orally as Mavenclad, it is prescribed for adults with active relapsing-remitting multiple sclerosis to reduce the frequency and severity of relapses. However Cladribine is also used in lymphoid neoplasms. It mimics the nucleoside deoxyadenosine but resists breakdown by the enzyme adenosine deaminase, causing it to accumulate inside lymphocytes and interfere with DNA synthesis and repair.

Common side effects include a reduced white blood cell count and an increased risk of viral infections such as shingles or oral herpes.

And it can cause neutropenia too.

 

30 June 2026 (Tuesday) - Fritsma Factor Update

The nice people at the Fritsma Factor sent out their newsletter today. You can read it by clicking here. There was quite a bit to take in. Sickle cell, lupus, Von Willebrands….

It’s a rather good source of CPD…

30 June 2026 (Tuesday) - Westgard QC Update

The nice people at Westgard QC sent out their update today. You can read it by clicking here. It was rather scathing of certain analysers… I wonder if the manufacturers of those analysers are happy to be publicly lambasted?