10 October 2026 (Saturday) - Platelet Refractoriness

Platelet transfusions don’t always do the trick. You gave a full adult dose, ABO-compatible, straight off the agitator, room temperature the whole way, and the post-transfusion count looks almost identical to the pre-transfusion count. So do you carry on stuffing in more platelets?

Here’s a treatise on the matter.

 

3 October 2026 (Saturday) - IgA Deficiency

The whole reason that we do CPD is to stay abreast of latest developments. And there is no field in which there are no end of developments quite like there is with blood transfusion.

Here’s the latest thinking on IgA deficiency…

 

14 August 2026 (Friday) - Seriously?

I’m not quite old enough to remember the first Moon landings, but I remember the Apollo 13 disaster and Skylab. I remember Dolly (the first cloned sheep) and Louise Brown (the first test-tube baby).

I had such high hopes for the future… it turned out to be such a disappointment.

 

7 August 2026 (Friday) - ABO Groups

ABO groups aren’t quite as straightforward as we might like them to be…

Here’s a little article on the subject…

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…

21 June 2026 (Sunday) - Still Waiting

Here’s food for thought – During my first week in this job I spend a day in each of the various laboratories. One of my most vivid memories was from Friday 18 September 1981 when the chief in the microbiology laboratory went off on a major rant about how the science of blood transfusion was dead. Apparently there were dogs in Japan being kept alive on cell-free haemoglobin-based oxygen carriers, and this chap was adamant that they would be used in humans in only a few short months, and the traditional hospital blood bank would be gone.

There was a *lot* of inter-departmental animosity (outright hatred) at the now-demolished Royal East Sussex Hospital, and the subject of artificial blood was never far from anyone’s lips back then.

Forty-five years later and the stuff still hasn’t delivered…

 

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.

 

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…

 

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

24 March 2026 (Tuesday) - Haemochromatosis

Here’s a little update on hereditary haemochromatosis. It’s a useful little bit of revision… 
 

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.

 

5 February 2026 (Thursday) - Thermal Amplitude and anti-A1

Here’s a rather interesting dissertation on anti-A₁.

 

I first heard about anti-A₁ in 1982 when I was working at the (now demolished) Royal East Sussex Hospital. But I never saw an example of it until I left the place and worked somewhere else.

That “somewhere else” had more cases of anti-A1 that my gran ever had cups of tea. At least one a day… until there was a huge laboratory refurbishment and re-build. The cases of anti-A1 stopped overnight, and in twenty more years there I never saw another case. Nor did I see any in the place where I worked from 2011 to 2017, nor in the place where I’ve worked ever since.

So what was going on in the late 1980s?

 

Looking back we used to do blood groups in tubes and all the testing done at room temperature was left on the drafty windowsills to incubate. Where it was cold.

And that’s where the term “thermal amplitude” comes into play. The week before the laboratory refurbishment I had a case of anti P₁ which the boss couldn’t detect because I was incubating my room temperature tubes on the drafty windowsill whereas he was doing his on the bench. We got out the thermometer…  the bench was just under 20^oC, the windowsill was 6^oC.

16 January 2026 (Friday) - Sub Types of A

Here’s an interesting little read about sub-types of the A blood group which got me thinking. Back in the day sub-types of the A blood group were a big thing. We’d often find the weak reacting A₂ with the anti-A₁. We hardly see them any more because the anti-A reagents are far better these days, and because the buildings we work in now correspond to more stringent building regulations and aren’t anywhere near cold enough for the cold-reacting anti-A₁ to show itself.

Those sub-types are still there… we just don’t notice them anywhere near as often as we used to. Is that an issue? Demonstrably not.

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.

7 December 2025 (Sunday) - Haptoglobin

A low haptoglobin is a good indicator of a haemolytic process…  Or so I always thought.
Perhaps not…

 

2 December 2025 (Tuesday) - Exchange Transfusions

There’s a phrase that is in common use – “exchange transfusion”. It implies that you take out all of someone’s blood because it is in some way sub-standard and exchange it for “decent” stuff. But you can’t just hoik it all out before putting in the good stuff as that would be fatal. Similarly putting the good stuff in one arm whilst taking out the bad from the other will lead to a degree of mixing.

Here’s an article examining the logistics of how it might best be done…

5 November 2025 (Wednesday) - TACO-Related Fever

Here’s something to think about… back in the day transfusion trigger limits were a *lot* higher than they are these days. We’d give three or four units of blood where these days we’d only give one. And back in the day we were investigating quite a few alleged transfusion reactions which were characterized by post transfusion fevers. We’d do blood cultures… but nothing ever grew.

Were we seeing fevers related to transfusion associated circulatory overload?

29 October 2025 (Wednesday) - Post Transfusion Purpura

Here’s an interesting (if rather obscure) condition – post transfusion purpura.

20 October 2025 (Monday) - Jaundice

Here’s an interesting case study. Massive jaundice… Bearing in mind that I never wanted to do haematology and I wanted to be a biochemist you’d think that after all these years some basic chemistry would have sunk through my skull. But every time I see a case study with chemistry results I have to seriously think about what they mean and look up the reference ranges…

16 October 2025 (Thursday) - Anti-D? Who Knows...

You have a patient with an antibody.
You identify the antibody and find it is anti-D.
You check the patient’s blood group.
You find the patient is D-positive.
You cry (well, I do)
 
Here’s a rather good article explaining what happens in this all too common situation.