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?

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.

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…”

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.

 

19 February 2026 (Thursday) - The ESR

I’ve just marked a trainee’s portfolio work on ESR.

The erythrocyte sedimentation rate is quite possibly the first blood test that was ever invented. You just suck some blood up a tube and see how much it settles out in an hour. The more it settles, the more ill the patient.

 

Professional blood testers laugh at it because it is so non-specific. In these days of high-tech diagnostics, those who know about high-tech diagnostics look down their nose at a test which is so non-specific.

However for a GP this is absolutely brilliant. With a limited time to spend with the patient, the GP has to determine if the patient is genuinely ill or malingering. The ESR tells him that. It don’t say what is wrong with the patient, but in the first instance it don’t need to.

All the GP needs to know in the first instance is does he need to spend more time with the patient, or can he tell them to clear off with a clear conscience.

 

Here’s a proper article about it.

18 February 2026 (Wednesday) - Red Cell Membrane Issues

I was talking with one of the trainees about the good old days… I’m sure they think I used to run the path lab on Noah’s Ark… We got talking about tests for red cell membrane abnormalities and I felt I might benefit from a little refresher on the subject. So here’s what I found.

 

Given a blood count with unexplained high MCHC (that doesn’t correct on warming) and reticulocytosis you have a look at the blood film.

 

If there’s lots of spherocytes we would do a direct antiglobulin test to rule out autoimmune haemolytic anaemia.

Back in the day we used to perform the osmotic fragility test but that is “so last century”. These days we use flow cytometry to look for eosin-5-malemide (EMA) which, being a structural red cell protein, is reduced in people with hereditary spherocytosis.

 

If there’s lots of elliptocytes we used to say “that’s hereditary elliptocytosis” and move on. These days there’s all sorts of molecular tests that can be done.

 

I found out that I wasn’t really that out of touch, but I am now rather inexperienced… mainly because these tests are only done in specialist centres these days.

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.

1 January 2026 (Thursday) - Only As Good As...

 Here's something to always bear in mind. What we do can only ever be as good as that which is sent to us... 

4 December 2025 (Thursday) - The Future...

The obvious way forward is to go back to how it was when I started. Don't expect people to run up massive debts in order to be able to do the job then pretend to be surprised when tehy go off and do some other job which pays better. Offer them the opportunity to get the qualifications as they work. Send them on day release (and pay for it too).

And find whoever it was who stopped the scheme which demonstrably worked and have a word with them...

 

24 November 2025 (Monday) - Frozen Platelets (!)

One criticism which is often levelled at me is that I am too flippant. Perhaps I appear that way when I tell the trainees that the golden rule of blood transfusion is “don’t kill anyone”. But as golden rules go, in my considered professional opinion I think it’s a good one. One way of not killing anyone was to make sure that platelets are stored at room temperature (between twenty and twenty-four degrees Celsius) and gently agitated. And to make sure they didn’t get cold.

Now not only is it being suggested that they might be kept in the fridge, but that they might even be kept frozen prior to use.

 

If there’s one thing I’ve found in blood transfusion is that opinion changes. What used to be absolutely a no-no becomes a possibility, and then is standard practice. 

 

1 October 2025 (Wednesday) - The Same (only different)

A colleague had a request for cryo yesterday which rather flummoxed him. He was asked for ten units of the stuff.

That’s a lot…

However when you read the factsheet it says:

 

“Cryoprecipitate is available as a single unit, or as a pooled product made up of five single units. Pooled units are more commonly used to treat adult patients”

 

It turns out that what I call one unit of the stuff is actually five. Where the medics wanted ten I would issue two and everyone would be happy.

One lives and learns.

Much the same happened when I was recently asked for prothrombin complex concentrate. I was asked for “one unit” and I inadvertently caused confusion by pointing out that the smallest amount I had was two hundred and fifty units. The poor doctor wanted “a therapeutic dose”.

 

There’s quite a bit of confusion caused by the use of the words “unit” and “therapeutic dose”. They mean different things to different people.

Maybe someone might standardize the terminology.

I wonder who that person might be…

(We’ll gloss over FFP which is prescribed per millilitre but comes in varying amounts of about 250-300 ml depending on the individual unit…)

 

13 August 2025 (Wednesday) - Medical Tourism

Here’s something to make you think (well, it made me think). We had a case of anti-U the other week. Yesterday we had a case of anti Mi(a). There’s obscure for you. 

It turns out that the frequency of the Mi(a) antigen is less than 0.1% among Caucasians, Negro and Japanese people, but in South-East Asia, the frequency is different. In Chinese blood donors in Hong Kong it is 6.28%, 88% in the Ami mountain people of Taiwan and 9.6% in Malaysian blood donors.

Well… this isn’t news, it it? There has always been racial variations in the distribution of blood groups. But… I saw an advert on Facebook the other day advertising going half way round the world for cheap orthopaedic surgery. Whilst you may well be getting first-class treatment, you’ll also be getting blood from local donors (if transfused). And possibly getting anti-Mi(a) and potentially other antibodies to rare (in the UK) antigens which may be an issue. Do UK screening cells have the Mi(a) antigen and all the other obscure (in the UK) ones?
I don’t know… 

 

27 July 2025 (Sunday) - Anti-U

The U antigen is part of the MNS blood group system and is a high incidence antigen being found in approximately 99% of Black individuals and virtually 100% of Caucasians. Consequently having a patient with anti-U who needs blood is, as my grandson would say, a pain in the glass.

I came in to the early shift today to find one such case. With a haemoglobin of 45 g/L the patient was symptomatic. Blood had been requested yesterday… we had been told that frozen blood was available. But it was frozen and was actually in Liverpool three hundred miles away.

There’s all sorts of talk about learning from these incidents and there is a lot to be learned. What do you do in a situation like this? Give blood which may well be detrimental, or wait until the blood is available… the waiting being detrimental.

I’m glad it’s not a decision I have to make.

22 May 2025 (Thursday) - B Platelets

From the Blood Bank Professionals group… It has been reported that bites from the Lone Star tick can cause the formation of specific IgE antibodies targeting galactose-α-1,3-galactose (α-gal). This is found in red meat and so can cause allergic reactions when you scoff any, when hitherto you’ve been shoving it down your neck like there’s no tomorrow.

Bearing in mind that there’s loads of ticks in the woods where I often walk the dogs perhaps I need to think about anti-tick treatments for myself as well as the dogs. You never know – what is good for an American tick might be good for a UK one.

 

Yes – I know… what has this got to do with CPD? Well, it turns out that this galactose-α-1,3-galactose stuff isn’t chemically unlike the B-antigen. Antibodies to galactose-α-1,3-galactose can cross-react with the B-antigen and cause a mast cell response.

 

It has been suggested that this has been seen in group B platelets which have been transfused to group O patients who’ve been suspected of having been bitten by these ticks who have received group B platelets.

Something which according to all the guidelines is perfectly acceptable.

Should we restrict the use of group B platelets?

23 February 2025 (Sunday) - Slide Saturday Challenge

Slide Saturday Challenge. Stomatocytes. There’s a rather insightful article on the things here.

Perhaps I’m a bit daft and a bit sensitive, but seeing stomatocytes gives me flashbacks to when an eighteen year old me was peering down a microscope whilst a rather nasty and vindictive senior MLSO (who I later found out had once fallen out with my uncle) was almost hysterical in his ranting about how useless I was because I couldn’t identify stomatocytes despite never having seen them before and having at best a few weeks’ experience of looking at blood films.

The Royal East Sussex Hospital was a truly delightful place to work all those years ago… but looking back I remember so many of those people with whom I worked and make a point of trying my hardest not to be like they were…

There’s reflection, but probably not how the nice people at the HCPC intend.

6 February 2025 (Thursday) - What if...

Here’s a couple of random thoughts that occurred to me whilst walking the dogs round the woods this morning.

I made a mistake at work yesterday. The mistake was that I thought I got something wrong. I hadn’t.

We had a phone call querying someone’s blood group. Last week our analyser wasn’t happy with a blood group so I did it manually and reported it as Rh(D) Positive. However records from way back when said she was Rh(D) Negative. I felt physically sick… but after a little to-ing and fro-ing it turned out that samples had gone to the National Blood Service and she was known to be Rh(D) Positive, albeit with a weak D. I’d actually got it right.

Back in the day when we did Rh groups we used to do a DAT on all negative reactions, and if that came out positive they were called Rh Du Positive. We now know there’s (effectively) a spectrum of positivity, and the modern antisera pick up more of the weak reacting D.

Which made me think… Back in the day had we been giving prophylactic anti-D to D-positive people during pregnancy? If so demonstrably it hadn’t been an issue. Had it?

 

My second thought was about how I’d worried yesterday. I had felt physically sick. Fourteen years ago I made a serious mistake at work. I never did get to the bottom of what happened. All I can say is that having made a mistake it was used as a way of getting rid of someone who didn’t always toe management’s line. Without going into details, what followed that mistake was stressful in the extreme.

But does this mean I am not allowed to make a mistake ever? Look at any hospital mistake that is ever made. No newspaper ever reports on tragic mistakes made by overworked staff who are racked with remorse. But they often talk about the incompetence of bungling medics.

I can remember a discussion about this very subject when I was doing my IBMS Special exam course in 1987 (MSc equivalent). Our tutor, the much-missed Pete Chopping asked us how many babies a midwife could drop.

Obviously he was being facetious, but it is a valid point.

This is where quality management should come in to play… I did a course on that last year.

 

I know I’m worrying over what-if. I should stop doing that. It does my blood pressure no good.

15 January 2025 (Wednesday) - Mobile Phones

The nice people at Lablogatory sent out their update today. This one was posed an interesting dilemma… Interesting in that is it actually a dilemma. The chap writing the article said “one thing I’d like to solve is the issue we see in the lab regarding the use of cell phones and other personal electronic devices. What options do we have as lab leaders?…”

 

Back in the day when I was a manager I was under strict orders that they were utterly and completely banned without question. The chap who gave me that order was always walking round fiddling on his mobile.

I found myself reflecting on the attitudes to mobile devices I’ve seen from managers over the years. Many are relaxed about them. Some would rather people didn’t have them in their pockets but see them as a necessary evil and a way of keeping people sweet. And others would quite happily let staff stand round idly chatting for up to half an hour but would go hysterical at the sight of a mobile phone.

 

The fellow writing the article then went on to say “you catch more flies with honey than with vinegar”. That was always my attitude, but I’m not a manager any more.

Personally I have my phone in my pocket all the time. If I get a message, my watch shows me a synopsis. Sometimes I need to deal with the message right away; other times not. Most people seem to do this these days. I don’t see this as an issue.

Am I wrong?

5 January 2025 (Sunday) - Transfusion Dependent

So… a group & save comes in on a four-year-old child with a generic diagnosis on the accompanying form. I was rather busy so I just put the thing through the analyser. The analyser wasn’t having any of it, so as my son once told his primary school teacher, if you want a job done, do it yourself.

Given that the child had a historical blood group of O Rh(D) Negative I was rather surprised to see mixed field reactions with anti-A and with anti-D. Obviously I’d stuffed something up so I did it again and got the same result.

I then delved into the child’s history.

 

The child had thalassemia major. Having had in-utero transfusions before birth he was having regular transfusions every couple of months. Bearing in mind pedipacks are all O Rh(D) Negative that’s what he’d been getting, as do all small children needing transfusions. And having been started on O Rh(D) Negative, that’s what he stayed on.

 

It looks like the child is actually A Rh(D) Positive – there’s no anti-A reaction in the reverse group, and where else would the A Rh(D) Positive part of the mixed field reactions be coming from?

BUT… how can we determine the child’s actual group bearing in mind his condition means he will never be off of blood transfusions long enough for his own group to come through?

 

I posed this question on the Facebook Blood Bank Professionals Group. It was interesting how many people posted responses without actually reading what I’d actually written.

4 January 2025 (Saturday) - Back in the Day

I was having a bit of a clear-out at home today when I found my old notes and exam papers for my Special exam. Back in the day after achieving professional registration we would do the IBMS Special exam. Billed as MSc equivalent you couldn’t progress at all in our line of work without having passed the Special exam, and it had a reputation for being incredibly difficult. Pretty much everyone with whom I worked when I first started told me they had failed the exam several times.

The Special exam consisted of three written papers which together accounted for fifty per cent of the mark, and a practical project accounting for the other fifty per cent.

I passed it on the first attempt, and having passed it I wasn’t obliged to do any kind of professional updating of my knowledge and skills until CPD became mandatory some twenty years later.

Looking at the old papers I took has made me realise just how vital it is that dinosaurs like me do CPD…

 

Paper One

• A two-hour essay. Look at the options.Is there a need for change in how we are trained? Change was to be avoided at all costs!!
• “Side Room Testing” was the devil’s work and conjured up visions of nurses playing at science. No one dreamed of the likes of us doing near patient testing.
• The future revolutionizing what we do? Pah. We thought it would. In fact we now do far less tests and send everything interesting to specialist labs… who themselves don’t actually have that much of a variety in what they do either with everyone specializing in different things.
• “Clinical Budgeting” was a management catch-phrase of the mid 1980s which has long since been superceded by other equally well forgotten terms.

Paper Two

Two one-hour essays. Again look at the options.

• Vitamin B12 deficiency. Back in the day it was radio isotopes and the Schilling test. (You’ve never heard of it, have you!)
• Erythropoetin… blah on about that for an hour?
• Laboratory investigation of myelodysplastic syndromes? Yes – we used to do that. Gets sent away now.
• Complement… don’t get me started. Back then absolutely everything that science couldn’t explain was down to complement.
• Automated diffs – that was the future. Bear in mind this was only two years after the launch of the first analyser to do a five-part differential count.

 

Paper Three

Three forty minute essays.

• Safety and AIDS. Bear in mind that this was only four years after HIV had been discovered, and that I was told that in 1981 the average life expectancy of people in our line of work was fifty-seven. No one ever actually said that we used to die from that which we caught in the lab, but that was implied.
• Bleeding time… don’t laugh. We used to do them. We really did cut someone and time how long they bled for.
• Rouleaux and plasma cells… string that out for forty minutes.
• Heparin monitoring… anti-Xa assays were years into the future.
• LAP – that used to be an interesting test to do. Not done one for years.
• Red cell survival rather went the way of the Schilling test. There’s only so much radiation you can inject into people.

Project

I spent an age working up a way of identifying haemoglobinopathies by iso-electric focusing. Like everyone else doing the Special exam I put a lot of effort into devising a technique which would never actually be used.

 

It is pretty obvious that the future expected from the mid-eighties wasn’t the future that came forty years later.