18 August 2025 (Monday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise. We kicked off with something of a false start when it told me it was unable to generate a scenario, but eventually it presented me with one case – a one year old lad with a nose bleed.

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

I got it right…

15 August 2025 (Friday) - BTLP-TACT Exercise

I’ve got a few minutes spare (and another snarky email saying I’m not doing enough BTLP-TACT exercises) so here goes:

 

70175 – a sixty-four year-old woman with CVA needing group and save

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

 

35842 – a forty-three year old woman having caesarean section also needing group and save.

She grouped as A Rh(D) Positive with a negative antibody screen

 

I got it right (this time).

 

14 August 2025 (Thursday) - Botyroid Nuclei

*Hypersegmented neutrophils*: are neutrophils with more than the typical three to five nuclear lobes or segments. Hypersegmentation is often associated with megaloblastic anaemia, particularly due to vitamin B12 or folate deficiency.

It can also be seen in myelodysplastic syndromes and other conditions affecting bone marrow function.

 

However this should not be confused with neutrophils showing a “botryoid nucleus”; a botryoid nucleus refers to a nucleus that has a grape-like clustering or lobulation with nine or ten tight lobes. Hyper-hypersegmented (!)

While less common than hypersegmentation, it is seen in heat stroke, influenza A, encephalitis, and drug overdoses including cocaine and methamphetamine intoxication.

 

Here’s a link.

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… 

 

12 August 2025 (Tuesday) - BTLP-TACT Exercise

There’s so much else I might be doing, but there’s a heatwave and it is far too hot to do anything… so I thought I might as well do a BTLP-TACT exercise.

I was presented with one case – a twenty-three year-old woman requiring group and save prior to a caesarean section.

She grouped as A Rh(D) Positive and the control *was* negative (!)

The antibody screen was negative.

I got the thumbs-up.

11 August 2025 (Monday) - Horiba Newsletter

The latest update from Horiba arrived in my in-box today. A case study on sickle cell anaemia, storage changes, a little test… something for nothing is always worth having.

10 August 2025 (Sunday) - Slide Saturday Challenge

 I thought myeloma... but plasma cell leukaemia looks similar. EIther way it is something I would be referring as a matter of urgency.