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…