7 September 2026 (Monday) - BTLP-TACT Exercise

 

Time for a BTLP-TACT exercise… I was presented with one case – a thirty-two year-old chap in the haematology clinic with sickle cell disease needing eight units of blood for an exchange transfusion.

He grouped as O Rh(D) Positive with a negative antibody screen. I selected all the HbS negative units there were (four).

I got it right…   In reality that would be a resounding fail because I only came up with half the amount of blood needed. In reality I would get onto NHSBT and have them send some suitable blood. But this isn’t reality. It’s a simulator. Not a bad one, but quite obviously a work in progress on which no progress is being made. (That’s very ungrateful of me, isn’t it?)

6 September 2026 (Sunday) - CML

Well… it looks like CML to me. There’s nothing else that gives you quite such an assortment of myeloid cells.

4 September 2026 (Friday) - BTLP-TACT Exercise

Time for a BTLP-TACT exercise… I was presented with one case – a fifty-five year old chap in theatre needing six units of blood for gunshot wounds.

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

I selected six units of O Rh(D) Positive K Negative blood.

 

I got the thumbs-up.

2 September 2026 (Wednesday) - Fritsma Factor Update

The Fritsma Factor newsletter appeared in my in-box today. As always there was a lot to take in, but as a source of haemostasis-related CPD it can’t be bettered.

2 September 2026 (Wednesday) - NEQAS 2605BF

I got the results of NEQAS 2605 BF today
 
For 2065BF1 said
 

Thrombocytosis

Target cells

NRBC

Bizarre red cells

HJB (?)

Echinocytes

Rbc Fragments

Lymphocytosis

 

I wondered if this was heat changes, it was a case of congenital dyserythropoietic anaemia from the haematology clinic.

 
For 2065BF2 I said
 

NRBC

Target cells

Botyroid neutroohils

Lymphocytosis

Polychromasia

?? Occasional sickle cells???

 

I wondered if this was a case of heat stroke, it was a case of homozygous sickle cell disease three days after being treated for malaria. Interestingly the botroid neutrophils weren’t spotted by most people.

 
How did I do? Well, as I said to a colleague, this was a load of bollox. I spotted all of the salient features. However someone known to have haematological diseases which are being treated *aren’t* going to turn up as random chance findings.
The organization of NEQAS blood films leaves a lot to be desired…

 

1 September 2026 (Tuesday) - A.I.

The latest missive from the United Kingdom Accreditation Service arrived in my in-box today. You can read it by clicking here.

Good luck.

I actually laughed out loud when I read the bit about using artificial intelligence. I actually use that with any UKAS publications with which I come into contact. Seriously. I really do.

Last month I mentioned on here that I found one of their articles to be incomprehensible so I emailed UKAS to ask for it to be translated into words that I could understand. No one replied so I copied the lot into Microsoft Copilot and asked it to translate it into everyday English, and it did.

So that’s what I do with stuff from UKAS nowadays. I want to understand it, and here’s one way that I can…

 

31 August 2026 (Monday) - Learning Monday

The correct answer is option 3. Matched sibling donor transplantation using bone marrow. For younger patients with severe or very severe aplastic anemia who have an available HLA-identical sibling donor, upfront allogeneic transplantation is the preferred first-line treatment.
The priority order of donor source for bone marrow transplantation is: (1) HLA-identical sibling, (2) HLA-matched unrelated donor, and (3) HLA-haploidentical donor if an HLA-matched unrelated donor is not rapidly available. Each of these donor marrow sources may be preferable to nontransplant IST.
Upfront transplantation from an HLA-identical sibling donor is preferred in eligible patients because immunosuppressive therapy is associated with a continued risk of relapse and clonal evolution to MDS or AML, whereas allogeneic transplantation offers a potentially curative treatment.