Friday, October 7, 2011

Blood Bank Halloween

The Blood Bank always has some pretty interesting Halloween decorations. Last year they had gel blood dripping from the top of the main door. This year I was excited to see a bloody hand at the Blood Bank blood product distribution window. The window is kind of like a fast food restaurant window - only it opens bottom to top instead of sliding sideways. I imagine it was designed in the 1960's. This morning when I went to take a photo of it for this blog that was marinating in my head, I was upset to find it missing. I wandered into the blood bank.

"Where is that bloody hand decoration that was in the window?"

A tech responded.

"Someone complained. We put it on the patient specimen refrigerator."

"What? It is fabulous! Who complained?"

"I know. We were upset too. We think that the patients over in fast track ED waiting area, the ones who use the lab bathroom, got upset when walking by it."

"Well, maybe an ED patient might find a bloody hand distasteful. Oh well."

I started to take a picture of the one on the patient specimen fridge. It looked great - the door is glass and you could see all of the bags of blood behind the bloody hand. I worried aloud. "If I take the picture here, well, there are patient names. Someone might see them, if I show the picture."

The tech answered, "I wouldn't worry, they are so small, how would you see them? There is another one on the ProVue, but one of the fingers is detached."

Since this was for the blog, and I think maybe anyone could blow up the patient specimen fridge pic and manage to find a patient name with the technology available these days, I decided it wasn't appropriate. Big possible HIPAA violation. So I wandered over to the ProVue, and took this pic. I love how festive everyone in the lab gets on the holidays.

So now I have to tell a Blood Bank story. As pathologists, we supervise the Blood Bank. One of my partners has a Blood Bank fellowship from Johns Hopkins, so he is the main supervisor, but when we rotate as clinical pathologists on call, we take the calls from every section in the lab. Most calls from the Blood Bank are routine, for example, "We've got a 56 year old man in surgery. We are out of 0 neg. Can we switch him to 0 pos?" "Yes, of course."

Sometimes, though, you've got to play God, which is kind of scary. There are a lot of shortages of blood products, and when multiple clinicians are fighting over products for their patients, ones that we don't have enough of at the moment, we have to decide who needs them the most, and triage appropriately.

The last time I was on call, I got a call from a heme/onc doc. She is lovely and intelligent and gregarious, and passionate about patient care. We were fellows together at the VA, and she often called me to do fine needle aspirations to diagnose follow up lymphoma patients. So we have been a team for a long time, and are on cell phone basis, which is a step above pager basis in the clinician world. I was at The Pizza Joint on a Friday night around 7:30 with my kids when the phone rang. I immediately recognized the number.

"Hey, what's up?"

"I'm so sorry to bother you at dinner, but I've got a big problem. My nurse has been talking to the Blood Bank and they say they are out of platelets - won't have any until 8 a.m. I've got a patient that desperately needs them. Can we call Red Cross? Have some flown in from somewhere? He just got out of surgery and he's bleeding out."

When she said the patient name I immediately knew the history. I had been dealing with him all day with a surgeon, and knew he was pretty critical. "Let me just call the Blood Bank and I will see what I can do. I'll call you back."

I plugged my kids in with my parents and their pizza-slinging, college student, summer sitter extraordinaire, and stepped outside where it was quieter to deal with the problem. Called the Blood Bank, and talked to the head tech.

"Yes, we are out of platelets until tomorrow. But we've got two set up for a patient in the CVICU. And we've got some baby platelets."

"What is the platelet count on the patient in CVICU? Are they actively bleeding?"

"Moderate thrombocytopenia. No bleeding."

"Well, get those platelets for our post-op bleeding patient. And save the baby ones, too, in case we need them."

I knew, especially since my dad is a neonatologist, that most baby platelets are set up on a protocol and given at a certain platelet number in a baby as routine - they could most definitely wait until the next morning at 8 a.m., not being critical, in the vast majority of cases.

I called my heme/onc friend back, and told her what I had managed - that we garnered two units from the guy in CVICU and had some babies if we needed them. She sighed with relief and thanked me. I went back in to The Pizza Joint to finish dinner and pay the bill.

The next morning I was triaging bone marrows and lymph nodes - it was a busy Saturday call. I never get follow-up - but checked on the patient I had emergently triaged platelets to in the EMR (electronic medical record) and was happy to see he was still alive. I also checked on the guy I had stole the platelets from - I would be lying if I didn't tell you I had a tiny anxiety attack in the middle of the night that he actually needed them more than my bleeding guy and my decision had hurt him - but he was stable as well, and now we had more platelets, and everyone who needed them was getting them. My turn to breathe a sigh of relief.

There is a moral here. Give blood products! And please don't be offended by our lab Halloween decorations - we are a very congenial, if a little nerdy, lot. We mean well.




6 comments:

  1. I LOVE the bloody hand print. I kind of want one to put on our refrigerator.

    Blood shortages are scary. Makes me really glad to be AB pos.

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  2. I love the pic! As a fellow doctor in acute care, I share the same slightly (okay, maybe more than slightly!) dark humour as you - I think it's a survival skill we learn in second year anatomy and never forget. Who can remain normal after dissecting a cadaver unless injecting a bit of dark dark humour :) along the way.
    And glad your Friday-night triaging worked out. It's nice to know that, as a worried clinician, you can actually ring up blood bank and speak to soemone about these things, and that rules can be bent according to need and the experience of someone such as yourself. Protocools are important, but clinical judgement alwasy wins in my opinion.
    I enjoyed your blog. Especially that wicked pic!

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  3. They put up a blood drive poster at work today, and now I feel guilty I'm not planning to give. But considering I'm already "donating" about 20 ounces of fluid per day, and am already intermittently lightheaded, I've decided I'll save more lives by not passing out while driving home from work.

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  4. Rock Star MD Girl - I want a bloody hand too . . . maybe on the shower door.

    FennyPenny - Thanks! Having trained in pathology, I dissected hundreds of fresh dead bodies, which is much easier than pickled cadavers in med school - everything is more recognizabe. As a result, my taste for dark humor is immense.

    Fizzy - I agree. No giving blood while breastfeeding. I was actually too anemic while pregnant/nursing to give blood - wasn't allowed. I remember giving blood one day and almost passing out at work - not good.

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  5. A blood bank is one of a few places where that bloody hand print decoration seems completely appropriate! ;)
    Thanks for the insight into what happens with triage in a blood bank, and inspiring me to go donate again - I'm long over due!

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  6. Thanks, PharmaMom! On my next call, I hope not to have to deal with shortages - those calls are much nicer. But then you've got the middle of the night emergency apheresis procedures . . .

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