What do academic transfusion medicine pathologists do during off service weeks, or even during the day?

[Pathinterest95]

For AP you typically are finishing up cases on off service weeks or you have frozens weeks. For TM when you are off service what do you do typically? Additionally on service what does the typical day look like?

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[SunBakedTrash]

Not TM myself but have a lot of friends in it. Lots of variability. Some run apheresis services which is a full clinical service with patient contact and full consultations. Much of the work is administrative so lots of paperwork, signoffs, meetings, etc. if academic, teaching and research are a part of it. The most critical thing is the call. You always get called about everything. If you have residents, they handle some of it, but if not, it’s on you. It can be anything from donor issues and questions about unit processing if you have a donor center, questions about appropriate utilization, transfusion reactions, alternatives, etc. Some also oversee recombinant products like novoseven and kcentra which are often ordered emergently. These can come any time of the day or night and can take anywhere from 30 seconds to 3 hours to handle. Your day might seem easier than the guy with a stack of prostate biopsies, but he likely sleeps through the night.

It’s harder and more nuanced than most people give it credit for, including anatomic pathologists. You have to make big decisions quickly and decisively. Clinicians have very little understanding of transfusion outside ABO groups.

 

[mike-sheree]

It’s a little better than the old days when a panicked surgeon would immediately demand the need for “fresh warm whole blood” and you’d have to do a little ‘splainin’😱. But you do need to know what your doing even as a community hospital path.

 

[SunBakedTrash]

It’s a little better than the old days when a panicked surgeon would immediately demand the need for “fresh warm whole blood” and you’d have to do a little ‘splainin’😱. But you do need to know what your doing even as a community hospital path.

Impact of Incorporating Whole Blood into Hemorrhagic Shock Resuscitation: Analysis of 1,377 Consecutive Trauma Patients Receiving Emergency-Release Uncrossmatched Blood Products - PubMed

In patients experiencing hemorrhagic shock, WB transfusion is associated with both improved survival and decreased overall blood utilization.

pubmed.ncbi.nlm.nih.gov

Looks like it’s back!

 

[wholeheartedly]

Clinicians have very little understanding of transfusion outside ABO groups.

As a former bloodbanker, it was quite surprising just how true this is.

 

[mike-sheree]

Impact of Incorporating Whole Blood into Hemorrhagic Shock Resuscitation: Analysis of 1,377 Consecutive Trauma Patients Receiving Emergency-Release Uncrossmatched Blood Products - PubMed

In patients experiencing hemorrhagic shock, WB transfusion is associated with both improved survival and decreased overall blood utilization.

pubmed.ncbi.nlm.nih.gov

Looks like it’s back!

Things never change!🤪

 

[mike-sheree]

As a former bloodbanker, it was quite surprising just how true this is.

Hey, I remember apoplectic HEME/ONCS who were CERTAIN I was trying to kill their 80 y.o. grandpa by giving him Rh+ product when he is Rh-. Please tell me this has changed in the COMMUNITY setting.

 

[mike-sheree]

As a former bloodbanker, it was quite surprising just how true this is.

See how they look at you if you “slip-up” and say “ABH”🫥

 

[wholeheartedly]

Hey, I remember apoplectic HEME/ONCS who were CERTAIN I was trying to kill their 80 y.o. grandpa by giving him Rh+ product when he is Rh-. Please tell me this has changed in the COMMUNITY setting.

No idea on community. I was at tertiary shop bloodbank until 2011 or so. People still freaked when rh or group switching ppl. All sorts of weird calls. My favorites

”what do you mean my patient has a positive antibody screen? like he’s Rh positive?”

“what do you mean you have to do an antibody identification? can’t we just give O neg? (for very hemodynamically stable pt)

”can’t we just irradiate the unit to get rid of the antibodies?”

 

[mike-sheree]

No idea on community. I was at tertiary shop bloodbank until 2011 or so. People still freaked when rh or group switching ppl. All sorts of weird calls. My favorites

”what do you mean my patient has a positive antibody screen? like he’s Rh positive?”

“what do you mean you have to do an antibody identification? can’t we just give O neg? (for very hemodynamically stable pt)

”can’t we just irradiate the unit to get rid of the antibodies?”

Tell them the tritiated blood units have not been govt. approved. Give a big shrug and a sigh.

 

[HemeOncHopeful19]

Hey, I remember apoplectic HEME/ONCS who were CERTAIN I was trying to kill their 80 y.o. grandpa by giving him Rh+ product when he is Rh-. Please tell me this has changed in the COMMUNITY setting.

To be fair I (and I imagine most H/O docs) did zero rotations in blood bank / transfusion medicine in my fellowship. I’ve learned a fair bit of this stuff reviewing for boards but if I don’t use it for then next 10 years I’m sure it’ll be gone.

Then again if blood bank says it’s fine I usually just say “ok”

 

[wholeheartedly]

Interestingly, the folks who did their med school training outside of the U.S. seemed to actually know what I was talking about most of the time. I wondered if their was a difference in emphasis during training.

I don’t really expect most docs to have in depth knowledge of bloodbanking. Coming out of med school I would hope they understand ABO/Rh, that there are other antigens on red cells, that ppl can make antibodies to those and if that happens additional testing will need to be done to find compatible red cells, and transfusion compatibility for products. Finally, if you need help the bloodbank techs and pathologists can be a good resource if you have questions.

 

[ScubaV]

Tangential, but reminds me of this guy who did some teaching on our blood bank rotations. Loved going on long rants about whether and when whole blood is appropriate, how there's nothing "normal" about normal saline and things like that. I think he even alluded to some kind of monetary conspiracy around saline. Very interesting and very intelligent guy, but also a huge douchenozzle that seemed to get pleasure from making residents look dumb.

Had another guy who gave coagulation lectures, also very intelligent and interesting, but his "interesting" traits manifested as stream of consciousness, far-reaching tangents often related to people's names or backgrounds. But eventually he'd circle back around and return to rapid-fire quizzing people on their assessment of a patient's coag values. He was nice though, even if you got it wrong.