Transfusion medicine/ Blood Banking help

[gbwillner]

Hello Path folk,
I am starting an elective rotation in transfusion medicine (2 wks, followed by 2 wks of molecular path). I know the essence of what I will be doing, that is, type-matching people and doing complement times, etc.. However, I really have no idea what I will be doing ... what type of patient interaction I will have or what I will physically be doing. I'm sure phlobotomists will be drawing the blood, and probably technicians will be doing the actual experiments... So what the crap will I be doing on this rotation? I really can't find much info on this subject.

I would really appreciate some feedback so I don't look like a complete tool on my first day. Partial tool would be acceptable.

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[yaah]

I anticipate it will be very low stress and you will have no real responsibilities. And they will explain everything to you. To prepare I would read about basic blood issues like ABO, RH typing, etc. You can use most standard texts to get the basics on this. If you know this it will probably put you ahead of the game. Patient interaction varies so much from place to place (usually there is minimal except in the pheresis unit which may or may not be part of what you do) that it is almost not worth mentioning. I expect you will be doing a lot of reading and possibly be given problems to work on (antibody problems, etc).

 

[gbwillner]

I anticipate it will be very low stress and you will have no real responsibilities. And they will explain everything to you. To prepare I would read about basic blood issues like ABO, RH typing, etc. You can use most standard texts to get the basics on this. If you know this it will probably put you ahead of the game. Patient interaction varies so much from place to place (usually there is minimal except in the pheresis unit which may or may not be part of what you do) that it is almost not worth mentioning. I expect you will be doing a lot of reading and possibly be given problems to work on (antibody problems, etc).

Thanks. Can you recommend any sources for study?

 

[EUA]

AABB Technical Manual is the Bible of blood banking, even though it is tedious as all hell.

The Compendium has a nice concise BB section.

Patient interaction? I go talk to them when they've had a transfusion reaction, because what the nurse writes on the form and what the patient actually experienced are often two distinct realities. On the other hand, experiences nurses can be an excellent resource when working up reactions.

 

[gbwillner]

AABB Technical Manual is the Bible of blood banking, even though it is tedious as all hell.

The Compendium has a nice concise BB section.

Patient interaction? I go talk to them when they've had a transfusion reaction, because what the nurse writes on the form and what the patient actually experienced are often two distinct realities. On the other hand, experiences nurses can be an excellent resource when working up reactions.

Thanks!

 

[djmd]

The blood bank guy is not bad.

http://www.bbguy.org/

 

[gbwillner]

The blood bank guy is not bad.

http://www.bbguy.org/

Thanks, that looks like the pefect place to start!

 

[Anna Plastic]

Man, two weeks. This is why I hate most rotations in transfusion medicine in pathology residencies--they are too short, and not designed well to try and teach what you need to know. If they haven't arranged a good rotation schedule for you, take charge of your education and go seek out learning opportunities.

Compatibility testing is only a small part of transfusion medicine, and you can get the board-passing basics of that in a couple days. I agree with EUA in going to review all transfusion reactions in person. Get vitals, review the medical history and medications, check start and stop times, and times of reactions, talk to the patient, etc.

If your hospital has any kind of emergency/massive transfusion protocol, I recommend getting involved with one of those as it goes down. Go into the OR or to the bedside to see what the clinicians are talking about with oozing/microvascular bleeding. Keep an eye on blood gases and coag values/crit as it progresses.

Does your place have any stem cell transplant patients? These patients are particularly good to round on with the hematology team to see issues of platelet transfusions and potential ABO mismatched transplant transfusion management.

Another good learning opportunity is to follow the coagulation consult team in your hospital--often these folks are called in to consult on patients pre-op or pre-procedure and who need to be managed with blood products.

As a segue into your molecular path rotation, if you have any kind of HLA lab there I would highly recommend visiting them and finding out what they do. I can think of at least two questions on CP boards last year that asked about HLA testing and transplantation. This will also be useful if they help out with patients who are platelet refractory.

If you get a chance, sit in on some of the transfusion management hospital committees. This way you can see surgery/anesthesiology/nursing takes on transfusion issues, and see how the blood bank fits into the medical care system as a whole.

As an FYI, there were just as many patient management questions I saw on CP boards this year as there were with laboratory/immunohematology questions. This included very picky questions reviewing vitals and clinical diagnoses and picking the transfusion therapy course. I think these questions more accurately reflect what you will be dealing with in practice, so I suggest getting up to speed during training.

So many of my colleagues who in residency viewed their blood banking rotations as a chance to catch up on autopsy reports or World of Warcraft are kicking themselves at the lost training opportunity--don't be like them. Two weeks....jeez, that is no time. Don't sit on your ass reading--total waste of your time. Read at night, and take advantage of being a resident during the day. Having few responsibilities frees you to be a highly absorbent information sponge--you will most likely distinguish yourself from your book reading peers by your initiative to involve yourself clinically.

And I agree with everyone on Blood Bank guy--his notes have pretty much all you need to know to pass CP boards. But to help you be a practicing pathologist, you gotta go see stuff in person.

 

[Gene_]

Man, two weeks. This is why I hate most rotations in transfusion medicine in pathology residencies--they are too short, and not designed well to try and teach what you need to know.

This person is probably a medical student. Otherwise, he would have asked fellow residents what he would be doing.

 

[DrBloodmoney]

I really like the AABB book by Marian Petrides. Practical Guide to Transfusion Medicine.

 

[Anna Plastic]

This person is probably a medical student. Otherwise, he would have asked fellow residents what he would be doing.

Yeah, actually, you're probably right now that I re-read this--sorry for the misfire there.

I still hold that many transfusion rotations in residency are poorly organized, and that residents are far too passive during the rotations, and that this reflects a passivity for transfusion medicine by pathologists as a whole.

This may not be of concern for a lot of folks, but there are rumblings about taking blood banking out of the hands of pathologists because of their general clinical cluelessness. To quote from an article in the AABB 2005 Think Tank ( E. Hathaway, Transfusion, Oct 2006, 45:172S ) volume of Transfusion:

"Proposal 2: move the practice of transfusion medicine from pathology to specialties that deal with clinical practice and patient care
The study of pathology is the study of the nature, course, and etiology of a disease.1 A specialty that is so clinically based as transfusion medicine may be better served if moved into a clinical arena.

Changing the directorship of the specialty of transfusion medicine from pathology to a clinical specialty such as hematology and/or oncology would be a paradigm change for most facilities. The Clinical Laboratory Improvement Act of 2003 only requires that the medical director be an MD and be qualified to be the technical supervisor under 42 C.F.R Subpart M, Section 493.1449(q) or 42 C.F.R. Subpart M, Section 493.1443(b).

Medical directors involved with direct patient care have an appreciation for the patient's condition and the appropriateness of care. The cognizance of risk in the management of medical product use would be better understood by a practicing clinician versus a pathologist, whose diagnostic clinical skills are not used on a daily basis.

This movement away from pathology promotes a model for creating a transfusion team composed of clinicians, SBBs, and other allied health professionals. This team makes recommendations for patient care, thereby improving communication between support services, promoting better utilization of blood products, and drawing on each other's academic knowledge and expertise in transfusion medicine....

...We need to rethink the roles of our traditional experts and seek avenues to incorporate expertise from clinicians who are actively involved in care plans for our patients. The issue of physician competency surfaces with this proposed paradigm shift. The existing adage of "give the doctor what he wants; he knows his patient better than I do" is a statement repeated many times by medical directors in smaller transfusion services who never see a patient. This statement should be evidence enough of the consideration for change in dogma."

Pathology is being chipped away from a lot of sources; LADoc has already spoken widely on pod labs and other topics. This is another area which pathologist could easily lose their role, mostly from a lack of interest and a false sense of security that we will forever rule the roost.

So while my first rant is possibly misdirected at a medical student, I hope residents out there take it to heart--work on your clinical skills during your blood bank rotations.

 

[sequela]

i just don't know what bc hematologist/oncologist is then going to do a second fellowship in transfusion med. that's a lot of post-grad training.

to make it a clinical specialty, it would have to be a subspecialty of IM or something. i suppose it would work though...by the end of thier im training, some subset of people will want out of full-blown patient care. but again, the "lab med" aspect may not appeal to the majority of im people. most people in medicine have zero desire to be in a lab setting, regardless of how much they want out of daily patient care. my point is that i think it would be one of these fellowships that was begging to be filled.

i don't think the "change in dogma" would be an easy transition. at all.

nevertheless, your point is very well taken. we need to take back the profession.

 

[gbwillner]

This person is probably a medical student. Otherwise, he would have asked fellow residents what he would be doing.

Yup, I'm a medical student (or I will be one on Monday)- compound that with the fact that I haven't seen a patient in 5 years... and you'll see why I'm so clueless right now.

Thanks to all for the advice- I'm already catching up on this stuff, most of which was lost somewhere in my brain long before my PhD....
G

 

[gbwillner]

The blood bank guy is not bad.

http://www.bbguy.org/

Just wanted to say thanks again- I just started today and the first thing that happend was I got sat down and pimped like mad. That web site saved my arse. Literally the first thing the Pathologist said to me was, "what's DIC and what causes it?"