FAQs
Answers to Recent Blood Bank Guy Emails
Below are actual emails that I have received via the contact page here at BBguy.org. I try to answer these with fairly brief responses, deliberately not including all possible details.
Names and specific hospitals have been removed for confidentiality purposes, and some questions have been edited for clarity and brevity.
Future Practice
I was wondering--since you said you practice a mix of AP and CP, if you knew what the job market was like for an AP/CP person with a TM Fellowship? I am seriously considering going CP only, my thought being that I really would like to do majority blood bank and lab stuff. If I had a AP/CP job, I would prefer it be something like 10% AP and 90% CP. Do these jobs exist? In your experience, what kind of "proportions" do private practice jobs typically have for AP/CP blood bankers?
As you noted, I am indeed both an anatomic and clinical pathologist, with subspecialty boards in blood banking/transfusion medicine. I have thought about this a lot, and I think that it is indisputable that the job market for someone with AP AND CP is FAR better in the private sector than for someone who is CP only. Most private groups are all about multitasking, and it is uncommon (except in very large groups) to find a situation where someone would be excited about hiring someone who only can do CP. Simply, AP pays the bills and is the biggest contributor of revenue to most private pathology practices. Many of those practices would be really interested in someone who could help them with signing out cases while taking care of the blood bank (or micro or chemistry or whatever), but I think that in most cases, their interest would really wane if the CP stuff was ALL that you could contribute. Now, to be fair, that is not always true, but I would imagine that the market for CP only pathologists would mostly be limited to larger, multi-specialty practices and academia (the obvious exception is work in blood centers for a transfusion medicine physician, but you expressed interest in something other than that!). My personal practice in Colorado at a ten person community pathology practice (spanning four hospitals) is that I spend 60-70% of my time on AP most weeks, and fit blood banking into the remaining cracks of time. That is my personal experience, but I believe that it is pretty standard. My best advice to you is simply this: Do what you like to do! Struggling through stuff that you don't like and don't feel like you have a talent for is no way to live, in my opinion.
Great Story!
"Just wanted to share an amusing call story that happened to one of my fellow residents. You've probably fielded a question like this already, but I found it amusing. We got a page from an intern (in July) asking for FFP. And in all seriousness, she asked 'Now, do you thaw it before you infuse the patient?' It is to my fellow resident's credit that she calmly assured the intern that we try not to infuse solid blocks of plasma."
This wasn't really a question, obviously, but it made me laugh, so I thought I would share it! It does bring up a larger issue, though, which is the mostly sad state of medical school education on blood banking and transfusion. We need to do a better job of teaching med students the basics of transfusion, because this kind of a story is, sadly, not that uncommon.
Irradiation for Septic Shock Prevention?
"Great site! I actually have a question regarding a patient with multiple myeloma who just recently went into septic shock after the last 2 blood transfusions within 2 weeks and wound up in the ICU on a ventilator. Would irradiating the blood have possibly avoided this? We're also looking to see how to prevent this going forward, if irradiated blood is not the answer."
The short answer is this: Irradiation will NOT prevent septic reactions in any way, shape, or form. Irradiation is really only used for one purpose and that is to prevent transfusion-associated graft vs host disease in significantly immunosuppressed patients (and a few others). If the sepsis truly came from the blood product (which is certainly possible), then the news is actually good. What I mean is that a contaminated unit of blood is rare, and the odds of it happening again are pretty darn slim. What I hope happened was that you guys were able to prove one way or another that the sepsis did or did not result directly from the transfusion. The way to do that is to culture the same bug from the patient and the blood product, and if possible, the donor. That takes some work, but it is worth the effort. You should also always consider the possibility that the sepsis came from another source.
Where's My Pathologist?
"Hey Blood Bank Guy, I am a Medical Technologist and am wondering how much exposure you have to your staff? I rarely see a Pathologist or even a technical specialist. I also want to know how managing inventory and product waste is handled in your lab. We waste a lot of products here. In the last week I have thrown out 7 platelets, yes, 7! I have thrown out O negative blood here before. I think that the BB has a civic duty to the people who donate blood (ME!) to not waste their products."
The frustrations you are expressing are common ones, unfortunately. I think that, especially in smaller hospitals, finding a pathologist who is really interested in blood banking is difficult to do. Sometimes, in those settings, communicating your frustrations with the medical staff at your blood supplier's office can help. Many of the blood bank docs who work in places like that really enjoy coming out and helping smaller places with their inventory management issues, and, if you have really pitched 7 units of platelets (I hope those are not 7 units of apheresis platelets!) in the last week, it sounds like some help could be in order. Obviously, I don't know your setting and I don't know your situation, but that's where I would start.