30 Minutes or Less

How many people have heard of the 30 minute rule for units of returned blood? If you haven’t there is folklore that says once a unit of blood leaves the blood bank it is ok to return it to inventory if they get it back before 30 minutes are up. We even have a place on the documentation that accompanies the unit of blood to write down the time that we can accept a return. It was recommended to us that we get an infrared temperature meter so we could actually take the temperature of units when they are returned. One day I decided to play with my new toy and figure out how long a unit could really be out and still be ok to return. Our policy states a unit can be returned if the temperature is 10 degrees Celsius or colder.

I split my little experiment into two parts. Using an expired unit of blood, I left the unit on the counter and took the temperature every minute for 30 minutes. For the second part, I held an expired unit in my hand (simulating a nurse or transporter carrying the unit) and took the temperature every 2 minutes. In the first experiment the unit of blood reached 10°C in 19 minutes; at 30 minutes I recorded a temperature of 14°C. As expected, holding a unit in my hand sped up the rise in temperature; it took 12 minutes for the unit to reach 10°C. After 30 minutes the same unit was 17°C.  In both experiments I mixed the blood before rolling the unit of blood around the thermometer.

This very informal experiment confirmed my suspicion that the temperature of a unit of blood is environment dependent. Put the unit in a warm room and it will warm up faster than if it were in a cold room. When we dispense units we place the unit in a thin plastic bag; the plastic on the blood units themselves is thin as well. There is no insulation from the unit and our warm hands.

So what do you do with this information? If you have a policy or use the 30 minute rule, I recommend suspending it immediately. There is no way of knowing what happens to that blood once it leaves your blood bank. If you do not have an infrared temperature meter, put it on the capital wish list for 2014. They will save you from taking back blood that is not safe and it will put a finite cut off point for taking units back. Once we started using the meter we found that the majority of blood that comes back is not suitable for reissue and ends up being disposed. While we do waste blood, I feel much better knowing that the blood that we do take back is suitable for transfusion and is ultimately better for the patient.

It is performing little experiments like the one outlines above that keeps us all interested in the laboratory field. What other career can you have a question about something, know how to figure out an experiment to find the answer, and then carry it out to see if you were right or not?  Now the real question I have is: when I order the pizza for lab week what are the chances it gets here in 30 minutes or less?

TommyTransfusion

Tommy Transfusion is the pseudonym of a blood bank supervisor in the midwest.

Another Passport Story, Part 2—A Bit of Horsing Around

In my last blog, I left off telling you about my lovely visit “on horseback” in the Kyrgyzstan mountains outside of Bishkek.  I had taken off with a guide, marshaling my skills to stay in the saddle on a scrawny but feisty equine.  As we traveled up the dirt road-trail, it was evident that my mountain pony was full of energy and a handful.  We trotted and danced a bit, and I was using my best skills staying in the saddle.  We were passed by a couple of cars racing up the dirt road and leaving a cloud of dust which didn’t help my nervous horse, and my guide kept a close eye on me.  After a short ride into the hills he had me weave my way up a side trail so he could take my picture with the rocks and mountains in the background.  As he was fiddling with my camera, a car came racing back down the dirt road and stopped just behind him, shouting out the car window.  He looked at them, at me, back at them, and then shouted something to me in Kyrgyz, pointing and gesturing.  I didn’t understand, so he raced his horse up the hill and shouted “Passport? Passport?”  I said yes, I had it in my pocket, and pointed.  “Show, show!” he said, and when I dug for it, the money was there but the passport was gone.  During the horse-dancing and prancing, it had apparently worked its way out of my pocket and fallen by the side of the road.  We looked back toward the car and the driver was waving a very familiar-looking little blue book out the car window and sporting a very mocking grin.

You can imagine that my rapidly increasing unease translated directly to my horse and he started a bouncing act amid trees and rocks, and dangerously close to a downhill cliff behind me.  It was nearly impossible to get off without killing myself—but get off I did, handed the reins to my guide and ran downhill toward the car.  The driver and his two passengers looked to be about college age, laughing and saying “road, road” and in gestures we communicated they had found it, showed me the picture and said “you!”.  Now, since passport pictures are like driver’s license pictures, and I was shaggy and windblown, any reasonable passport control agent would have looked twice for verification…but it was indeed me.   What they wanted was money and had they given it back I would have given them all I had, and gratefully.  But the young man holding it did not offer it back, and raced the car engine.  I was a bit angry and said rather forcefully “that is mine, you give it back!” I reached into the car and grabbed it from him, amid more laughter and a bit of harassment from his passengers that now he’d lost it and “no money!”  By then my guide was standing behind me and the two of us were more of a menace than they were interested in, so they laughed and raced on down the road.  Whew.  After a few deep breaths, my guide looked at me with a very serious scowl and said “put passport HERE!” and demonstrated by shoving his fingers down the front of his shirt. I immediately followed directions and we trotted on back.  My ASCP colleagues were waiting for me as we jogged back up the driveway at the resort and I quickly borrowed another $20 bill, tipped my guide heavily and thanked my lucky stars that:1) the passport didn’t fall out of my pocket into the river;  2) the kids in the car were more interested in a little fun money than fencing it and; 3) the driver had slow reflexes.  Later that evening over a much-needed glass of wine, I reflected I had probably used up a couple of my “nine lives” on that adventure!

So if you are ever in the mountains outside of Bishkek, Kyrgyzstan and want to go horseback riding, I have a wonderful guide and a rather skinny Cossack pony I can recommend, just contact me at bsumwalt@pacbell.net. However, I would advise putting your passport close to your body somewhere OTHER than your jeans hip pocket!

 

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Why I Love Microbiology

I’ve been off the bench for almost a year, and while I don’t miss clocking in at 7:00 am or shoveling my driveway at 5 in the morning so I can get to work, I do miss actually working in a microbiology lab. Here are a few reasons why.

1. Making something out of nothing. For me, growing microorganisms on an agar plate is the closest thing to magic a laboratory scientist can do. Today, the plate is sterile; tomorrow, teeming with bacteria!

2. Learning more about a patient’s personal habits than you wanted to. Gram negative bacteria in a throat culture, oral flora in a necrotic toe, a forty-something with a UTI caused by S. saprophyticus or isolating Pasturella canis from a buttock incision site. Microbiologists know everyone’s dirty little secrets.

3. The technologist becomes the patient. When my husband and I adopted kittens, I immediately broke out in an itchy, scaly rash. Of course I performed a calcofluor white stain on a skin scraping that … just happened … to find itself on a glass slide. Diagnosing my own ringworm infection was equal parts exciting and dismaying. And since some of my flaky skin also made its way to an agar plate, we had a great fungus for our students.  (For the record, we identified Mycosporum gypsem.)

4. Finding the occasional zebra. I’ll never forget the feeling the first time I recovered Malessezia furfur or the day I found an H2S-producing E. coli.

5. Learning something new everyday. Whether it was a new process at the bench, a new organism I hadn’t seen before, or attending an infectious disease lecture given by a resident, I was constantly learning about the exciting world of bacteria.

And last, but certainly not least:

6. Using my unique skill set to make a difference in patient’s lives every day.

What are some of the reasons you love your job?

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Engage Yourself to Transform Our Profession

It’s never too early to be an engaged pathologist-in-training. This means that we must understand our past and have a strong vision of the future we hope to shape. We must evaluate the forces that have influenced the role and perception of our profession within society, what we did or didn’t do in the past that has led us to our current status, and not only what things we would like to change but also to what do we want to change them.

Since I have an advocacy and organizing background, I may look at our profession a little differently than other residents. First, we are a small profession. The majority of medical students do not choose to become pathologists. But I believe that may be due to at least in part, to a lack of commitment to nurture our pipeline. There is no national medical student organization for those who are interested in learning more about pathology as a profession, and often the little exposure that medical students do get is not an accurate representation of what they would do during residency and ultimately, in the working world.

It’s never too early to be an engaged pathologist-in-training. This means that we must understand our past and have a strong vision of the future we hope to shape.

Secondly, we are still more discohesive (and I’m not talking about a lymphoma here) than we should be as a profession. This may partly be due to the diverse nature of our profession where AP and CP are all considered pathology. In many Asian or European countries, pathology residents must choose one track or the other; they, more times than not, do not have the option for combined AP/CP. So does this confuse or hurt us to educate our future pathologists in this manner where allegiances are often diluted? I say no, not directly. But since we do have so many subspecialties, and consequently, subspecialty organizations, many residents and pathologists who are limited in terms of time and energy have to choose and prioritize which organization to devote their efforts. Even though we have ASCP and CAP as more all-encompassing organizations, we could still have stronger solidarity and more frequent interactions between these groups.

Thirdly, from my n=1 (level 3 evidence which isn’t always worth much), most residents and attendings I see have very little interest or experience in political advocacy even though this may be the greatest avenue we have for palpable change. I have seen some committed to curricular reform. I have also seen some who promote the profession by serving on hospital and program committees as well as leadership in state and national societies. But what I don’t see much of are those who keep track of what is going on in DC and within society that affects our profession and who attempt to do something to change what they perceive as negative. We need to change our culture and encourage and train our residents to get involved early in such activities.

And last, but not least, we need to own our value as physicians. We must not allow anyone to treat as us less than a physician from another specialty. And practice makes perfect–we as residents should start early by serving on organizational committees, etc. I will be doing my part this weekend serving on the CAP Council on Education (COE). I’ll let you know how that goes.

As an aside, creating an organization to educate medical students about pathology is a pet project of mine. If you’re interested in helping to start such an organization where we can also serve as mentors to pathology residents-to-be, please feel free to email me at bchung73@uic.edu.

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

Classified

“I retweeted an Instagram picture someone posted on their Facebook page that shows how to place blood tubes in a centrifuge. There is also a vine of it on their LinkedIn profile.” Confused yet? I’m a millennial, more commonly known as generation Y, and if there is a social network out there people my age are either on it or bored with it already. The question that keeps coming up is where do the social networks fit in to professional life? Perhaps the bigger question is can you be yourself while maintaining a professional persona? Most large organizations have social media policies that prohibit their employees from speaking badly about them on social media sites. Some policies also allow a company to terminate someone if the person lists them as their employer and does or posts something that the employer feels isn’t up to their standards.

The reality is if you are on these sites and you list your employer you must be careful. If people ask my advice on social media I usually tell them to stay as ghosts, and don’t list your employer. In my personal situation I don’t even have my real last name on my Facebook account plus it is private and even if you knew what my name was you couldn’t search it. Now, I really have nothing to hide seeing as I have over 1000 friends on my Facebook account but I not only want to control what goes out but more importantly who sees it. My feelings are, keep your personal life personal and your professional life exactly that.

Some may find it surprising that a young person isn’t posting every aspect of their life but I just feel that my organization doesn’t need to know what I have for dinner after I leave for the day. It is really each individual’s choice on what they want to follow or add but it just seems to me that it is a little to easy to become emotional about something and next thing you know it’s out there for all to see. It is pretty much a daily occurrence that some celebrity has to apologize for something that is taken out of context and the same goes for everyone else. When you tweet out that you can’t stand your boss, smiley face; you may not be around to explain the sarcastic nature of the post.

As a supervisor, I would never recommend being friends with people you lead unless you understand and realize that everything you post will be fair game in the workplace. I think a lot of people either forget that or simply don’t understand the significance of social media until it’s too late. Just because something happens outside of the organization, if one of your coworkers sees it you can bet that it will find its way back to the workplace. This is the personal aspect of social media and if your organization requires you to have a public account as a leader to be available for comment and questions nothing says you can’t have two accounts. Have a public profile and a personal one that you can set to private. When people ask me at work if I have any social media accounts I just tell them that information is classified.

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.

 

Another Passport Story, Part 1–A Bit of Horsing Around

On a recent trip to Kyrgyzstan, I had a wonderful time with an interactive training for laboratory pre-analytical procedures and specimen transport with key laboratory leaders. Our sessions were designed to give them a full picture of the challenges and opportunities ahead as they build stronger laboratory systems. The two week stay started with arrival in Bishkek, the capital city, on Easter Sunday morning. (Actually, it was the middle of the night!) It was still dark when we checked into the hotel and we took hot coffee to the hotel rooftop for an “Easter Sunrise”. I cherish sunrises all over the world, and taking a solitary moment to watch the sun move slowly through the haze over the distant mountains and bring the city to life was very special.

Sessions covered two weeks and in between we had a weekend to explore and see a bit of Kyrgyzstan. It was suggested we take an overnight into the mountains, which were covered in snow even in late spring, to enjoy their favorite “resort and spa.” A little relaxation and sightseeing in the mountains sounded excellent….we headed off with our ever-protective and accommodating driver.

One of the treats offered at the resort was a horseback ride along the dirt road into the mountains. Some of you may know I have horses and love to ride, so this was a natural attraction and I immediately signed up for a ride and a guide. They showed up with three of the tallest, skinniest, poorly-tacked horses I think I’ve ever seen and I secretly wondered how these ponies ever survived the tundra temperatures! But the ever tough “Cossack horses” are suited for it and much faster and well-adapted than our overly-coddled pleasure horses, so I quit frowning and clambered on. My mount was too tall and had a cock-eyed saddle, and I’m certain he could feel a bit of nervous body language. Riding takes your full attention and I wanted free use of both hands, and also a safe place for identification and tip money. So I put my passport, tip money, and the hotel phone number and cell phone in my jeans pockets. Safety first! However, this turned out to not be as safe as I thought …

Next time….the rest of the story!

 

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.