Blood and Cancer

This is a double post. One rant and one thing I'm actually happy about. Naturally we have to start with the rant.

There are a couple of floor nurses that are about to make me go apeshit. I work a third shift and my night starts at 10. Frequently we have units of blood that will expire at midnight. For years and years and years, as long as it was issued by midnight it was ok for use. The policy remains intact, yet a few nurses have taken it upon themselves to "educate" some of their patients. By educate I mean fill their heads with crap.

These Nurses are informing their patients that the units are going to expire at midnight and that the infusion will probably take longer than that. I don't know when we decided that a patient can pick and choose what unit of blood they want, but I guess these nurses have taken it upon themselves to allow this to be a decision. The expiration dates a largely arbitrary designed to mimic life cycles in vivo. There isn't a time bomb that's going to go off and make the blood suddenly useless or even less effective for that matter, it'll raise you're HCT and your HGB exactly the same way as a unit drawn 2 days ago.

It upsets me because it's a huge waste, at $400 a pop it's no small expense. It's tantamount to allowing a patient to refuse a medication because it expires that night. How ridiculous is that. All because a small group of nurses have decided unilaterally that these patients should be "educated."

We're a pretty large hospital. We have a contract with the local blood center to recieve short dated PRBC due to the high volume of infusions that we have. We're a last resort to make sure someone's donation is being used properly. I now have to deal with returning and destroying these units, and subsequently taking phone calls from Docs asking why it's taking so long to get Mr. so-and-so's blood transfused.

Anyway, The good news that you've all been waiting for.

Working third shift I don't get to stay in one department of the lab like other shifts do. It makes it much harder for me to become really good in any one area of the lab, yet I'm expected to be an expert for the night. Before I came to this hospital the only section I had ever worked in was the blood bank. about 2 years ago I cross trained in hematology. You remember basic stuff from school but it's hard to recognize and remember all kinds of crazy cells that you see from oncology patients.

We have one particular oncology patient that has been in our hospital for about the last year and in and out for the last 5. We save his slides for new employees and for students to look at, basically I've seen every abnormal cell you could possibly have in this patients blood. As I was saying earlier it's difficult to remain proficient in an area working there maybe once a week. During every morning run I do my best to pick this guys slide out of the pile and review it for myself to remind myself what some of these abnormal cells look like. You have to be the person driving yourself to become better at your job I keep up on my own continuing ed by doing things like this.

Yesterday morning I looked for his slide and couldn't find it. The first thing that came to my head, unfortunately, was that he had probably passed away, it's weird that I never new the guy but I felt like I did just because I saw his name so often and I kinda followed how he was doing.

I was doing a little investigating and found out that our system had autoverified his cbc. I asked for a redraw because I was sure it had to be a mislabeled specimin. I started to review his history and his slides had been more and more normal for the last month or so and it turns out it was the correct patient. So congrats Mr. Cancer. It's a big deal when a patient goes from 90% blasts to being within normal ranges so that an analyzer will autoverify your cbc. I'm really happy for this guy that I'll never know beyond a slide with a drop of his blood.