By: Kaylin Viccellio
As Medical Laboratory Professionals, most of us are usually confined within the four walls of our labs, no windows connecting us to the outside world, and no face-to-face contact with patients during their time in our care. Sure, we may contact nurses for things such as hemolyzed samples and critical values, but beyond the crackle of phone connections our rapport with the rest of a patient’s healthcare team can feel nonexistent as if we have no interactive roll. However, we laboratory professionals are an integral part of the healthcare system and can make a difference in a patient’s outcome.
It is impossible for a single department or member of the healthcare team to know everything needed to diagnose and care for a patient. We all have our own specialties and realms of knowledge that allow us to analyze presented information from a unique perspective. That is why a collaborative work environment is necessary to produce the best outcomes.
I have had several experiences over my short time in the laboratory so far where my collaborative efforts with other members of the hospital system have provided a patient with a more positive outcome. The most recent of the experiences occurred in the blood bank where a patient with no history presented to the emergency room with an H&H of 3&11. With orders placed for units and the type and screen almost finished, I was at the ready to complete the crossmatch. However, the ping that came next from the ECHO showed the completed type and screen, revealing a dreaded positive antibody screen on this critical patient.
I quickly placed a call to the patient’s nurse to let them know about the positive antibody screen. I gave some estimates for the time it would take to identify the antibody, find antigen negative units, and complete compatibility testing. The nurse, poor thing, was brand new and had absolutely no idea what I was saying, gave me a very slow oookkk before hanging up. What happened after that sent me into patient care overdrive.
As the antibody panel was finishing, the house supervisor came into the laboratory. They wanted to know how much longer it was going to take to get blood for the patient, and insisted that if it was going to be more than a few minutes, then the doctor would just take O negative ones.
I wanted to yell and scream at this request, but I just took a deep breath and placed myself in the minds of the emergency room doctors and house supervisor.
Considering the size of my hospital, I know our ER doctors are not used to having any delay in getting blood to a patient. For them, when a trauma or emergency comes in they do normally “just get O negative blood,” but this was not a normal patient. It was up to me to make sure they understood what was happening and the possible dangers of a typical emergency release.
After five minutes of refusing to give out O negative blood, the antibody panel was completed. With a confirmed little-c antibody I was now able to convince the house supervisor that the circumstances of this patient differed greatly from our normal emergency release protocol. I explained the possibility of a hemolytic transfusion reaction and the possible repercussions to the patient should they transfuse units that have not been antigen typed for little-c.
The house supervisor still seemed a little apprehensive about what was happening so I gave further details of the next steps we would take to safely secure the patient's units. I pulled down our benchtop binder of package inserts to show the house supervisor exactly how the anti-sera test worked for the units, and described that for my coworker and I to test a large batch of units it would only take approximately ten minutes per batch.
After hearing my many pleas and thorough description of the process at hand, the house supervisor agreed to let us test the units as long as she could stay in the lab so units could be delivered to the ED immediately. Right outside the doors of our blood bank she stood while we tested nearly our entire inventory. Less than twenty minutes later we found three little-c negative units that the house supervisor could safely take to the patient.
Later that night the house supervisor came back to say thanks from themselves and the doctor. They wanted to thank the lab for taking the time to explain what was happening, and why a regular emergency release of O negative blood could have further harmed the patient since they were unaware of the potential complications
As Medical Laboratory Professionals we have the power to be the difference in a patient’s outcome, or even diagnosis. We build a healthcare team with many collaborating groups of doctors, nurses, pharmacists, radiologists, respiratory therapists, laboratory professionals, and more. Within this team we are playing a key role between the bedside treatments and numeric result interpretation. We may be the ones to suspect a case of mono in the patient with fatigue, to see the slide full of blasts on the patient presenting with petechiae, or to keep the patient with antibodies from having a transfusion reaction. Even if we are unseen and locked away inside our laboratory walls, with the extensive amount of knowledge we each have, we are undeniably a vital part of every patient’s healthcare team.