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Stories from the lab: Snow storms and broken hips

I was the youngest lab tech at my first job in a lab. I was 21, single, and always looking to get some extra cash by working overtime. So it was without hesitation that I volunteered to stay at the hospital when a snow storm came in overnight and the morning techs were either running late or would not be able to come in at all. I had been working all night, but it wasn’t like it was a very busy place. Back then, it was actually a pretty comfortable job. I was able to do most of my coursework for my MPH while working overnights there, in fact.

The morning of the snowstorm, I went upstairs to collect blood from the dozen, or so, patients that needed blood work done before the doctors came in for morning rounds. I wasn’t in too much of a rush because I knew that the doctors would probably take their time before coming in on such a miserable morning. So I took about an hour to draw all those people and walked back down to the lab. As I was crossing the patient waiting room, I noticed an old man sitting on a chair. He was holding a pink piece of paper which I immediately recognized as a lab order.

I had seen the snow outside. It was a good foot-and-a-half. So I wondered how this old man had gotten there. I was also wondering what he was thinking coming in for blood work in the middle of the storm. I walked over to him and asked if I could help him. He handed me his lab order and told me that he had a doctor’s appointment in two days. “I need this lab test done before then,” he said. The order, written a month before, was for coagulation times, tests done when a patient is on blood thinners.

To recap, he was there during a storm, and he was there to get blood work at the last minute when he could have gotten it any time in the last month. Sure, I’m guilty of leaving things last minute, but I don’t usually risk life or limb to get something done. Then again, he didn’t exactly risk a lot. He told me that his son worked for the township and had a plow truck. That’s how he got there in the middle of the storm, at 6am in the morning. And so, I took his blood and sent him on his way. He said he was going to have a smoke outside while his son got there to pick him up.

A half an hour later, I got a call from the emergency department. It was the head nurse, and she told me to come down with two units of O Positive blood. I grabbed the blood, the forms that had to be signed by the physician before handing it over, and I ran down the hallway to the emergency department. Once there, I found out that the old man had slipped and fallen on the ice outside while waiting for his son to get there. The old man broke his hip and was bleeding internally. The physician in charge wanted to transfuse him as soon as possible.

We hit a little bit of a snag because the nurse taking care of the old man did not want to give the O Positive blood. She said it would kill him. The doctor and I looked at each other and shook our heads. The doctor took the blood and started to set it up himself. The nurse said she wasn’t going to risk her license by giving someone blood that was not O Negative.

Let’s digress a second and get a quick blood banking lesson. You and I have one of several types of blood. The usual A, B, O type refers to little bits of sugar/protein/fat on the surface of our cells. If you have one type, you’re blood type A. If you have another type, you are blood type B. If you have neither, you’re blood type O. Then, circulating in your blood plasma (the liquid part of your blood that is not cells), you have antibodies against the blood type that you are not. So if you’re an A, you have antibodies against B. If you’re a B, you have antibodies against B. And, if you’re an O, you have antibodies against both A and B. Why we develop these antibodies without being exposed to the opposite blood type is still a little bit of a mystery. (At least it was the last time I checked. Maybe I’ll check again later.)

The “positive/negative” part of the blood type is a whole other thing. In that case, you either have or don’t have the “Rh factor” (named after Rhesus monkeys) on your cells. If you do, you’re a type A/B/O positive. If you don’t, you’re negative. Unlike the ABO system, you don’t have the opposite antibodies for Rh in your blood. If you’re negative, you will not make anti-Rh antibodies until you are exposed to Rh-positive blood. If you’re Rh-positive, you won’t make those antibodies at all. This Rh factor is important for pregnant women who are Rh-negative because Rh is dominant. If the father of the child is Rh-positive, the child has very good odds of being positive and exposing the mom to the Rh factor. The mom then makes antibodies that can cross the placental barrier and attack the blood cells of the unborn fetus. (Anti-A/B antibodies can also do the same, by the way. Mothers who are A can deliver a child with problems if the child is type B, and vice-versa.)

The reason why you give O Negative blood in emergencies is because you don’t want the person to develop anti-Rh antibodies if they’re Rh Negative. If they do develop those antibodies, they might have problems if they get pregnant. In the case I’m talking about, we were dealing with a man (not likely to get pregnant) who was in his 70s, thus not likely to be getting Rh-positive blood in the future. And he was getting O Positive only because the physician knew the importance of keeping O Negative around for emergencies having to do with younger women or children, people who would have a problem if they had anti-Rh antibodies for whatever reason and would react badly if we gave them Rh Positive blood. Was there a chance that the old man had anti-Rh antibodies? Yes, but it was minimal.

As it turns out, his blood type was Rh Positive, so all the drama that the nurse raised was a moot point. The old man ended up having emergency surgery for his injuries. He required more blood, but I had enough time to get his blood type and crossmatch blood for him. He ended up being the headache of the day because of the amount of time consumed in getting blood ready for someone. Trust me, you want your blood banker to be focused on you and only you when getting blood ready. You can die from a bad transfusion within seconds, and it’s not like we can take out the incompatible blood that went in.

The reason why I’m telling you this cautionary tale is because we, including myself, have become very complacent when it comes to our health. We treat medical appointments and visits to get our blood taken for lab tests as a nuisance, a chore that needs to be done but one that we can put off until later. And then, like the old man, it can all go badly if we leave it until the last minute. So don’t. Go get your blood work as soon as your doctor orders it. That way, if something is amiss, he or she can contact you and treat you. As it turns out, the old man bled a lot because his blood clotting times were elevated. I’m not his physician, so I don’t know if they were in target range, but they didn’t help when he broke all that stuff on the inside when falling on the ice.

The other point to this is that there are men and women buried deep within the soft underbelly of the beast that can be a hospital doing a lot of great work for your health. They’re the lab techs and their support staff who make sure that your healthcare provider gets all the information they need to treat you better. So don’t be one of those people who shows up last minute, demands that the test be done immediately, and that the results be called to the provider at an ungodly hour.

And if you’re a healthcare provider, chill out about the lab work, will you? It will get done. I assure you that the blood is not sitting on a table, waiting to be analyzed. We’re probably doing other stuff, like blood banking or reading slides of blood from children with cancer. Important stuff. So please take a deep breath and treat the patient, not the lab result.

Thank you for your time.

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René F. Najera, DrPH

I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
About Epidemiological: I am the sole contributor to Epidemiological, my personal blog to discuss all sorts of issues. It also has an About page you should check out.

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