Session 99 Today, Dr. Aaron Shmookler joins us who has an interestingly different type of specialty. He is a pathologist trained Blood Banking & Transfusion Medicine specialist. A year and a half out of training now, he serves in an academic setting in West Virginia. Thank you for listening to us! Please check out all our other available resources on Meded Media. [01:48] Interest in Blood Banking and Transfusion Medicine Aaron took a transitional year and started his residency in Neurology. But he realized something was missing – the lab. He went into pathology really enjoying the field. Then he finished his Pathology residency and quickly realized he also missed taking care of patients on the bedside. So he subspecialized in Transfusion Medicine and Blood Banking that has the bedside aspect of care. Then he also gets to do the laboratory side where he works behind the scenes. [04:14] Traits that Lead to Being a Good Blood Banking & Transfusion Medicine Specialist In this specialty, you have to be detail-oriented, very specific, and concise. This is generally true in the field of pathology as well. What got him initially interested in Neurology was when he began caring for patients with Alzheimer's disease. Specifically, he was interested in localizing lesions. [06:35] Types of Patients At the bedside, they perform a procedure called apheresis. He describes it as an "oil change" to patients. So if you have a patient with sickle cell disease, they can be chronically dependent on blood transfusions. One of the ways they can be treated is by exchanging their abnormal red cells and transfusing them with normal red cells. The procedure can take a couple of hours. When the problem is with the patient's plasma, they'd also take out the plasma and given them back new plasma. Nevertheless, there's a whole slew of guidelines put out by the American Society for Apheresis. This would give you an idea of the kinds of conditions they would be treating and see what kinds of patients they encounter. Aaron is also in charge of all the blood products dispensed in their hospital. This refers to whoever who needs blood such as emergency patients who come in with trauma or surgical patients in the OR. They also give blood to obstetric patients, basically, anyone who needs a blood product. [08:55] The Role of a Physician in a Blood Bank As someone in charge of the blood bank, a physician makes sure that all blood products that come out are going to be compatible with the patient who is going to receive the blood product. One of the ways to do this is to make sure patients haven't developed any antibodies to some of the antigens in red cells. If they have, he makes sure he's able to find units of blood that would be negative for those antibodies. Sometimes, they might not be able to work up with the patient's antigen status. As a result, they may need to release blood emergently. In this case, they caution physicians who require that blood that they haven't really completed all the testing they need to do to find the best-matched blood for that. An example of this would be cases of patients bleeding significantly and they can't wait for any testing and they'd have to transfuse something. They're able to provide special blood for this, but they can't guarantee this wouldn't cause an adverse effect. So they have to be mindful of these particular conditions. They also manage factors. Factor VIII, for instance, is used to treat patients with hemophilia. They also make sure the doses are appropriate. [11:35] Typical Day, Procedures, & Taking Calls For Aaron, a typical day would be coming to work and following up on any patients that may have come in at night that required a significant amount of blood. Aaron also takes some time to teach residents and conduct research. Part of his training includes clinical pathology. In terms of procedures, Aaron does apheresis. This involves the help of a nurse to run an apheresis machine and he oversees all of it as i