LIVING THE LAB LIFE
A BLOG FOR ASCLS REGION V
This morning, we kicked off the day with a moving performance by the Pillsbury House Theatre in Minneapolis. Their performance, “Breaking Ice,” focused on discrimination and inclusion, both in and out of the workplace, and how we can open ourselves up to crucial conversations to address these issues. The performance was very moving, as was the discussion that followed. For a small group breakout session, the performers asked us to participate in an ice breaker exercise where we would present ourselves to each other with phrases that start with “I am from.” This prompt led to very personal responses (most of the people at my table were in tears at the end of the exercise). When we are open and honest about who where are and where we come from, we can really open the door to addressing the social issues that permeate through our society.
So where are you from?
The first breakout session I attended featured a panel of presenters from all walks of the laboratory profession (Industry, Technical Consulting, Education, Lab Administration, Public Health). Each speaker detailed the career path they took to get to where they are today. This was a great presentation to have for a room full of students (Thursday is student day, with over eighty students in attendance). It is very exciting to see all the opportunities available to laboratory professionals who are dedicated to a lifetime of learning.
The second breakout session I attended, titles “Stroke Numbers Matter,” was given by stroke certified nurse practitioner Gail Wallace from Essentia Health. She gave a great summary of how stroke is treated; she stressed how critical it is to catch those early symptoms. Much of treatment for stroke depends on laboratory values, and the clock is ticking. Having fast turnaround times on essential laboratory results is essential for effective stroke care. When a patient first arrives in the emergency department, the first results needed are glucose, creatinine, and PT&PTT. The glucose level is important, as signs of hypoglycemia can mimic a stroke. A glucose level will likely be obtained by EMTs while on route to the hospital. A serum creatinine is needed to assess kidney function, as radiographic dyes can be nephrotoxic. Most hospitals that treat a lot of stroke patient will want to utilize a POC device to obtain a result at bedside. Coagulation testing is critical to have for stroke patients, as the clot-busting drug TPA is contraindicated in patients who are on Coumadin or other anti-coagulants. After the initial diagnosis, there are other values that will be needed to help determine the cause of the stroke. Hemoglobin A1C will be ordered to diagnose diabetes. A lipid profile will be used to assess whether the patient is a candidate for statin therapy. Hypercoagulation panels, which include more esoteric testing like anti-phospholipid antibodies, thrombin time, DRVVT, etc. may also be order to determine if the patient has an underlying coagulation problem that had not previously been diagnosed. If vasculitis is part of the differential diagnoses, then ESR, CRP, and ANCA testing may be indicated. The lab plays a big role in stroke care. It is always great to hear how we laboratorians contribute to patient care from other healthcare professionals.
Lunchtime was a bit of business, and a bit of fun. ASCLS-MN had our annual membership meeting. At this event, we said goodbye to our outgoing leadership team and hello to the leaders who have step up to the plate for the 2017-2018 year. Award were given out to the members of ASCLS who have made major contributions to the organization in the past year, at the state, regional, and national level. A special congratulation goes out to this year’s member of the year: Karen Renaud! Congratulations! You deserve it!
After lunch, Technical Writing was the topic of choice. Tanisha Sealey-Kessel, MBC, MLS(ASCP)CM, CPQA, a technical writer for Be the Match/National Marrow Donor Program, discussed the all the aspects of well-written technical documents. As laboratorians, we know how important these documents are; we refer to procedure manuals, job aids, quick guides, and package inserts daily to do our work. Ms. Sealey-Kessel’s talk focused on the seen critical aspects of technical writing:
My favorite part of the whole talk was the video she showed at the end that I include here for your viewing pleasure.
The last talk that I attended was given by Dr. Jim Stubbs, MD, Chair of Transfusion Medicine at Mayo Clinic. He presented a topic that triggered a knee-jerk reaction in every blood banker in the room: transfusing cold (1-6°C), non-agitated platelets. Dr. Stubbs’ team focused on the utility of use cold platelets (with no agitation) in actively bleeding patients. Cold platelets are far more practical for ambulatory care than room-temperature, agitated platelets, as they can be thrown in a cooler along with packed red blood cells and thawed plasma. A lot of research has shown that the aggregation, adhesion, and clot strength abilities of platelets is enhanced in cold platelets versus room temperature platelets (this was news to me). The problem is that cold platelets do no survive as long in vivo, thus the long-standing requirement that platelets be stored at room temperature. But when transfusing to trauma patients, that deceased survival time is less of an issue, as those patients do have competent bone marrow that can synthesis platelets once the patient is stable. Since achieving hemostatic control is so critical for trauma patients (the ideal is to achieve hemostatic control within six hours), it is desirable to start platelet transfusion ASAP. Cold platelets have a decreased risk of bacterial contamination, but unfortunately, they tend to clot up when stored in cryo-rich plasma. In the pilot project performed at Mayo, waste turned out to be the big deterrent. Many cold platelets expired before they were given (AABB/FDA mandated an expiration of three days rather than the typical five days) or clotted up in storage. Additional research has indicated that cold platelets are stable for as long as 14 days, so with extended expiration dates, this could prove to be a beneficial system. Overall, the talk was very interesting. As someone who hasn’t been in the field that long, it is exciting to see when the standard quo is challenged for the sake of better patient care.