Physician Decisions After-Hours in the Hospital Blood Bank: Component Selection

Blood bank medical coverage can be daunting to both the practicing general pathologist and the pathology resident in training. Even for the blood bank specialist physician, decisionmaking on call can be stressful. The blood bank is somewhat unique among the clinical laboratories in that many of the issues that arise after-hours and on weekends are urgent, if not lifethreatening, and involve therapeutic measures in addition to diagnostic testing. Blood bank decisions may also require more clinical information than was provided with the blood sample received. The transfusion medicine physician must often review patient charts or laboratory results from other divisions of the laboratory, as well as discuss the patient condition with the ordering physician. Thus, blood bank medical practice can be more clinically focused and interactive than some of the other laboratory specialties. This review will cover some of the more common situations that arise that involve the pathologist in the blood bank after hours. Most decisions can be divided into component selection issues and testing issues. Table 1 lists some of the common situations in each category. Almost by definition, if the decision must be made after regular on site medical staffing hours, the decision is urgent in nature. Therefore, these decisions carry an increased level of stress and the need to possess certain knowledge, experience, or other resources to make a timely decision.