Recognize the doctors patients often don’t see

There are doctors that patients see. And there are the doctors that patients almost never see.

Patients see me, an obstetrician, at prenatal visits, in the ultrasound unit, or on the labor floor. But they don’t see all the wise radiologists reviewing their imaging studies, or the educated pathologist assessing whether their biopsy is cancerous. Some of the most important doctors that our patients don’t see are the ones in the Montefiore blood bank/transfusion medicine unit.

Some very smart and caring pathologists run this unit, and also serve as faculty at Albert Einstein College of Medicine. One of my favorite doctors there is Dr. Joan Uehlinger, director of the Montefiore blood bank, and, more recently, her colleague Dr. Ronald Walsh. If you’re an obstetrician, these people are very important to you (and even more so to your patients).

Here’s an example of some of the things transfusion medicine does: They keep a high-tech, high standards lab running to process and store all of our samples. They work with us to have blood products ready for all of our pregnant patients. Transfusion during and after delivery are rarely required, but can be life-saving. They work with us on an administrative level to design protocols that ensure that safe blood can be available, almost instantaneously, for those rare times when we need it emergently. Transfusion medicine helps us work with patients with transfusion limitations — those that have difficult-to-match blood types, or religious beliefs that require special accommodations in order for them to be able to accept some, if any, of our transfusion medicine.

Testing antibodies

On a day-to-day level, the blood bank processes blood specimens from pregnant patients to assess them for antibodies. We test for antibodies because the wrong ones can attack a pregnancy (which might have a blood type different from mom), so the testing tells us who to monitor closely for this rare but frightening complication. Most of these patients have pretty common antibodies to red cells (most commonly RhD) but there are a lot of others: Kell, and Lewis and “C” and “c,” and a lot of elusive rare ones. Even for those of us who take care of these patients all the time, these lab results can get confusing pretty fast, and it can be hard to keep track of which antibodies are meaningful in pregnancy.

Who to call when things get complicated

So what do I do when I get a rare antibody result? Of course, I look it up in a textbook and in online sources and in medical publication databases. But I also email Dr. Uehlinger, and now Dr. Walsh. My email says: “Here’s this strange antibody. Do I need to worry about complications in this pregnancy?”

And here’s what’s wonderful. Dr. Uehlinger and Dr. Walsh email back, right away; they often put medical literature citations in their email. In our correspondence, we work out the lab result, from their end, and the patient situation, on my end, and together we devise a plan for how to monitor this patient and her pregnancy.

Everyone should know about transfusion medicine/blood bank doctors. They’re great clinical resources for all of us who practice medicine; they’re some of the smartest, most caring doctors behind the rest of us on the front line. Your patients may never get to meet Dr. Uehlinger or Dr. Walsh — but both are taking great care of them anyway.

Eve Karkowsky is an assistant professor of obstetrics and gynecology, Albert Einstein College of Medicine, Bronx, NY. She blogs at The Doctor’s Tablet.

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