Sunday, March 04, 2007

Life as a blood eater

I read with interest "A lifeline of Blood" by Dr. B. Patrick Moore to mark the 60th anniversary of the opening of the first provincial unit of Canada's national blood transfusion service (BTS) in Vancouver, BC on Feb. 3, 1947. "A lifeline of blood" motivated me to write this blog, an updated rendition of a posting I originally wrote for MEDLAB-L in1998 and which later appeared as a 2005 entry in another blog I maintain.

Seeing Dr. Moore's historical note reminded me of the years when I worked as a medical laboratory technologist (aka clinical lab scientist) for Canada's national blood supplier, the Canadian Red Cross Blood Transfusion Service (now Canadian Blood Services) in Winnipeg. The facility was (and is) a combination blood center and transfusion service that performs all crossmatching for the city and small rural hospitals in the province, along the lines of Puget Sound Blood Center in Seattle. It was the mid-60s to late '70s, a time when we performed risky practices and never gave safety a thought.

Back then I knew of Dr. Moore, whom everyone called "Paddy" Moore. To my young eyes (I was practically a child laborer!) he was a "biggie" at National, meaning national headquarters from whence all wisdom seemed to flow.

Those golden days were pre-AIDS. See Pneumocystis Pneumonia -- Los Angeles. MMWR 1981Jun 5; 30(21);1-3 and AIDS timeline - click on each year for details. Syphilis and hepatitis B were the main concerns and we had tests for those, such as they were. I recall testing for the HBsAg (previously the "Australian antigen") using counterimmunoelectropheresis (CIEP).

Talk about a primitive test - you had to pipette just the right amount of liquid agar on a glass plate (an art in itself), wait for it to set, punch out wells, add reagents, incubate, then look for precipitin lines (positives) by holding the glass plate against a black background. I often had difficulty seeing even the positive control!

As an aside, it was an early indiction that my future lay more on the transfusion service side than on the blood centre side. The latter I eventually came to refer to as the "dark side" just to tease my blood centre buddies who worked increasingly with automated instruments. To me they were becoming less and less true blood bankers compared to those who worked in transfusion services and got "down and dirty" with their hands. Eventually, of course, automation made inroads into pretransfusion testing, so we are all now disciples of the dark side.

Back to HbsAg testing by CIEP: Once a colleague came running to me exclaiming, "Pat, help! I just swallowed the positive hep B control!" Frustrated with trying to control the tiny bulb on a tiny pipette (actually just a capillary tube), she had used her mouth to suck up the reagent and dispense it! We called National and their sage advice was to "drink lots and lots of water" and let nature take its course. Of course, the positive control was presumably not infectious as it was only the surface antigen, but who knows what all was in the darn reagent.

Those were also the bad old days in more ways than one. For example, we used no SOPs, if you can imagine. All instructions were passed from trainer to new employee. Talk about standardization - NOT!

Near the end of my time at the Winnipeg BTS (by now I was a senior technologist and trainer) one year I decided on my own to write a procedural and policy manual for the crossmatch laboratory on my holidays. I went to a cottage on a nearby lake for two weeks and in between canoe trips wrote the manual in long-hand (pre-computers days too). All on a volunteer basis without official sanction, and, of course, they used the manual.

Having recently gotten married, my husband thought I was nuts. But he soon grew to understood that the organization was family and that working for the BTS was getting paid to do something that my colleagues and I loved and was great fun to boot.

One of my fondest memories from my Red Cross days was how we used to "shuck" (pour out) blood clots from 100s of donor specimens into kidney dishes before preparing 5% saline suspensions for red cell testing. All the while smoking and drinking coffee, of course. Time was a factor and those clots got tossed with wild abandon - it was the start of what could be a very long day depending on the clinic size. We worked until all blood was tested and sorted (put into inventory), no matter how long that took. For the 1000+ donor clinics held on the day after New Year's Day that could be from 07:00 to 23:00 hrs. No union to influence working hours in those days, either.

But I digress. To start each day we would shuck like crazy until the kidney dishes were full. Blood would splatter everywhere, including all over us, our smokes and coffee cups. No gloves, of course, only white lab coats that we wore everywhere including into the lunch room. My most vivid memory from those days is the taste of blood on my cigarette filter (I gave up the cancer-emphysema sticks in 1987). The blood tasted awful, probably more so as I'm a vegetarian.

The second most vivid memory is of bloody finger streaks on the back of everyone's lab coat (after all, techs need to keep their hands clean and buttocks are as good a place to wipe as any). Some of us were regular Picassos!

When hepatitis B testing was instituted at the blood centre (during my years there we went through counterimmunoelectropheresis, reverse passive hemagglutination, and radioimmune diffusion, all now considered prehistoric), one year all lab staff were tested for both HBsAg and anti-HBs. Of the 20 or so technologists none were positive for HBsAg and only one was anti-HBs positive.

Of course, the BTS was testing healthy blood donors for hepatitis and Canada had a relatively low prevalence rate. Mind you, some of the specimens did test positive, and perhaps some of those made their way to my cigarette filters. Also, in the 1960s we bled donors from Manitoba's two penitentiaries. Indeed, once the rate of HBsAg in jails became known, prisoners were dropped as donor sources.

In retrospect, based on my experience working at the Red Cross BTS in the pre-AIDS days, I view the risk of contracting hepatitis and other blood-borne agents from lab-related activities as being low but certainly not zero. Consider that there were two technologists in the neigbouring province of Saskatchewan who contracted hepatitis B and died from mouth pipetting positive controls in the chemistry lab. We in the blood centres had luck on our side.
Baruch Blumberg , awarded a Nobel Prize in 1976 for his discovery of HBsAg, tells the story of how his laboratory technologist came down with hepatitis B before they knew what the Australian antigen was.

Even given that the risk of contracting a blood-borne disease in a blood centre laboratory is low, personally, I would not want to play Russian roulette with a million-bullet gun cartridge containing only one bullet. Sooner or later, someone gets the bullet. The low risk may apply to all the risks that we try to prevent by using universal precautions, especially if the causative organism (unlike HBV) does not survive well on inanimate surfaces such as counter tops.

Today's students and younger lab professionals are astounded at the practices of smoking, mouth pipetting, etc., in the laboratory. In retrospect, even this vegetarian, once blood eater, finds them surreal.

It's hard to realize that when I first joined Canada's national blood transfusion service it was less than 20 years old. A Yikes! thought but somehow it puts everything in perspective.

Cheers, Pat