Project: Red Room

Red. It's a lovely color for lots of things. Apples, lipstick, Corvettes... but not an ideal color for a small bedroom.

Even the radiators were painted red! Who does that?

Since I designated this a snow day and I didn't go into work, I made myself useful and covered the walls with primer. I used the "High Hiding" interior latex primer from Valspar (in the red can - ironic!), which we had really good luck with in the past when we had to paint over the black baseboards and molding in another room. First I did the edges with a paintbrush, which is my favorite part:

And then I went nuts with the roller to get the walls done and ended up covered in teeny speckles of paint like I always do. I managed to avoid the carpet for the most part, thank goodness, and none of the cats got painted, either. I'm not very good with roller technique, but I get the job done. I learned somewhere you're supposed to paint in "W" shapes to prevent striping, but I somehow always manage to make everything uneven and streaky. For that reason, I don't think my husband will trust me do the final, pretty coat in the color we've chosen. Here's how the walls look all primed and ready for real paint:

We bought three sample cans of yellow paint to see which we like best, because yellow can veer towards "banana" or "big bird" really easily and we'd like it to be a more buttery shade. Mmmm, butter room.

Snow Day!

We've already gotten almost 2 inches of snow, and they're calling for a whole lot more over the course of the day. After several near-misses, it looks like this storm is going to hit us head-on and bury us. I don't feel safe taking my tiny car into work and back in 6 inches of snow, especially since the worst part is predicted to hit just before I'm headed home, and I do not feel like camping out at the hospital overnight. So, I called out and I'm declaring this a snow day. Hopefully I can get some stuff done and then come tell you all about it. But first, I figured I would surprise my husband with a cleared driveway, since he was up most of the night and will probably have no energy for shoveling once he wakes up.

Before:
After:

All by myself! I think I may have had half a heart attack in the middle there, but I recovered. I know it doesn't look like much of an accomplishment, but it's the heavy, wet, snowman-making snow, which is fun to play in but hell to shovel. And since the snow was right and I needed company, meet Lumpy, my snowman.

His eyes are cherries and his nose is a carrot, so he's probably going to be pecked to death by birds before the end of the day. Poor snowmen, such short, tragic lives.

Now it's time for a cup of coffee and a to-do list.

Blood Bank - Expiration Dates (Red Cells)

I'm going to start answering lab questions bit by bit - I'll try to be as clear as possible and as detailed as necessary without putting anyone to sleep!

Let me start with the question from Anonymous:

Does blood go bad if it's kept in the fridge too long?

Short answer, for those too hurried to read on: Yes. Yes it does.

Now, let me get a little deeper into this, for those who may care.

Your blood is made up of different components - red cells, white cells, and platelets - floating around in a liquid called plasma. The components all have different functions in your body. Red cells transport oxygen to your tissues, which is why folks who are severely anemic will be exhausted and weak, and be short of breath as they try to get enough oxygen to keep going. Platelets stop bleeding by making a plug at the site of an injury to a blood vessel and sealing it up, while plasma contains soluble (dissolved) factors that also participate in the clotting process, along with a host of other proteins, including antibodies. These are the main three components we use in the blood bank: Red cells, platelets, and plasma.

Here's a tube of blood that's been spun in a centrifuge:

Red cells are down at the bottom, plasma on the top, and the fuzzy white layer in between them is a mix of white cells and platelets. The percentage of blood that's made up of red cells is called your hematocrit - a normal number for that is around 35-45%. This patient's hematocrit is about 21, which is very low, and probably what's bringing them to the emergency room.

Way back in the old days of blood transfusions, they would take a unit of blood from a donor, and then give it to a recipient, whole. You'd get the package deal, all the components for the price of one.

This is a unit of whole blood:

Notice how the top is clear fluid - that's the plasma. You can see it because the unit has been sitting for along time and the cells have settled.

As we got smarter about the details, we figured out that the different components could be separated out and given separately, to treat patients more effectively. Giving entire units of whole blood to a patient can easily throw the body in to circulatory overload, which means the heart can't pump properly because there's too much blood volume for it to handle. You're also giving the patient components they don't need and can possibly have a bad reaction against. So there was an eventual shift towards transfusing patients with only the component they needed, instead of whole blood. Running out of hemoglobin because you're not making enough red cells? You'll just get red cells. If you're bleeding, you'll get platelets or plasma (depending on various lab tests and the type of bleeding, one or the other, or both, may be indicated). This way we're giving much smaller volumes, exposing patients to less foreign material, and treating specific problems with the right products.

So when blood is initially processed from a donor, it gets split up - the blood is centrifuged so the heavy red cells sink to the bottom and the plasma floats on top, with a layer of white cells and platelets in the middle. The bags that the blood is collected in are coated with anticoagulant to keep the blood from clotting, and additives to keep the red cells alive longer. Depending on the mixture of additives and anticoagulants, a unit of red cells will have a different lifespan, between 35 and 45 days. Why do they eventually expire? Well, red cells are alive. After a certain point, the cells will die and no longer be of any use transporting oxygen - not to mention the fact that when they die they release some nasty stuff like free hemoglobin and potassium, which aren't very good for you when they're not bundled up and safe inside a red cell membrane. We keep them cold (1-6C) to keep their metabolism slow and also to prevent any bacterial growth - while every effort is made to clean the site before inserting a needle for a blood donation, bacteria are sneaky little things and may get in, and keeping everything cold will retard their growth if they're in there.

This is a unit of what we call "packed red blood cells" - the plasma has been taken off and it's been filtered to remove white cells, which can cause transfusion reactions.


So, blood is good for a little over a month in the fridge after it's taken from a donor, because studies have shown that not enough red cells stay alive past that point to make the unit a useful therapy, and the stuff leaking out of the cells gets to be in too high a concentration to be safe. The pros call that the "storage lesion". When transfusions are needed for babies, we always make sure to have very fresh blood (under 10 days old) because of those products that dying cells leak out. An adult can handle a small increase in potassium, but an infant's system could easily be overwhelmed, so we reserve very fresh blood for infant transfusions. Another option is to wash the unit to remove the bad stuff, but that gets expensive and increases the chance of contamination since you need to open the bag. When we do need to open the unit for any reason, we need to change the expiration date to 24hours, because of the possibility of contamination.

Tune in soon for an expiration date lesson on plasma and platelets!

Jen's Library: The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down - a Hmong Child, Her American Doctors, and the Collision of Two Cultures
by Anne Fadiman

When I first read a blurb about this book and added it to my "to-read" list, I was given the impression that it would be an examination of the differences between "Eastern" and "Western" medicine, and how immigrants to America may not accept "modern" medical explanations and treatments and choose instead to rely on their traditional ways of healing. And it is about this, but only in part.

We follow the story of Lia Lee, infant daughter of Hmong parents recently arrived in California's Merced county, as she is diagnosed and treated for severe epilepsy. While the doctors try her on several combinations of anticonvulsants, her parents feel like the medicine is making her sicker, and they decide to give her only some of them, some of the time, while consulting with healers to bring her "wandering soul" back to her body. It doesn't help that the Lees can't speak or read English, and the constant changes in medications and dosages, and increasingly complicated medical instructions, get to be too much to handle. The side effects of the medications are sometimes severe, and when she is hospitalized she sometimes gets sicker from hospital-acquired infections, so it's not difficult to see why they would resist trusting the doctors. They love Lia like crazy and try to find ways to heal her, but eventually, social workers take her away from her parents because they feel that she is not getting the medical care she needs. It's a tremendously sad story, with the frustration and pain very clear on the sides of both the doctors and the family, both of whom think the other side isn't listening to what they're saying and are going to hurt the child.

This touching story is told in small pieces, while the rest of the book drifts towards educating the reader on Hmong culture and history, which, while interesting, wasn't what I expected. I was really hoping for more of a comparison between the cultures in terms of medical beliefs and practices, but that topic is only lightly explored here, which is unfortunate, because I think there was probably a lot of material to work with. It's more of a historical look at the Hmong people and their arrival in America in large numbers, and the culture clash they've experienced. Still worth reading, but know what you're getting before you jump in.

A day in my blood bank life

My day started with an antibody problem. A double antibody, actually, but luckily for me only one of the two was showing up, which made my workup much easier. I got that done quickly enough that I only delayed my dinner break by half an hour, so my tummy rumbles didn't deafen anyone. My coworker helped out while I was on break by typing 8 units to look for compatible blood, but only one was negative for what we needed, and the patient needed three units set up, so when I got back from my break, I had to phenotype the rest of the units on the A-negative shelf to find some that we could give this patient - I could have called the Red Cross for units instead but it's cheaper for us to do it.

While that's happening, STAT specimens are coming in from the emergency room. Some are pregnant women who are bleeding, and they need their blood type to see if they need a shot of Rh immune globulin. Some are GI bleeders. Some of them are cancer patients whose blood is delpeted after chemo and they need a transfusion because they're weak and having trouble breathing. I'm doing my best to prioritize as they're coming in one after the other. Things marked "routine" are sitting in the rack, waiting until I have time to get to them. I'm also in charge of all the rapid testing for influenza, mono, strep, and RSV, and we're in full blown flu season so those swabs are starting to pile up. While my latest type & screen is incubating, I start a batch of 3 flu and 2 RSV, and then a few minutes later they bring me a new handful of swabs so I set up 2 streps and another flu - now I have several timers set for different tests, so things are beeping everywhere. I hate beeping.

So, while I'm calling a positive flu result to the pediatrician in the ER, someone shows up to get plasma on a patient. I don't see any thawed, so I look up the patient in the computer - no, nobody called to say they wanted a unit of plasma, so I need to call the floor and tell them it'll be a half hour while it thaws. I pull a unit out of the freezer to thaw, and oh, now my timer's going off for my type and screen, so I need to move that to the centrifuge. Oops, forgot to put that flu result in the computer. And looks like those strep tests are done too, better result those. And there are two papers in the fax machine asking me to add on more units to a couple of patients.

Phone's ringing, now a patient in critical care is crashing and they want 2 units NOW and then 8 for the OR because they're wheeling her down the hall to surgery almost as we speak. Yessir! I'm on it! Once I find the specimen in the fridge, I see there's not much left, those tubes must have been only a quarter full when we got them yesterday. I can crossmatch 6 units, tops, before I run out of specimen, and that will leave them stuck with needing to get a new specimen in the middle of surgery. I tell the nurse I'll give her those 2 units now, and she should get a new specimen right afterwards so I can get ready for the OR. She agrees and hangs up. So I go back to working on another ER Stat and those two add-ons, and they call back to say the Dr does not under any circumstances want her redrawn now. Get as many as I can ready and he'll make do. I don't like this idea, but there's not much I can do other than document that this was his call and he's aware of the situation. So I get those ready while I get back on the phone to call Labor and Delivery with a result on a baby's cord blood. I have to talk fast because the printer paper that my unit tags are printing on is about to flip over and get crunched up and jam, so I need to get over there to rescue it. Oh, and the plasma's done thawing and the thawer alarm is screeching at me to tell me so.

Now the OR calls. The anaesthesiologist wants to know how much blood we have ready for a patient. Well, we don't have any because we don't have a specimen on him. The doctor's confused, because the patient is wearing a blood bank armband, so how do we not have a specimen? Well, it turns out that when I called the emergency room yesterday to tell them their specimen was too hemolyzed for me to use, nobody bothered to cut off the armband. So when he went upstairs, they assumed he had a valid specimen. So here he is about to get cut open and because he's got an armband on, they figured everything was ok! It happens, it's not the end of the world, I told him to get me a new specimen and we could have stuff ready for him within 45 minutes. But he was upset (rightly so) and was asking all sorts of questions about how this could happen. All I could do was apologize and tell him we can do it in 45 mins. Over and over again.

And the pediatrician is calling, asking for RSV results on a sick kid. A test I haven't had time to set up yet. Sigh. More apologies, promises to get right on it. I feel terrible, because I know that if they're calling it's because there's a very sick kid out there waiting for the right diagnosis and treatment. Then the OR calls about that first patient, asking if I have the 8 units they need... so I have to tell the whole story again and make sure they know I'll need a new specimen if they go through all six units.

And I really, really have to pee.

So, this wasn't just a post to vent about how hard I work or how stressed I am - plenty of my coworkers work just as hard, and not every day is like this. I'm just trying to give a picture of a busy day and open this blog up to questions from the audience about what I do. The hospital lab and blood bank are mysterious hidden places, and most people have no clue what goes on there, or why. so if anyone has anything they want to ask about the lab, the blood bank, or about blood or medical testing in general, please ask in the comments, and I'll take the time in future posts to address them all.

Jen's Library: Vaccinated

Vaccinated - One Man's Quest to Defeat the World's Deadliest Diseases
by Paul A. Offit, MD


It is entirely possible that Maurice Hilleman saved your life. And chances are good you've never heard of him. He never won a Nobel prize, he's not featured in many textbooks, and he never got his picture on bubblegum cards, and yet his contributions to public health completely eclipse those of other, more familiar names.

This book is both a history of vaccination and a biography of a man who contributed so much to the field. We've all gotten our shots to help keep us protected from polio, pertussis, rubella, and many other diseases that once terrified people because of their destructive power. Yes, in most children, measles and mumps are relatively mild and short-lived illnesses, but thousands of children developed complications and became deaf or blind, or paralyzed, or hospitalized with meningitis. The reason that we don't fear these viruses anymore is because we have means to protect ourselves thrugh vaccines - many of which Hilleman developed.

When his daughter came down with a case of mumps, Hilleman cultured her throat for the virus, which he then used to make an attenuated (weakened) strain that was enough to cause the body to make antibodies, but not enough to infect a person and cause the disease. You know you're a scientist when you see your sick daughter as a body full of starter material for your viral cultures!

Hilleman predicted the pattern of influenza pandemics and was instrumental in getting vaccine made against the 1957 asian flu. FYI: he predicts another one in 2025, so please be sure to get your flu shot that year. He developed a vaccine for chickens to prevent them getting Marek's disease, a tumor disorder - essentially a vaccine against a form of cancer. He was the first to purify interferon, a virus-inhibiting substance made by our immune systems - interferon is used in treatment of viral hepatitis and certain cancers today. He made a vaccine against Japanese Encephalitis Virus that was used to protect American troops during WW2.

Over the course of his life, Hilleman developed vaccines for measles, mumps, chickenpox, hepatitis A and B, Haemophilus influenzae, and Streptococcus pneumoniae, and performed many experiments and made many discoveries that helped others to make progress towards other vaccines and treatments.

This was a fascinating look back at the history of vaccination and many of the researchers who played a part, and I recommend it to anyone who has any curiosity about medical history, or even history in general. I was pleased to see chapters on the modern anti-vaccination movement as well, along with the controversies surrounding the development of some of these vaccines. Some use embryonic cells because the viruses involved will not grow well in other animals' tissues, which is a huge moral issue for many. Some vaccines made from human blood or from monkey tissues carried a tiny risk of piggybacking other viruses along and infecting people, despite extreme efforts to prevent that from happening. Also, in the early days, vaccines were often tested on mentally retarded children. This was not because of their condition or because they didn't need consent - in fact, they did have consent of the parents - but because these children lived together in large asylums and were at great risk for these childhood diseases. That doesn't necessarily make it right, but they had logical reasons at the time and weren't doing it maliciously.

I can't believe I never even knew this guy existed. Part of it is because he worked for pharmaceutical companies and not in academic research, but I'm not sure that's a good enough reason for his contributions to be glossed over when learning about vaccinations. We all know Salk and Sabin - we should know Hilleman too.

Green Card Update!

I got a letter today.
It looked like this:


I has a happy.

What's for Dinner - Grandmaman Adèle's Stuffed Tomatoes

Another wonderful recipe from the family book that turned out incredibly delicious. This is definitely making me want to keep going and try them all!

Grandmaman Adèle's Stuffed Tomatoes

Her recipe:

2 slices of bacon, chopped
1/2 medium onion, diced
4 medium tomatoes
1 Tbsp Dijon mustard
2 eggs, beaten
1/3 cup light cream
1 slice whole wheat bread, shredded
1 cup mild cheese (gouda, cheddar, monterey jack)

Fry up the bacon with the onions till onions are soft, and set them aside in a mixing bowl. Add eggs, cream, mustard, bread, and cheese to the bowl, and mix well. Use a sharp knife to cut off the top of the tomatoes, and scoop them out with a spoon. Fill them with the stuffing and cook at 450 for about 15 minutes or until the tops get brown and crispy.


My changes:
Had no bacon, so I sprinkled some bacon salt into the mix.
Had no Dijon mustard, so I used Hellman's Dijonnaise.
Had a whole wheat baguette so wasn't sure how much I needed... I kept adding bread to it until it looked like a stuffing instead of a soup. I think if you followed the recipe exactly you'd have a squishier result, so I recommend adding more bread. It ended up being about 1/3 of a small baguette.

These were delicious. We had 4 medium tomatoes to stuff, and had enough stuffing left over that I managed to also fill half a giant tomato that I found in the fridge (I think its other half was involved in last weekend's party dip). Definitely err on the side of bigger tomatoes for this recipe, because especially if you increase the amount of bread, you get a lot of stuffing. The end result tastes somewhere between a bacony quiche and an oniony, mustardy omelette, smooshed into a tomato.

There are so many possibilities for this dish - varying the cheese or the type of bread will give you different flavors to play with. Considering how well this one was received, it's on the "try again" list for sure, so I'll be changing it up now and then to see what works. I'll also use real bacon next time!

Green Card Update!

My husband got a very official-looking letter in the mail yesterday, with a big blue government seal stamped on it and everything. Considering the return address read "U.S. Citizenship and Immigration Services", I flew through the kitchen, poked him in the chest with it, and begged him to open it immediately while I jumped up and down in very unladylike excitement.

The letter inside says that his petition to let his foreign wife stay in this country as a permanent resident has been approved!

So the green card is on its way and I can resume normal breathing. I'm so happy to be done with paperwork for a while! The entire process only took 5 months, which is astounding, considering that most of the stories I read online about other immigrants' experiences said it took forever to get through it all. We had some help filing the paperwork and we made very sure to do everything by the book, from my initial work visa and subsequent renewals at the border, to my "advance parole" document so I could visit home, to the final adjustment of status. I think that helped speed everything up, but I also think we got very lucky and hit a period of quick processing times. I will take small miracles as they occur and thank the stars for them.

I get to stay. I'm so glad.

Appetizer - Spinach-Cheese Swirls

These were also made for the New House Party. I printed the recipe off the Pepperidge Farm Puff Pastry website, which has dozens of awesome uses for a sheet of frozen puff pastry and which I'll likely visit again for more appetizer ideas. I brought the page with me when I went shopping, to make sure I picked up everything I needed, and then when I finally got down to it Friday night, in the kitchen with everything ready to go, I couldn't find the stupid paper. So I had to delay my project as I hunted it down online and re-printed it so I had instructions. And then discovered at the very end when I threw the puff pastry box into the recycling bin that the recipe was on the back of it the whole time. Durr.

The recipe is here. I followed it exactly except that I had no garlic powder, so I used garlic salt instead. The pastry cracked a little as I rolled it but it held together decently. Cutting it was very hard - maybe it was because my knife wasn't sharp enough, but I squashed it pretty flat as I cut it so I ended up with flattened ovals instead of pretty round swirls. I also should have greased the cookie sheet, because they stuck a little and I had to chip some of them off. Oh, and I need to acquire a pastry brush. Applying an egg wash with a fork is not very efficient or effective.


The result was underwhelming: they were edible (and pretty) but not really anything special. I would have thought that garlic and cheese and spinach always combine and create glorious yumminess, but this flopped. How could it, when it is made from all the flavors I love best? It tasted like a spinach pie, and not a particularly good one. It needed salt, and probably a lot more garlic and parmesan. I might try it again and tweak it for more flavor, but it's not high on my list of retries. Oh well.