Nick joined the NHS in 1970. Here is the story of a memorable night during the course of his career.
A night on-call
This is a story of how on-call in a path lab worked in 1976.
I was then a basic grade (Grade 1 now) working at the Maelor General Hospital in Wrexham. As a recently qualified as a Fellow of the IBMS, I was gaining experience.
Haematology was pretty basic back then; a full blood count (FBC) required Drabkins solution for the haemoglobin concentration (Hb), and the white blood cell count (WBC) was done on a Coulter Model D.
However at night, this was left to clean in detergent, so every WBC had to be done using a Fuchs Rosenthal chamber, and counted using a microscope.
A call came to my home (on-call meant o/c; in those days it was usual to spend most of the night in bed). There was a male patient needing help, they were unable to stop his chronic bleeding.
In the laboratory
Samples arrived in the lab for FBC, group and cross-match (X-match), and clotting; probably urea and electrolytes (U&E’s) as well as I covered all the out of hours lab tests. The cross-match sample was left to spin (centrifuge) whilst I did the FBC. The Hb wasn’t terribly low I remember; just as well as it gave me the time to observe and reflect. The WBC was normal.
The 1st clue I had was the X-match sample; it was in a glass container but hadn’t clotted properly. This was usually sorted with an orange stick to ring around the sample inside the bottle, and re-spin. Clotting tests were found normal (Prothrombin Time and Partial Thromboplastin Time with Kaolin or PT and PTTK as they were then known).
Grouping and x-matching commenced (90 minutes incubation). I spread a blood film and used a rapid staining method and checked it microscopically (x400 magnification).
My experience with the X-match sample, and the normal clotting tests set me thinking. You are probably wondering why there is no platelet count; that too was done manually, and only if specifically requested (even in day-time hours).
A sample from the FBC bottle was prepared and put into an Improved Neubauer chamber kept in a moist petri dish, and left to settle for 30mins. No shortcuts I’m afraid, however, I was well versed in blood film examination and could make a pretty good estimate of platelet numbers from a stained slide. They looked low. The count confirmed a value of less than 50 (normal 150-400) consistent with a reason for bleeding.
Working to save the life of a patient
I contacted the Doctor informing him of the platelet count, and it was agreed that platelet replacement should be considered. This didn’t happen much at Wrexham then. I had done my training in haematology and blood transfusion on day-release at Liverpool, which was our regional blood-bank. I knew the centre and arranged urgent supply of appropriately grouped platelets.
The night was wearing on; platelet infusion was done and a second x-match sample was sent to me in case multiple X-matching might be required. The doctor rang to confirm the bleeding was now under control; he came to the lab and thought it would be a good idea to repeat the platelet count.
I showed him the second X-match sample which had obviously clotted and reassured him it wasn’t needed.
The night ended with a cured patient and the satisfaction of a job well done. This was one of the few times in 38 years of lab work where I received an official pat on the back for my part in saving someone’s life. It wasn’t looked for as I thought I was only doing my job at the time.
Things were certainly quieter on-call those days but testing samples was much more time-consuming in the days before automation.
N.J.Aylmer-Brewin CSci FIBMS