Anesthesiologists transfuse more blood than anyone

[@jdriggers]

Hey Max, I work in the lab and blood bank. This video is excellent! Pathologist do offer great support for providers to help make decisions in times of massive transfusion or unique situations with a patient, but it is your Medical Laboratory Scientists and Medical Laboratory Technicians in the blood bank that are preparing those MTP coolers, tagging and crossmatching RBCs, tagging platelets, thawing and labeling plasma and cryoprecipitate during that time. Next time you have a large bleed requiring MTP, once the patient is handed off and you no longer have to manage them, take a walk down to the blood bank and thank them for their role in rapidly supplying blood and blood products to keep the patient alive. They will appreciate it more than you could ever imagine.

[@MaxFeinsteinMD]

Thanks for letting me know! As you can tell from the video, I wasn't aware of the role of Medical Laboratory Scientists and Medical Laboratory Technicians, but I am glad to know about their role and will look for an opportunity to swing by the blood bank!

[@bemidji22]

@jdriggers you beat me to the exact comment. Fellow BB tech here. Mad respect back to you guys and anyone else here for working the trenches of that discipline. Max, thanks for giving some shout out to the transfusion world. We don’t look for the spotlight by any means but it’s nice to see people with your platform throwing some love our way. Any OR staff watching and reading these comments: have your pt type and screened BEFORE you take them to the OR (think at that preop appt weeks before the surgery while you’re drawing all the other preop labs). A nightmare scenario I’ve had in my career many times over is a brand new pt to us coming across my desk 25 mins before their surgery start time (or having the blood tube sent AFTER the team starts the surgery) and the screen portion of testing comes back positive. Or at the very least, check the pts blood bank record before you start cutting.

[@the.mermaid.scientist]

@maxfeinsteinmd Definitely ask for a tour of the blood bank, if the techs aren't in the middle of an MTP 😜 I'd be stoked to show you the fridges and analyzers and all the other equipment!

[@BirdiesGoCherp]

I'm a 2nd year anaesthesiology resident at my university hospital. The scariest moment when I had to transfuse a lot of PRBCs and whole blood was during C-section of a patient with a placenta accreta totalis. Once they cut into the uterus, the pt's bp tanked so quickly we had to put her on norepinephrine for a while until we transfused enough blood. We don't have rapid infusion pumps, nor do we have pressure bags. We usually use a three way attached to a syringe to act as a pump. We ended up transfusing 9 bags of PRBCs and 1 whole blood, 8 FFP units as well.

[@the.mermaid.scientist]

MLS here - Agreed, the OB hemorrhages are the scariest, worst ones. Had 2 of them on the same night!! during my first week as a baby lab tech fresh out of school. Fortunately I had two very experienced coworkers that helped me with everything.

[@360compass]

Hi Max, I’m not a doc or resident but enjoy learning about medicine from your videos. BTW, I’m scheduled to donate my 89th unit of blood on Wednesday. Thanks for reminding me of how important my donations are. ~ Larry

[@lindythecandylover]

I had to have a blood transfusion during my spinal fusion from losing so much blood during the surgery. I am so grateful for blood transfusions and that anesthesiologists always ask patients if they are ok with receiving blood transfusions if needed during their procedures. Blood transfusions saves lives just like it saved mine.

[@tammydurfee9871]

I had to have a transfusion after my spinal surgery. My blood loss during surgery was minimal, but my labs and bp weren't at the level the surgeon wanted.

[@tamarinmangold1414]

I had multiple blood transfusions during my 11.5 hour spinal fusion (T2-L2 with two disc prostheses placed) and they also used a cell saver throughout the surgery to collect as much of the blood I was losing as they could and then transfused it back to me. Also extremely grateful to the anaesthetist/anesthesiologist and all those who donated blood and continue to do so. 🙏🏻🙏🏻🙏🏻

[@moosebat47]

Had 3 transfusions after 12 hour T10-S1 fusion due to chemistry issues. Only thing that got me upset were the costs, $3K a pop!! They get the blood for free, yes there are processing costs to spin the blood down and store it, but come on, really??

[@marty6055]

My wife had surgery last week. While talking to the anesthesiologist I told him about your channel and how helpful you are. He seemed really interested and I hope I got you a new subscriber.

[@MaxFeinsteinMD]

Thank you, and I hope your wife is doing well!

[@lindaschad9734]

I, too, tell every physician I meet about you and your videos. They have all been very interested in hearing about you.

[@MichaelMinhLeMD]

Blood donation piece at the end is AWESOME

[@peachmelba9333]

Well I had my close encounter with a Board certified Anasthesiologist yesterday during my procedure- We have some really cool brother/sister ones at The Ohio State University- Wexner Medical Center in Columbus Ohio. He left my last conscience moment with a Smile on my face and I awoke with gratitude He had watched over ME well! Blessings in Your Career!😊🎉😊

[@ilovetotri23]

Your videos give me a never ending respect for the job that anesthesiologists do!

[@starfishgurl1984]

Great video! As an O+ CMV- blood donor of 19 years who recently reached my 14th gallon milestone as a hero for babies I really appreciate seeing the behind the scenes action of what happens and how the blood is used because I’m never on that side of things so it’s nice seeing the impact it has as a reminder of why donating is so important!

[@aell6965]

Thank you for being a consistent blood donor!! It’s the consistent ones that really make a world of difference!!

[@GreggBB]

Amazing video! So good to see and hear what goes into this aspect of what you do. And a huge thanks to all those who work so hard to get all those blood products ready for you especially when you need large volumes of any of those products to keep them alive.

[@darriontunstall3708]

Great video man, I learned so much! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy! It takes a special person to be an anesthesiologist or CRNA, and you’re one of them! I really wanted to be a anesthesiologist physician

[@SnoLeopurrd]

Shouting out the pathologist but not the med lab techs who do all work in blood bank 🥺 Thanks for the video though, I'm still a student so I didn't know the anesthesiologist did so much of the blood transfusion. Immunohematology was one of my favorite subjects so far, I'm excited to do my clinical rotation in blood bank in the Spring!! It's a little daunting though, since it's probably the closest to direct patient care that a lab tech can get, not just giving diagnostic test results but actually deciding which donor units to give.

[@sherrydawson6253]

Hi Max. Loved this video I had no idea it's the anesthesiologist job to do the transfusions. I thought it was the OR nurse . Also I never heard of the rapid infuser machine. Lord have mercy of what all u are responsible for. It amazes me. When u started your residency there was it scary? I love ❤️ how u educate us. Your pts are so blessed to have u. Your program is just so awesome. I hope they hire u when your all done with your fellowship.😊when is that?❤❤❤❤

[@lauralulu4444]

I remember before I went into surgery last June, the nurse asked the anesthesiologist, “you know she’s O- right?” And she said “yeah I know” and that’s the last thing I remember before being knocked out lol. It was my 3rd time getting my left ear opened so I’m assuming I probably needed blood. I just thought it was cool and comforting hearing my blood type get acknowledged since I know I can only get O- blood so it’s very important I get the right type :)

[@PsRohrbaugh]

Bloody awesome!

[@MaxFeinsteinMD]

Heh I see what you did there.

[@tammydurfee9871]

My brother went in to have a gallstone removed from a liver bile duct. During the surgery the surgeon could not see and nicked an artery. My brother did not start bleeding then it was after they got him to his room and settled that the bleeding started. He was taken to the er where he had whole blood, frozen platelets and other blood products. When he was taken to surgery he had gone through enough blood and blood products for six people. Luckily when they got him in to surgery he finally stopped. Now he he has a problem with blood clots and has to take xarelto.

[@medtech6758]

It’s the Medical Technologists in the Blood Bank you should be thanking! They’re the ones testing products with your patients so you can safely transfuse, and they are working under great stress.

[@MaxFeinsteinMD]

Thank you for pointing that out!

[@laratheplanespotter]

And thanks for all the education. I’m a forensics student and I’m loving your videos!

[@laurafowles2311]

It's the Medical Technologist that provides the cross matched blood not the pathologist, the Pathologist oversees the blood bank.

[@annadavis2547]

I went through 7 units of blood over an 5 week period due to an emergent placental abruption. 3 during the day I had the c-section. They took the baby because I was bleeding faster than the blood could be transfused. The following morning my platelets were at 0. Very scary time. BTW the anesthesiologist was superb. He talked me through the procedure and wiped my tears. Baby taken at 25 weeks gestation. We both did well afterwards.

[@DamonJohnCollins]

Great subject Max... Thanks for the video.

[@monicaperez2843]

Arterial Blood Gas = hurts like Hell! Also it has to be run to the lab ASAP. One of my jobs as a volunteer was running Arterial Blood Gases from the nurses' station to the lab . . .

[@the.mermaid.scientist]

If you or anyone else are curious, the lab values can change significantly when the sample's transport is delayed, enough to produce erroneous results. we can add disclaimer comments to the lab report if the doctor still wants results.

[@shernandez2276]

I love the way you explain your job although I’d suspect it’s more than just a job. Do you ever feel overwhelmed?

[@lesliecrowell]

I'm hoping you'll talk about OSA and the risks associated with general anesthesia (particularly recovery and effects of opioids on OSA). Thank you for all the fantastic educational videos you share. 🙏🏼⭐️♥️

[@orangew3988]

Obstructive sleep apnea?

[@michaelriccard3021]

Max. As always your videos are great! I am not in the medical profession but as a frequent past patient with many anesthesia experiences I have found it so fascinating to learn how it all worked and has given me a ton of respect for the profession. On the topic of potential future videos. As a kid I had a tonsillectomy but I have no idea how you can deal with intubation and airway management if the surgery itself is in the mouth. So I guess anesthesia when the surgical field is in the mouth ( pharynx , tonsils etc)

[@PsRohrbaugh]

Something you didn't talk about but feels relevant are the blood recovery unites on the suction systems. Maybe touch on that with a short?

[@MaxFeinsteinMD]

That's a great idea, thank you!

[@lane2063]

@@MaxFeinsteinMDI’d like to see that as well. I donated two units of blood for my first two A/P lumbar fusions. A third was required in 2018 and I was surprised that no autologous donation was required. Although the doctor was very reluctant to go back into the area for a third time he called in a vascular specialist and it worked out well.

[@dueljet]

I am a orthopedic circulator and have only had to order blood for the anesthesiologist a few times. I have never had to initiate our mass transfusion protocol. I do pull albumin (5%) on a more frequent basis. I have seen more people refusing blood products due to fear of receiving "vaccinated" blood.

[@elshpen]

Love the Dr. Glaucomflecken cameo!!

[@Careers4_You]

Thx man.

[@benbookworm]

There's also beginning to be some understanding that blood transfusions should perhaps be treated like organ transplantation. More than A/B/O +/- matters for side effects. One researcher suggested not transfusing blood merely if the patient is low on blood, but only if they're actively hemorrhaging.

[@pamela6636]

Excellent video!

[@theresabacon7171]

So informative!!!

[@jgreer1999]

Great video. My daughter has ITP, and is pregnant. Can you do a video about this type of case and how you would manage it?

[@elizabethlewis3509]

How do you handle elective surgeries when patient refuses blood transfusion but needs blood.

[@MaxFeinsteinMD]

In some circumstances, patients can have some of their own blood stored weeks before the surgery so it can be transfused back to them during the actual surgery (their body would have regenerated that blood in the meantime). There are some other strategies along these lines, but overall if a patient refuses a blood transfusion, then I have a frank conversation that they may have an increased risk of dying from bleeding. Ultimately, I explain the risks, benefits, and alternatives to the anesthesia plan, and it's up to the patient to decide how they want to proceed.

[@bikramlamichhane337]

Max can you make a educational video on blood and blood products?

[@ejm6122]

Hey Max! I haven't received any notifications from your channel in at least 7 or 10 months. I was afraid that you discontinued your channel. Im elated that you popped up this evening.

[@MaxFeinsteinMD]

Thanks! I’ve been posting videos every couple weeks actually

[@ejm6122]

@@MaxFeinsteinMD lol I'm currently feverishly going through them...

[@rochelle-xz8gl]

Well when I needed surgery I had no option but to have 3 blood transfusions after surgery.

[@falcon7279]

god I love your videos, makes me want to become an anesthesiologist

[@ericB3444]

Just become a clown. Like a pro clown. You can get a free nose at Rite Aid on red nose day.

[@nypdbob]

Thank you

[@AJMansfield1]

Is it possible for a patient to have their own blood used as a transfusion? If a patient had a planned upcoming surgery where a transfusion was expected to be necessary, but was still healthy enough to donate blood and recover from it before the surgery.

[@the.mermaid.scientist]

Yes it is possible, but the patient must be minimum 110lb (~50kg) and 11g/dL hemoglobin. I have not seen this in practice at my own facility, it's all allogeneic (compatible donor).

[@chass1347]

Hey Max, Congratulations on your graduation!! Love your videos!!! Keep them coming. I know you don't give medical advice, so let's call this hypothetical: You have a senior citizen patient that has previously experienced post anesthesia memory loss, defined as "Holes in their day" for weeks. Now they want to refuse Versed, Propofol and any other "amnestic" drugs for surgery. Would there be solutions to proceed with general anesthesia? Secondly, though they are not Jehovah's Witness, they don't believe in getting blood products for their 3 level ACDF surgery. Are they in jeopardy? Would this be cause to cancel surgery?

[@elizabethlewis3509]

Great video. You touched on alot of issues concerning me. My mother was given a bad blood transfusion thus I have lost faith in receiving any blood products. Does the blood donation facility check donors blood before accepting them as a donor? Would certain medications disqualify them from donating?

[@evag9476]

Yes. They also test every donation of blood for a variety of things.

[@aell6965]

Donors go through a screening process where they are asked many questions that involve drug use and sexual activity (types of lifestyle behaviors that increase risks of having hepatitis B, hep C, HIV) assuming the donor is honest in answering, most would not be allowed to donate due to the increased risk. Those that answer no to those types of questions would be allowed to donate but would still be tested for such diseases. Every single unit is tested as well. So even the if a person answers the questions the same every 8 weeks when they donate, every unit will still be tested for all of the same diseases, there is actually much more being tested than just those as well. There is always a very small chance of false negative testing though so there is always a small risk when receiving blood products. Medications are screened as well and many are OK such as cholesterol meds but other such as antibiotics to treat an infection would not be OK and would not be allowed to donate for a period of time. Also many medications that can cross the placenta and harm a fetus would not be allowed to donate either. There is a LOT that goes into the screening process both for the donor’s safety and the recipients as well! We really rely on the honesty and integrity of the donors to be honest and truthful to mitigate the risks to the recipient.

[@joshbritton]

Is there a risk to placing a large bore IV every time just in case you need a rapid infusion? Instead of having to place it in the middle of the case?

[@MaxFeinsteinMD]

Yes, every procedure we do comes with risks. For IV placement, risks in include infection and bleeding. With larger bore IVs, there can be a higher risk of causing vascular injury as well.

[@paulkoza8652]

Thanks, Max. This was very informative. It did raise a question. I had a colon resection a number of years ago. How do I know if I was given blood products during this surgery? There was no record of this on the hospital's billing report, so I assume that I did not.

[@the.mermaid.scientist]

Ask the hospital for your own medical records. You may be able to access your records online too, depending on what charting program they use. they may or may not charge money for paper records.

[@shellderp]

they should have a full writeup of everything done in surgery, I got one for my resection

[@mateusrocha4783]

Any thoughts on Patient Blood Management?

[@locykulas2839]

Hello, Max Would you kindly recommend any study guides for the MD exam in anesthesiology?

[@lillywho]

Have you or would you do a video on spinal anaesthesia? I'm not sure it's the correct term. I'm going to have surgery where they're going to be directly numbing the spinal column's nerves, and that prospect seems rather daunting, so I'm morbidly curious about the topic.

[@BirdiesGoCherp]

It is called spinal anaesthesia, it's a form of neuraxial anaesthesia where we inject local anaesthetic into the subarachnoid space to stop signals from being transmitted through the spinal cord.

[@lillywho]

@@BirdiesGoCherp I know that, but I was interested in the whole setup procedure. Turns out he had already done a video on epidural so I watched that. Really didn't help... I don't like the idea of purposely turning my back to be stabbed in the back a couple of times, but the benefits for post-OP pain management are just too great to refuse...

[@BirdiesGoCherp]

It honestly isn't that bad, I had it performed to me when I was getting my knee done. Just one prick was all it took, most of the time it just takes 1 jab and we're in.@@lillywho

[@Twinsen764]

Which you would do a video like "Anesthesiologist reacts do a movie scene"

[@ericB3444]

Sonnyball, YOUS talk about blood so much that me aunt MARMALADE thinks YOUS is a VAMPplus. That’s a vampire that carries around the plus sized iPhone.

[@bradmoore1247]

Generally how do I keep my iron levels high enough to donate?

[@laratheplanespotter]

I wish I could donate my blood but my PoTs won’t let me anymore. I did get to 10 units before I got sick though and I am a registered organ donor 😊

[@anthonywatkins8938]

Hey max been transplanted once with liver failure this yr found out today 11 months down road half has died and right is starting to faill what's my chances of being under longer and everything love ur stuff

[@emobean]

My mom is O- and I'm O+. I'm terrified that she'll need blood one day, and I won't be able to donate any to her. that being said, she has chronically high red blood cells. maybe there's hope LOL

[@laurafowles2311]

I dont think you know what the medical Technologist does, we are a critical part of health care, we provide the laboratory results you base medical decisions on.

[@OrionHartwick]

Lol thats a lot of blood

[@PowerUpJohn]

I wondered who ordered most blood transfusions as an emergency nurse? I almost thought it was hematology / oncology, needing one for IVIG. I had 4 RBC transfusions for surgeries & anesthesia cross-matching me makes sense. Thanks donors! 🅰️🩸