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Alumni Spotlight: Dr. Ben Fialkow of the American Red Cross

11/17/2016

Fialkow

Name: Lawrence (Ben) Fialkow, D.O.

Hometown; Originally from Columbia, S. Carolina and now lives in Brighton

Family; Wife, Alice Rutkowski, son, Duncan, 8

Occupation; He is Medical Director of Blood Services (East Division) for the American Red Cross. This coverage area spans seven states in the Northeast including NY and PA.

Education; He earned his D.O. degree from Des Moines University and began post-graduate training in Internal Medicine at Maimonides Medical Center and at the University of Louisville. He spent the first year of his pathology and laboratory medicine residency at the University of Pittsburgh and finished at the University of Rochester. He later did a fellowship in Transfusion Medicine at Emory University Hospital.

Connection to UR; He was a resident in Pathology and Laboratory Medicine from 2004-08. He now serves as faculty for the Transfusion Medicine Fellowship at UR and is a regular judge for Pathology Research Day.

What first brought you to Rochester?

I had never heard of Rochester before I came here for residency and my wife. She’s a tenured professor at SUNY Geneseo, but even before she got tenure we knew we wanted to stay in the area. I targeted this Red Cross job after my training and it’s worked out very well.

Describe a typical day for you at the Red Cross.

I am part of a team of three physicians located in the Upstate NY, Boston, MA and Farmington, CT, who are responsible for all the Red Cross issues in NY, PA, Massachusetts, Maine, Connecticut, Vermont and New Hampshire. Basically, I’m responsible for any donor issues, blood product issues, or any issues with blood products being transfused at the hospital. During the day I get numerous questions about donors – if they’re okay to donate or how to handle some sort of reaction to a donation. I spend a lot of time on the phone with hospitals giving them recommendations. I’m not necessarily in the office a lot

Why did you choose blood banking?

I was actually trained in internal medicine. I wanted to pick something that would allow me to stay as close to patient care as possible. With transfusion medicine, you’re essentially involved with patient care all the time, and that’s why I went in this direction.

What’s something people may not know about your job?

As a medical director at the Red Cross, I’m one step removed from patient care. A lot of times when I’m discussing issues over the phone, it’s hard for people to understand that I don’t have an office where I see patients on a daily basis. I’m almost more of a manager where I oversee the laboratory and the blood products, but it’s more of a managerial role with a little bit of patient care. I don’t fit into the mainstream of what most consider a physician to be.

What advice can you give medical students or trainees?

If you’re not already decided on a field in medicine, when you go out and do your different rotations, pay attention. I went into internal medicine because I liked the lifestyle and the attitude of internal medicine docs, and was turned off of other careers because I didn’t necessarily see myself as that type of individual.

It’s the same thing with pathology. When you’re going through your pathology residency, think about whether you want to be a clinical pathologist because you like the laboratory side of things versus the anatomical side. Really pay attention to what you what you see yourself being in 10 or 10 years because, ideally, this is the job you are going to keep for the rest of your working life. Make sure you’re happy.

Do you have any professional goals for the future?

I did a lot of research when I was in training, and I’d like to get back more into the research field and maybe publish more.

Do you have any hobbies?

I am an avid runner. In the rain or snow, I am out there running every day. Otherwise, I love reading cheap science fiction and horror novels. The rest of my time is spent being a fulltime dad. It keeps me busy but it’s very rewarding. 

Alum Blood Banker, Dr. Triulzi, a Leader in Transfusion Safety

9/16/2016

Dr. Darrell Triulzi, M.D., gets excited when thinking about the direct impact his work has on patients.

The former URMC Pathology resident (1986-1990) now serves as the director of Transfusion Medicine at the University of Pittsburgh Medical Center Department of Pathology and medical director of the Institute for Transfusion Medicine.

Triulzi MDHe originally intended to work in internal medicine but switched to pathology during his second year of residency. After a rotation in the Blood Bank, Triulzi says he found his calling. 

“I immediately fell in love with the Blood Bank because it combined clinical medicine and pathology," he said. "It was one of those niches where you could do both clinical and laboratory medicine, and there aren’t many places where you can do both.”

After residency, he completed a fellowship at Johns Hopkins University and later joined the faculty at University of Pittsburgh, where he's worked for the last 25 years. His driving inspiration is finding ways to improve patient care and safety in transfusions, and a practical way to do that is by participating in clinical research. 

He has taken part in a number of multi-institutional NIH-funded clinical trials since the 1990s. These studies have addressed such questions as: Will HIV patients who receive transfusions progress to AIDS more quickly? The findings said no. Or, a study published in The New England Journal of Medicine asked, what’s the proper platelet dosing strategy for cancer patients? What about the storage duration of blood in cardiac surgery patients?

A follow up study published in Blood questioned whether it made a difference if platelets are apheresis or pooled, fresh or stored or ABO matched. When results showed that it did not, a number of providers responded positively, saying this information helped them strategically manage platelet inventory. Triulzi most recently began working on an NIH study examining the use of an antifibrinolytic agent to reduce bleeding in cancer patients.

He is co-chair of a multidisciplinary health system-wide patient blood management (PBM) committee at UPMC alongside fellow co-chairs, an anesthesiologist and a trauma surgeon. Like many PBM groups across the U.S. the committee has worked to promote restrictive transfusion practices in clinical settings.

While blood transfusions can be life-saving, there are safety risks linked to using them. Physicians are therefore encouraged to only administer transfusions when absolutely necessary for the patient. Triulzi says this effort is having a real impact in recent years as UPMC has reduced total transfusions by more than 30 percent. 

“I’ve always enjoyed taking care of patients and the clinical side of medicine,” said Triulzi. “I think one of the reasons I chose blood banking is because it’s a consultative service to the clinicians that’s not so much looking at slides like most pathologists do. There is a more outward focus.” He added, “Most physicians at the hospital think that I’m a hematologist as opposed to a pathologist, and I take that as a compliment.”

Triulzi has fond memories of his time in Rochester, where he met his wife Mary, a dietician. He continues to keep in contact with longtime mentor, Dr. Neil Blumberg, director of Clinical Pathology, and credits Blumberg with triggering his interest in academic pursuit within his career.

An Albany area native, he and his wife have three children, Leah, 23, Ben, 20, and Sam, 15. In his free time Triulzi enjoys studying American and European history, attending University of Pittsburgh football and basketball games, and playing fantasy football. 

 

 

The Lifesaving Work of the Blood Bank and Transfusion Medicine Unit

7/13/2016

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Have you ever wondered what happens to blood donations when they are taken to a hospital?     

According to the American Red Cross, 6.8 million Americans give blood each year. The Blood Bank and Transfusion Medicine Unit at Strong Memorial Hospital receives and stores these blood products to be ready for patients around the clock. 

We spoke with Debra Masel, Blood Bank chief supervisor, and Aimee Kievitt, lab supervisor, to learn more.

Where do blood products stored in the Blood Bank come from?

The vast majority of our blood comes directly from the American Red Cross located on John Street in Henrietta.

There is also a small donor room located off the main lobby at SMH where patients scheduled for surgery, and who qualify to donate their own blood, can have a unit of blood collected. This blood is then stored in the Blood Bank specifically for them if a transfusion is needed during their surgery.

What are the main functions of the Blood Bank?

We do testing to make sure that the blood received from the American Red Cross is compatible with patients who need it. If a patient has any type of transfusion issue, we need to identify and resolve the problem to ensure that the blood is truly compatible and that we’re not causing more harm by transfusing them.

Our attending physicians, nurses, residents and fellow provide clinical consultation on effective and safe use of blood transfusions, and evaluate transfusion reactions.

How much blood does the Blood Bank receive each day?

We transfuse about 100 units a day. During the blood collection process, approximately 500 milliliters of whole blood is collected which is then separated into red cell, plasma and platelet products. A unit of red cells has a volume of approximately 400 milliliters, which includes a preservative solution to increase the shelf life of the product.

What’s the difference between a blood sample and a blood product?

A blood sample is drawn directly from the patient and is used to complete pretransfusion testing to ensure compatibility with the intended blood product. Blood products are collected from volunteer donors.

A donation is separated into its component parts – plasma (55%), red blood cells (45%), and white blood cells and platelets (less than 1%) – which are each stored and used separately to help multiple patients.

What happens when there’s a trauma patient in the Emergency Department who needs blood products?

The Blood Bank has a trauma pager so when a Level 1 trauma patient is being transported to the hospital, the technologists are notified. They then prepare the trauma cooler with four units of O Negative (O-) uncrossmatched red blood cells, commonly known as the “universal donor.” When a staff member from the ED comes to pick up the blood, he or she will bring a patient blood sample for testing to be performed.

It is important to switch the patient to blood products identically matched to their own blood type as soon as possible, since our research at SMH shows that ABO identical transfusions are safer than use of “universal donor” red cells or plasma.

BloodbanktestWhat kind of testing does Blood Bank perform?

The Blood Bank processes about 120 patient samples a day, many of which are outpatient samples for pre-operative and prenatal testing. About 90 percent of our transfusions are given to inpatients and the remaining 10 percent are transfusions received by outpatients.

What happens if a patient with very rare blood type needs a transfusion?

Sometimes there are other complications besides a patient’s blood type. If a patient has multiple antibodies, for example, finding compatible donors in the available blood inventory may not be possible.

In that case, we contact the Rare Donor Registry via the American Red Cross and a national search is initiated to identify a compatible donor. If we request something that’s available in the registry, they send it to us. We have gotten products from Florida, California, and other states.

What if the Red Cross can’t find what you’re looking for?

If we have a need for a rare unit and the American Red Cross has nothing in inventory, they can search their database to find a donor who matches the patient’s needs. They contact the donor and let them know that they are a rare match for a patient in need and request that they come to a center to donate.

How does a critical shortage in blood donations affect the work of the Blood Bank and Transfusion Medicine Unit?

In the event of a critical shortage (and it would have to be very dramatic) hospital administration and our attending physician and resident on call are notified. Our physicians and technologists will triage requests so that only clinically urgent transfusions are performed during the shortage.

The hospital chief medical officer may ask surgeons to reschedule elective surgeries so that the available blood supply can be conserved for urgent needs.

Thankfully, the community response to blood shortages has been good in bolstering the blood supply so that the drastic measure of rescheduling surgeries hasn’t happened in many years.

What’s a more common type of shortage you encounter?

When there’s a shortage of O- blood and the Red Cross can’t provide our normal inventory levels, we may need to evaluate every requested transfusion for clinical necessity and urgency.

It’s very important to obtain a patient sample as quickly as possible so that trauma patients receive products identical to their blood type instead of group O- blood. In those cases, it requires a higher level of communication and coordination between Blood Bank and the ED or Operating Room so we can appropriately supply their needs.

The same is true for platelet shortages. Our physicians, nurse and technologists evaluate each request for necessity and urgency. We discuss orders with providers to hold off on transfusion or reevaluate whether a transfusion is absolutely necessary when the necessity or urgency are not clear from the order.

Bloodbank3When do you have the greatest need for blood donations?

Summers (around the Fourth of July) and December tend to be the two times when supplies are running lowest. Schools, which hold many blood drives, are closed, and people are on vacation so they are not available to donate blood.

What have been the biggest changes in blood banking within the last decade?

There has been a national push for restrictive transfusion practices, and this is a good thing. Blood transfusion can be lifesaving in certain situations but it’s not the cure-all. A transfusion is like a liquid transplant. If a patient doesn’t have a specific need to be transfused, they shouldn’t be.

Research performed here has led to substantial changes in transfusion practices to render them safer for the recipient, such as use of ABO identical transfusions, leukoreduced transfusions for all patients and washed transfusions for select patient groups. This has led to many fewer complications of blood transfusion and increased survival in some instances.

How has your role in patient care changed over time? 

In the last decade, our staff has started to interact more directly with nurses and ordering providers to discuss patient cases; their underlying diagnosis, signs, symptoms, and whether transfusion is the most appropriate course of action. There have been more of those types of collaborative and educational discussions. 

In photos: 

Top: The Blood Bank at URMC stores all blood products in a cooler where staff can pull units needed for patients. 

Middle: Lisa Hughes, a medical technologist, performs a test to determine the blood type of a patient who has received a bone marrow transplant.

Bottom: Medical technologist, Kim Bastian, releases a blood product to a patient for a transfusion. In this case, the patient has had transfusion reactions, so the product has been "washed" with saline to help prevent further reactions from occurring.

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