Collaboration Proves Key to a Quick Diagnosis

Collaboration Proves Key to a Quick Diagnosis


[music] One of our youngest techs
or newest techs rather, had noticed that one of the samples that
she was working on kept giving flags saying that there was
a clot in the tube. This is the second day in a row
that this was happening. And she simply just took
the tube and inverted it to see if there was a clot in there. And it wasn’t clotted.
It was a clear serum sample. But it stuck to the bottom of
the tube when she inverted it. Which is a red flag to say
this sample had gelled. Because of that, they stopped me
as I was walking through the lab. I went and looked at the tube and
said, “That’s kind of a problem.” And I took down the patient’s
medical record number, looked at the chart, and saw
that the patient had a very high
total protein, a low albumin, and the fact that the sample was
gelled were red flags for us. So I was able to call the patient’s
clinician and have a conversation. And the clinician was like, you know, we’ve been having trouble figuring
out why he doesn’t feel well. He’s been fine up until
three or four weeks ago. When he said he’s just been really
tired, sluggish and doesn’t feel well. And so in that conversation
I was able to explain to him that because of this pattern
of laboratory values and the fact that the sample was gelled that it would be really
advisable for him to do a protein electrophoresis study
on the sample we already had. So he had Waldenstrom’s macroglobulinemia. His IGM and immunoglobulin protein
or an antibody protein was sky-high and his blood was viscous and
this was actually happening in him. And it’s really a medical emergency. So with Waldenstrom’s macroglobulinemia, what it really means is that it
is a cancer of the bone marrow. And so you have one population
of cells that’s taking over and it’s making this very large
protein complex called IGM or
immunoglobulin M. And what can happen is with
this big protein complex, is that essentially it makes
your blood very thick. And so your heart has to work
very hard to push it through. And then because of that viscosity or how sludgy for lack of
better term the blood is they get a lot of symptoms
associated with that— fatigue, more prone to clotting. They can actually have serious
and fatal consequences of this
high protein concentration. His outcome could have been
much more serious if he wasn’t identified earlier
and then treated so rapidly. And really the reason that
we have that treatment is we communicated from the technologist
to me to the clinician, the hematopathology group,
the hematology oncology group,
transfusion medicine. All of these people coming together
discussing at different time points, we were really able to affect this
patient’s outcome much quicker. My name is Dr. Mark Cervinski and I am an associate professor of
pathology and laboratory medicine at the Geisel School of
Medicine at Dartmouth, and the Director of
Clinical Chemistry at Dartmouth Hitchcock
Medical Center in Lebanon, New Hampshire. [music]