Power in the Blood

        There is an old hymn we do as a bluegrass number called “Power in the Blood.”  Today’s post though, is medical instead of music.  I hope you aren’t disappointed.  (Never know which way ole Dr. B’s gonna go, huh?)

       A family recently asked me some good questions about what you could tell from the blood smear.  The answer is a lot.  Our family can lay claim to an early N.C. pediatric hematologist, so we’ve been talking about blood around the dinner table a long time.  (Aren’t docs weird?)  Anyway, the whole conversation set me to thinking about an old med school story.  It is apocryphal, but still a good one.

        We had an old hematologist at Sandhills U. who claimed he could diagnose anyone in the hospital by a review of the peripheral blood smear.  No history.  No exam.  No chart.  No other data.  Nothing but prick the finger, put the blood on a microscope slide and bring it to him and he’d tell you what was wrong.  There’s Power in the Blood, he’d boom out in a most excellent baritone.  He had a standing bet.  If a group of interns could stump him, he’d buy dinner.  If they lost, it was on them, and he got to choose where.  Everyone knew he liked Kell’s, a local steakhouse out of the price range for the students, and the Professor was good.  He got few takers.

        Of course, every doctor on the planet knows how difficult this feat is.  Near impossible.  We are taught to take a history first, and that it is your most important piece of  information.  If you don’t where you are headed after the history, you are in trouble.  In fact, we had one old Doc who used to say if he didn’t know what was wrong with his patient in the first five minutes, there was a ninety percent chance no one would ever figure it out.  (Bear in mind he had the advantage of knowing years of the patient’s history before hearing the first word on that encounter.)  I wouldn’t go that far, but the idea of diagnosing from a smear alone is an Olympic Dive with a degree of difficulty of twenty.

        One day a group of medical students decided they were going to stump the old Professor, and set out to insure success.  They recruited the number one smart @^^ intern to head up the search team, and off they went.  After a hospital wide hunt, they found their candidate. 

         Their primary criterion was to find a patient with a single medical problem, and one so obscure the hematologist could not make the diagnosis from a blood smear alone.  (I know all this makes you wonder when we find time to practice medicine.)

        They found their man on the orthopedic floor.  The patient was a young male who had fractured his femur in a motor vehicle accident, and was near discharge. 

        Now, one thing med students can do is take a history, and they descended on this poor boy with zeal.  This kid not only had nothing else wrong, but his family history was clean too.  The grandparents were living, his parents and siblings all healthy; there was nothing.  This was a car wreck, and that was it.  They took their smear to the Professor with great confidence, the intern leading the way.  

        The ace intern issued his challenge.  

        “Sir, if you would review this slide.  We believe this patient can not be diagnosed from a peripheral smear alone.”

        The professor placed the slide under the microscope and began a systematic review.  For a long time he did not speak,  The students were confident.

         He began to issue a few pronouncements. 

        “Hm.  The white cells are normal in appearance and number.  I  doubt this patient is suffering from any systemic infection.”

        He continued to peruse.  The intern gloated.  The old Professor seemed stumped.

        The Professor went on.  “And judging from the size, shape, and color of the red cells, I believe this to be a healthy individual.”  Professor Lauton held his cards close and continued his search.

      He scanned the slide again.  The tension was growing.  They had him.  He stopped.

        “Hm.  In this quadrant there is a finding of significance.  Here is a fat globule.  Care to look?”

       Now the intern was less confident.  He peered into the microscope.  “Yes sir, I see.”

        “A fat globule is an indication of fracture, usually of a long bone.  Given we have established this is a young healthy individual, I am going to say this must be trauma of significant force, such as in a motor vehicle accident.”

        The med students rolled their eyes.

         The Professor went on.  “Given this is trauma to a long bone in a young individual, I am going to say this involves risk taking behavior, so it more likely this is a young male rather than a young female patient. ”

       He paused.  “Therefore, I must conclude this is a young male patient who has been involved in a traumatic injury, most likely a car accident.  Given the finding of a fat globule in the peripheral blood smear it had to be a bone fracture that would warrant inpatient orthopedic treatment, so I’ll say he has a fractured femur.

       Not to be outdone, the smart @^^ intern said, “Well that’s great Professor, but which leg?” 

        I don’t know about y’all, but I don’t believe I’d a said that. 

        Gonna turn into a bluegrass mucisian for the weekend, so will report back my findings.  Remember, there’s Power In the Blood.  And don’t forget, whenever someone wants to lay bets on their own game proceed with caution.

Dr. B

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