As a transfusion medicine physician, I must know if I can trust my staff’s interpretation of immunohematology testing.  I may be called at night and they will provide me with results and I must use these to make a medical judgment.  If their interpretation is flawed, I might make a decision that harms the patient.

I really don’t like multiple-choice questions, but nowadays this is often the norm.  For my staff, especially senior staff and those who want to be promoted to senior staff, I have developed a series of projective exercises to help me understand their thought processes.

Here is another exercise, usually given to base medical technologists.  I have the staff review this panel and tell me to interpret it:

Everyone reports this is anti-S, enzyme-labile, but relatively few bother to ask for the S phenotype.  All were trained to check the phenotype as part of the workup.  I also had a version of this examination in which I only showed the AHG results.  Many did not ask to perform enzyme.

The proper answer was probable anti-S, enzyme-labile, but request S phenotype. If the enzyme had not been performed, then the enzyme panel results should be requested.