Clinical Report: When Pathology Met a National Crisis

Overview

A pathologist recounts beginning residency shortly before the September 11 attacks and describes a citrate reaction during a subsequent plasma and platelet donation. The account also traces how the attacks and later anthrax mailings prompted the author to write and present educational material on biological threats.

Background

The narrative places pathology training within the immediate aftermath of the September 11 attacks, when the author expected blood products to be urgently needed and sought to donate. Component donation uses sodium citrate as an anticoagulant; the author’s account explains that citrate returning to the circulation can temporarily bind calcium and lower ionized calcium. The article also describes the author’s response to anthrax mailings through research and public education. Related articles address the visibility of pathology during COVID-19 and workforce pressures in histopathology, but do not provide additional clinical data for this account.

Data Highlights

The article provides no trial or population-level numerical data. It reports that symptoms began 10–20 minutes into the author’s first plasma and platelet donation and resolved within minutes after the machine was slowed and supportive measures were provided. The author later donated again without a reaction.

Key Findings

• On September 11, 2001, the author was a first-year pathology resident completing a surgical pathology rotation at North Shore University Hospital.
• After the attacks, the author sought to donate blood products but was initially deferred because of the long donor queue; the eventual donation was plasma and platelets.
• During that first component donation, the author experienced perioral and peripheral tingling and numbness, chills, tremors, muscle cramps, nausea, and a perceived slowing of the heartbeat.
• The nurse slowed the collection machine and provided milk, slow breathing into a paper bag, and a blanket; the symptoms resolved within minutes. The nurse identified the event as a citrate reaction, and the author later learned that citrate can temporarily bind calcium and lower ionized calcium.
• The author reports that a subsequent donation several weeks later proceeded without a reaction.
• Following reports of anthrax-containing letters, the author wrote six articles examining seven pathogens or biological agents, including diagnosis, prevention, and treatment, and presented a special report at departmental Grand Rounds.

Clinical Implications

The account describes a donor reaction temporally associated with citrate anticoagulation during plasma and platelet collection and reports symptom resolution after the collection was slowed and supportive measures were given. It does not provide comparative evidence or establish a general management protocol.

Conclusion

The article combines a personal account of a citrate reaction during component donation with reflections on pathology and public education after the September 11 attacks. Its clinical detail is limited to the author’s experience and explanation of citrate’s temporary effect on ionized calcium.

Related Resources & Content

1. The Pathologist, 2022 — Pathologists at the Table: Keeping Our Place After COVID-19
2. The Pathologist, 2020 — Averting a Histopathology Crisis
3. The Pathologist, 2020 — Pandemic Pathology
4. INTERPOL, 2023 — Disaster Victim Identification Guide
5. CDC/NIOSH — Policies and Procedures: World Trade Center Health Program
6. Autopsy practices for high-consequence infectious diseases: global guidelines, alternatives, and the BSL-4 gap
7. the pathologist — An Identity in Danger
8. INTERPOL Disaster Victim Identification Guide, 2023
9. CDC/NIOSH World Trade Center Health Program: Policies and Procedures
10. Autopsy practices for high-consequence infectious diseases: global guidelines, alternatives, and the BSL-4 gap