Photo Credit Marc Burford

Unique specialty proves valuable in many areas

No, Memphis Coagulation Laboratory Director Carolyn Chesney, MD, doesn’t run the world. But she probably could if she wanted to.

Happily married to pathologist Thomas McC. Chesney, MD, the high-energy mother of six has forged her own bold path to a uniquely customized niche that has so many facets it seems unlikely any single successor could fill it. Considered one of the top coagulationists in the country, Chesney captains a laboratory that serves as a reference lab and processes specimens from across the country. She also serves as a hematopathologist with Trumbull Laboratories and is  a member of the Pathology Group of the Mid-South (of which her husband is president). 

She is a full professor of both medicine and pathology at the University of Tennessee Health Sciences Center.

Lest we suspect that she is loafing, she diagnoses leukemia and other diseases on bone marrow specimens and serves on-call for the Baptist Hospital blood bank.

A Memphis native and graduate of Vanderbilt with a BA and MD, she spent six months in medical school researching coagulation at the Oxford University Hemophilia Center in England, where hemophilia was first discovered in Britain. She did internal medicine residency at Vanderbilt followed by an additional four years at Harvard/Massachusetts General Hospital Hematology/Oncology (HEM/ONC) program doing further coagulation research before returning to Memphis to pursue her passion, which she discussed with Memphis Medical News.

Even Google seems perplexed about what coagulationists do. Why the mystery?    

Coagulationists seem to fall through the cracks. Clinicians who train in hematology/oncology are primarily interested in becoming oncologists. They learn to manage patients with thrombotic and bleeding problems, but they don’t train extensively in this specialized field. While pathologists learn about coagulation testing, they don’t usually manage the interactive aspects of patient care, as a good consulting coagulationist must.

In order to make the diagnosis, coagulationists must first understand the clotting system and how it works. They determine why someone is bleeding or clotting, and  then treat that person using appropriate products and techniques to stop the bleeding or keep clotting under control.

Coagulationists are needed when, for example, a patient taking Plavix – a very potent antiplatelet agent – needs to know whether it’s working. There is a subset of people that are Plavix-resistant, and if you’re one of them, there’s no point in taking an expensive daily medication that isn’t working.

On the other end of the spectrum, if a patient on Plavix needs surgery ASAP, Plavix must be stopped for five days before surgery. If Plavix inhibition can be tested and shown to be in a safe range sooner, then surgery can be performed, saving time.

So an on-site coagulation lab is a valuable asset?

With the right tools, a coagulationist can discover these answers and many others right away, often within 15 minutes of getting the specimen in the lab. We get calls from the operating room sometimes – bleeding is going on so we do immediate testing and get fast results which we communicate to the surgical team. There’s no time to send specimens off to a lab in another state.

How important is coagulation testing?

Far more people die from the consequences of thrombosis, than die of breast cancer. Yet it’s much easier to prevent some of these problems than it is to prevent breast cancer. The knowledge is available – we  just have to make sure it gets disseminated to the primary care doctors who are seeing the bulk of these patients.

Coumadin and Heparin and other anticoagulants are very dangerous drugs. You’ve got to get it right or somebody could bleed to death; or they could have a thrombotic event or pulmonary embolism. Millions of people suffer from these problems every year in this country alone – it’s a big problem.  So coagulation testing is very necessary – very much in demand.

I feel passionately about correctly diagnosing and treating these patients in a cost effective manner, and I try to train my students so they share that passion.

How did this unusual field develop locally?

I came to Memphis from Boston when the Navy sent my husband to the Millington Naval Hospital. I was a hematologist at UT, taking care of patients, and I had an NIH funded grant focusing on coagulation research. Baptist Hospital recruited me to head their coagulation lab because I had experience in the field.

Coagulation testing wasn’t automated as it is now. You had to know the biochemistry to set things up and I could do that. Fortunately, Baptist allowed me to continue my research and my professorship at UT, where I’m in charge of hematology module in the pathophysiology course for second-year medical students. I train all the pathology residents in coagulation – they rotate with me – and all the HEM/ONC fellows at UT, as well.

What’s unusual is that we do in-house at Baptist almost every coagulation test you can send out for anywhere in the country – because that’s the way I originally set up the lab.  As time went on and more things were automated we continued to incorporate available testing using the latest techniques – not only for Baptist Memphis and its regional hospitals, but for the American Esoteric Laboratory (AEL). We’re their reference coagulation laboratory, receiving specimens from all over the country.

We also serve as a reference lab for the Bleeding Clinic for St. Jude and their hemophilia program. I do their inhibitor assays. We do Heparin antibody testing for the MED and other hospitals.

I like having control over all the testing. Other hospitals send out most tests to the bigger national laboratories. Since I already have the knowledge and we have a big volume, it’s practical and cost-effective for us to maintain a comprehensive coagulation lab right here in Memphis where we have a faster turn around time and can consult with physicians personally.

How many other coagulationists are there in the country?

Not a lot. Nobody does exactly what I do. It’s a unique combination of skills and interests that I’ve acquired sort of by accident – because of my interests and the opportunities that arose. Nobody can set out on a training pathway to end up like this. Training programs are not set up that way.

I’m not saying there are no coagulation programs; it’s just not the major interest of most of the people who go into those fields.

What accomplishment makes you proudest?

I’m very happy each day if I can do a good job, make the correct diagnosis and help each patient. And I care deeply about training the upcoming generation of medical students, residents, and fellows and imparting the fun of doing medicine.

Amazingly, at the end of the day, Chesney still has energy and enthusiasm to spare for an array of hobbies and leisure interests. She speaks and studies many languages including French, Greek  and Polish. She enjoys traveling, reading, gardening, cooking, and ordinary domestic chores she seldom has time for.

 “Maybe if I got to do them more often, they wouldn’t be so interesting!” Chesney quips.

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