Hoxworth

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What is convalescent plasma? What is the rarest blood type? How much blood is used during a trauma or surgery? Get the answers to your most pressing blood banking questions and listen to In the Know with Dr. Oh!


Hoxworth Blood Center, an internationally recognized leader in transfusion medicine, takes you inside the world of blood banking!  Hoxworth's Chief Medical Officer, Dr. David Oh, covers all aspects of blood donation and transfusion medicine. Tune in and learn about new advancements in the field of blood banking, get answers to our most frequently-asked questions, and uncover the truths behind the most common rumors, myths and fabrications about blood donation.

Have a burning question for Dr. Oh? Contact us at hoxworthintheknow@uc.edu. 

All caught up on episodes of In the Know with Dr. Oh? Stay up to date with Dr. Oh on Twitter: @InTheKnowDrOh
Instagram: @InTheKnowDrOh

Podcast Episode Transcripts

Alecia Lipton (00:27):

This is Alecia Lipton, and you're listening to in the know with Dr. Oh presented by Hoxworth Blood Center, University of Cincinnati. Our series of podcast will feature Dr. David Oh, our Chief Medical Officer, covering all aspects of blood donation and transfusion medicine. Most importantly, we will discuss how all this impacts you, the listener. Today's episode of In the Know with Dr. Oh focuses on convalescent plasma. First and foremost, Dr. Oh, what is convalescent plasma?

Dr. Oh (00:59):

Plasma is the plasma that we collect from a person who has been infected with COVID-19 and recovered. So COVID-19 convalescent plasma essentially contains the antibodies that can neutralize the virus from people who have recovered

Alecia Lipton (01:15):

Well, we're in blood banking and we've collected red blood cells, whole blood, platelets and plasma. But with the COVID 19 pandemic of 2020, we saw a new aspect come into blood banking, where we had to start collecting convalescent plasma. When did we start doing that?

Dr. Oh (01:35):

So it's actually not a new therapy. It was used over a hundred years ago in the flu epidemic of 1918. We started collecting COVID 19 convalescent plasma in April of this year,

Alecia Lipton (01:46):

When we first started working with the convalescent plasma in April of this year, we were doing that as part of an FDA study. Could you tell us a little bit about that?

Dr. Oh (01:57):

FDA has been very helpful in helping us to collect convalescent plasma and distribute it for people who need it. They provided a guidance, uh, which we pretty much use as a rule, a book to, or a playbook to help us in terms of collecting and distributing the product. We asked that donors who are interested in donating convalescent, plasma, contact us, and we evaluate their symptoms. And if they have any test results, that's very helpful in terms of us allowing them to go ahead and donate complex supplies.

Alecia Lipton (02:29):

And it looks like in about August the FDA then released some of the barriers so that it was easier for physicians to order convalescent plasma.

Dr. Oh (02:40):

In the pandemic we collected convalescent plasma. And the only way that patients could actually receive pelvis plasma was through three different mechanisms and they all had to be FDA approved protocols. So one was what we call an EIND and that's for individual patients. So a physician would see a patient that they wanted to treat and would actually have to contact FDA for permission to use the convalescent plasma. FDA was great in terms of being able to turn around those requests very rapidly, typically within a day. And, but you can imagine that the paperwork involved in that was pretty cumbersome. And that was a difficult process for both FDA and for individual doctors who were requesting. So the Mayo Clinic had a study, which had a lot of interest. It actually became an EAP or an extended access protocol, so that many hospitals across the country could use it and allow more patients to be able to get a convalescent plasma.

The Mayo clinic EAP was reviewed and approved by FDA, and actually FDA started recommending that physicians who requested plasma under an EIND start using the Mayo EAP because it was an easier process for them to get the convalescent plasma. Um, the other mechanism, the third mechanism was actually for individual hospitals or hospital groups to construct their own clinical trial. So this was an option that required a lot of work on behalf of the hospitals, but a couple of different hospitals in the Cincinnati area (Christ system and TriHealth system) developed their own protocols. And these had to be approved by FDA as well. And once those individual protocols were approved, then they could start enrolling patients to get convalescent plasma under the specific requirements of that specific protocol.

Alecia Lipton (04:25):

It sounds as if Hoxworth really worked hand in hand with the area hospitals and the FDA at the forefront of the COVID-19 and convalescent plasma usage.

Dr. Oh (04:34):

That's one of the great things about Hoxworth Blood Center. We have a very close relationship with our hospitals and we're able to work out some of these types of details. We are the only blood collector and supplier in this primary area. So all of the different hospitals in Cincinnati and the surrounding tri-state area, essentially get all of their blood from Hoxworth Blood Center. So we can help them directly with any special requests that they have or special processes such as this, we work closely with Christ Hospital and TriHealth in terms of helping them with their protocols and making sure that the convalescent plasma portion of those made sense. And we also worked with the UC health system with multiple studies that they were working on as well.

Alecia Lipton (05:17):

So you mentioned that Hoxworth Blood Center supplies blood to over 30 hospitals in the tri-state region. So does that mean no matter which hospital you're in at this point in time, if you are diagnosed with COVID-19, you have the ability to get convalescent plasma?

Dr. Oh (05:33):

Yeah, essentially we have been providing convalescent plasma to all the hospitals that we provide typical blood products to. And so that's essentially all of the hospitals in the area that includes the Mercy system, TriHealth, UC Health, Children's Hospital, Christ. So essentially if you or a loved one are receiving convalescent plasma in the Cincinnati area, you've gotten it from Hoxworth Blood Center.

Alecia Lipton (05:59):

When somebody has recovered from COVID-19 and they're considering, you know, I can go donate. Now, I've been symptom-free for 14 days. Does everybody have those antibodies or are there some people who might not have antibodies?

Dr. Oh (06:11):

There are people who, when we test do not seem to have antibodies, we perform antibody testing, which was not actually available in April for us to use. So initially we were accepting donors who had a test positive for COVID-19 at the time of diagnosis. It's hard to remember, but it was very difficult to get testing back then. So we were very fortunate when we had donors who had this type of test results. If we didn't have a test result because of a lack of testing availability, we actually held those convalescent plasma units that we collected until we were able to, to bring on, uh, an antibody test of our own. When we do do that testing the vast majority of people who report that they have had a COVID-19 infection, uh, do have, uh, antibodies that we are able to detect. And we actually want that level to be high enough for us to be able to have a lot of antibodies when we transfuse those to people who are actively infected

Alecia Lipton (07:07):

When somebody is contemplating, whether or not they should donate convalescent plasma, of course, we want them to pre-register for that on our website. And that is hoxworth.org/covid-19. So again, that's hoxworth.org backslash COVID dash 19. And why is it that we need people to register ahead of time? Why can't they just walk in the door and say, hi, I'm here to donate convalescent plasma?

Dr. Oh (07:35):

With all of our blood donations, even our standard blood products, we really would like for our donors to make appointments ahead of time, we have a limited amount of staff and equipment. So we really need to make sure when a donor arrives that we have availability for them so that their wait time is actually minimized for COVID-19. There's an extra level of qualification that has to happen because we don't want to be collecting people who won't have high levels of antibody. So oftentimes we really want to have documentation if it's at all available that the person was actively diagnosed with COVID-19.

Alecia Lipton (08:10):

You talked about having documentation that there was a positive diagnosis of COVID-19. Uh, what is it that you're looking for? Is it a doctor's note? Test results? What would the donor need to collect?

Dr. Oh (08:22):

We would prefer to have an actual lab result. If they have had a, for instance, nasal pharyngeal swab, that was positive. That's actually probably the best thing we could have. We also will accept, uh, doctors attestation that a person was infected, you know, early on. It was very difficult to get this documentation, but now it's actually pretty easy. I think for, for people to get that and testing has become much more available. So that testing is usually available.

Alecia Lipton (08:48):

I think one thing that's important for our listeners to know is that when you come and donate blood at blood center, we do a variety of, um, I believe 19 different tests on every unit of blood that's collected, but we do not currently test for COVID-19 or antibodies.

Dr. Oh (09:06):

That's correct. So for the general population, who's donating blood, we do not test for COVID-19. This is something that I think a few blood centers are doing, but really in terms of, you know, our function and our mission that COVID-19... Having people donate just to get results for COVID-19 was something that we did not feel like we should be, um, trying to do. The testing is not foolproof as well. So we really want people to have had a clinical symptoms and infection. If, if that's been, uh, documented for them before we would try to collect them for convalescent plasma.

Alecia Lipton (09:41):

And then the actual donation process, what is it like when you're coming in to do a convalescent plasma donation?

Dr. Oh (09:49):

Typically we have two major ways that people donate blood. One is whole blood and that's I think what most people traditionally think about when they think of blood donation. So oftentimes these are in a mobile setting, a donor will have a blood collected into a bag that actually has multiple empty bags connected to it. And it's a pretty rapid collection process. We collect about 500 milliliters of blood. Oftentimes you'll see that blood rocking on a scale that mixes the blood as it, as it weighs it, that is not the way we collect convalescent plasma, the other major mechanism, or a way that people donate is through automated devices. And so this is the way we currently collect platelets and we can collect plasma as well as we do that. A convalescent plasma, a donor will qualify just as they do for a whole blood donation, and then they will donate so that the blood goes into a device and we use disposable kits for every single donor that comes through. So, so the blood is kept separated from the actual machinery. The automated device will spin that blood at high speeds and allow us to actually layer out and collect the specific portion that we're interested in. Platelet donors will actually have platelets collected at the interface between the plasma and the red cells and for convalescent plasma donors, we're actually going to skim at the plasma level. So it's a very efficient way for us to collect that plasma and then return all of the other blood components back to the donor.

Alecia Lipton (11:18):

So it's very efficient. Also, as the donor, you're getting back some fluids as well. So, um, you leave feeling great. You're hydrated. How long does the process typically take? Is it the same with whole blood or is it as long as a platelet donation?

Dr. Oh (11:32):

It's kind of in between those two? So it's about an hour for most people, I would say whole blood is actually about 10 minutes in terms of the actual from needle to end of collection. But of course, with all of these donation types, there is an interview process, a questionnaire that needs to be answered and a recovery time in the, uh, after donating and what we call our canteen. So people can have some juice and cookies before they head out the door.

Alecia Lipton (11:57):

Yeah, that's the best part of the day, the juice and cookies. You did bring up something very important there, and that was the personal interview prior to donation and also filling out the donor questionnaire. So I think it's important that listeners know that when you're donating convalescent plasma, you're still going through that questionnaire process and there are still criteria that you need to meet. And that would be things such as travel medication and lifestyle restrictions, correct?

Dr. Oh (12:26):

That's definitely true. So unfortunately, sometimes we'll have donors who come in and are very excited to donate, whether it's convalescent, plasma or other blood products. And then through the interview process, we are unable to collect blood from them because they're ineligible for one reason or another. It's hard to understand sometimes why we would defer somebody for specific types of travel or for specific risk factors for a transfusion transmitted diseases, or even for donor safety reasons. But these questions are actually fairly uniform throughout all blood collectors. We use essentially what we call AABB, which is an organization over blood banks, donor history questionnaire, which has been approved by FDA. So you'll have a similar experience wherever you donate in terms of the types of questions that we ask. And the reasons for that are really regulatory in nature.

Alecia Lipton (13:17):

No. When people come to donate blood, they can't donate blood every day. Um, there are safety mechanisms put in place so that safe for you, the donor. So for whole blood, you can donate every 56 days. Platelets, you can donate every two weeks. What is the rule for convalescent plasma donors? How often can they donate?

Dr. Oh (13:36):

Yeah, this is a new product for us. So we've had work in terms of what we feel is appropriate for donation intervals. And you will see actually see some differences between different blood centers that are collecting convalescent plasma. At Hoxworth, we have decided to collect every seven days, a new convalescent plasma donor for up to four donations. So essentially for a month, we collect once a week, at most. After that fourth donation, we ask the donors to come back every 14 days. This is a change from earlier where we were asking people to come back every 28 days. But when we've looked at the antibody levels of our donors, we see that they do decrease over time. And that the best opportunity for us to collect plasma is early on in infection or as early as possible. Uh, for the first several months, at least. Many people will actually continue to have a good antibody levels over an extended period of time. But many people will have a more dramatic drop. And then we really would not want to use their plasma because the antibody levels are not as high as they could be.

Alecia Lipton (14:40):

Thank you for listening to in the note with Dr. Oh brought to you by Hoxworth Blood Center, University of Cincinnati for additional information, visit us online at www.hoxworth.org!

This is Alecia Lipton, and you're listening to in the know with Dr. Oh presented by Hoxworth Blood Center, University of Cincinnati. Our series of podcast will feature Dr. David Oh, our Chief Medical Officer, covering all aspects of blood donation and transfusion medicine. Most importantly, we will discuss how all this impacts you, the listener. Today's episode of In the Know with Dr. Oh focuses on convalescent plasma. First and foremost, Dr. Oh, what is convalescent plasma?

Dr. Oh (00:59):

Plasma is the plasma that we collect from a person who has been infected with COVID-19 and recovered. So COVID-19 convalescent plasma essentially contains the antibodies that can neutralize the virus from people who have recovered

Alecia Lipton (01:15):

Well, we're in blood banking and we've collected red blood cells, whole blood, platelets and plasma. But with the COVID 19 pandemic of 2020, we saw a new aspect come into blood banking, where we had to start collecting convalescent plasma. When did we start doing that?

Dr. Oh (01:35):

So it's actually not a new therapy. It was used over a hundred years ago in the flu epidemic of 1918. We started collecting COVID 19 convalescent plasma in April of this year,

Alecia Lipton (01:46):

When we first started working with the convalescent plasma in April of this year, we were doing that as part of an FDA study. Could you tell us a little bit about that?

Dr. Oh (01:57):

FDA has been very helpful in helping us to collect convalescent plasma and distribute it for people who need it. They provided a guidance, uh, which we pretty much use as a rule, a book to, or a playbook to help us in terms of collecting and distributing the product. We asked that donors who are interested in donating convalescent, plasma, contact us, and we evaluate their symptoms. And if they have any test results, that's very helpful in terms of us allowing them to go ahead and donate complex supplies.

Alecia Lipton (02:29):

And it looks like in about August the FDA then released some of the barriers so that it was easier for physicians to order convalescent plasma.

Dr. Oh (02:40):

In the pandemic we collected convalescent plasma. And the only way that patients could actually receive pelvis plasma was through three different mechanisms and they all had to be FDA approved protocols. So one was what we call an EIND and that's for individual patients. So a physician would see a patient that they wanted to treat and would actually have to contact FDA for permission to use the convalescent plasma. FDA was great in terms of being able to turn around those requests very rapidly, typically within a day. And, but you can imagine that the paperwork involved in that was pretty cumbersome. And that was a difficult process for both FDA and for individual doctors who were requesting. So the Mayo Clinic had a study, which had a lot of interest. It actually became an EAP or an extended access protocol, so that many hospitals across the country could use it and allow more patients to be able to get a convalescent plasma.

The Mayo clinic EAP was reviewed and approved by FDA, and actually FDA started recommending that physicians who requested plasma under an EIND start using the Mayo EAP because it was an easier process for them to get the convalescent plasma. Um, the other mechanism, the third mechanism was actually for individual hospitals or hospital groups to construct their own clinical trial. So this was an option that required a lot of work on behalf of the hospitals, but a couple of different hospitals in the Cincinnati area (Christ system and TriHealth system) developed their own protocols. And these had to be approved by FDA as well. And once those individual protocols were approved, then they could start enrolling patients to get convalescent plasma under the specific requirements of that specific protocol.

Alecia Lipton (04:25):

It sounds as if Hoxworth really worked hand in hand with the area hospitals and the FDA at the forefront of the COVID-19 and convalescent plasma usage.

Dr. Oh (04:34):

That's one of the great things about Hoxworth Blood Center. We have a very close relationship with our hospitals and we're able to work out some of these types of details. We are the only blood collector and supplier in this primary area. So all of the different hospitals in Cincinnati and the surrounding tri-state area, essentially get all of their blood from Hoxworth Blood Center. So we can help them directly with any special requests that they have or special processes such as this, we work closely with Christ Hospital and TriHealth in terms of helping them with their protocols and making sure that the convalescent plasma portion of those made sense. And we also worked with the UC health system with multiple studies that they were working on as well.

Alecia Lipton (05:17):

So you mentioned that Hoxworth Blood Center supplies blood to over 30 hospitals in the tri-state region. So does that mean no matter which hospital you're in at this point in time, if you are diagnosed with COVID-19, you have the ability to get convalescent plasma?

Dr. Oh (05:33):

Yeah, essentially we have been providing convalescent plasma to all the hospitals that we provide typical blood products to. And so that's essentially all of the hospitals in the area that includes the Mercy system, TriHealth, UC Health, Children's Hospital, Christ. So essentially if you or a loved one are receiving convalescent plasma in the Cincinnati area, you've gotten it from Hoxworth Blood Center.

Alecia Lipton (05:59):

When somebody has recovered from COVID-19 and they're considering, you know, I can go donate. Now, I've been symptom-free for 14 days. Does everybody have those antibodies or are there some people who might not have antibodies?

Dr. Oh (06:11):

There are people who, when we test do not seem to have antibodies, we perform antibody testing, which was not actually available in April for us to use. So initially we were accepting donors who had a test positive for COVID-19 at the time of diagnosis. It's hard to remember, but it was very difficult to get testing back then. So we were very fortunate when we had donors who had this type of test results. If we didn't have a test result because of a lack of testing availability, we actually held those convalescent plasma units that we collected until we were able to, to bring on, uh, an antibody test of our own. When we do do that testing the vast majority of people who report that they have had a COVID-19 infection, uh, do have, uh, antibodies that we are able to detect. And we actually want that level to be high enough for us to be able to have a lot of antibodies when we transfuse those to people who are actively infected

Alecia Lipton (07:07):

When somebody is contemplating, whether or not they should donate convalescent plasma, of course, we want them to pre-register for that on our website. And that is hoxworth.org/covid-19. So again, that's hoxworth.org backslash COVID dash 19. And why is it that we need people to register ahead of time? Why can't they just walk in the door and say, hi, I'm here to donate convalescent plasma?

Dr. Oh (07:35):

With all of our blood donations, even our standard blood products, we really would like for our donors to make appointments ahead of time, we have a limited amount of staff and equipment. So we really need to make sure when a donor arrives that we have availability for them so that their wait time is actually minimized for COVID-19. There's an extra level of qualification that has to happen because we don't want to be collecting people who won't have high levels of antibody. So oftentimes we really want to have documentation if it's at all available that the person was actively diagnosed with COVID-19.

Alecia Lipton (08:10):

You talked about having documentation that there was a positive diagnosis of COVID-19. Uh, what is it that you're looking for? Is it a doctor's note? Test results? What would the donor need to collect?

Dr. Oh (08:22):

We would prefer to have an actual lab result. If they have had a, for instance, nasal pharyngeal swab, that was positive. That's actually probably the best thing we could have. We also will accept, uh, doctors attestation that a person was infected, you know, early on. It was very difficult to get this documentation, but now it's actually pretty easy. I think for, for people to get that and testing has become much more available. So that testing is usually available.

Alecia Lipton (08:48):

I think one thing that's important for our listeners to know is that when you come and donate blood at blood center, we do a variety of, um, I believe 19 different tests on every unit of blood that's collected, but we do not currently test for COVID-19 or antibodies.

Dr. Oh (09:06):

That's correct. So for the general population, who's donating blood, we do not test for COVID-19. This is something that I think a few blood centers are doing, but really in terms of, you know, our function and our mission that COVID-19... Having people donate just to get results for COVID-19 was something that we did not feel like we should be, um, trying to do. The testing is not foolproof as well. So we really want people to have had a clinical symptoms and infection. If, if that's been, uh, documented for them before we would try to collect them for convalescent plasma.

Alecia Lipton (09:41):

And then the actual donation process, what is it like when you're coming in to do a convalescent plasma donation?

Dr. Oh (09:49):

Typically we have two major ways that people donate blood. One is whole blood and that's I think what most people traditionally think about when they think of blood donation. So oftentimes these are in a mobile setting, a donor will have a blood collected into a bag that actually has multiple empty bags connected to it. And it's a pretty rapid collection process. We collect about 500 milliliters of blood. Oftentimes you'll see that blood rocking on a scale that mixes the blood as it, as it weighs it, that is not the way we collect convalescent plasma, the other major mechanism, or a way that people donate is through automated devices. And so this is the way we currently collect platelets and we can collect plasma as well as we do that. A convalescent plasma, a donor will qualify just as they do for a whole blood donation, and then they will donate so that the blood goes into a device and we use disposable kits for every single donor that comes through. So, so the blood is kept separated from the actual machinery. The automated device will spin that blood at high speeds and allow us to actually layer out and collect the specific portion that we're interested in. Platelet donors will actually have platelets collected at the interface between the plasma and the red cells and for convalescent plasma donors, we're actually going to skim at the plasma level. So it's a very efficient way for us to collect that plasma and then return all of the other blood components back to the donor.

Alecia Lipton (11:18):

So it's very efficient. Also, as the donor, you're getting back some fluids as well. So, um, you leave feeling great. You're hydrated. How long does the process typically take? Is it the same with whole blood or is it as long as a platelet donation?

Dr. Oh (11:32):

It's kind of in between those two? So it's about an hour for most people, I would say whole blood is actually about 10 minutes in terms of the actual from needle to end of collection. But of course, with all of these donation types, there is an interview process, a questionnaire that needs to be answered and a recovery time in the, uh, after donating and what we call our canteen. So people can have some juice and cookies before they head out the door.

Alecia Lipton (11:57):

Yeah, that's the best part of the day, the juice and cookies. You did bring up something very important there, and that was the personal interview prior to donation and also filling out the donor questionnaire. So I think it's important that listeners know that when you're donating convalescent plasma, you're still going through that questionnaire process and there are still criteria that you need to meet. And that would be things such as travel medication and lifestyle restrictions, correct?

Dr. Oh (12:26):

That's definitely true. So unfortunately, sometimes we'll have donors who come in and are very excited to donate, whether it's convalescent, plasma or other blood products. And then through the interview process, we are unable to collect blood from them because they're ineligible for one reason or another. It's hard to understand sometimes why we would defer somebody for specific types of travel or for specific risk factors for a transfusion transmitted diseases, or even for donor safety reasons. But these questions are actually fairly uniform throughout all blood collectors. We use essentially what we call AABB, which is an organization over blood banks, donor history questionnaire, which has been approved by FDA. So you'll have a similar experience wherever you donate in terms of the types of questions that we ask. And the reasons for that are really regulatory in nature.

Alecia Lipton (13:17):

No. When people come to donate blood, they can't donate blood every day. Um, there are safety mechanisms put in place so that safe for you, the donor. So for whole blood, you can donate every 56 days. Platelets, you can donate every two weeks. What is the rule for convalescent plasma donors? How often can they donate?

Dr. Oh (13:36):

Yeah, this is a new product for us. So we've had work in terms of what we feel is appropriate for donation intervals. And you will see actually see some differences between different blood centers that are collecting convalescent plasma. At Hoxworth, we have decided to collect every seven days, a new convalescent plasma donor for up to four donations. So essentially for a month, we collect once a week, at most. After that fourth donation, we ask the donors to come back every 14 days. This is a change from earlier where we were asking people to come back every 28 days. But when we've looked at the antibody levels of our donors, we see that they do decrease over time. And that the best opportunity for us to collect plasma is early on in infection or as early as possible. Uh, for the first several months, at least. Many people will actually continue to have a good antibody levels over an extended period of time. But many people will have a more dramatic drop. And then we really would not want to use their plasma because the antibody levels are not as high as they could be.

Alecia Lipton (14:40):

Thank you for listening to in the note with Dr. Oh brought to you by Hoxworth Blood Center, University of Cincinnati for additional information, visit us online at www.hoxworth.org!

Alecia Lipton (00:29):

You are listening to In the Know with Dr. Oh, and today's episode focuses on convalescent plasma. If you have recovered from COVID-19 and you've been symptom-free for at least 14 days, we encourage you to go online and register to make a convalescent plasma donation. And you can do that www.hoxworth.org/covid-19. So I was looking at the figures this morning, Dr. Oh, and it looks like Hoxworth, since April, has distributed over 2,622 units of convalescent plasma, and we've collected just over 3,052 units from prospective donors. Can you give us an idea of current usage? Where are we at with our usage and in this area, especially as the diagnosis of COVID-19 is creeping up?

Dr. Oh (01:35):

Today is, uh, early December. So we are experiencing a third spike and not just here locally, but nationally, there have been more COVID-19 infections recently than there ever have been, uh, previously, uh, in the pandemic. So initially when we started collecting in April, uh, we were just distributing a few units per day to the hospitals. Um, that reached kind of an early baseline in September, where we were distributing about eight units per day to our hospitals. Over the past few weeks, we had multiple days where we were distributing over 60 units to the hospitals per day. So as a result of that, we asked our hospitals to start transfusing one unit of convalescent plasma per patient, uh, rather than oftentimes they would give two units. And so to make sure that our supply lasted longer, this is consistent with the way that convalescent plasma is transfused throughout the country. So it's either one or two units per patient, typically, per course. Um, so I think that was a very reasonable. And so recently we have had, I would say, uh, a 400% increase in terms of the amount of convalescent plasma that's been distributed, and it keeps going up as, um, more and more people become infected with COVID-19.

Alecia Lipton (03:00):

I've seen many Different graphs shared through the media about what the anticipated growth is for COVID-19 positive cases. And it looks like that's going to continue through January. Are you seeing the same thing, do you think we're going to need to continue to have more and more convalescent plasma donors?

Dr. Oh (03:19):

You know, there aren't a ton of different medications that physicians have in their armament against COVID-19 infection. So we've been very happy that we've been able to help with convalescent plasma. As you mentioned earlier, in August of this year, a convalescent plasma received an EUA status, which is an emergency use authorization, so that it was found over tens of thousands of transfusions, um, throughout the pandemic to that point, that safety profile was really good for this. So there was very little risk for people to receive convalescent plasma efficacy was reasonable to expect as well. So it makes sense as a model that antibiotics would help in terms of neutralizing virus and, and help with course. And there have been many, many anecdotal reports of, uh, really rapid improvement after convalescent plasma. So with the likely efficacy of the product, as well as a very high safety level, uh, it became one of those drugs that, uh, clinicians could start ordering without having to have their patients participate in the FDA approved trial because they had established, um, and gained so much experience with the use through the EAP study and other mechanisms

Alecia Lipton (04:36):

That's great that they product is much more widely available now for patients in need. You mentioned that the current protocol is to administer one unit of the convalescent plasma per patient. Is it recommended that that be done earlier in their illness or do they do that when they're more critically ill?

Dr. Oh (04:54):

I think most of us believe that when a patient receives convalescent plasma earlier in their course, it's more beneficial. So we definitely don't want to give convalescent plasma if somebody is very mild in terms of symptoms and, and likely won't require hospitalization or, you know, uh, more intensive treatment, which many people have fairly mild symptoms where I think it probably works best and has most efficacy is early in hospitalization as a person becomes closer to having to require ventilation or to be put on a ventilator if we can give convalescent plasma in that time period, I think that there are probably cases where the patient does not go on to become ventilator dependent, which I think is a bad sign for them, a marker for them as they go forward. So if we use it judiciously, uh, and I've heard, you know, many reports of, of this being the way that it's been used and, and with good results. So it's probably early in hospitalization before the person gets on a ventilator.

Alecia Lipton (05:58):

For listeners out there, you have a positive Diagnosis of COVID-19 and you have recovered and you have been symptom-free for at least 14 days, we do encourage you to go online and register to be a convalescent plasma donor. You can do that at www.hoxworth.org/covid-19. With Hoxworth, we're always talking about how we need donors. We need to have blood on the shelf before the need arises. And that's also very true with convalescent plasma. So we can't let people say, Oh, well, I'll donate when someone in my family needs convalescent plasma, can you explain the rationale for having the product on the shelf before it's needed?

Dr. Oh (06:39):

It seems fairly simple to just collect plasma and then have it available. But we do have to do a lot of preparation for the products, as well as testing that's performed on every single donation that occurs. We don't recommend a directed donation of convalescent plasma at this time. The safety of convalescent plasma has been shown through tens of thousands of, of transfusions to this point. So we would not really want people to, to try to direct their plasma. It, it ends up adding a lot of complication to the process that really is not necessary.

Alecia Lipton (07:11):

And you also have to be able to match up those blood types, correct?

Dr. Oh (07:15):

That's correct. You may have heard for red cells, that O is the universal donor. For plasma, AB is actually the universal donor, and there's only about 4% of the population is blood type AB I think in desperate times when AB is not available, clinician may make the decision to use A plasma, but it's a, it's usually something we try to avoid as much as possible. So if we, especially when we get AB donors to donate their plasma, that's usually the most, uh, the most efficient.

Alecia Lipton (07:47):

And recently it's been hard to turn on the news without hearing about COVID-19 convalescent plasma, different treatments that are being used to treat those with the COVID-19 virus. Is the convalescent plasma therapy similar to what President Trump received during his stay in the hospital?

Dr. Oh (08:05):

Yeah, my understanding is that president Trump did receive some antibodies treatments, uh, that were developed and available for him in limited amounts. So other people have not been easily able to get those therapies, uh, that he was, but the mechanism is generally the same with convalescent plasma and, and some of the treatments that he received and that the antibody should neutralize the COVID-19 virus, and so work in a similar manner.

Alecia Lipton (08:32):

When we've talked before about this type of therapy, you explained to me that it's a concept called passive immunity. And can you explain how that works and how the infected person then develops antibodies?

Dr. Oh (08:46):

Typically for a person let's say, who has never been exposed to COVID-19, let's say somebody gets infected with that after an exposure. So that would develop antibodies as part of their immune response. And that's the way our body tends to deal with micro-organisms that we encounter. Uh, and so, um, you, you actively develop antibodies to fight off this infection. It's actually the same thing after getting a vaccination. Uh, and the reason we get vaccinated is so that we form antibodies against, um, the virus or bacteria that we're concerned about. So that is a natural, active immune response. If you take plasma from somebody who has actually developed those antibodies and give them to somebody who has not previously been exposed to the virus or bacteria that you're worried about, you give those antibodies to that recipient in a passive manner, because it's just transfused. So your body actually hasn't developed those antibodies on their own, but those antibodies are present in the plasma that's transfused, and that can help to neutralize the virus until your own body then is able to mount a response. And then you become actively immunized as well after exposure to the virus itself.

Alecia Lipton (10:01):

One of our goals of the In the Know with Dr. Oh Podcast series is to let our listeners know about transfusion medicine, convalescent plasma, blood donation, and how it will impact them as the listener. Right now, we're hearing a lot about social distancing, especially with the third spike in COVID-19. Is it safe to come in and donate right now?

Dr. Oh (10:25):

That's a great question. Um, you know, early in the pandemic, in the state of Ohio, uh, I know that there were a lot of travel restrictions that were placed. And at that time, we made a point and, um, the governor supported this to, to make a distinction about blood donation in that we still do require and need people to come out and donate blood as kind of a medical necessity. So, we take precautions at our collections sites. We social distance as much as possible. Of course you can't keep six, six feet away and and be able to, uh, collect blood from somebody. But we have all of our staff and, and people who come into those facilities wear masks at all times. And we try to keep exposures, you know, as low as possible. So, uh, we do encourage people to come out, uh, during this time period, I can't say it's, you know, absolutely. You know, the safest thing you can do that the safest thing people can do is just stay home and not leave their house, but it is reasonable for people to come out with a specific intent to donate blood, to help others. It is a medical necessity for us, and it is something that I think we are still encouraging people to do.

Alecia Lipton (11:41):

We encourage people to make wise decisions in their daily business. We have to go to the grocery store, we have to go to work. We have to go to the gas station and just doing social distancing, we can still accomplish those tasks. And it's the same with blood donation. It is a medical necessity. And as long as you're practicing good hygiene and social distancing, then coming to donate blood and or convalescent plasma should be safe for you.

Dr. Oh (12:08):

Yeah. You know, Alecia, even with the pandemic going on right now and all the precautions that we're taking surgeries are still happening and people still need blood. People have cancer. They, they go on chemotherapy. There's still the need for other blood products like red cells, platelets and plasma that's not convalescent plasma for patients who are, who are having the blood blood requirements. Blood transfusion is actually the number one procedure that's performed at hospitals. So this has continued at a rate pre COVID 19. And so in addition to having to collect all the convalescent plasma that we are, and having to social distance and having less, uh, ability to collect on mobiles, because we're social distancing, we still have the same blood needs from the hospitals as before. So, it's very challenging for us in this time to provide not only the convalescent plasma, but also the other blood products that people need.

Alecia Lipton (13:05):

Is there anything that would prevent somebody from donating convalescent plasma other than our typical guidelines for travel and medication and lifestyle?

Dr. Oh (13:16):

That's a great question. So if somebody qualifies with all the questions that we ask, we actually do a lot of testing after the donation as well. So one of the things that we do do is we test for a lot of infectious disease markers. Occasionally a donor will have a positive infectious disease marker. That actually does not mean that they have, uh, the infectious disease that we're testing for! We use very sensitive tests. Unfortunately, sometimes we have donors who are not actually infected who have what we call false positives to that process. And then we notify them that unfortunately they're unable to donate blood going forward. Uh, sometimes we will recommend that they see their physicians if the results are worrisome, but many of these tests, unfortunately we know, are very, very sensitive and we'll sometimes have people that test falsely positive right now.

We're actually having a lot of, uh, false, positive syphilis tests, uh, nationwide, which it sounds really scary, but all of these tests are required to be performed as a process in, in releasing blood for transfusion. And then we want to be as safe as possible so that there are no transfusion transmissions as much as possible through, uh, through blood transfusion. Uh, and so, um, actually people who are having false positives for syphilis testing, uh, we encourage to come back in eight, eight weeks and we actually send them a letter. Part of the testing processes also to prevent a rare transfusion reaction called TRALI, which is actually a pulmonary reaction where the recipient will have trouble breathing after a transfusion of some blood products, especially those that contain a lot of plasma. These reactions are very rare, but they have been associated with donors who have actually been pregnant.

And, uh, actually donors who have actually been pregnant multiple times are at higher association with recipients who receive plasma from them. So we've started screening blood donors for antibodies to what we call HLA. And these are not a problem for them at all in terms of life and, and clinical significance for the donor themselves. But because of this association, with this rare, uh, transfusion reaction, we have not been using blood or plasma or platelets that has been collected from donors who have these antibodies. That can be quite high percentage of women, donors who have had pregnancies, especially if they've had multiple children. Uh, and so up to even 20 to 30% of, of women who have had three or more children. So it's not, unfortunately it's not uncommon for somebody to come out, try to donate blood with us and especially plasma or platelets, and then be told, Oh, unfortunately you can't continue to donate those products in the future

Alecia Lipton (16:03):

Because you can't donate one product. That doesn't mean that you can't donate at all. Correct?

Dr. Oh (16:08):

That's correct. So, uh, if we detect these antibodies and so essentially we ask a question on our questionnaire, if you ever been pregnant, and if they answer that, yes, then we will perform an additional test. If, for people who have never been pregnant or who are males, um, they typically do not have these antibodies. So they are not actually screened for this. We would actually ask those donors who have an anti HLA antibodies to donate, uh, red cells for us and whole blood. So those red cells can be used without significant increase in risk for recipients

Alecia Lipton (16:40):

Patients in the hospital don't get a holiday from illness. There's still cancer. There's still surgeries. There's still traumas and people still need those blood and platelet transfusions. So it's important that we continue to have people come in and donate blood. If you're interested in donating blood, you can call Hoxworth at (513) 451-0910 or visit www.hoxworth.org to schedule your blood or platelet donation. Again, if you have recovered from COVID-19 and you're interested in making a convalescent plasma donation, you do need to pre-register online and you do that www.hoxworth.org/covid-19.

Alecia Lipton (00:40):

Hi, I'm Alecia Lipton. And today you're listening to in the know with Dr. Oh brought to you by Hoxworth Blood Center. Today's episode is going to focus on the eligibility for donating blood and the deferrals that may come with that. Dr. Oh, can you start out by talking about how the blood center is regulated?

Dr. David Oh (00:58):

Sure. Blood centers across the United States are highly regulated. Uh, when we create blood, FDA actually considers it to be a drug. So we have to make sure that we adhere to what we call a CGMP or current good manufacturing practices. What we put on a label as on a unit of blood actually really needs to reflect the contents of that bag, the same way as if you buy a medication at your pharmacy, uh, you'd want the label to reflect the contents of each bottle.

Alecia Lipton (01:27):

Okay. And I think what's important about that is that people realize that Hoxworth, isn't just sitting there making up rules. These are rules that are mandated by the Food and Drug Administration.

Dr. David Oh (01:37):

That's correct. So FDA, I always consider as our friends, they make sure that the drugs that are manufactured are up to a very high quality level and are safe for people who receive them. They create regulations for us in the CFR code of federal regulations. They also release guidances for industry, which we adhere to whenever they're released and so multiple times a year, we'll get a new guidance on specific areas of concern for the FDA, and we make sure that we comply with them.

Alecia Lipton (02:07):

Okay. I think a good takeaway from that, as you said, the FDA is our friend and I think that's important. They're there to make sure that, you know, the blood or whatever is being manufactured, whether it be blood, platelets or plasma is safe for the person receiving it and that it's also safe for the person to be giving it.

Dr. David Oh (02:25):

Yeah. Their rules and regulations really allow us to know what is expected from us. And we make sure to comply with that. You'll notice if you've donated at different blood centers across the country, that the questions that we use are all very similar. Those have been created through the industry in coordination and collaboration with FDA. And anytime we have questions, the FDA has to review those SOPs or forms that we create to make sure that they're comfortable.

Alecia Lipton (02:53):

So Hoxworth Blood Center is the steward of the local blood supply for the tri-state, being Ohio, Kentucky, and Indiana. And part of our mission is not only to supply that blood, but to make sure that it is a safe supply.

Dr. David Oh (03:06):

That's correct. So there is a lot of testing that goes on, uh, after you donate a unit of blood. Some people will say, Oh my goodness, you guys, we're giving our blood and we're not getting any money for it at all. How difficult can it be, you know, to your job. And there's a lot that happens after you donate to make sure that that is safe for a person to receive as a transfusion. There are a number of infectious disease marker tests that have to be performed. And we have to make sure that the parameters of the bag that we collect are adequate for release.

Alecia Lipton (03:41):

What are some of the disease markers that we test for?

Dr. David Oh (03:43):

There are specific infectious disease markers and tests that have been approved specifically for the use and purpose of testing blood donors, I'll list off a few of them...hepatitis B, HIV, hepatitis C. Those are kind of the major viruses that we're really concerned with and, and were a definite problem in terms of safety in the eighties. The development of tests has been a real step forward in terms of safety, where the current risk of contracting HIV or hepatitis C through blood transfusion, it's about one in 2 million transfusions that occur. So it's very, very safe.

Alecia Lipton (04:23):

I've heard people in the past say, well, you've asked us all these screening questions. Why then are you doing these medical tests also? Can you tell us the validity of the testing? Why do we go that extra step?

Dr. David Oh (04:35):

So that's a great question. There actually, a couple layers of safety that we have established for the blood industry. Uh, one is the donor history questionnaire. So we want to make sure that when you're answering all these crazy questions that are asking all about your social life, that by asking those questions, we're actually decreasing the number of people who may actually be infected with, uh, one of the transfusion transmitted infections that we're concerned with.

Alecia Lipton (05:02):

I know that a lot of times our donors will have questions for us about, "can I donate if I'm taking specific medications?" Obviously you can't donate. If you're taking a blood thinner, that would not be good. We wouldn't want you to bleed too fast. Um, but I think a lot of people are surprised to know that they can donate blood if they're taking antidepressants, birth control pills, even aspirin for a whole blood donor is okay. Um, can you talk a little bit about medication restrictions?

Dr. David Oh (05:31):

So this is a very difficult area. You can imagine for each blood center, if we had to evaluate every single drug that's out available for people, including even over the counters, it's very difficult for us to create a questionnaire for donors to complete and, uh, and even a reference to keep that up-to-date. So we really, again rely on our friends at FDA. Um, they have worked with an organization called AABB, which, uh, used to be known as the American Association of Blood Banks. They have created a donor history questionnaire and a list of medications that are of more concern for us, for donors. So that is actually available. If you go to the internet, you can actually Google that up for AABB and then blood donation medications, and you'll be able to find the most current list of medications.

Alecia Lipton (06:18):

One of the things when I was looking through the list, and I like how you explain that if there is a drug that could potentially cause a problem with pregnancy, that a good rule of thumb is maybe you can't donate blood if you're taking that. And when I was looking through the list, I saw that a lot of the acne medications like Accutane or some of the hair loss medications like Propecia, you can not donate blood if you're taking those. And also on those labels, it has very clear statements, that if you're a pregnant woman or if you're planning on pregnancy, that you should not take those medications.

Dr. David Oh (06:52):

So every time somebody comes and donates, we actually give them this list of medications that they need to look at before they donate and see if they are taking any of them within the time limits that are listed.

Alecia Lipton (07:03):

And I imagine that that list with the FDA changes quite rapidly as new drugs are being released to the public.

Dr. David Oh (07:11):

Yeah. With COVID-19 emerging worldwide about a year ago, FDA took some long awaited steps to look at donor eligibility. There's a real concern that we would not have enough blood for patients in the hospital who need blood, but use and need continues even with COVID-19, taking up other medical resources. So, FDA relaxed, uh, or reduce the intervals for many conditions, as kind of long awaited measures that the industry supports and should not affect donor safety. So travel to areas that are known to have a malarial risk was a big change from 12 months to three months. And many of the changes were decreased from 12 months to three months in terms of bovine insulin. Um, there was concern for mad cow disease, and that's when a lot of these restrictions occurred.

Dr. David Oh (08:14):

One was for bovine insulin, and the other was for travel in Europe and exposure at military bases. Uh, but now if you were previously deferred for those reasons, we're asking you not to just show up at donor centers and donate, but to give us a call if you've donated at Hoxworth before and been told not to donate because of any of these reasons. We have a deferral evaluation process where within a few weeks, we can remove deferrals if it's appropriate based on a lot of these changes that have occurred recently. So, yeah. So if you've been told you can't donate before, you can contact us at www.hoxworth.org and start the process.

Alecia Lipton (08:58):

Right? That's a great point. We want you to call ahead of time so that we can start you in the process to get you to be eligible, to donate. Again, we don't want you to make that special trip in and then be told we need to do some paperwork and have you come back. So you can always give us a (513)451-0910 or visit us at www.hoxworth.org. You have been listening to In the Know with Dr. Oh, brought to you by Hoxworth Blood Center.

Alecia Lipton (00:29):

You're listening to the second part of our episode of In the Know with Dr. Oh. We're talking about eligibility and deferrals on today's episode. I'm Alecia Lipton and I'm joined here in the studio with Dr. Oh! Dr. Oh, we were just talking about, um, some of the testing and the disease markers. Can you elaborate a little bit more on that?

Dr. David Oh (01:02):

Thank you. Yeah, you know, one of the big breakthroughs in terms of blood safety was development of testing for viral transmitted diseases and one of the big ones was HIV, right? So that was such a huge issue in the eighties. And it's still a big concern for us. In 1985 an antibody test was developed for HIV, which was amazing given the short time that we had, and the knowledge that we had about the virus at the time. It was developed very rapidly, and these antibody tests are actually tests that will look for antibodies that people will have formed after exposure to, uh, in this case, HIV. They had a window period of approximately 22 days or actually about 30 days. The tests have gotten much better over time.

Dr. David Oh (01:58):

So we have much more faith in the antibody tests that have been developed. They have built both become more specific and sensitive. So by specificity, it means that there are less false positives that occur with the antibody test, but they still do occur. And sensitivity means that the ability to detect a virus in almost everybody who has the infection. The second great breakthrough in terms of HIV testing occurred in the late 1990s and early two thousands with the development of what we call NAT testing or Nat testing, which essentially very similar to PCR testing. So for HIV, we look for the RNA associated with HIV infection and we're able to detect that and decrease the window period, which is the period between exposure and the time that those tests will be positive. So from the antibody testing, about 30 days to, um, Nat testing, which brought that down to about less than 10 days was it was a real dramatic increase in terms of blood safety. So back in the, in the heyday of HIV, before we even had an antibody test, the risk of HIV in certain areas of the country, were as high as one in a hundred units, which is just really scary. Today, again, as I said, previously, the risk is about one in 2 million units. And I actually think it's much less than that. Since 2000 there have been, uh, probably less than five cases of HIV transmission that have occurred through blood transfusion.

Alecia Lipton (03:24):

And that's nationwide.

Dr. David Oh (03:26):

Yes, yes. And those cases are not well known or publicized. Um, they're just so rare now, it's very rare for that.

Alecia Lipton (03:35):

That's definitely a different world than what it was in the early 1980s.

Dr. David Oh (03:39):

Yeah. I did want to mention, so if you are a donor and you've gotten a letter from us saying that you have had a false positive for HIV... For years and years, it was very difficult to have those donors come back and donate. Again, there is a donor reentry process that is available now, if you just had the positive antibody test. On some occasions, we, we can't reenter people and for some people, the testing will remain positive and it's not due to exposure to HIV. We would know with the, the Nat test is, is exquisitely sensitive and specific. Um, so that's actually the, the, the really great tests that we have. But we're still performing both tests to make sure that people who are, especially who are people who are on antiretroviral medications today, where the HIV may not be directly detected through PCR processes, that we would know that people were exposed previously and have antibody formation.

Dr. David Oh (04:32):

So we're still, we're still using both tests. I often get the question: Why would an antibody test be positive, right, to either HIV or hepatitis B or hepatitis C or any of the other infectious diseases we test for? And I try to explain it this way, and, and this is how I think of it. So, uh, scientifically I think in general, this makes sense. But if you've ever had a car key and you go out to a parking lot and you see a car--this actually happened to me once I, I had a blue Prius and I used to live in California. So they're all over the place. And I stuck the key in a car that wasn't mine. It looked just like mine, but it wasn't mine. And the key went in. And, um, and that's sometimes what will happen is that an antibody test will try to detect a specific antibody.

So we know it should just fit for this one infection. But we create so many different antibodies and we can have broad reactivity. So sometimes you'll have an antibody that was directed to something completely different or a different substance in your serum that can cause interference and can cause, cause it to look like you have an antibody match for what you're looking for. In some cases that's a once in a lifetime thing and the next time we test you, there's no reactivity. In other cases, you may have been exposed to something that looks enough like the antigen that you're testing for where that reactivity will continue to occur. And because we have to test every single donation with all these different tests, if you have a positive test, even though we do additional testing, those units are not able to be transfused. And we would just ask those donors not to donate in the future.

Alecia Lipton (06:08):

Okay, great. And that is just for the overall safety of the blood?

Dr. David Oh (06:12):

Yes. So as we're trying to create these processes to create, you know, safe, transfusable products, anytime there's a hiccup in the process, we would rather be safe and not use that blood, versus going through a bunch of different double checks and saying, okay, it's okay to use in case there was an error that occurred along the way.

Alecia Lipton (06:30):

Excellent. You've mentioned how the testing has gotten so good in recent years, that we can catch those little minute antibodies regardless to what disease we're looking at. In the early 1980s, I think it was maybe 85, they put into place that men who had previously had sex with other men were a lifetime deferral. In 2017, that was then changed and it was made a 12 month deferral. And then earlier this year, um, the FDA came back again and made a new change. Um, and now it is a three month deferral. So three months since their last sexual intercourse with another man.

Dr. David Oh (07:12):

Yeah. Uh, sexual contact actually, I think is how they define that. So, so this is a very sensitive area. So, I'll present this as well as I can, and I hope nobody gets upset with this discussion. But I think one of the reasons I wanted to do this podcast, uh, was to be able to kind of share some of the current thinking and the reasons for why we do certain things. So initially, you know FDA did require when we talked about the donor history questionnaire, right. I think the question was essentially if you had sexual contact with another, if you're a male who had sexual contact with another male, any time since 1977, then that would be a lifetime deferral. And with the level of testing that was available at that time with as many as one in a hundred units that could conceivably, you know, transmit HIV before we had a good test,

Dr. David Oh (08:02):

I think that, uh, you know, we had to be as careful as possible and try to restrict anyone who had a significant risk for HIV from donating blood. So really that's a, you know, recipient safety issue. Then we have been fortunate with the development of testing, as you've said, especially with antibody testing in 1985, and then the nucleic acid testing that evolved in 1999 or 2000, to, to bring that window period down to less than 10 days from the time of exposure to having our tests turn out positive. So with that, I think it was time to kind of reevaluate this rule in terms of deferral since 1977 for any MSM and sexual contact. I don't want to go into a lot of the details of that on our podcast, but you can go and look on Google and all this stuff is available.

Dr. David Oh (08:55):

In the guidance for industry, FDA provides a really nice background for the rationale for these different policies that are in place. They did reduce that from a one-time ever since 1977 MSM contact to 12 months. And I think that that was very reasonable at the time because many of our other deferrals for behavioral activities that would increase risk for hepatitis or HIV were at 12 months. So for, for example, if you got a tattoo--I always bring this up, or even a blood transfusion that was screened with the current testing that we have, so the blood transfusions are extremely safe now, related to HIV and hepatitis risks--it would be a 12 month deferral after either of those exposures. So if you got a tattoo at a non-licensed parlor, it would be a 12 month deferral.

Dr. David Oh (09:51):

And, and really, I think we felt as an industry, gosh, 12 months seems like a long time with the really much better sensitivity of our testing nowadays. So FDA did make that change to, to reduce from 12 month period to a three month period. And with the change for MSM, they made changes for tattoos and for a bunch of other things as well, that I think the industry was really waiting for. Some of these, uh, it's a two-edged sword, right? So we want to make blood as safe as possible, but we also want it to be available for people when they need it, need it. And the travel 12 month issues were really causing a lot of problems, uh, in terms of being able to keep a healthy blood supply across the country.

Alecia Lipton (10:32):

I think the travel is an important thing to bring up because we are so travel centric right now. Not as much with COVID-19, but prior to that people were vacationing, they were going on cruises. You would hear about church groups going on mission trips, and oftentimes they would be in an area considered a malarial zone. And then that would defer them for 12 months.

Dr. David Oh (10:54):

Yes, yes. The risk of malaria transmission through blood transfusion is actually...the incidence is actually very, very low. So I think that's another reason we can feel a little more secure in, in easing some of these restrictions, the estimates are that there may be two cases to three cases a year. But again, it's, it's difficult to sometimes find the data for you as well. So it's not a very common incidence for sure.

Alecia Lipton (11:22):

So with the FDA relaxation we have now, men who've had sexual contact with other men, they now have a three month deferral, as opposed to 12 months. We also have individuals who've traveled in malarial zones, they're now down to a three month deferral, so we're kind of making things the same.

Dr. David Oh (11:40):

It's really exciting. Actually, the director at Hoxworth is a physician. I think he'll, he's okay with us talking about this. Dr. Cancelas, he's Spanish and he's spent time in Europe, and so was unable to donate because of the variant CJD risk and the donor rules. So those have been relaxed because the incidence of CJD has just really....vCJD has just really plummeted worldwide. And so I think that was a very welcome change for people who do a lot of traveling, who have spent time in Europe, for our military people who have spent time on U.S. bases. It's a huge ability for, for those people who are, are typically great donors and, you know, are really giving, to be able to give blood again. So we do have a process for that. Again, we ask people not to just show up at the donor centers, but to contact us and make sure that we can remove the deferral and do the legwork that we need to, to be able to make sure it's good for them to come and donate.

Alecia Lipton (12:44):

One deferral that's also exciting: Previously, if you were a breast cancer survivor, you were deferred from donating blood. And a lot of times, if you're a survivor of any type of cancer you want to give back, you want to help other people. And now once you are cancer free for one year, then you can donate again. Correct?

Dr. David Oh (13:03):

That's correct. Yeah. And the primary reason for that 12 month deferral, we want to make sure that, that for the donor, that, you know, they're clear in terms of not needing to have urgent medical care, and we've already taken a unit of blood from them. So 12 months is just to make sure that, you know, everything looks like it's going well for them. There have been no cases that I'm aware of transfusion transmitted cancers, carcinomas. So I think we feel secure in that, that if that were a real concern, we'd see, we'd have seen cases for sure by now. We do ask people who have had primary leukemias or lymphomas to, to not donate, but in terms of adenocarcinomas or other types of cancers, um, uh, those people are eligible to come back after a year, considered cancer-free.

Dr. David Oh (13:57):

Every time you come and donate, we do a fingerstick evaluation for hemoglobin hematocrit to make sure that it is safe for the donor to donate the fingerstick tests are not the best out there.

I will tell you, but for us to, to operationally collect blood FDA has approved this process for us to evaluate donors. I would say that, you know, people who donate blood, especially the red stuff, so whole blood or red cell donations really need to look at their iron levels. And especially for women who have blood loss occurring during the, during their reproductive years. So I do recommend in general that donors who are frequent donors, even frequent platelet donors, consider taking a multivitamin, a daily multivitamin that contains iron. It's not surprising if a donor ends up having iron low iron issues, um, because they're a frequent donor. It is a cause of iron loss. And so we want to be careful with our donors. We want to encourage them. Yeah. If you donate frequently, make sure you take a daily multivitamin with iron.

Alecia Lipton (15:11):

Okay, great. Other than the multivitamin, um, we can also get iron from the food we eat. Um, are there any recommendations you can give for that as far as, you know, a good, um, high iron diet? Yeah.

Dr. David Oh (15:22):

Yeah, sure. So you can look on the internet. I know everybody has a different diet process, right. So I don't want to tell people what to eat. Of course the foods with high iron are great. The studies have actually shown though that, um, if you're a frequent blood donor, supplementation is a better way to go. It's very difficult to get enough iron just from diet to be able to compensate if you're a frequent blood donor.

Alecia Lipton (15:44):

Okay. And then this would be, um, an over the counter supplement you could get.

Dr. David Oh (15:48):

Yeah. That's typically what we recommend is over the counter, you could get just iron itself or you can get a multivitamin with iron. And I think most people today are, are looking at, you know, multivitamins as something. So just make sure you have a good iron content in it. Okay.

Alecia Lipton (16:01):

Okay. Talking about iron and making sure that our donors have a healthy iron store, for individuals, once they turn 16 and they can donate, if they're a female, we're only going to let them donate once a year until they're age 19. And if you're a male, you can donate twice a year. Why do we have that difference? And why at 19 do we then said, well, you could donate four times a year?

Dr. David Oh (16:25):

Yeah. So there were some concerns, especially that's a kind of a sensitive time in terms of our maturation, right? So that we didn't want people to be iron deficient as we're collecting people at, at fairly young ages. So I think it's a general process that many, many blood centers across the country started recommending in terms of decreased amounts of blood that are donated before the age of 18, really. And so we have that policy now for 16 to 18 year olds. We may actually relax it a little bit for 18 year olds as we kind of go forward, so those years between 16 and 17.

Dr. David Oh (17:00):

Most of the States across the country allow blood donors to donate at age 17 without any parental consent or those types of issues... That's written into state laws. And those laws were developed , I think, earlier in terms of war efforts and community supporting a blood donation, uh, to support the country, uh, and, and they've remained on the books, uh, when people donate age 16, typically there's a parental consent that we have, uh, signed, uh, as well. We do want to be very sensitive with those donors.

Alecia Lipton (17:35):

Thank you for listening to, In the Know with Dr. Oh brought to you by Hoxworth Blood Center, University of Cincinnati. For additional information, visit us online at www.hoxworth.org.

Alecia Lipton (00:40):

I'm Alecia Lipton, and you're listening to In the Know with Oh presented by Hoxworth Blood Center, University of Cincinnati. Each episode will contain facts about blood donation. Hoxworth Blood Center is the steward for the local blood supply in the tri-state region. And I'm excited to say, I just looked at numbers and we are now collecting over 100,000 blood products a year, and those are used to help save lives in over 30 tri-state hospitals. In the studio with us today, of course, is Dr. Oh and then we have a special guest, Dr. Oh, could you do the introductions?

Dr. David Oh (01:16):

Thank you very much, Alecia. I'm so pleased to have Caroline Alquist with us today. She is our medical director over the TID laboratory and therapeutic apheresis, and we'll discuss a little bit more what that means today. There may be a lot of alphabet soup going forward, and so we'll try to clarify as we go. Caroline has been with us for less than a year, but it feels like she's been with us forever and that's a good thing. Um, so we're very pleased to have her. Can you please share with us a little bit of your history in terms of your education and how you came to occupy that role you have here today?

Dr. Caroline Alquist (01:53):

I actually Cincinnati native. I grew up here in Hyde Park and attended Ursuline Academy in Blue Ash. After which time I left and went down to Wake Forest for university, and then followed that up with grad school, getting my MD and PhD at Louisiana State University of New Orleans. After that, I went into a pathology residency there as well, which was a phenomenal opportunity to do both anatomic and clinical pathology training. And from there I segued to Dartmouth Hitchcock Medical Center, where I actually studied transfusion medicine and blood banking…great opportunity to work with some of the leaders in the field, specifically, given their interests, in managing our blood supply when we have scarce resources. Afterwards, I returned back to New Orleans to work for Oschner, um, where I got a great chance to really develop my skills in histocompatibility, HLA in particular. I stayed there for a few years, but  the call of my family got me to come back and I was really excited for the opportunity to join Hoxworth six months ago and, and really join this team.

Alecia Lipton (02:53):

We're thrilled to have you here with us. And I think, you know, we should mention that not only are you an MD, but you also have a PhD as well.

Dr. Caroline Alquist (03:00):

Yeah. I had a great opportunity in grad school to pursue both degrees. Um, it was an opportunity that I couldn't pass up and I'm really glad I followed that path.

Dr. David Oh (03:08):

I think we should call you Dr. Dr. Alquist. We mentioned that you were medical director of TID at Hoxworth. So what does that mean? TID?

Dr. Caroline Alquist (03:20):

There are a lot of letters in what I do. TID is actually transplantation immunology division. It's known as HLA in a lot of centers. Essentially what we're looking at is the immunology of transplant, specifically how the human body interprets self and non-self. HLA just stands for human leukocyte antigen, which is just the first place we discovered the HLA molecules. That's actually the fuzz on all of our cells. What it is really is a name tag, it's a name tag, our immune system uses to say, do you belong to me or should I kick you out? So what TID does is, is we figure out what organs and what bone marrow best match your compliment of HLA antigens. And we really help the clinical teams select the best matches for when a bone marrow transplant donor's available, or when a deceased donor solid organ, or even a living donor solid organ becomes available. And that's the predominant bulk of our business. However, we do also do some business looking at disease associations and pharmacogenetics, meaning some HLA fuzz can actually have a huge impact on how you respond to different drugs or whether or not you're going to be predisposed to get certain diseases, like narcolepsy or celiac disease.

Dr. David Oh (04:33):

Most people think of Hoxworth Blood Center as a collection center. These are definitely other activities. What do you think in terms of having this at a blood center? I know when I was at Stanford, before I came here, we had an HLA laboratory as well. And actually our former director ended up taking a position there, allowing you to come to us, which is awesome. So what do you think about the synergies that are, are present for a TID laboratory, HLA laboratory located in a blood center?

Dr. Caroline Alquist (04:58):

TID is really a study of blood. So it makes sense that we're, we're situated within a blood center environment. I think being a physician in HLA, it'd be pretty lonely to not be surrounded by my transfusion medicine counterparts, with which I'm on the phone with all the time. So it's a lot easier, I think quite frankly, to be in the same building with people that I can bounce ideas off of and get more clinical information about cases and, and discuss things professionally in a more comfortable environment.

Dr. David Oh (05:26):

You know, the other thing about Hoxworth that's really interesting is that we are part of the University of Cincinnati. Is that important for what you do in the TID area?

Dr. Caroline Alquist (05:34):

It is nice to have a university so close by because HLA is something a lot of people don't know a lot about. However, it does have its fingers in all the different specialties. So being so close to a university setting gives me the opportunity to look into interdisciplinary research options and, and to be there for my clinical teams across all the specialties, being part of a university makes me feel, I know that I'm always accessible to my customers. However, the university system really reinforces that feeling and makes those opportunities even easier to come by.

Alecia Lipton (06:08):

Part of the mission for Hoxworth Blood Center is not only to save lives, but it's also to educate. So having that relationship or being part of the university really kind of brings everything together. In layman's terms since I'm the only one in the room without MD, after my name, to me, I think what TID a good explanation would be. It's keeping you from rejecting that organ. It's making sure that the organs you're getting are the best match for you. Would that be a good explanation?

Dr. Caroline Alquist (06:37):

That's absolutely correct for a transplant with bone marrow. Of course, we're looking to match you, right? We want your fuzz to look just like the fuzz we're giving to you, with a certain amount of exceptions. However, with solid organ, we don't get deceased organs coming across our doorstep on a regular, predictable fashion. So we've really had to take a radically different approach. In solid organ, I'm never trying to match you. I'm really just trying to avoid things I know that your immune system doesn't like. It's called an antigen avoidance strategy. Meaning if you're on a list to get a solid organ, I want to know what antibodies you have so my lab will do that testing so that the algorithm that, that helps allocate organs knows that. And the idea is that you will never be offered an organ, which we know that you would not be really compatible with, antibody-wise.

Alecia Lipton (07:22):

How many hospitals do you currently work with?

Dr. Caroline Alquist (07:25):

I believe currently we work with 12 hospitals. I would have to fact check that... HLA is, uh, a pretty niche market. So we are, um, often picking up business for more far-flung hospitals, um, because we're, we're close, we're available, we're centrally located. And we're really lucky to have so many people interested in this field at Hoxworth. So we're a really good resource to really less-close hospital systems.

Dr. David Oh (07:52):

So let me ask, I know it's not a tremendous number of hospitals, but I think over 10, at least that we are certainly helping with. Can a hospital, uh, offer transplantation without the use of an HLA laboratory?

Dr. Caroline Alquist (08:08):

They can offer transplantation as long as they have access to an HLA laboratory. In the past, historically, you'd want at your HLA lab really close because a lot of transplants relied on this thing called a cross-match, meaning I literally mix the patient who wants the organs. I take their serum and I just mix it with the cells of the donor who you might want. And as long as they play nice in a test tube, you'd get the organ. As technology's advanced, we're actually able to do a lot of these cross matches virtually called the virtual cross-match, which makes physical proximity a lot less important, which is why we're able to help a lot of programs that are a lot further away because these virtual cross matches, we know correlates so beautifully with the physical cross-match results. There's no reason to prevent a patient in a far-flung location from getting that organ immediately if we can do the physical work on the backend next business day, but we know that what the result's going to be.

Dr. David Oh (09:02):

It seems like in organ transplantation, there's a big difference between a live transplant and an organ from a deceased donor. Can you talk a little bit about the different roles that you have in live transplantation versus a deceased organ transplantation?

Dr. Caroline Alquist (09:17):

Yeah, no, there are. So there's immediate use HLA, which is going to be our deceased donor organs, where we have to make a decision very quickly with the clinical team, whether or not it's a good compatible match. And then there's the bone marrow transplant and live organ donation. I call those less immediate stress, because we get to plan. We get to take our time and make sure things are thoughtfully matched and made optimal for both of the donor's safety and the recipient safety. For living donor transplant, where we're typically talking about kidney... Some programs, do do living liver, um, partial liver transplants as well, but currently at the university setting, which we work, um, the living donor population is really relegated to the kidney donations. And what's beautiful about it is if you would like to donate to a loved one, a friend and acquaintance, or even a far-flung stranger, you can submit your sample.

We can work you up, keep your identification anonymous, should you decide to remain anonymous and we can figure out the best match for you as a living organ donor. What's also amazing as you could even enter something called a chain, meaning you don't match the person you were hoping to donate for, but you can donate to someone else who's got a partner that can help you, or if the chain's even longer, you help someone who can help someone else who that third person can help you. And these amazing chains take a phenomenal infrastructure that really allows this to happen, but these chains allow living donation like never before.

Alecia Lipton (10:45):

Being part of Hoxworth, we're able to see that saving treatment, um, continue every day, whether it be through our donors coming in, or be it through the work of the work that you do in your lab.

Dr. David Oh (10:58):

Dr. Alquist, can you talk a little bit about the type of technology that you use in performing your, uh, your evaluation of samples?

Dr. Caroline Alquist (11:04):

Sure. So the HLA lab uses a really wide array of technology. HLA was developed, you know, decades ago, and we actually still use some of that original technology. So we're using anything from cytotoxicity assays, which is the real historical, um, stuff, but it's still quite useful. Um, cytotoxicity assays mean I literally mix your plasma or serum with the cells from your potential donor, and I see if your serum or plasma has antibodies that would kill or hurt those lymphocytes. And I look under a microscope and I say, Oh, that doesn't look good, or, they're playing nicely that we can proceed. That's a lymphocytotoxicity assay. We do use that technology, but we've added a lot of other cool stuff. So now more commonly, we use solid phase assays, which are going to be things called Luminex beads, meaning we've coated these synthetic beads with, with antibodies that are antigens rather that we know about.

And we mix it with your serum and plasma. And we see what antibodies floating around in your serum or plasma attach to those beads. I send it through a flow cytometer, and that tells me exactly how much antibody and what specificity it has within your blood. So that's a lot more convenient, right, than asking for live cells from a potential donor. Um, and we do that all the time to really determine what somebody's antibody profile is while they're waiting for a solid organ, or even if they're being worked up for a bone marrow transplant, because we never want to give you a bone marrow transplant from someone, if they have antigens to which you have pre-formed antibodies.

Dr. David Oh (12:36):

And next generation sequencing?

Dr. Caroline Alquist (12:38):

Yes. Lots of toys! So in addition to antibody studies, which are going to be your, you know, cytotoxicity and solid phase assays, we do a lot of typing as well. 'Cause we need to know what that fuzz is, what the HLA fuzz is. So there's a lot of methodologies we can use to look at HLA typing. We can use real-time PCR. We can use next-generation sequencing. All of these modalities are available depending on how quick you need your samples. Also different technologies give you a different resolution. So we can know down to the tiniest kink, what your fuzz looks like or where we can get a, uh, a grand picture before proceeding down any certain pathway.

Dr. David Oh (13:15):

So fascinating the rate of technology advances and keeping up. And so we need people like you to be able to direct our laboratories. I know, I know we have certain accreditations...and in Blood banking, we always think about AABB. Um, can you talk a little bit about ASHI and your qualification with that?

Dr. Caroline Alquist (13:33):

Sure! ASHI is the certifying body for histocompatibility and immunogenetics. It was designed really just to focus on HLA. So it is kind of considered the, the central accrediting body for all HLA labs in the United States. What's interesting is the only way to become an ASHI-approved director is its own pathway. So it does have its own board. Uh, it used to be known as the American Board of Histocompatibility and Immunogenetics; however they recently merged ABHI and ASHI, you know, more alphabet soup. It's now known as the American College of Histocompatibility and Immunogenetics. The whole process is that you enter either as an MD or a PhD with a board certification, which you can be, of course, the ASHI certification currently available. And you undergo a full background check, credentials verification, and you enter a directors-in-training program.

This director-in-training program then consists of at least two years of collecting cases and on the job education. What they want is you to be fully immersed in a histocompatibility lab, taking in those experiences in real time, while collecting interesting cases, they then ask you to submit 50 cases per area of interest. There's up to six areas you can submit in: solid organ living donor, solid organ deceased donor. You've got bone marrow transplant from a related donor, bone marrow transplant from unrelated donors, transfusion support, and histocompatibility for other purposes, there's always a waste basket. Um, and every group requires 50 cases to be submitted. And you need to do basically a book report on 10 of those cases for each division as well. So it's a huge amount of paperwork that used to be sent. Now you are able to send it on a jump drive, thankfully you can send it on a jump drive, um, back to the American Society for Histocompatibility or Immunogenetics, now known as the American College of Histocompatibility and Immunogenetics, um, and they actually send it out to reviewers.

So there are qualified directors all over the world that are willing to review those reams of paperwork to evaluate whether or not you truly know what you're talking about. Um, and that allows you to proceed to an oral interview phase. If they accept your, your portfolio and your oral interview will be all your reviewers plus, um, there's always a few extra people in the room to make sure everything proceeds as planned. And following that oral interview, should you pass it, there can be subsequent interviews. Um, you'll get a letter that says that you were officially accepted as an accredited and approved ACHI director. This is now known as being a fellow or associate of ACHI. So, because I took their board as well as my pathology boards and transfusion boards, I am considered a fellow of ACHI.

Dr. David Oh (16:25):

Wow.

Alecia Lipton (16:26):

Definitely one of the best of the best.

Dr. David Oh (16:30):

I appreciate your sharing that, I think it's important for people to kind of understand that real specialization that has to occur in the years of training that it takes to, to get to your level. Um, I would expect that you'd be like a 70 or 80 year old person sitting across from me, but you're actually very young. And so it's amazing that you've, you've done what you've done. So I really appreciate your spending time with us today.

Alecia Lipton (16:53):

Yeah. Thank you so much, Dr. Alquist. So this has been part one of our discussion with Dr. Ahlquist, stay tuned for part two. Again, this is In the Know with Dr. Oh presented by Hoxworth Blood Center.

Alecia Lipton (00:27):

Hi, I'm Alecia Lipton and you are listening to part two of our interview with Dr. Caroline Alquist from Hoxworth Blood Center. You are listening to In the Know with Dr. Oh, and this part of the episode, we're going to talk about therapeutic apheresis. Dr. Oh, can you tell us a little bit about therapeutic apheresis and then turn it over to Dr. Alquist and she can explain what that is at Hoxworth?

Dr. David Oh (00:52):

Sure. So therapeutic apheresis actually is a, is kind of an umbrella term? And it relates to a lot of processes and procedures that are done with fluid exchange. I would say it's different from dialysis, which uses a filter. We're actually collecting and re-infusing different fluids. And that could be plasma, that could be albumin, that could be red cells, that could be, in terms of collection, stem cells. So that's kind of a, an umbrella term that we use. Dr. Alquist is actually our director of therapeutic apheresis. We spoke to her last time, in relation to her the hat that she wears as our director of our HLA laboratory. But this is actually another big hat that you wear. So welcome!

Dr. Caroline Alquist (01:44):

Thank you for having me.

Dr. David Oh (01:46):

So maybe you can explain better what therapeutic apheresis is, and your role here at Hoxworth Blood Center.

Dr. Caroline Alquist (01:55):

Absolutely. So I joined Hawksworth about six months ago, and I have taken the role as the director of therapeutic apheresis, which is something I did in my previous job as well, managing the apheresis team. So what this involves really is, as Dr. Oh pointed out, this is the removal of a small amount of blood into essentially a giant centrifuge that's going to separate your blood into the heaviest to lightest components, like a Neapolitan sundae. You're going to have your red cells on the bottom, followed by your white cells and platelets, and then your yellow, which is your plasma, up top. Using this beautiful centrifugal separation, we have an electronic eyeball with an electronic straw that can remove the layer of interest.

So if you have antibodies you need to get rid of, we're going to take off from the yellow, right? Cause your antibodies live in your plasma. We're going to pull into a giant bag and throw it in the trashcan. Okay. And we'll replace it with a, with a substance known as albumin, which is a heat-treated human blood product. Or we can also use human FFP, or fresh frozen plasma, um, depending on your coagulation status.

Similarly, that little electronic eyeball and straw can drop down to your white cells and we can collect stem cells if that's what we're going for. And we do not throw that back in the trash. We would put that in a freezer until you're ready for them, or we can even transfuse those fresh. If you have too many platelets, we'll just take those off of you, throw those in the trash can. Same with if you have too many white cells in a case like leukemia, or if you have a red cell disorder like sickle cell disease, we can remove that whole red cell layer, replacing it with healthy donor red cells. And we infuse that all back to you.

Dr. David Oh (03:30):

That's a terrific explanation and description. So we use similar technology with our blood donors, to collect platelets and also to collect double red cells and occasionally plasma as well. So it's a very similar technology that we use for our blood donors. The difference I think, for what you're directing here at Hoxworth is that, it's actually for clinical indications. Can you talk a little bit about some of the procedures that we do use therapeutic apheresis or that we're involved with through our therapeutic apheresis department?

Dr. Caroline Alquist (04:02):

Sure! So Hoxworth offers a full complement of apheresis services. If I described it a few minutes ago, we do it. So we do offer, our most common procedures we do perform for other hospitals, are going to be therapeutic plasma exchange. That's going to be removal of any substance in the plasma that could be causing you harm. Additionally, we do red cell exchanges for our sickle cell population here in the tri-state area. Um, we also offer extra corporeal photopheresis, also known as ECP. It's a mouthful, I know. Essentially, this was designed to get sunshine in the body, all right? We knew a long time ago that sunshine was really good for cutaneous lymphomas. But once it went into the body and those cells got away from the sunshine, we didn't know how to get to them. We realized we can use our cool apheresis machine to pull out your white cells, expose them to UV light and reinfuse them. That's all it is. So we gave it a real fancy name for sunshine in the body. We use that commonly to treat graft versus host disease, following bone marrow transplant. However, it does have some interesting off label indications for rejection after lung transplant or heart transplant, which we've seen some success with.

Dr. David Oh (05:09):

Can we go through the different procedures that you talked about in a little bit more detail and, uh, kind of related to indication, so it would be used for, so I think you started with plasma exchange. Is there a classic disease that would require plasma exchange?

Dr. Caroline Alquist (05:25):

We do use it a lot for antibody-mediated rejection, which dovetails really nicely with my role in HLA. Um, essentially after transplant or before transplant, you could have antibodies we know that could be a problem with that transplant, be it solid organ or bone marrow transplant. And so, because I know HLA antibodies are floating around in your plasma, I can sip those off and throw them in the trash can. And if they're not there to cause problems, then we can prevent some of that damage. Typically the clinical team will also be utilizing drugs to prevent more antibody from being manufactured, but this gets rid of whatever's floating around at the time of the procedure. And I guess if we just work our way south, we'll start with plasma exchange.

Dr. David Oh (06:06):

Can you talk a little bit about TTP?

Dr. Caroline Alquist (06:08):

Oh, sure. TTP is another common indication that we use plasma exchange for.

Dr. David Oh (06:13):

I'm going to let you tell us what TTP stands for because my tongue always gets tripped up.....

Dr. Caroline Alquist (06:19):

Thrombocytopenic thrombotic purpura is essentially a disease that occurs when you suddenly develop an antibody to ADAMTS13. Okay. I know this is a whole lot of letters again, all right. This is a metalloproteinase that essentially is your lawnmower, lives in your blood. So you're constantly your endothelial cells that make up your vascular system are constantly pumping out a protein known as Von Willebrand's disease. Not only is that a mouthful, it's also the longest human protein produced, and that is constantly being grown on your endothelial cells like grass. ADAMTS13 is our fancy lawnmower that makes sure that those stay short. So if you develop an antibody, do your lawn mower, the grass gets out of hand and it starts occluding your vessels. Okay? And as that grass starts occluding your vessels, your platelets get stuck, your red cells get popped, and these patients are going to show up with really low platelets and anemia.

And the symptoms of low platelets are typically bleeding from the gums, strange bruising. Some people have some neurologic signs, typically as a result of clotting vessels in the brain, which can present with stroke-like symptoms. Other people just say they have headaches, or they have more ambiguous complaints, but that telltale sign is we're going to draw a CBC and we're going to see low platelets, a high LDH typically caused by those vascular occlusions, and some also contributed to, from the popping red cells. And we also are going to see a slight anemia. So if we know that you have an antibody to your lawnmower, and we need to get that out post haste, um, the best way to do it is throw that plasma away. So we use our therapeutic apheresis plasma exchange program to pull the plasma out into a waste bag, throw it in the trash can and give you healthy human plasma with functional lawnmowers included to start paring back the Von Willebrand factor proteins that have been expressed in your, in your vasculature.

Dr. David Oh (08:09):

Is this process a one and done, or is it something that patients will continue to do?

Dr. Caroline Alquist (08:13):

This is a process we're going to be doing until you recover. So typically for an indication like this, you would get a central line and we're going to do this daily until we get your platelet count higher than 150,000 per microliter. And your LDH has normalized, telling us that you're not really making as many clots in your organs and your platelet count is sustained at a safe level. After we reached that, it's depends on your clinical team, if they would like to do a taper, wean you off slowly, make sure you're not going to start dropping platelets again, or we could stop cold-turkey and see what happens. Different programs have different approaches. And so far there's not been a conclusive study which is the best way to go about it. It's interesting cause you produce this auto-antibody for unknown reasons, and it just goes away after awhile for unknown reasons. So it is kind of a weird transient disease that we do see fairly frequently

Dr. David Oh (09:04):

And often it comes back again in these people as well. So you can have a second case or refractory cases that do occur. So it's interesting, so with these patients, they have low platelet count and you know, this is, a lot of our audience are blood donors here. We actually don't use platelets as treatment for TTP, but we use plasma. So that's another donated product. Um, why do we use plasma instead of just albumin or other blood replacement?

Dr. Caroline Alquist (09:32):

So the reason we want to use human plasma is 'cause we have to give functional lawnmower activity back. We have to give that healthy ADAMTS13 back to start paring back that that protein that's being expressed. And we don't get platelets of course, because the only reason your platelets are low is they're getting stuck in the grass and causing clots. So we don't want to add more fuel to that fire.

Dr. David Oh (09:52):

So it's interesting, you know, as we asked blood donors to come in, sometimes we'll ask them to donate plasma. Sometimes we'll ask them to donate platelets. Sometimes we'll ask them to donate red cells. And it's because there are different indications for each of these different products and we have to have supply of each type in order to, to help patients with therapies. And with plasma, if you're an AB recipient, right, an AB patient, you really should just get AB plasma. If you're O, you can get any blood type. So it's a reverse of the universal red cell donor. The universal plasma donor is, is AB.

Alecia Lipton (10:27):

It's very important to mention that with these treatments, we need donors. There is not a substitute, there is not a medicine, there's nothing developed in the lab that we can give them. So we need those volunteer donors to come in on a regular basis, whether it be the red cells, the plasma, or the platelets.

Dr. David Oh (10:45):

Let's talk a little bit about sickle cell disease in red cell exchanges. That's the primary reason for that. Tell us a little bit about it.

Dr. Caroline Alquist (10:51):

Okay, yeah. Sickle cell disease is a great candidate for the therapeutic apheresis program. Essentially what we know is that at a certain level of sickled cells in your blood, you are more prone to having strokes or multiorgan damage, which can manifest in a lot of different ways, such as acute chest syndrome, which is the sudden pain in the chest caused by the sickle cells, occluding your vessels. We can see priapism, once again, it's those sickled cells occluding vessels. There's a whole host of things. There could even be a, a really bad pain crisis.

Dr. David Oh (11:25):

So, so who, who gets sickle cell typically?

Dr. Caroline Alquist (11:28):

So sickle cell disease is commonly seen in our African-American population.

Dr. David Oh (11:32):

And, and what's what happens in sickle cell? The red cells are not, uh, formed in the right shape. Is that right?

Dr. Caroline Alquist (11:41):

Yeah. Essentially what happens is those cells, when they experience any kind of de-oxygenation, they actually form a sickle like shape. And unfortunately, a sickle like shape does not nicely go through our vascular tubes, like our typical round or oval shaped red cell. So once they form that strange shape, they're more likely to get stuck. And when one gets stuck, it's like a log jam. And that causes a lot of problems, which is why most of our sickle cell patients, we have a goal to keep their hemoglobin S under 30%.

Dr. David Oh (12:09):

Yeah. So it's less likely to sickle then, and cause problems. And, and some people actually get regular red cell exchanges, even if they aren't currently having an exacerbation of disease, to prevent the adverse supply that can occur, like stroke. And so as we try to collect red cells, are there additional challenges that we have in terms of, of finding red cells that are compatible for, for these recipients?

Dr. Caroline Alquist (12:38):

Absolutely. So, as you can imagine, if these patients are constantly getting transfusions, there's a lot of possibility for them to develop antibody, right? 'Cause everybody's cells are covered in a different fuzz, like my HLA fuzz, but also in blood antigen fuzz. All fuzz can be interpreted by the immune system as foreign, if it doesn't match your, your name tag. Right? So what we're finding is many of our typically African-American sickle cell patients when they get repeated transfusions, if that blood is not from African-American donors, they're at a much higher risk of developing antibody, just because there's genetic variation and certain Euro or Asian donors are less likely to have the antigens that match in African-Americans patients. We do do a level of extended typing or matching here at the Hoxworth. We make sure that we're always ABO, Rh, C, E, and K matched, to try and prevent allo-antibody formation. But unfortunately, there is no magic way to prevent it from happening overall. So yeah, one thing that we would love is if we had a stronger African American donor base to help out our sickle cell program, because that would provide blood less likely to incite allo-immunization in these patients, which makes them much, if you develop these antibodies, you're much more difficult to find compatible blood. So these patients, we have to plan days, if not weeks ahead of time, to make sure that we have blood that will match them.

Dr. David Oh (14:04):

I think the other challenges with this population is oftentimes when we give transfusions, we're giving a couple of units, right? One or two units, whenever a red cell exchange occurs, we're having to do based on, on volume, right. Or size of the patient. So very small kids would have a smaller blood volume, but for an adult, you know, we were exchanging what, between 10 and 15 units, I would say, or donated units per event.

Dr. Caroline Alquist (14:29):

Well, it depends on your, your body size. Your blood volume is very dependent on what your weight is. So we see some people that require five, and we see some people they require 15. Um, it's very dependent on what your stature is and, and how much blood we need to replace to get that fraction of hemoglobin S under 30%.

Dr. David Oh (14:45):

Yeah. And you talked a little bit about matching beyond ABO, and we'll have to have another episode to talk about minor red cell antigens as well. But it provides a lot of additional challenge for us to match this population.

Alecia Lipton (15:01):

Ideally the blood supply at the blood center should match the demographics of the city that you're serving. Right now, as you said, we do need more African-Americans and that, so that we can serve people here close to home, sickle cell patients right here, children and adults in the tri-state.

Dr. David Oh (15:18):

Yeah, it's, it's one of the really neat procedures. I think that we perform that really affects a lot of children in terms of, of needing these to prevent for stroke and other events. I'd like to talk a little bit about STEM cell collection as well, because that's a major activity for the therapeutic apheresis department, and people may not be aware of this activity. So we do collections not only for local patients, to find matches, but also for the NMDP or the National Marrow Donor Program. Can you talk a little bit about STEM cell collection performed?

Dr. Caroline Alquist (15:55):

Absolutely. So STEM cell collection is typically performed before a patient undergoes some kind of myeloablative or non-myeloablative chemotherapy regimen, which is essentially...

Dr. David Oh (16:06):

So, so what is myeloablative and non-myeloablative?

Dr. Caroline Alquist (16:10):

It means "how bad do we bomb your bone marrow?" Um, essentially....

Dr. David Oh (16:16):

It sounds like we're very violent here, right?

Dr. Caroline Alquist (16:19):

We are very violent! Bone marrow transplant, if you want to replace your bone marrow with someone else's, you've got to clear the field. So you just gotta decide what regimen you're going to use to clear the field. You can actually donate stem cells to yourself in certain diseases, for example, in multiple myeloma, you can donate your own stem cells, which has been shown to give you longer disease-free survival. Meaning we collect your stem cells, you receive your chemotherapy and then we give them back and you repopulate your marrow with your own cells. There's a number of diseases where we can approach it like that, where you donate your own stem cells, we bank them and give them back to you later. But more commonly, I think, um, with, as with NMDP, we use healthy donor bone marrow cells, which we collect in any location.

Dr. Caroline Alquist (17:04):

We can cryopreserve them or ship fresh to the patient in need. So for the National Marrow Donor Program, they help us select and find healthy donors that are perfect matches or good matches or haplo matches, whatever the program needs. We collect those cells from those healthy donors here at Hoxworth, keep everyone comfortable--we're so grateful for those donors when they come in--we take those cells and we will do whatever the clinical program needs so we can freeze them, we can keep them fresh, we can do whatever manipulations they need. And then we make sure that product gets to the patient in need wherever they're located, it could be here or it could be international.

Dr. David Oh (17:41):

Yeah, actually, I guess I just caught myself. We use such alphabet soup here and I thought it was being good defining what an NMDP means, but I think they actually changed their name to Be The Match. So that may be what more people are used to hearing, but we are a center of a collection, apheresis center pf collection, a center of excellence for NMDP or Be the Match, which I think is a great activity for us. How many nurses do we have in our department?

Dr. Caroline Alquist (18:06):

We currently have eight full-time RNs in our department, which are amazing. We are, they're able to be available seven days a week, 24 hours a day to patients in need for anything from planned stem cell collections to emergency TTP situations. This is a really dedicated, hardworking team that allows this program to exist. Without their commitment, we couldn't, we couldn't serve our population with the strength and ability that we do.

Alecia Lipton (18:35):

I think important to point out is this team is mobile. So they're not just staying at Hoxworth. You have them going out to hospitals.

Dr. Caroline Alquist (18:42):

That's right. When we get the call, we will be there for you. We have clients throughout the tri-state area, and if there's a patient in need, we get our machine bedside to you. We don't expect you to transfer your patients to us. We'll come to wherever you need us to be, which is really a pretty amazing service that we're able to provide here. Many programs do not have that capability. So that is certainly a unique strength to the Hoxworth system.

Dr. David Oh (19:08):

Yeah, that's a great point, Alecia, you know, we actually have devices that are stationed at one of the Mercy hospitals in town, at TriHealth, at Children's Hospital. And so, of course we're so close to UC as well. So yeah, so we often do procedures at the hospitals for those patients. And we actually, we'll go into a little bit more of the alphabet soup here. Can you talk a little bit about FACT and the fact that we are an accredited FACT collection center?

Dr. Caroline Alquist (19:38):

I think FACT just goes by FACT now, too, right? I don't think that they don't, they don't use a longer name anymore. Um, so FACT accreditation is essentially accreditation system for the collection and transfusion of stem cells. We are a FACT accredited location, meaning that we follow the highest standards for protocols, procedures, facility standards, to make sure that we serve our population in the most safe way for both our donors and recipients.

Dr. David Oh (20:08):

And we're also AABB accredited for this activity as well.

Dr. Caroline Alquist (20:11):

Absolutely.

Dr. David Oh (20:11):

Yes, definitely. So I don't want to leave them out. And AABB just stands for AABB right now.

Dr. Caroline Alquist (20:18):

Formerly known as an American Academy or Association of Blood Banks! AABB is a very important force in the blood banking world and they also do govern cellular therapy practices and do have a large say in making sure our cellular therapy practices are, are up to snuff.

Dr. David Oh (20:35):

Yeah. And so for some of our hospitals in the area, we prefer provide the apheresis collection services under FACT, so that they can be FACT accredited as a program overall, as well. And we're really an integral part of that whole process.

Dr. Caroline Alquist (20:49):

Absolutely.

New Speaker (20:50):

I know another activity that, that we have at Hoxworth is as part of our mission is research, and I believe therapeutic apheresis supports that mission in many different ways. Maybe you could mention, maybe you could discuss that a little bit.

Alecia Lipton (21:05):

Absolutely. Our apheresis team plays an integral role in the research happenings in the tri-state area. Most cellular therapy programs are doing work on mononuclear cells, known as MNCs. So this is going to be the same layer that stem cells hang out in, but we know we can collect them, right, cause it's just a layer of the centrifuge blood. So we collect that mononuclear cell layer, and we put it in a bag and we'll send it to whatever lab we need to for processing. Some of these technologies are going to be educating T cells, getting them to target certain tumors or target certain systems. There's also gene editing research going on. Basically, if you need that raw source material of mononuclear cells, our team can get them for you.

Dr. David Oh (21:51):

And I guess the last question I have for you is, from my experience, before joining Hoxworth, therapeutic apheresis was actually something that, that we did not do very much when I was in San Diego for about 10 years. And when I was at Stanford, that activity occurred, but it was not under the transfusion service. And so I think it's interesting at Hoxworth, that this really is run by, by us as transfusion medicine professionals. And I guess I would just like your thoughts on that.

Dr. Caroline Alquist (22:21):

No, absolutely. I mean, apheresis has been a technology around for quite some time. I mean, since the 1950s we've been developing these cool new instruments and they get new iterations regularly. What we know is that it's applicable to just about every facet of medicine there is. So it's really no surprise that certain areas have, have started operating apheresis services. I know that nephrology is a service that commonly also is involved in apheresis and dermatology for ECP reasons, that photophoresis, I had mentioned earlier. We know that the service can be run by a lot of different specialties, but given that it is really very transfusion medicine based, it does fit quite naturally into the purview of a transfusion medicine service under physicians that are boarded in transfusion medicine. This is, this is our bread and butter. So it feels like a comfortable service for us. And it's something I'm really proud that we include in the, in the Hoxworth portfolio.

Alecia Lipton (23:17):

Dr. Ahlquist, thank you so much for joining us today. I hope that you'll come back again and you've been listening to in the know with Dr. Oh presented by Hoxworth Blood Center. We'd like to hear from you. What do you want to hear about in future episodes? You can email us at hoxworthintheknow@uc.edu. You can also always give us a call at (513) 451-0910. Thank you. On behalf of Dr. Alquist and Dr. Oh, you've been listening to In the Know with Dr. Oh! 

Alecia Lipton (01:11):

You are listening to In the Know with Dr. Oh, brought to you by Hoxworth Blood Center. I'm Alecia Lipton and I'm in the studio with of course Dr. Oh. Good morning, Dr. Oh!

Today's episode is going to discuss blood centers. And when I say blood centers, I'm talking about blood centers that collect blood here in the United States, and those are kind of divided into two different areas.

Dr. Oh (01:35):

There are national blood centers. I like to think of three different divisions. Actually there are a national blood organizations that collect blood. There are independent blood centers that are more regional and focus and then there are hospital-based blood collection sites as well.

Alecia Lipton (01:52):

Okay. And Hoxworth would fall into that independent area, correct?

Dr. Oh (01:56):

That's how I would categorize it. Yes.

Alecia Lipton (01:58):

Okay, and what is the best way to describe an independent blood center? Who do they serve? What do they do?

Dr. Oh (02:05):

The first blood center was set up in Cook County in 1937.

Alecia Lipton (02:10):

Right, I think just like a month before Hoxworth.

Dr. Oh (02:12):

That's right. And so we think that in terms of regional blood centers, Hoxworth is probably the oldest functional community blood center that distributes blood, to multiple organizations. So in the 1930s and forties, many blood centers were formed because Regents needed blood, hospitals wanted to perform surgeries, uh, and had need of blood, but they didn't want to set up their own blood collection organization. That's a lot of work. It's a lot of infrastructure that needs to be developed. And it makes more sense in terms of economies of scale for blood centers to be developed, to serve a particular region or city or County or numerous counties in the same physical area. And that's really how most blood centers I think popped up in the thirties and forties. I was at San Diego blood bank and they were formed in, I believe, 1950 and Hoxworth, again, in 1938, so many of these areas were formed by the hospital groups banding together to try to be as efficient as possible and support a blood center that can then provide blood to all of the different users.

Alecia Lipton (03:25):

Okay. That's a great explanation. And with Hoxworth we serve over 30 hospitals here in our tri-state region, so it's your regional hospitals. We have 30 that we serve and I think one thing that's always important to mention to our donors is when you donate with Hoxworth, you're actually saving lives close to home. When people tell me, oh, I live in Florida, where should I donate blood? I'm like, well, who's your regional blood center in Florida, you know, that's where you live, donate, and then you can help friends, family colleagues, people that are right there in your community.

Dr. Oh (03:57):

Yeah. So philosophically, you know, as independent blood centers and you'll sometimes hear the term blood center or blood bank, I think originally most of us were called blood banks. And then later on we realized that blood center actually made more sense because the hospital transfusion service were often referred to as the blood banks. So many of the blood collectors that changed their names to become blood centers. So we are Hoxworth Blood Center. We serve the hospitals in our region. And so our goal really is to collect blood, to meet all the needs of the hospitals in our area. If we caught a little bit above that, that actually is, is good for us because there are occasionally opportunities where we can resource share and provide blood to other blood centers that are needing it. And then we can also shoot to always have enough blood and a little bit more for our, all of our hospitals.

Dr. Oh (04:54):

Uh, and I think that's kind of the best place for a blood center to be is just a little bit above the need of all of your local, uh, hospitals. If you collect, uh, twice as much blood, let's say, or three times as much blood as your community needs, then you are kind of what we call an exporting blood center. There's nothing wrong with that, but then you're dependent on demand from other areas and that can sometimes be difficult, but if you are exporting blood that actually helps to support your infrastructure, uh, by, um, by providing blood to other areas. And so you can make sure to, to service your local hospitals as well. If you are an importing blood center, which often happens in, in, um, urban settings, um, you can't collect enough blood to service all the hospitals that you care for. So you then rely on blood from other blood centers, uh, to meet that local demand.

Dr. Oh (05:47):

And so that often means, uh, importing blood, um, from, from, uh, other organizations. National blood centers, so those are like American Red Cross and, and I would call a Vitalant, out on the West coast, um, now, uh, somewhat of a national blood center. Um, they will often, uh, collect within their own system, uh, in areas where, um, they collect more than their local needs are and export those out to other areas. So I spent a number of years out in California, and I believe that for those systems, you know, much of the blood was collected, uh, sometimes in other areas to support the need in the big urban centers that they, they service.

Alecia Lipton (06:25):

Okay. That brings up, um, a great segway into the American Red Cross. Um, we see American Red Cross vans, we see advertising, but I think it's important to differentiate what they do here in this region. Um, they do just disaster work and they're phenomenal with their disaster work and with their educational programs, but they don't collect blood in this part of Ohio.

Dr. Oh (06:48):

Yeah. So it's interesting. So I actually worked for American Red Cross. I don't know if you knew that, Alecia, right after I got out my fellowship, I worked for them for about, about two years. And, uh, it was, it was an opportunity for me to really learn because they collect between 40 and 45% of the blood, you know, collected in the United States. They have a national system. So, uh, if you go to a Red Cross at any area, they, they kind of operate under the same SOP or standard operating procedures. Um, I think that's really challenging for them sometimes because, um, those SOPs are made, you know, nationally, and then they have to be implemented at each individual site. And when you, when you produce blood, uh, oftentimes your facilities are not cookie cutter and identical from one center to another, and you have to make those kind of SOPs work for you, uh, locally. Um, they have advantages in terms of, of being able to collect again in, in areas that, um, don't use as much blood and to be able to supply that to areas that are using it more. So American Red Cross does have two major divisions and one is biomedical services, which is more the blood collection side of things. And the other is disaster relief and, and they operate, um, um, quite separately at least, uh, that was my experience when I was with them.

Alecia Lipton (08:06):

Yeah, my very first blood donation in high school, it's with the American Red Cross. They service that part of Ohio that I grew up in.

Dr. Oh (08:13):

I actually donated when I was in college and Wisconsin.

Alecia Lipton (08:17):

Yeah. When I was in high school, you know, you turned 16 and it was a right of passage. Um, my father, who was a Marine, he always donated blood. He started donating when he was a recruit and they really didn't give him much of an option. He said, an officer came in and said, you're donating blood today. Um, so it was something very important to him. So as soon as I was 16, I knew that was something that I would be doing.

Dr. Oh (08:39):

Yeah. So for us at Hoxworth, you know, I think it's important as we try to, to reach out to our donors and have conversations with them to let them know. Yeah, we do service all the hospitals in the area. Um, and that if they donate with us, you know, I can't, I can't say a thousand percent blood will not end up being needed by another hospital that needs it. But the vast majority of the blood that we collect will stay and will help your friends and neighbors that are in need of blood locally.

Alecia Lipton (09:08):

That's wonderful to know that you're actually helping somebody that you may run into in the grocery store. You're never really going to know that person, but just that feeling of walking away after donation, knowing, wow, I could help save somebody’s life.

You have been listening to In the Know with Dr. Oh, I'm Alecia Lipton. We encourage you to follow us on Twitter, Dr. Oh now has his very own Twitter account @IntheKnowDrOh. Let us know what you think about the program, what you'd like to hear going forward. Again, this is Alecia Lipton with Hoxworth Blood Center, and you've been listening to In the Know with Dr. Oh.

 

Alecia Lipton (00:41):

You're listening to In the Know with Dr. Oh brought to you by Hoxworth Blood Center, I'm Alecia Lipton and I'm in the studio with of course, Dr. Oh.

Today's episode is going to discuss blood centers. We talked in the beginning a little bit about the regional blood centers, and of course we talked about Hoxworth, we're Hoxworth and we served this part of the tri-state, but there's also community blood center, which serves the Dayton area and a little North Kentucky blood center, which serves Lexington and I believe over to Louisville. And then there's Indiana Blood Center. So we're not unique. Um, there are how many independent blood centers do you think? I know the list is staggering.

Dr. Oh (01:22):

I don't have that exact number on me. There is an organization that most of us are members of and that's BCA and ABC. So a little bit more alphabet soup for us. So BCA is Blood Centers of America and ABC is America's Blood Centers. And those two organizations really have a lot of overlap right now. And most independent blood centers are a member of those two organizations. It provides us with the ability to communicate with, with each other. And when one of our independent blood centers are needing blood, um, we have a whole network  which is probably about 45%. I would say, of the blood collected in the United States is from a member of American split centers or BCA. We are distinct from Red Cross, and sometimes it's, you know, when you're trying to do branding and things like that, it can be very confusing to donors because they just want to donate blood.

And I think that's important for us all to accept that and, and to appreciate that that's really just what donors want to do. It’s our job to supply that blood, and manufacture and do all the different steps that are required…. collection, processing, labeling storage distribution  and make sure that that blood reaches it to the end point and is used appropriately. And then if there are any issues that come from it that we follow up with it. So, um, so we, we do take that responsibility in the region for making sure that, you know, surgeries aren't canceled because there's a shortage of blood, and that the blood products we provide are as safe as possible.

Alecia Lipton (03:09):

And I know that you have regular, being that you are chief medical officer, regular communication with our area hospitals about what the needs are and what we have on our shelf.

Dr. Oh (03:18):

Yeah. That's one of the really great things about my job. So I was, after being in a national organization, I really wanted to be in an independent blood center. So I went to San Diego first, and it was great there because I could, you know, you get to know the hospitals, you get to know the medical directors at the transfusion services, and work with them really intimately and make sure that their needs are being met. It's harder sometimes if you're not really embedded in a specific region and you have more of a wide focus. Then I went to Stanford and then of course, when I was at Stanford, we had fewer customers. We still did export to some, we did provide to some non-standard hospitals, but really had a couple of big clients there that were internal.

So our communication was really intense. And then coming here, one of the things I really loved is that I actually get to talk to myself all the time because I'm the medical director at UCMC. And that part of a kind of an older style of blood center, um, relationship with hospitals where you can actually wear the hat of the blood center, medical director, as well as being a transfusion service medical director. Those opportunities are kind of less today. So that was one thing I really was looking forward to in terms of being in Cincinnati. And then Hoxworth actually used to provide the medical direction for Children's Hospital here, CCHMC, until just a few years ago. Before I got here, that switch was made, but they had brought in a couple of great transfusion service, medical directors, board certified in transfusion medicine, Dr. Stephanie Kinney and Dr. Michael Lassos. And it's been a pleasure to work with them as, as their blood supplier. And we meet every week actually, and talk about interesting cases and  make sure that their needs are being, being met.

Alecia Lipton (05:11):

Right now, we were looking at numbers and it looks like Hoxworth is going to eclipse a hundred thousand units of collected blood this year. That'll be when we hit our fiscal year, June 30th. Are we using all that blood? Um, is there really a need for a hundred thousand years?

Dr. Oh (05:27):

Yeah. The, the amount of blood that, that doesn't get transfused is, is really low. I don't have an exact number for you on that, but the vast majority of what we collect gets transfused. We provide to all of the different hospital systems in Cincinnati. So I hesitate to list them all off, cause I'm going to forget somebody, but the Mercy system, you know, Tri Health, Children's Hospital, UC Health, if I'm forgetting somebody to let me know Christ for sure. Yeah. They've got a great partnership with them and it's, it's great because, um, as the sole provider to those hospitals, we know that there's any questions that they can come to us and we can help to provide solutions and answers. I've been in areas where there have been multiple blood providers and it's, it, it really interferes with your ability to work as closely with the transfusion services when they're not sure who provided, you know, the blood that they have questions about.

Alecia Lipton (06:26):

That probably goes hand in hand with the other services Hoxworth provides, when you're doing therapeutic apheresis,  it's the same organization, it's Hoxworth, that's supplying the product and also Hoxworth that is providing the service.

Dr. Oh (06:40):

Yeah. So, you know, I don't do all those things myself, although I do help with the therapeutics service, but we know when a call comes into Hoxworth, I can tap on Dr. Alquist and say, Hey  um, there's therapeutic need, apheresis need there. And she can ask me about plasma supply. And, and we work together to provide a seamless, I think, solution of service clinical services from the blood center, therapeutic apheresis, you know, we talked about previously, that's not a service that many blood centers provide. There are many, many blood centers that actually do not provide that service. So it's great for us to be able to do those things as Hoxworth and provide multiple solutions, very broad array of services,  including cell therapy as well.

Alecia Lipton (07:27):

I think one of the great things from my aspect of looking at Hoxworth is that we were one of the first blood centers in the country to be able to collect and distribute convalescent plasma. And that was, um, in April, um, I believe was our first collection. Can you tell us a little bit about that?

Dr. Oh (07:44):

That was really something that in December was not on anybody's radar, really. It's been a great experience here to be able to get that program up and going and to provide these products that there's just a lot of demand for locally. And so that was something that, that we could do. Number one, I want to thank FDA for their guidance in the whole process because they gave us kind of what their expectations were and communicated very well with the blood center community. I want to thank our donors as well, because even though we were late in seeing cases here, we actually were able to collect the first units of convalescent plasma from people who had contracted it outside of Cincinnati. I want to thank the governor as well, and Amy Acton because with their policies, we did not see our spike until a little bit later on.

Dr. Oh (08:37):

So we actually were able to collect convalescent plasma and have it ready pretty much as the first cases were hitting Cincinnati. And then I want to thank all the donors who, who unfortunately were sick with COVID at one point, but recovered and then wanted to help their fellow man up by giving plasma. It's a great example of, of what we do. But a new application of our whole, our whole job is to reach out to the community, have donors come, donate of themselves, and to help their friends, family, neighbors who are sick and need blood products.

Alecia Lipton (09:15):

We discussed independent blood centers, national blood centers. And then you said there was a third, what's the third?

Dr. Oh (09:25):

Yeah. So hospital based blood collection is less than 10% of the blood collected. And it's actually gone down significantly from, from 10 years ago. Oftentimes you'll see, like I'm from California. So Stanford, initially was owned and operated by their school of medicine. And then is a little bit more hospital oriented at this point. UCLA is a great example of a blood center that's affiliated with the hospital system that they service. The typical model, then, is that they don't actually collect more blood than they use and provide it to other hospital transfusion services around. It can happen. And at Stanford, we actually were able to provide blood to the community, but that was, that was rare. Most of the time they collect, they try to collect enough blood for it to support their internal needs, but usually they have a secondary blood supplier where they can top off on the levels that they need.

Sometimes they will collect platelets and really concentrate on platelet collections  and then  rely on  other blood providers to import their red cells in their plasma. Um, so, um, that makes sense, cause oftentimes platelets are, are the hardest to collect. Um, so typically with hospital collection services, um, it's a partial solution and it so relies on, um, other blood providers to, to kind of top off the supply. I think it's difficult for hospitals to operate, um, a blood collection service as well as a transfusion service. You may think that they're kind of interrelated operations, but really those are our two very separate things. And there's an incredible regulatory requirement when you collect blood, essentially blood is a drug and it needs to be labeled as so. And if you do that improperly, that's not good. So yeah, so hospitals often are, you know, they have to think of their mission and, and mission critical things. And, and really, I think at this point, getting blood from a reliable partner actually is beneficial for them. And it's an endeavor that, gosh, set up their own, you know, their own infrastructure to collect blood is a huge  undertaking when really, you know, the mission is to care for patients not to create the medications or drugs that are needed to treat your patients.

Alecia Lipton (12:03):

Exactly. I think Hollywood kind of puts into everybody's mind that there's a blood center in every hospital because when they show an accident, they're like, Oh, go down the hall and donate blood. And that's not necessarily the case. I think that kind of segues us into what I'm going to say is a fourth area of donation. And that would be plasma centers. Sometimes we hear on the radio about a plasma center and they're going to be paying people to donate their plasma. I feel that it's important that listeners know that the FDA prohibits blood centers from paying somebody for their donation, it's a volunteer act. And when you are paid, then it can not be transfused to an individual. Can you explain what that product is then?

Dr. Oh (12:50):

Yeah. So, um, that's a great question. So I've never worked at a source plasma center. But from what I understand, the plasma that's collected by those organizations  is typically fractionated. So it's pulled together and then fractionated to get specific blood elements. So albumin is a common protein  solution that is formed typically from donated  blood  through plasma centers. IVIG is another, and it's in huge demand. And so when you do donate plasma and get paid for it, you are doing good things. And that those products are absolutely needed by people. Um, when we collect blood, blood centers, we often hear from our donors, “Hey, you know, how can you go ahead and sell this product right here? I'm giving this blood for free and, you know, it should be free to the hospitals.”

There's a lot of costs that go into the collection again, collection, processing, and labeling, distributing, testing, storage of a unit of blood. And we are a nonprofit organization. So, the vast majority, I think, almost all members of BCA, ABC, the Red Cross, Vitalant out on the West coast, we're all nonprofit organizations. And so any revenue that we see will go back into the organization and go into collecting more blood and making it safer and more efficient and, and all those different things. When you donate plasma for source plasma and get paid for it, um, typically those companies are for-profit. Oftentimes they're not, you know, American based actually even, and that's okay, right, but it's a different model. It's a different model in terms of regulations.

Dr. Oh (14:54):

We label our blood and as either paid donor or volunteer donor. And so that is from the regulations that, that, you know, we work under. So traditionally, you know, blood centers that collect blood for transfusion purposes are almost always volunteer. Uh, donor based, there have been a few companies that have popped up that have tried to pay donors. Uh, and then you have to label those units as paid. And that is something that in general hospitals, you know, don't want to see. Um, there have been studies that have been performed, which show that donors that, that donate for money are at higher risk for many of the transfusion transmitted diseases that we test for. And we try to reduce the risk of, but, um, your tests are not a thousand percent  foolproof. And so that additional layer of safety is to have a volunteer blood donor pool versus a paid donor source.

Alecia Lipton (15:59):

I think I've also seen documentation that if somebody is getting paid, especially a significant amount of money, they may tend to be disingenuous on their donor form.

Dr. Oh (16:09):

Yeah. I have heard that as well. When we think of the blood safety measures that we take, oftentimes we think of a two tier system. One is the donor history questionnaire, which everybody hates to fill out when they come to donate. And we ask all these personal questions and it's long. Uh, but that is the first tier to really make sure that people who answer all those questions are at very low risk for transfusion transmitted diseases. Um, it's also for donor safety as well, but once somebody clears that first hurdle, we feel like they are a low risk population. And then when we do our infectious disease testing or for transfusion transmitted diseases, it actually makes those tests more effective. And we have more faith in a negative predictive value, um, for the tests that come back negative. If you collect blood from a very high risk population that has a high incidents of, of a disease, um, you are incidents or prevalence of disease. You actually will have the tests, even though they function exactly the same, you will have the risk of more false positives occurring and possibly than having a transfusion transmission of one of these things, we really don't want to see.

Alecia Lipton (17:28):

You have been listening to in the know with Dr. Oh, I'm Alecia Lipton. We encourage you to follow us on Twitter @InTheKnowDoctorOh, let us know what you think about the program. What you'd like to hear going forward. Again, this is Alecia Lipton with Hoxworth Blood Center, and you've been listening to In the know with Dr. Oh.

 

Alecia Lipton (00:31):

I'm Alecia Lipton and you are listening to In the Know with Dr. Oh brought to you by Hoxworth Blood Center. Today in the studio, we're joined by Michael Whiting and Michael is our manager of our call center at Hoxworth. So when you are getting phone calls at home or texts, or maybe even emails, that's typically Michael's team that's reaching out to you to make that lifesaving blood donation. Michael, welcome to In the Know with Dr. Oh! We're anxious to let our listeners know a little bit about donor recruitment, how it's evolved through the years. But first, if we could just let everybody know a little bit about you... Rumor has it, you're quite the soccer player.

Michael Whiting (01:25):

Those are all lies. Yeah, I did play for UC, played midfield and scored goals for them. So I have, I have all the records for scoring goals or did this is way back when, back in the seventies...

Alecia Lipton (01:38):

...A Few short years ago!

Michael Whiting (01:40):

Yes, a few short years ago, but we did play top level. So we did play number ones in the nation. In one week we played two number ones. It was St. Louis and Indiana where we played one on Tuesday. They played each other on Thursday and number one, beat number two. And we played the other number one on Saturday.

Alecia Lipton (02:02):

Wow.

Michael Whiting (02:02):

I know. We lost both games, but yeah. So I also played competitive open division men's all the way until I was 38.

Alecia Lipton (02:13):

Oh, that's great.

Michael Whiting (02:14):

I know! I was playing upfront, then I played midfield. Then I played outside back and then eventually I played bench and that's it.

Michael Whiting (02:22):

And then when people in Cincinnati think about marketing, you know, Cincinnati has lots of great institutions here. And I think one of the greatest that we think of when we think of marketing and products is Procter and Gamble. And you had quite an illustrious career with P&G before you came to Hoxworth.

Michael Whiting (02:40):

Yes, My favorite marketing company is Procter and Gamble. So I did start out in the call center and then rose to more of a project management. So eventually I was managing global crisis management for them and also acquisitions and divestitures from a contact standpoint. I lasted there until I retired around 30 years.

Alecia Lipton (03:08):

And then we were lucky enough to get you on our team at Hoxworth, so....

Michael Whiting (03:11):

Right. I retired from, and then I realized that the world of retirement is a little bit aggressive with the elderly, especially in Kroger. So I had to come back, come back to work. And luckily I was blessed to to find Hoxworth.

Dr. Oh (03:35):

Michael, when did you join Hoxworth's team?

Michael Whiting (03:37):

Five years ago. Yeah, it'll be five years in May.

Dr. Oh (03:41):

That's fabulous. Yeah, I know you've been here ever since I got here about three years ago.

Michael Whiting (03:44):

And I had no background in blood.

Dr. Oh (03:47):

Wow.

Michael Whiting (03:47):

Right. I was, I was marketing. I had some background in healthcare. Pepto-Bismol Vick's led that from a North American standpoint for Procter and Gamble. And, but then I came to Hoxworth and then started to learn about blood. And right now I'm a platelet donor on a consistent basis....and we can talk a little bit about that. So it's, it's critically important for our hospitals, for leukemia, cancer patients for, for donations.

Alecia Lipton (04:19):

That's great. A lot of people will say, well, you're a blood bank. What does marketing have to do with a blood bank? And I think a lot of people don't realize that not everybody wakes up on a daily basis and says, gee, I'm going to go to the blood bank today. So marketing is needed. You do need to be able to reach out to people.

Michael Whiting (04:38):

It's critically important. It really is understanding the message going out to our community and having them understand the importance of blood collections to our hospitals that we support. And every single day, we meet early in the morning to discuss the status of our blood and where we need to alert our community for them to come in. And in some cases we have an adequate supply, but in many cases, depending on the type, we need to alert the community. It makes you so proud to be part of greater Cincinnati, because when we do send out a message to our community, they respond. They come in even in the single day, they'll walk in. This happens when we put an alert out within the media, or we use some of our other tools such as social media.

Alecia Lipton (05:39):

That's great. I know that reaching our donors has changed a lot over the years. 20 years ago, everybody had a home phone, so you could call people and you've been catching them at home. They may or may not have an answering machine, but it's not so easy to get ahold of people anymore. What are some of the things that you've seen change just in the five years that you've been here?

Michael Whiting (06:01):

I just want to preface that I came from Procter and Gamble. So we were doing a lot of connecting with consumers, utilizing multichannel. We were emailing, texting, chatting, calling, putting the ad out social media was also, when you look at social media today, the channels keep on changing, but there's fundamentals to the demographic of Facebook, Instagram, Twitter. And now there are other channels that come and go... Snapchat would be one. Tik Tok is another. Those continue to change. And those are also very critical for us to have multi-channel. So when I hear call center, we're really, we're not that. We're a contact center. This is my analogy. We are responsible from my business standpoint, the one-to-one relationship, and then marketing would be the one to many. So they would, they would be responsible for going out to hundreds to thousands. And then we are responsible for the one-to-one, the talking to, the email, the chatting that needs to happen one-to-one. And that's really, that is the fun part for me to talk to somebody, especially with what a platelet is, the length of the platelet, the importance of the platelet, convalescent plasma, the importance of a convalescent plasma. Also to share a little bit about the details about the antibody, the titer levels, and have them really link in. And then once you link them in, then they'll come back and that's really the portion of our responsibility. It is not only for that single donation, but it's the continuation of those donations through their lifetime.

Alecia Lipton (07:59):

I think it's also important to let our listeners know that you and Dr. Oh converse on a regular basis. If not a couple of times a day, at least daily on that message and how it's going to go out to the community.

Dr. Oh (08:15):

Yeah. We meet pretty frequently. We'll always talk about our current needs. I mean, that's always important to make sure that that day, if our platelets are lower, that we make sure that we concentrate on those. And it's hard sometimes to get an immediate response, but we're always aware of that and really the successes in the long term planning. But yeah, we meet all the time and we talk about the needs.

Michael Whiting (08:38):

It's really, really important. And it's not a long discussion. So at times it is, and we had discussion yesterday just on the status of how fluid the convalescent plasma donations are and what we should do. And even today, we had a question about the link for the deferral, for the new J & J to come out and how long that is, because our donors want, want to know if they can donate right after that vaccine. So having that very quick open discussion is critically important for us to move the business forward.

Dr. Oh (09:14):

Well, you and your folks are having that conversation with our donors. And, and we want you to be, be able to answer some of the questions, at least, you know, the, the more common ones. I know you guys can't answer every single question that's out there. And sometimes those have to get referred, you know, up and that's, that's totally great, but if you can help to provide some of the answers and really understand the process you know, that's just a great thing for us in that communication process. You know, the convalescent plasma is really interesting, I think a year ago, you know, we weren't even doing any of that at all. It wasn't, it was just getting on our radar about a year ago, but we've had an opportunity to talk to many people who've never donated before, who have become convalescent plasma donors. And then now many of them are unable to continue to donate convalescent plasma because,usome new changes have gone into place and anybody who's been symptom free for greater than six months, we've actually decided to not continue to take them because antibody levels get lower. Can you talk a little bit about some of those conversations with CCP donors or convalescent plasma donors and, and the relationship building that's occurring?

Michael Whiting (10:23):

So if you think about those individuals, they, they did struggle. Some were in the hospitals, some were on ventilators.

Dr. Oh (10:34):

Yeah.

Michael Whiting (10:34):

Some are not. So the variation of I had a runny nose and I had a headache also goes to the converse, that they're in the hospital for over 10 days on a ventilator. So when they come to us and they're symptom free, they want to give back.

Dr. Oh (10:54):

Yeah.

Michael Whiting (10:55):

And, and that's where we can assist them with shepherding them through the entire process of a convalescent plasma, especially when they've never donated before. So there's some, some hesitancy for them to come in and have a needle stuck in their arm and then have them spend an hour and 15 minutes. The result though, if their antibody levels are high enough, then we can share with them that that donation is assisting struggling patients in the hospital that has COVID-19. And specifically, those are assisting the hospitals here in greater Cincinnati. And then once they move off, the, the relationship has already been, been built. So we can now talk to them about the next platform for them. So the next platform, if they meet the criteria could be platelets, which is critically important, red cells, or whole blood. So dependent on their schedule, what they can give to us, they're jumping on the opportunity and they continue to want to help our community.

Speaker 4 (12:11):

Yeah. I think it's really fabulous. You know we've really met a lot of people with the convalescent plasma journey that we've been on and sometimes it's an abrupt one. So now when we have a new possible convalescent plasma donor, and we were able to collect that firstconvalescent plasma donation from them, about half of them are not able to continue to donate convalescent plasma for one reason or another. The antibody level requirements are actually pretty high. So people who actually were sick, but may and may not just have that, that antibody level that we want in the convalescent plasma at this point. So, you know, we want to be able to offer them another opportunity to give back and many times for them, it's an introduction to blood donation and, and hopefully we'll form some long lasting relationships because of that.

Michael Whiting (12:58):

Yeah, that's great. Critically important. It's the long-term relationship. How many people are in greater Cincinnati? Is it 3.4 million?

Alecia Lipton (13:07):

A lot. At any given time, when you look across the United States, about 37% of the population is eligible to donate blood at any given time. And that changes based on deferrals, medications, travel. Right now of that 37%, only about 6% actually donate. So that's why we're constantly putting out messages of, we need new donors. We have people that may have donated with us, you know, for 20 or 30 years, but now maybe they have a medication they're taking and they can't donate anymore. Until blood can be manufactured in a laboratory, we need to rely on the kindness and generosity of the community. So it's not that we're putting out a message saying come in because it's a nice thing to do. We're saying, come in, it's a nice thing to do, you're going to save a life and we truly need you to heed that call and come in. Sometimes people will say, Oh, you call me all the time. And when my friends tell me that, I'm like, well, if you donate blood, then we won't call you all the time because you will already have an appointment. The one thing I think is great with your team, Michael, is I'll talk to a lot of people and there'll be like, Oh yeah, I talked to Latrice or I talked to Karen. And so they have that relationship with them. And it is that one-to-one communication.

Michael Whiting (14:34):

Having that relationship with us creates that bond. So of the 6%, we really want to build that up, as always, welcome new donors....it is making sure that they, that we meet them. They are, if they can come in today, great. If they want to come to a drive, a mobile drive, that is also equally great. If they can't come in this week and they come in in three weeks and then we can answer all the questions that they have as they have changed any medications. In many of us, especially with platelet donors, we have that relationship. Some platelet donors donate 12 to over 20 times a year and we schedule them out and they can donate every two weeks. And so those, those are precious times that when we schedule them, they want a, a specific day, a specific, a specific time. And every December,uwe get a call from them and we schedule them out for six months or a year.

Michael Whiting (15:47):

And they come in, they come in every single time and they have a relationship with our phlebotomists, with our donor services staff. So it is the strength of our community is the strength of our relationship, how we can build that is having that one-to-one relationship. And they know our names. And we know there's, it's fun from a contact standpoint, we don't want to have lengthy conversations. So, you know, at P & G, it was around 300 to 500 seconds that we needed to have people in and out, in and out. Well, we were a little bit more forgiving because with the building of the relationship when we have a verbal conversation, so we're, we go past the 500 seconds. Especially when we have a dedicated donor that they have questions that need to be asked. And that's one of the pieces. If, if we have a question with that, we can't answer that we're able to text Alecia or Dr. Oh, and we can get an answer pretty quickly. Sometimes even during that conversation to get that answer to them, and then we can schedule them.

Alecia Lipton (17:02):

I think some of the most fascinating calls that you get to make is when you work with our reference lab, and you're trying to find that specific donor that might be a match for somebody. Can you tell us a little bit about that?

Michael Whiting (17:15):

Yes. Karen Williams is my colleague and she is unbelievably great. She actually is the boss. I just take her leads. She is in the lead with our white cell and HLA complex blood types, where we have a patient that need a match. It's usually a platelet match for that individual to reboundin the hospital. So we do find those matches via our technology and systems. So we can identify an individual that has been a historic platelet donor, and we call that individual and they usually have to come in within 24 hours. If you want to get verklempt, or your eyes welled up with tears? It is that, that call, you call whoever that person is. So I'm just going to say my name, if you call it Michael Whiting, and you indicate that that individual, we have an individual that is in need of a white cell donation.

Michael Whiting (18:23):

They will stop whatever they're doing and they will drive. And they will come in for a white cell donation. I've done two of them, two or three of them. And it's two arms and it will take two and a half hours for that white cell to be donated, but it goes directly to that patient and it assists them to rebound. So, at times we call up more than one person. So we have to get a white cell donation every single day for two weeks or every single day for a week. And consistently our community responds by yes, whatever you need, whatever the date, I'm coming in.

Alecia Lipton (19:10):

Very fortunate that we live in a very altruistic community and that people do respond. Dr. Oh, could you expand and let us know what some of the cases might be that would need those specialized donors?

Speaker 4 (19:23):

Yeah, I think the most common where we really need Michael's team to give that one-on-one follow up is for platelets. And sometimes there are patients who just don't respond to the typical platelets we give them off the shelf. We can try to do what we call a platelet cross-match and then that doesn't require calling in special donors. But oftentimes what happens is that the recipient will have antibodies that pretty much clear the platelets that we transfuse immediately. So we need to recruit specific donors who are lacking those antigens and the antibodies won't clear them. And so then they can function for longer. And so we have a, we can run a search and try to identify our current platelet donorswho may qualify for this. And then we ask Karen, here's a list of donors. Can you please call them and see if they're willing to come in? There's a patient who is just not responding to other products who really would benefit from a platelet donation. And it's just shocking how often people will be like, yeah, I can come in tomorrow or I can come in later today. And I think that it's a, it's a microcosm of kind of what we do at a larger scale all the time, but it really is one specific patient who is in need of a specific product.

Michael Whiting (20:40):

We have some people that won't give a platelet donation on a regular basis because they want to first ask us, well, do you need me for a white cell?

Dr. Oh (20:52):

Oh, wow. That's great.

Michael Whiting (20:53):

So they, they will, they, they know all about it and they're willing to change their day and come in.

Alecia Lipton (21:02):

That's great. Dr. Oh, how often can somebody donate white cells?

Dr. Oh (21:08):

Don't have the specific number on there? I think we have probably a eight week deferral and I guess so same as whole blood because there is some red cell loss during that process. We don't have a ton of the white cell or granulocyte donations, but oftentimes they are a pediatric population. It seems like the, to give agranulocyte transfusion to a smaller person usually has a better effect than to give it to a larger person. And those patients are critically ill. So there are some adverse reactions that can happen with granulocyte transfusions, but that patient typically is at a point where oftentimes the physicians feel like they won't survive without the specific product. And oftentimes, you know, we don't, we don't try to tell all of our, our donors that, "Oh my gosh, automatically, everybody's going to survive." But at, at that point, the physicians are usually looking for, for something to help. Oftentimes ransplant patients ill be, you know, who are, who have a severe,uimmunologic defects will benefit from these, from these transfusions

Alecia Lipton (22:17):

Currently at Hoxworth, We need to collect at least 400 units of blood a day and 50 units of platelets each day. When you look at your day or your week ahead, Mike, what is it that you and your team do to get us to those levels,

Michael Whiting (22:33):

As you think of where we are today with the pandemic, we thought it was a year ago in March that our, our world changed. Especially changed with our mobile drives, where we had to suspend them. So it led to, and we have two locations generally that we collect blood. One is mobile. So those buses that you see driving around and also different locations outside of our core, which is the 275 loop, our Neighborhood Donor Centers are, we call NDCs. Those are two locations that changed. So we, we were dependent on changing our design to increase our hours at our neighborhood donor sites, the fixed sites, and also decrease our mobile. So because of that in the last year, we, we look for the community to respond, to coming into our neighborhood donors sites, more than ever. And they did currently, as you talk about today, 2021 mobiles are coming back, but still they're not at the level of where they should be because of social spacing. So it's really dependent on the combination of mobiles and NDCs. Every single day, every single morning, it is a necessity for us to fill up the neighborhood donor sites because we need 350 red cells...

Alecia Lipton (24:18):

350 to 400.

Michael Whiting (24:20):

...And 45 now, platelets per day per day. So it's all about scale. It's not two people. We need to have a lot of people coming in. And that's sometimes why we celebrate and give away a t-shirt. Not to prompt people to come in, but do at least give them some fun item as they spend time with us. And they get to walk around with a St Patrick's Day green shirt which allows us to, you know, get free advertising and also for them to spread the word, because as we said, 6% of our population give, we need more. So if we can somehow do that combination of building up our base also have people come in at the neighbor donor sites and deliver that daily need. Then if we deliver that daily need, right, then we then support our hospitals and patients in need. That happens every day. So every day we don't have 300 people or 400 people coming in, and that creates an angst at 7:00 AM in the morning when I'm looking at the data, which I then share that angst with our group at 8:30 AM. And then we build a plan for that day, for that week, for that month. I mean, sometimes we just need to be fluid and change the plans that are in place or trust that those plans are set to deliver those 400 people a day.

Alecia Lipton (26:01):

And there's 400 people a day. That's just what we know we need to meet the everyday needs of our hospitals. That doesn't take into consideration, you know, a major trauma or a crisis that might occur, right? So that, that can change. And you and your team are kind of always on standby for when you get that.

Michael Whiting (26:22):

I want to note that we are part of a, of a larger network throughout the United States. So as you had issues over in Texas...our Number one priority is here. However, if we have a location that is struggling like Texas with the weather, then if we can, we'll assist. And we have very close partners in Ohio, such as in Dayton. But we do reach out to our other networks throughout the United States and assist. So it's very, very strong. It is a portion that I love to be part of is a meaningful, not just minimize Proctor and Gamble, which I love, but it's saving a life. It's immediate. So, you know, when you give, it will go to a patient locally, and if we deliver upon what we need locally, we can assist other communities in the United States.

Alecia Lipton (27:33):

I think that's a great wrap up of what our donor recruitment does when we're calling, when we're emailing, when we're texting. So, Michael, thank you for being part of our team at Hoxworth. And thank you for helping us save more and more lives. You have been listening to In the Know with Dr. Oh brought to you by Hoxworth Blood Center.

Alecia Lipton (00:41):

You are listening to in the know with Dr. Oh presented by Hoxworth Blood Center, University of Cincinnati. Before we get started with today's episode, I just want to mention, we want to hear from you, our listeners. What would you like Dr. Oh to discuss during these episodes? You can always send us an email or you can follow Dr. Oh on Twitter and that's brand new out there. Dr. Oh, I know that you've been tweeting up a storm lately.

Dr. Oh (01:08):

I need to tweet more actually, but yeah, it's In the Know with Dr. Oh I think, on the Twitter handle, it's actually @InTheKnowDrOh, where we're limited on characters. But yeah, it's been fun. And hopefully you'll add me to your follow list and, uh, get amused every once in a while!

Alecia Lipton (01:25):

As we all know, Hoxworth is the steward of the local blood supply. We're the only supplier to our hospitals, and that's over 31 hospitals right now in the tri-state, but we're also a renowned institution for our research and our other medical services. So today we wanted to bring in somebody who knows firsthand exactly what we do and is behind that work. And it's Dr. Carolyn Lutzko. So Dr. Lutzko, welcome to the program.

Dr. Carolyn Lutzko (01:51):

Thank you. I'm glad to be here.

Alecia Lipton (01:53):

And I was looking at some information and you joined us in 2010, which seems like it was not that long ago. I guess you kind of put me in proper timing today. It's a good while.

Dr. Carolyn Lutzko (02:07):

I still feel like I'm new kid on the block in a lot of ways, so, but yes, it's been over 10 years.

Alecia Lipton (02:12):

And, um, we have a very special relationship with you because not only are you Hoxworth, but you're also Cincinnati Children's Medical Center Hospital. And can you tell us a little bit about how that duality works there?

Dr. Carolyn Lutzko (02:25):

As you may know, a focus of our work is bringing cell therapies to patients. And I always like to think that you can provide medications to people or other things, but honestly, if their cells know what they need to do, we just either have to get them the right cells to get to the right place, or in some cases fix the cells. There's two aspects to that. One is, at Hoxworth, we do a lot of work where we provide cells, whether it's blood cells or STEM cells or other cells to our patients. Whereas at Children's, we do a slightly different angle on that, where the labs will sometimes transfer a gene that may be defective or that can help augment the cells and then give it back to the patients. And so there were, the focus is really on cell therapies, um, with slightly different angles for it. So they really complement, we teach each other, we help each other from both institutions, just a slightly different angle on the types of therapies we do.

Alecia Lipton (03:24):

And there are people who literally all over the world come to Cincinnati Children's Hospital for treatment in cancer for their children. So, um, yes, we're treating the tri-state patients, but people come from everywhere.

Dr. Carolyn Lutzko (03:38):

Absolutely.

Dr. Oh (03:39):

Dr. Lutzko, I had the pleasure to meet you about four years ago when I was, uh, interviewing for this position. And, it was just fabulous to get to know you and find out a little bit about the work that you're doing. So in your current role, you are director of translational development and cell manipulations laboratory, uh, at Children's Hospital. Is that correct?

Dr. Carolyn Lutzko (03:59):

That's correct.

Dr. Oh (04:00):

But you also hold a title at Hoxworth Blood Center. And what is that?

Alecia Lipton (04:03):

I do, I'm the director for regenerative medicine and cellular therapies.

Dr. Oh (04:07):

Wow. That's a lot of, uh, expertise that you have. Could you tell us a little bit about your journey and kind of where you went to school and some of the programs that you attended?

Dr. Carolyn Lutzko (04:17):

I am Canadian. And, um, I did my undergraduate degree in genetics and biology in Canada at the University of Guelph. Then I worked for a couple of years in the lab and realized that I really wanted to know more, that there was so much more we could do to develop new genetic therapies. Um, and so I did my PhD at the University of Toronto, also in Canada, and that was another four or five years to get there. And then, you know, I really, we made some really good progress at the beginning of that field of transferring genes into cells so that we could fix a patient's own cells to give back to them rather than transplanting someone else's, just because there's so many drugs and complications with that, but some of the world's experts were in the United States. And so I went and did some training for four years with Dr. Cohn in Los Angeles, at Children's Hospital Los Angeles, and stayed there for a number of years and became an assistant professor at the University of Southern California and started up my lab there studying those. But there were a couple of things going on at the same time. Number one, I really wanted to be in a place where you not only researched, but actually were able to get those therapies into patients. And we had the goal of that in LA, but really it, it ended up being just really more focused on starting new therapies, testing them in mice or, you know, test tubes. But in Cincinnati, the teams at both institutions were taking those and giving them to patients. And that's what I wanted to do. So I was really, really lucky to be brought to Cincinnati, to join this team from both sides, the Hoxworth team and the Cincinnati Children's team.

Dr. Oh (06:08):

Wow. So the translational work is what you were really looking for and you found that environment here in Cincinnati. Can you say a little bit about how that's different than many other areas?

Dr. Carolyn Lutzko (06:20):

One of the really special things about Cincinnati is that there are not what we call silos or fences between the physicians, the researchers, the translational, the, you know, the support and laboratory people that it's, if you have an idea or expertise, you just reach out and people are approachable. We all have the same goal. There's not territory about not wanting to step on people's toes. It's just a really collaborative environment where you can it's, let's get our ideas out, let's share, let's learn, and do better. And other places try to do that, but it just seems harder, but so that was what I was looking for and what I really see. So physicians, researchers, students, laboratory professionals, doctors, it's just, it's an easier transition and better working teams I find here.

Dr. Oh (07:13):

That's fabulous. Yeah. I found that too. Uh, I was pleasantly surprised I guess, or maybe that's the wrong word, but I was very happy to find that working at Hoxworth, for me. And so then I have another hat that I wear with UC Health and working in the transfusion service. So I still have that patient contact, in addition to my work at Hoxworth, where we touch all the different hospital systems so that we can provide them with the products that that people need. And, but I can provide a little additional help at one other, a hospital system as well. And the collaboration is just there and it's, it's very welcome for people to work with other groups.

Alecia Lipton (07:51):

I would think that collaboration comes a lot from the fact that we are part of the Academic Health Center and most blood centers, I think we're the only blood center right now in the United States, that's part of that educational academic health center. So that helps us with that research, that helps us get, you know, the grants that we need to get monies in to cover the research and then the development at the hospitals so that you can get it into those patients.

Dr. Carolyn Lutzko (08:19):

It's interesting that there's definitely money from companies and especially the federal government, the National Institutes of Health for like starting what we, you know, the really early stages of hypothesis and just new ideas and testing them out...as I said, sort of the test tube area. There are resources to pay for clinical trials, usually, by either from drugs or again, different, but that area across either the expertise and the funding for that is really hard to find. The research group at Hoxworth is really so well-known to have their foot in both worlds, that they can get those therapies and transition them and really translate them across from the research idea to actually getting it into people. It's just, it's really hard. It's expensive, it's a slightly different area of expertise. And it's definitely an area that I'm really proud of for Hoxworth, but it is that collaboration with the academic health center and the surrounding hospitals, including Children's, that lets us do that.

Dr. Oh (09:21):

I was looking at your CV and, uh, of the 27 pages. So it was, it was a it's so impressive. I think that you really bring the hard science, right? The basic science, uh, into that equation. And without, without you, we wouldn't have those therapies to be able to use in patients as we go ahead with clinical trials and those types of things. So from your CV, we could talk about a dozen different things, I think that you could, uh, you could provide more information on. I think one of the things that you've done a lot of work with is pluripotent STEM cells and lineages and, and those types of things. But I think with our limited time, one of the really interesting areas is CAR T development. And you were one of the world's experts on that. And for so long, the goal for many of us has been a cure for cancer. And, you know, we talk about that phrase, cure for cancer. CAR T is actually a cure for cancer that we're seeing and it's a recent development. And so maybe you could talk a little bit about CAR T from the very beginning, from your viewpoint as being someone who's actually seen all these developments happen in a very short period of time to where we are today and what you're doing with it.

Dr. Carolyn Lutzko (10:35):

So CAR T, so that's big, huge word is Chimeric antigen receptor T cells. And we just call them CAR T for short, because it's way too long otherwise. But what it is, it's a lot of words, but really it's taking immune cells from a patient and transferring in a targeting receptor that will find something. And so in this case, usually it's used for cancer. And so you take a patient cells, their immune system doesn't normally recognize their own tumors, unfortunately. Um, and that's how they end up with cancer. But if we take their own cells and transfer in a gene that can target those cells, there can be amazing responses. Um, it's not across the board and it's not ready for every cancer type yet, but there are some miraculous changes. So it's nice in that it's not really drugs. There typically are not long-term side effects. There could be short-term ones, but really they can work very effectively. So it's just a new way of looking at it. Essentially what we would do is patient would go into Hoxworth. So if, if they're part of a clinical trial, which is where many of these still are, they're not sort of a prescription you would up at your pharmacy right now, you know, your doctor would recommend and enroll you for a clinical trial and you would go to Hoxworth. We have a lot of patients at Hoxworth, and Hoxworth will take their blood or blood, apheresis products. Then it would go to the cellular therapeutic group that I'm part of. And we may fix it up a little bit or freeze the cells down, and then it would then go to another lab where they would transfer in the targeting receptor for the cancer cell, the lab at Children's is one of those labs around the countries that will actually do that transfer.

So we'll, we'll take the cells and transfer the anti-cancer gene or that the targeting gene in right now, it goes back into the freezer so we can test it. And then we make sure it's safe. We want to make sure that there are not any sort of known inhibitors or other things in it. And once it meets safety criteria, that will be transferred back to the patient's bedside and will be infused. And that process is usually about a month, but Hoxworth plays roles along that way. But again, it's one of those examples of you've got Hoxworth as our blood provider for the community. You've got your physician's offices, you know, some of the hospitals and others that are involved. And so the process is not challenging other than it's just a lot of moving parts. Um, and patients are very sick when they get these therapies. So that makes it a little harder. It can work wonderfully. There are a few of these that can sort of be ordered almost like a prescription. And that's for a couple of types of leukemia and the, you know, your oncologists or physicians can order those, but most of them are still in these clinical trials, really making sure that they're safe, but there's new approvals on that pretty much coming every day.

Dr. Oh (13:40):

It's just from a 20,000 foot view, it's taking the person's own cells at this point, maybe in the future, it'll be somebody else's cells, but at this point, their own cells. We collect them using special devices and techniques. They get manipulated and kind of a targeting, I guess you could say, of some of those cells that will hit those cancer cells that have these specific markers on them, and then use the power of the immune system that we all have that has evolved over all of our lifetimes and use that massive power to hopefully eliminate the cancers if we target them appropriately, if those cells do what we hope that they can do. So it's really a fascinating evolution. I think, of science, uh, over time to create really a very strong weapon in the war against cancer.

Alecia Lipton (14:29):

Are terespecific cancers that we see, that are responding better to the CAR T therapy than others?

Dr. Carolyn Lutzko (14:36):

Yeah. So at this point, the best successes are with, um, what we call liquid tumors. They're usually tumors of the blood system or of, uh, one of the cell types in the blood. They have the best results, but there are some, you know, new things coming for, we call solid tumors. So a little bit more organ specific. And I think it's a little bit of a challenge of logistics that the blood is just a little more accessible and available than some of the tumor sites that are, you know, more embedded in an organ, but there are improvements, but that definitely has been lagging behind.

Alecia Lipton (15:12):

Also as a nonmedical person, I'm assuming that this is a much better option for a patient, especially if they're immunocompromised, they're getting their own product back as opposed to a chemotherapy or radiation that can cause more sickness.

Dr. Carolyn Lutzko (15:27):

Yeah, it's a very targeted therapy, which is nice. With a chemotherapy, often they'll kill sort of all many cell types. And so it could be all dividing cells. So, so you can have, that's why there's so many side effects with a lot of chemotherapies. They can, you know, they are definitely important in the treatment of cancer. If there is one of these therapies available for a patient's type of cancer, it's just much more specific. It targets exactly the cells that the cancer cells and really has fewer side effects in general. You need to see your physician and go through that because there can be some, um, but as a general trend, there are definitely fewer side effects in other tissues, but there can be some. And so unfortunately, there are no treatments without any risk at this point for something like most cancers.

Dr. Oh (16:20):

Yeah. I think your point about this effectiveness in liquid tumors, as you said, is very interesting. I've been fortunate to be able to sit on the local board for the Leukemia & Lymphoma Society. And a lot of their activities now are oriented towards finding therapies. And these types of therapies are things that they're trying to highlight right now. So we try to partner with other organizations as well in the area, uh, and coordinate with them. Many of the people that have these tumors need blood products outside of these special therapies.

Alecia Lipton (16:52):

When we started the program today, Dr. Oh kicked it off with talking about, you know, a cure for cancer. That's something that we're always looking for. It's been in the news lately when we were able to develop the COVID-19 vaccine. And they're like, you know, if we can do this, we can find a cure for cancer. What are your thoughts if you had your crystal ball, when do you think we'll see a cure for cancer?

Dr. Carolyn Lutzko (17:16):

Hmm. I don't know. I think the challenges that cancer's so many different diseases. And so it's almost like saying, when will we get a cure for all viral disease? You know, where there's COVID and there's flu and there's, you know, all kinds of different, the common cold, there's all kinds of different viruses. And I think that that's the challenge with cancer. There are excellent outcomes and results and patients surviving for some types or more than they have the past. So that's, that's hard. Um, and I think that, you know, I don't think that CAR T is going to be perfect for every cancer. And one of the reasons is we choose something to target on the cancer cell. And we really hope that it's unique to that cancer cell and is something that's not on your healthy tissues and that's really important, but not all cancers have that.

Dr. Carolyn Lutzko (18:12):

You know, the cancers can evade the immune system because sometimes they're so similar to your healthy tissues, that it makes that challenge. Otherwise you'll really injure your healthy tissue. So I think that there's going to be an arsenal. There will be continued to be medications. There will continue to be regular transplants STEM cell transplants or other things. There will continue to be developments in these immunotherapies and medications. There's other things called immunotherapies that maybe we should spend a minute on. What we're really talking about are cell immunotherapies, where we're taking this cell to harness the immune system. But there are definitely medications that provided immune therapy by lots of different ways, trying to activate a patient's immune system right in their own body or unmasking some of the tumor specific antigens, they're called, but just sort of unique things about tumor that are masked, our immune system doesn't see it.

Dr. Carolyn Lutzko (19:10):

So I think that there will continue to be some of those improvements as well. So it's going to end up still being an arsenal. I think of strategies, but there will be continued improvements as we've seen over the last 10, 20 years in children, I know a little better, but there are definitely some leukemias where there's 80% cure rates, which was not what we were saying when, when I started in this field and probably you as well, Dr. Oh. So there's improvements being made and there will continue to be, but unfortunately it's not tomorrow or the next five to 10 years that we will really have that cure that we're, but we will make absolute improvements during that time.

Alecia Lipton (19:48):

Well, and I think when we talk about a cure for cancer, we kind of look at it being all encompassing, but you brought up something that I think is important for people to realize is cancers are very unique. There are lots of different forms of cancers and also individuals are unique. So individuals need to be treated differently because what works for patient A might not work for patient B and C.

Dr. Carolyn Lutzko (20:11):

One of the things with, maybe we can talk a little bit about the downsides of a CAR T therapy. Um, I think from a biological standpoint, I think they can work really well, but they're very expensive right now. And that just makes it cost-prohibitive for patients or really the cost structure of how you fund them. So that is definitely a downside to it. And that's the personalized side of it. Over time, most medications reduce or strategies reduce with time as we learn more and we get more efficient at it. And so that will, you know, one of the things Hoxworth is working on is trying to have it more generic, where we can have something off the shelf. So rather than every person, making immune therapy for every person, we may make one that can work for many types of people and the doctor could order it. There's lots of places, not just us that are working on it, but we are definitely working on that for a few different strategies, and I think that will make a difference.

Alecia Lipton (21:14):

You have been listening to In the Know with Dr. Oh, brought to you by Hoxworth Blood Center.

Alecia Lipton (00:10):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. I'm Alecia Lipton, and here in the studio is of course, Dr. Oh because he's in the know. And then our special guest today is Judith Gonzalez. Dr. Oh would you like to introduce Judith to our listeners?

Dr. Oh (00:27):

Sure. Well, we'll, maybe we'll let Judith introduce yourself a little bit. Judith is our director of Laboratories at Hoxworth Blood Center. And so I think this will be a really interesting conversation. There's a lot that goes into getting that blood from a donor that we collect to a patient. And so Judith plays a major role in making sure that that happens safely and efficiently. So, Judith, can you tell us a little bit about yourself?

Judith Gonzalez (00:54):

Thank you, Alecia and Dr. Oh for having me here today. My name as Dr. Oh mentioned is Judith Gonzalez. I am a native of Texas. I've lived in California for 11 years and I'm now an Ohioan and proud to be one, so thank you for having me. My role in the organization is the Division Director of laboratories. It is a crucial role as there are five departments in that area. I bring with me about 25 years of experience, the majority of that being in a lab director role. I did have in my career, I was able to work in the hospital industry. So I was a hospital blood banker chemistry person. I did all areas of the hospital laboratories. Then from there, I did end up at the San Diego and I was in their donor center. I specialized and I was in their immunohematology reference laboratory. And then I promoted into the quality control laboratory manager role and then the, the director in that area. So I bring a lot of experience and a lot of passion for the industry and what we do to service our community.

Dr. Oh (02:00):

When somebody donates blood they're collected by our collections or donor services department that blood then gets transported to the main laboratory that we have. And can you talk a little bit about the different departments that are in your laboratory?

Judith Gonzalez (02:15):

So, as many people know, we are a blood donor center and we service a large area in this tri-state area. Very many customers. What people don't know is that the blood that you donate or platelets that you donate, it doesn't stop there. It comes up to the laboratories for a lot of extra work that gets done before it gets shipped to any hospital. Some of the laboratories under my purview include the immunohematology reference laboratory component manufacturing laboratory, the quality control laboratory, product management and distribution, and then the biomedical engineering department. And each department, although under the purview of laboratories, specializes in entirely different activities. So they all have their own own sets of policies and procedures that they do to ensure that we have a safe, pure, and potent blood product.

Dr. Oh (03:05):

So a lot of what we do, we use acronyms and one of them is GMP.I know this has been a major passion for you as well as focus for our laboratories. Can you talk a little bit about what GMP means and and what that means to you?

Judith Gonzalez (03:20):

GMP is good manufacturing practices. It's a set of policies and regulations by which laboratories who want to excel in what we do as an industry follow. It's kind of like the perfect set of instructions on how to be the most excellent laboratory you can be. It talks about safety, it talks about following gmp, following processes that in ensure that you're performing an activity continuously in one manner and consistently so you do not deviate from the processes that are set. And it ensures that your final product is always consistent. So it is a main area of focus. It, it definitely is something that's of high priority to the, to our department. We conduct regular GMP training from an organizational perspective on an annual basis, but the laboratory goes above and beyond and does quarterly presentations that have to do with air corrections following SOPs. And this ensures that we keep our staff competent in this area. And then on a daily basis, GMP is discussed with the staff. We always find the opportunity to ask them questions throughout the day and to make sure that they are following those guidelines and regulations.

Dr. Oh (04:33):

Yeah, a lot of people don't realize blood is actually considered to be a drug, right? A medication. And so when we put a label on a unit of blood, that is a label just like you would expect on your bottle of prescription medications that you get from your doctor. And so pharmaceutical industry is very used to GMP in operating to make sure that all those products are, you know, up to what is on the label. And we have that same obligation for us. Each product is kind of a lot of one, right? So it's it's not like we make a big lot of thousands of, of pills, but the blood unit has its own individual number on it, you know, for each individual collection. So there's a lot that kind of goes in. Blood is not only a a drug, it's a biologic. So we fall onto a lot of different regulations and it's so important for us to keep principles like GMP in mind as we create our, our products. So Judith, can you talk a little bit about each of the different departments that we just mentioned, and maybe we can follow the flow of blood from, from a collection into into how we receive it into the laboratory. And, and you can talk about how your different departments interact.

Judith Gonzalez (05:40):

So the donor services department collects the blood, it gets delivered to the laboratory in coolers that are validated and temperature controlled. So once those coolers come into component manufacturing lab, that department is made up of, of 18 different staff members. Those staff members unpack all the blood that's collected either there in the central location or in our outlying neighborhood donor centers. They ensure that everything was packed accordingly, according to the way validation approved to be. They unpack all those products, they distribute it to the different departments. Some the apheresis platelets go to quality control laboratory for further manufacturing and testing. The component manufacturing lab has apheresis plasma that they aliquot into multiple components from that one donation. So they're able to service multiple patients from one donation.

Dr. Oh (06:36):

So when a unit of whole blood comes in and, and we have different products that we're collecting, right? And so it, it's interesting the output is, is really red cells, plasma platelets and, and cryo, which we'll, we'll talk about in another podcast in the future, but it seems simple with just four products essentially that go out. But there are many different flavors of those products. And then when they come in, we actually are able to collect from whole blood, right? Red cell and a plasma typically. So that all happens in your area with people who are specifically trained on every step of the process. So that we don't have any deviations that go through that process. So I just wanted to clarify that as we come through, one donation will yield two or three products.

Judith Gonzalez (07:14):

And that is just what I just mentioned. That was just apheresis plasma. When we have a whole blood, like you mentioned, that goes through a whole different process. So whole blood gets put into a centrifuge, it gets spun down, and the red cells that are in that whole blood get packed to the bottom of the bag. Then you have a layer of buffy coat in between the red cells and your plasma. There's a lot of equipment used in the department. So large floor centrifuges are used. Those products get removed from the centrifuges, get put on expressors that squeezes that blood bag. All the plasma comes off the top, gets put into another bag. That's one component by itself, just the plasma from that whole blood donation. The Buffy coat also be made into a different product. At this time we don't do that. And then the red cells stay packed in that bag itself. So right there you have two different products. If you chose to make cryoprecipitate, which is a whole different product line that comes from a whole blood donation. So you can technically have three different components from one whole blood donation of plasma cryoprecipitate and a packed red cell. Those then get further manufactured. The liquid plasma gets put into a blast freezer and is frozen. The cryoprecipitate goes through a whole other manufacturing process. The red cells get attached to a leukocyte reduction filter, and that filters out all the, the majority of the white blood cells in that unit. So then you have your red cell that's filtered which is a non leukocyte, reduced, packed red cell, your frozen plasma, and potentially a cryoprecipitate frozen product should you manufacture that line.

Dr. Oh (08:57):

Yeah. So it's, there's a lot that kind of goes in after the collection process happens.

Judith Gonzalez (09:02):

Absolutely. And all of this happens within the same day of collections. We rarely, if ever, although allowed to continue manufacturing those components the next day with the number of staff that we have, the amount of equipment and the expertise that we have in the department, they are able to manufacture all of the day's donations from all seven donor centers in one day.

Dr. Oh (09:24):

So use the term apheresis previously. So for us, that means separated on a machine. And so we do specific collections for that, for plasma and for platelets. And it used to be we would drive platelets from the whole blood going through that Buffy coat layer. But currently almost all the, the platelets in the United States there are a few exceptions, but most of them are collected through apheresis. And so we have donors who donate those very special products. I know Michael Whiting, who is on a previous episode, is calling that liquid gold right now.

Judith Gonzalez (09:58):

Yes. <laugh>.

Dr. Oh (09:59):

And and so those don't get processed as much. And they, the apheresis products don't have as much manipulation in the laboratories, but we do collect them and then enter 'em into our computer systems and process them as they go through. And then a lot of what you've talked about are the whole blood, right?

Judith Gonzalez (10:14):

And That's correct. The one yellow product I say with air quotes that is gold, is our platelet products. That is an apheresis collection that's collected on a, on a machine that separates out only the platelets from the donation and everything gets given back. The red cells get given back to the donor. Those platelets come into the component manufacturing lab as well and then directly get segregated and they get sent to the quality control laboratory.

Dr. Oh (10:40):

So let's talk a little bit we talked a little bit about components. Let's talk about the quality control laboratory now.

Judith Gonzalez (10:45):

Absolutely.

Dr. Oh (10:45):

So really a lot of that work is related to the platelets that come through, right?

Judith Gonzalez (10:50):

The majority is the platelet manufacturing, but they also are required to do testing on other product lines as well. So regulations require a minimum amount of testing from a quality control perspective for different testing parameters to ensure that the products meet the regulations for transf fusible clinical components. The quality control laboratory does all the further manufacturing on platelets. The platelets come in, it's a large volume component. And those platelets can either be made into a single product, a double product, or a triple meaning. You could potentially have three different clinical components for transfusion to three different patients if needed. This department has a huge role, they're rarely ever seen, but the, a level of testing that's required for these products is extensive. And this department is made up of six different, actually they have 10 different staff members that perform these activities. They perform testing on platelets and there's several different testing parameters required. They perform testing on red blood cells and they ensure that every single donor whose donates has a sample sent for infectious disease marker testing, which, which is a whole other requirement from a minimum screening for protective measures for infectious diseases.

Dr. Oh (12:05):

Wow. So that's a lot of testing. So what are the qualifications typically of somebody who's working in our QC laboratory?

Judith Gonzalez (12:11):

So the staff in the QC laboratory, this laboratory is con, it's considered clia laboratory clia, meaning Clinical Laboratory Improvement amendments of 1988. So in 19 8, 19 88, a committee came together and set a whole new set of regulations that govern departments that do high complexity and moderate complexity testing. Because of that, the staff members in that department are not just your college grads who are trained on the job. They're college grads that have national certification called Clinical Laboratory Scientists. So CLSs, so the employees in this department have that degree, the bachelor's of Science degree, they have certification nationally, and some even have state licenses in those states that are required to have licensure. Ohio is not one of those states. So they are highly educated, trained. So when they come to us, they have already learned all the clinical aspects of the science that they learn through their Bachelor's of science degree. It's a specialty.

Dr. Oh (13:10):

Wow. That's great. Are there a lot of men or women who primarily are the CLSs that we are able to find?

Judith Gonzalez (13:18):

So that is a very interesting question. When you look at the spread of gender across the laboratories, high number of laboratorians are female, there are men. But when you look at the clinical laboratory scientists, the majority, again are females. So in the quality control laboratory, all 10 of those employees are females. Wow. so yeah, highly trained women. Another department that we will get into as well is the I R L, the IMMUNOHEMATOLOGY Reference Laboratory. They too are a clear regulated laboratory and they're made up of six staff members. Only one of them is a male. So it's really interesting to see the number of female that go into this field in this industry and support what we do from a clinical perspective.

Dr. Oh (14:02):

So let's take a step back from the departments and talk a little bit about, about that, cause I, I find it fascinating. You know I've got two daughters and we've always talked about women in stem. Whenever I go into a blood center, not just ours, but you know, other blood centers out there, there are always a lot of women who are interested and have, you know, key, key positions like, like yourself in the laboratories. And I guess I I just wanted to ask you about your thoughts on that in terms of women in science.

Judith Gonzalez (14:30):

So I've always been raised that education is power in life. There's so many things that can be taken away from you on any given day, but education and learning can never be taken away from you cause that is in your mind. And that's something that you've learned and it's yours. So I promote education amongst all children, all young adults, regardless of gender cause they're all important. But when we talk about women, you see a lot, you see more men in management type roles and you see women in these lower level roles. And when I say lower level, I say respect because they are critical roles needed in what we do. Science, technology, engineering, and math. Those are very critical areas and we have many women that play these roles. And, and so a role that I see myself in, in the community is always promoting that. So anytime I come up upon a young child or a a a a, a child that's in grade school or even entering college, I always ask them, what do you wanna do with your life? Like, what do you wanna be when you grow up? And I let them answer. And then I always say, did you know that you could do this in science? Did you know you could do this in science? I recently ran into a young girl, she probably was eight years old at, while doing my taxes this year, <laugh>. And I talked to her about the whole area of science and technology and being an engineer, being a clinical lab scientist, she was so excited. She asked if she could come to our labs to visit <laugh>. And absolutely that's not something we highly promote cause these are secure areas. But, you know, engaging those young adults to know what their options are in the science field is critical. Cause a lot of the times, you don't know, when I went to college, I did not know about medical laboratory sciences or being a clinical laboratory scientist. I learned that by going to my college, the college career center. And there was many pamphlets and I was like, what do I wanna do with my science degree? And one of them was medical technology, which is the older term for medical laboratory scientists sciences. And that's how I learned about it. And then I started asking my professors especially in the lab areas, what is this job? What, what does it mean? And it was quickly identified that this is the area I wanted to go into. cause although I have a passion for science and math, I excel in labs. So doing the work and investigating and doing clinical studies was very important to me. So yeah.

Dr. Oh (16:49):

Well, I think it's just great for our organization. At Hoxworth, we're part of University of Cincinnati we're actually kind of going through a next lives here education program and, and orientation. It talks about diversity in the workplace and for us to have you as our division director and laboratories, I think is a, is a great thing for us. And then of your managers most of them are, are females I believe as well. So we are trying to make sure that women are well represented, but it's, it's not just based on, oh, we need to promote a woman. It's based on on quality and, and, and or deserving those positions and, and functioning very well at those positions.

Judith Gonzalez (17:27):

Absolutely. When we talk about our laboratory management team, including myself, we're made up of seven individuals. Each one of us is either a director, an assistant director, or a manager over these areas. And of those of us, seven, only two of them are men. Again, like you said, we're an equal opportunity employer. So we always have interviews and we hire the most highly qualified person that also fits with our team. So yes. And of the rest of the five management members, we are all clinical laboratory scientists. Two of us are specialists in blood banking, which is a separate certification from our m l s certification, industry-wide.

Alecia Lipton (18:06):

Judith, we'd like to thank you for being our guest today. This was phenomenal. We hope that you'll join us again, cause I know there's a lot more we can talk about.

Dr. Oh (18:14):

Definitely.

Alecia LIpton (18:15):

You have been listening to in the Know with Dr. Oh, brought to you up by Hoxworth Blood Center.

 

Alecia Lipton (00:10):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. This is part two of our interview with Judith Gonzalez, director of Laboratories at Hoxworth Blood Center.

Dr. Oh (00:21):

So let's get back to the QC laboratory. So and then we'll go to immuno hematology. So for the QC laboratory, can you talk a little bit more about some of the tests that are performed, especially for platelet qc in terms of, gosh, you know, the stuff we do before we distribute the products to the hospitals.

Judith Gonzalez (00:41):

So this is a very loaded question, <laugh>, back in the day, it

Dr. Oh (00:45):

Used to be very simple, right?

Judith Gonzalez (00:46):

Absolutely. There was one type of product manufactured one way with one requirement for ensuring that you're reducing the risk of bacteria in that product. In the last couple of years, there are now three different ways. And so we actually have three different types of platelet products that are different in the, in the way in which they're manufactured and tested. Manufacturing remains the same. The testing is very different. So for platelets, one of the requirements is ensuring that there isn't bacteria in the product. So we do what's called bacterial detection testing. That is where we take off an a certain amount of platelets from the product that's called an aliquot using a sterile syringe. And we inoculate bottles that have growth media in there. This growth media is in the bottle, and it's a food source for any bacteria that may be existing in that platelet product, which there should not be any. The bottles get loaded into an analyzer and they incubate at controlled temperatures with agitation for a minimum of five days, at which time it's using Kemi illumination to detect any CO2 production in the bottle. If there is any CO2 production in the bottle that indicates the presence of bacteria, those products are immediately quarantined and discarded after further testing to identify what the organism is. That is very rare occasion, and again, we do not distribute those products. Other testing that's required or is volume. So because we use bags to store these platelets in the bag, manufacturer only allows for a certain volume in each bag. So we have to make sure the volume requirements are met. There's a minimum and a maximum. There also has to be a certain concentration of platelets in the bag. So again, through extensive testing on a different analyzer, we're able to determine the number of platelets that are in the bag, and then we multiply that by the volume on the bag, and we're, what we end up with is a final yield of the, of the platelets in the bag. So that also has another, there's a lot of parameters that dictate the acceptability of a plate, the product. Lastly, one of the, the, the last things thing that has to be there is residual white counts. So these products, these apheresis platelet products automatically get filtered during collections. And what that's what's happening is white cells are being pulled outta that platelet product, and of course, it, it's not a hundred percent. So it does a, a certain amount. So then we test those products to make sure that the threshold is below a lower limit for white cells in that product. And that's just for the manufacturing aspect of it. For the testing, again, there's a lot of different infectious diseases. I won't go through all of 'em, but a smattering would be H I V H B V, west Nile Virus. A lot of the common things that we see nowadays that we wanna make sure that the donors are negative for, for those products.

Dr. Oh (03:43):

Wow. When you talk about all that, it's, it's really amazing in terms of, of the testing that we do perform at, at Hoxworth. So let's go ahead from QC Laboratory to talk a little bit about after all the QC is done or or in the pro after we're ready to, when we're ready to ship the products to the hospitals, what happens then?

Judith Gonzalez (04:03):

So once these products are deemed acceptable by the quality control laboratory, they again go back to the component manufacturing laboratory for labeling and label validation. So what that means is we use a blood establishment computer system that houses all of the information that was collected from the donor, all the testing that was done by the laboratories, and through a set of algorithms and alerts, the computer system tells us whether these products are good to go out the door or not. If they are, then they get a label put on the final base label on the product that has the a the blood type, the expiration date, the type of product it is any licensure from the donor center that qualifies it to cross state lines. It gets labeled and then a secondary label validation occurs, which is a double check of that label that matches that donation. Once that occurs, the products are taken to the product management and distribution department where they're kept in critically controlled temperature equipment. So if it's a platelet, it gets put in an incubator at 20 to 24 degrees. If it's a red cell, it gets put in a refrigerator. So they, they, they put, get distributed to their appropriate storage location until they're needed in the product management department. They are the face of the laboratory to our community. This is the department that interacts with our hospitals on a daily basis and multiple times a day for product orders, for any issues, concerns, deliveries. So hospitals put in orders through an electronic system that we have in that department, and the product management team that's made up of eight different individuals receives those orders electronically, retrieves the components that match the order, and then ensures that they're packed appropriately for distribution to those hospital customers. They play a very vital role. They also interact on an industry level, should we ever run into a situation where we don't have the appropriate inventory to support our community, which again, is also very rare. We do have partnerships with other blood centers across the United States that we resource share with. So they're constantly on a different platform, seeing if any other facilities require blood assistance or if we require blood assistance, we can put notices out there.

Dr. Oh (06:22):

Yeah, so we work with organization called Blood Centers of America and America's Blood Centers. And most of the blood collected in the United States is through an organization that's a member of one of those organizations, typically local, regional blood centers. And we work together and freely share products easily share products, I should say between each other so that we have a strong infrastructure as a system nationally. So there are times when we look at this distribution, ar center and look for additional products to bring in. But there are also times when we are able to resource share and provide those products to other centers that are having a, a low inventory at, at a certain amount of time. One of the really tricky things for us is our platelets, right? So there's just a five day or a seven day life on these platelets after the date of collection and it's kind of like grocery store trying to keep their lettuce fresh. Maybe that's the <laugh>

Alecia Lipton (07:21):

From the mill. The mill.

Dr. Oh (07:21):

There's probably a different vegetable that I should use, but that's the only one I can think of. But but yeah, cuz they're so short-lived that it's kind of impossible to not have periodic times when you need some or you have access that she can share. So let's talk a little bit about I R L, and I think this is the area that a lot of people think of in terms of blood bank laboratory, but it's actually one of the smaller, you know, departments that you have. Can you talk a little bit about what we do in our I R L? We are ABB accredited. Maybe you could talk a little bit about that as well.

Judith Gonzalez (07:55):

So, until recently, the I R L was the smallest laboratory that we have staff-wise. We do have the bi biomedical engineering department that now is a, a two-person team <LAUGH> that's growing. But the IMMUNOHEMATOLOGY reference laboratory, hence I R L, is a nationally accredited laboratory. We're accredited by the American Association of Blood Banks as an accredited laboratory. And interesting enough, in the past two weeks I've been doing investigation of how old our I R L is with regard to accreditation. That was a big unknown at Hoxworth Blood Center, who was the second oldest blood center in the United States, but currently the oldest one that's open <laugh> the number one blood center that was older than us, no longer exists. So at when I realized this history being new to Ohio, I wanted to know how old is our I R l, like how, how long have we been an accredited laboratory? And we've been accredited as far back as 1969.

Dr. Oh (08:51):

Wow.

Judith Gonzalez (08:52):

Yeah. And that took a lot of digging on behalf of, of Hoxworth blood center research documents and the American Association of Blood Banks, they took this as a challenge and the only way they were able to find that was through newsletter archives, oh my gosh. Back in the late, late sixties. So that was quite interesting. That is, that definitely is a feather in our cap because being accredited means you have gone above and beyond all regulatory requirements to ensure that you can perform the testing that's in that laboratory. This laboratory, i r l is also a clear regulated lab. Again, like I mentioned, the clear are set of amendments and rules that we follow to ensure that we are accurately and proficiently performing high complexity testing. So the I R L, again is also a face to our hospital customers. Their primary role in the organization is customer support. So when you have a patient that comes to the hospital that may, may require blood for transfusion regardless of their situation, whether it's they have their sickle cell patient or they're going to surgery, they are required to have samples drawn that go to the hospital blood bank for testing, and they do a screen of what the patient's blood type is and if they have any antibodies in their system that would interfere with that blood transfusion. Our hospitals are great partners, they're great customers and they're, they're, again, our clinical laboratory scientists as well that are able to conclude all this on their own. There are occasions when they get stuck, whether it be sh short, having a short staff in the department, whether it be lack of reagents to do the testing that's required, or the lack of knowledge, they just hit a roadblock that they, they've done all the testing they can, they don't know what else to do. And that's when they refer these samples to the immunohematology reference laboratory for further testing, we have the expertise and knowledge equipment, reagents and staffing to be able to solve these highly complex puzzles for these patients. They're, we call 'em puzzles because it could be as simple as one antibody, or it could be multiple antibodies or antibodies with other factors that are interfering with testing. So it really is like a puzzle for these CLSs in the I R L to determine what is going on and what let's i, let's give this antibodies names so that we can ensure that we find the corresponding red cells or products that match this patient for a safe transfusion. They are a great team. They are one of the few departments in the building that work 24 hours a day, seven days away week, 365 days a year. They're always available for consultation, they're always available for workups. And again, they come with a higher level of expertise and training above and beyond just your regular hospital laboratories or even your donor center laboratories.

Dr. Oh (11:41):

It's a really important resource for, for hospitals. Hospitals can't be expected to do everything, right. So they run their own laboratories and they do a gazillion different tests. But in blood banking, there's just a certain point that a hospital can can handle. And then for them to actually do the really advanced workups that we do at Hoxworth, it's, it's impossible to, for them to, to have that staffing just for their own hospital. So, so we have the responsibility to provide that level of testing and support as a region to be able to to, so that each hospital doesn't have to invest that infrastructure themselves. And and so we take a lot of pride in that and and, and we work very closely with all of our hospitals. So each of the individual hospital systems that we have can take things to maybe a different level, depending on their size and their complexity, but at some point those samples will come to us. So, <laugh>, let me ask you a question. So sometimes I'll run into people who are not as experienced in terms of blood transfusion and they'll say, well, gosh, why don't you just give, oh, negative red cells if you have what we call a positive crossmatch, right? And, and cause o negative is universal, right? So we can just give those products safely to patients. Can you just very shortly kind of say why that's not that the case?

Judith Gonzalez (13:03):

Absolutely. So yes, O negative is the universal donor for red blood cells transfusions, but the, the majority of the population do not have that blood type. So when you have donors coming in, certain percentages are going to be your a group, your B group, your O group or your AB blood group. There's four blood groups. So to, to just provide o negs to every blood transfusion. Although that is perfect world, we don't live in that perfect world. We, it takes a lot of effort to recruit and market to those o neg donors to come in and provide that precious resource. So we reserve those for those that definitely are o neg patients or are neonatal population or people who come in with an extreme trauma to the hospital and we don't have time to determine what their blood type is to give them their matched product. You would go with the universal donor o neg. So there it, there, it's, it's a balancing act to make sure that you are properly being a good steward of the blood supply and using that o neg resource correctly. So abusing that by giving to a hundred percent of your transfused patients would not be a good practice. So that's not something we encourage.

Dr. Oh (14:17):

Yeah, o negs are a, a relatively small percentage of the population. And then even when you do give the o neg there are other minor red cell antigens that also have to be compatible, especially when a patient develops antibodies after being transfused previously. And so those can be very rare, even to the extent where maybe the, the, the most famous incompatible situation is a Bombay where essentially a recipient will have antibodies to almost every single red cell that they would be exposed to other than another person who would've donated who also has this Bombay phenotype. So I won't go into a lot of the details there, but we have even had those types of cases in our, in our short history that I've been here. And so it's, it's really a great, I think for our I R L to be, you know, among those ab B accredited laboratories in, in the United States.

Alecia Lipton (15:12):

The complex work that the laboratory has just kind of puts into perspective that we need blood on the shelf before the patient requires it. Just the amount of testing that it goes through, the amount of processing. Judith, we'd like to thank you for being our guest today. This was phenomenal. We hope that you'll join us again, cause I know there's a lot more we can talk about. Definitely. You have been listening to in the Know with Dr. Oh, brought to you up by Hoxworth Blood Center.

 

Alecia Lipton (00:10):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. I'm Alecia Lipton, and with me in the studio is Dr. Oh because he's in the know. And we have a special guest today, Dr. Kristina Prus, who is doing her fellowship at Hoxworth Blood Center. Welcome Dr. Prus.

Dr. Prus (00:28):

Thank you. I'm glad to be here.

Alecia Lipton (00:30):

I guess one of our first questions for you before we get into, you know, a lot about transfusion medicine is where are you from? What brought you to Cincinnati?

Dr. Prus (00:39):

So I've been really traveling all around. And really cause I wanted to see a lot of different areas and see how a lot of different hospital systems operated. I'm also a little unique in that I'm not a pathologist, so a lot of the people who go into transfusion medicine have a background of being in pathology residency and then moving on after that. Going back to the beginning, I grew up in Chicago, so I am a Midwesterner at heart. But then I ended up doing medical school kind of in rural Illinois in Peoria. And then I went off to pediatrics residency in Richmond, Virginia. So totally different. And then I went back here to Cincinnati. I'd never been here before, but the program, we had a great reputation and so I ended up doing peds hematology oncology and through that I did a research project that got me really interested in blood through all through my research and, and understanding allo antibodies. And so because of that I got to know the people at Hoxworth Blood Center very, very well and they sort of inspired me to wanna go into transfusion medicine. And so that's how I ended up here. And so it's been great to be back in the Midwest. It's been great to, to get to see a little bit different part of the Midwest though still be close to family, but at the same time being somewhere that has much better weather than Chicago and really just the same kind of wonderful people.

Alecia Lipton (01:54):

We're thrilled to have you here with us and it's always great to have another Midwesterner. You know, Cincinnati's kind of a much smaller big city but similar enough to Chicago that you probably don't feel too far away from home.

Dr. Prus (02:07):

Oh yeah. And the traffic is so much better that, you know, you can actually enjoy parts of the city as opposed to Chicago where sometimes you just, I'm not even gonna leave my house cause it's just not worth it. <Laugh>,

Alecia Lipton (02:17):

One thing that you mentioned was your educational career. You know, a lot of people think, oh, you go to med school and you're done. But really a physician's learning is never done. There's always, you know, another step to take, whether it be a fellowship or an accreditation. So you're getting ready to finish up your fellowship?

Dr. Prus (02:37):

I am. It's so exciting. It's been seven years actually of postgraduate training, so it's been a long time. A little bit longer than, than most people do. I'm about the equivalent of a neurosurgeon cause they go to school the same amount of time. But it's nice, it's been wonderful every step of the way and every part of it has brought me something new to the, the table. And so it's been absolutely perfect and I'm so happy to have, you know, be finishing my training with all these wonderful people at Hoxworth.

Alecia Lipton (03:06):

That's excellent. Dr. Oh can you tell us a little bit about the fellowship program that you ever oversee at Hoxworth Blood Center? Sure.

Dr. Oh (03:12):

We're really pleased to be able to offer fellowship program in transfusion medicine, blood banking. As Kristina said, most of the people who come through are pathologists and they've already done four years of pathology typically. And then they want to specialize in transfusion medicine and blood banking. Pathologists often run the transfusion service in a hospital. So if you need blood at a hospital, oftentimes that service is, is run and managed by a physician who's trained in the laboratory to make sure that the blood bank functions and gets the products where they needed and to perform the appropriate testing that is required. There are people who come in from other specialties. Pediatrics is is definitely one of them. It's a very interesting mix, I think. And we sometimes have people from internal medicine. We've had previous fellows from internal medicine as well. Other specialties that are interesting as background are anesthesia, even surgery. We offer the one year fellowship, which is intense learning about blood and for us a lot about blood collection as well and processing so that you have a real comfort level with the products that we're using in the transfusion service. Each transfusion blood banking fellowship is, is different. We are very fortunate to have such a large component being our blood collection at Hoxworth Blood Center. Many of the fellowships are much more clinically oriented with so much smaller exposure to the blood collection processing, distribution side of things. But I really like our fellowship because it's got a nice blend of, of everything. So blood collection as well as adult transfusion medicine exposure and pediatrics for sure as well. So we have such a strong facility here in town with Cincinnati Children's Hospital and there are very close partners of ours with the physicians who are transfusion medicine, blood bank boarded, helping with us in terms of our teaching and providing really great exposure to our, our fellows as they come through.

Alecia Lipton (05:15):

Well, of course, Cincinnati Children's Hospital Medical Center is world renowned for their care, especially their cancer care. And about 80% of our collected platelets actually go to those patients at that hospital. So when you donate platelets at Hoxworth Blood Center, 80% chance it's probably gonna go to Cincinnati Children's.

Dr. Oh (05:33):

Yeah, so one of the great things I think about our program here is not only Children's with the amazing cancer number of patients who are, he's seen here for cancer treatments and therapies, but also they're a level one trauma center as well as U C M C is a level one trauma center as well. And so I am the medical director of the transfusion service at U C M C, so we make sure that the fellows get a lot of exposure to that as well. And so not only do the fellows get to see the, the production and collection and all that goes into being able to get the products for distribution and for use as well as to see the use on the other side. And, and we do a lot of novel things here as well. I think platelets we've really concentrated to make sure that those are available. We have a number of different platelet products and actually are introducing some changes as regulations have changed and and are required to do additional processing steps coming this fall. We also provide whole blood and and that's for trauma victims trauma patients as well. And I think that the other thing we did this year, which was totally anau audible, we weren't expecting was the whole Covid 19 convalescent plasma process. So I think Dr. Prus has seen a lot in her one year here. What people see does vary over the year. And actually it varies quite a bit according to their interests and their backgrounds. One of the really great things about Dr. Prus is she actually knows more about immunohematology than a lot of the people who have a pathology background. She's been interested in research in that area and has done a lot of amazing things with Dr. Russell Ware who's a, you know, very prominent physician at Children's Hospital. Can you talk a little bit about that research and your ability to continue that during your fellowship year?

Dr. Prus (07:20):

Yeah, and that research is really what got me into this fellowship and got me so excited about just blood in general because when you're going through pediatrics, pediatric hematology, oncology, you don't really think about blood beyond, oh my patient's hemoglobin is low, their platelets are low, they need more, I'm just gonna order some. And so, you know, as part of my research I was able to really dig into these concepts of, you know, what else happens? What are our other issues with with red blood cells and where do these antibodies come from that make it so difficult for people, especially with sickle cell disease, to receive the right type of blood. And so with my research, I really got into that and I started with my hematology oncology fellowship and then was able to kind of transition during that. What had happened was Covid kind of threw research all, all out the window. There was a period of time where research was shut down essentially, where you really couldn't go in and do anything because we were trying to be safe. And so because of that, my whole project got pretty delayed and with that I was starting to think about what do I wanna do with my next step? And ended up, you know, approaching Hoxworth Blood Center and Dr. Oh and Dr. Cancelas and saying, you know, I really want to learn more about blood, but I also really wanna finish my project. And they have been so wonderful about making sure that I have the time to not only learn the blood bank, but also be able to spend some time back at Children's to really be able to, to wrap up this project and be able to get it published and get it out there to the medical literature. So it's been really a great partnership I would say, especially because a lot of my project is very intense when it comes to allo immunization and looking at the rh. So most people when they think of blood, they think, oh, I'm positive or negative for, for an Rh factor. But it's actually much more complicated that than that, especially in patients who have, you know, sickle cell disease are from an African background where we see a lot more diversity in the genetic code of those of that gene. And so because of that, I have the resources at Hoxworth, including our I R L, our reference lab, which, you know, those people there, the, the technologists you know, they are just absolutely some of the most brilliant people I've ever worked with. And you ask them any question and they somehow know the answer <laugh>. And I think maybe only once or twice they've had to say, oh, let me look it up, and then they figure it out. So they, it's been really nice from my research perspective to have that resource as well because anytime something did come up I could just walk to the office next door and say, Hey, can you, you know, help me understand what I'm seeing with my results. And so that's been a really crucial piece as well because I went into this not knowing how to do a lot of these laboratory techniques and I went into it not necessarily being a laboratory side person, I was more of a clinical side person taking care of patients and having people with that background to help me to learn has been just absolutely irreplaceable. And it's made my research go so much better and, and really help me understand it so much better. So I was really, really thankful that they were able to, to take me on and take on a, a pediatrician as opposed to, you know, a pathologist. And it's been really great. And it's been a nice transition as well to really learn the laboratory side cause I feel like I'm so much stronger as a clinician and as a pathologist now too, cause I'm, I consider myself a fake pathologist now <laugh>.

Dr. Oh (10:41):

I do too. I do too

Dr. Prus (10:42):

<Laugh>. And so, you know, now having both of those sides, I feel like I'm able to, to really be that much stronger. So it's been, it's been great <laugh>

Dr. Oh (10:51):

Oh we're so glad to have you. You know, we have space for at least we have space for two fellows every year. We often just have one and occasionally we have none. And I haven't, fortunately I haven't been here when we haven't had a fellow, but having a fellow present adds so much to the experience of what we do. cause our facility is an organization, it is set up to teach people. And when you don't have the student there, it's like, oh, I wish I could teach somebody this. When we see these amazing cases that kind of go, come through all the time. We've worked a lot on, on our hematology reference laboratory since I've gotten here and it's just a really great part of our laboratory. And and it's great to have Christina here because she really challenges the text as well. And yeah, you, if for young people out there, if you're thinking of going into STEM areas, immunohematology or laboratory is like being a puzzle solver, like a master puzzle solver. And that's what you do when you come to your, to your job is to, to try to figure out these things. And so it really requires people who are inquisitive and who want to know and get, get to the bottom of things and, and people who, who become professionals in that area tend to really, really love it. And so I've been so pleased. We've got our assistant director Jenny O'Connor who has come and she actually trained at the same place I did for my fellowship and she I think has really done a fantastic job and we'll have a podcast with her.

Alecia Lipton (12:20):

Oh yes.

Dr. Oh (12:20):

At some point in the future.

Dr. Prus (12:20):

Yeah. And I will jump in and and say too, it really is a puzzle. And that's what got me so excited about my research too, was that not only was I, you know, testing samples and recording things, but then I got to go back and say, how do I figure out what this antibody actually is and how do I test the right number of samples to be able to find it? And that's where really people like Jenny really helped me a lot because I wasn't, you know, like them where they had access to as much blood as they needed to. cause the patient usually is in the hospital when they're working these cases up. But for me, I had a limited amount of serum to work with and I couldn't get anymore. So when I was out, I was out <laugh> so they were able to, to really help me figure out like which cell lines do I test? Which ones are the most important ones to help me rule in and out on these antibodies to figure out what it is. And you know, it really is a puzzle. And I've heard actually multiple people from multiple institutions now, including Hoxworth, say it's like playing Sudoku almost, you know, with trying to eliminate and think about it. I mean, it's a really cool career and I definitely would recommend it to, to anyone who is really interested into science and really into like puzzle solving cause it's, it's just so fun. <Laugh>.

Dr. Oh (13:28):

So what's interesting also about Immunohematology is it uses these techniques that have de been developed early in the 19 hundreds and essentially a lot of them are untouched. I mean we, we still use the same methodologies but at the same time we're introducing all these new technologies as they emerge DNA to, to help us with finding blood that's crossmatch compatible. We are doing, we're doing a lot of different things. So it's, it's really continues to be interesting and to continue, continues to develop. I remember at one point somebody asked, gosh, isn't being in blood and transfusion medicine kind of boring? cause essentially we've just been providing red cells, platelets, you know, plasma over, you know, all these years that, you know, gosh it's the same thing over and over again. But there's so many different flavors and variations and as you learn more there's just more to learn and to do. So it's a very challenging area.

Dr. Prus (14:19):

And I think that's something that Hoxworth does really well too with its education in that we don't only train a fellow, we have people rotating through with us all the time. So we have medical students that come and join us to understand what's going on. We have other fellows from other programs coming through, including adult hematology, oncology, pediatric hematology, oncology will sometimes come through as well. Anesthesia will come through and rotate with us. And so it's really just to show, just kind of get us a sense of flavor. And I think that that's so helpful cause I actually did that during my first year of my fellowship over at Children's and I had no idea that blood was so complicated and you know, even though I was someone who had been ordering it for four years at that point, I had no idea all the little nuts and bolts under the hood that go into making sure that the blood is safe and making sure that it's the right blood for the patient. And so it was just a really eye-opening experience and I think that Hoxworth is doing fantastic things by making sure that all these other trainees are coming through as well. That it's not just one fellow that, you know, learns everything. It's, you know, let's make sure that all the other people who are involved in the blood process and giving it to patients are also aware of some of the other things that we do to make sure that the patient is always as safe as possible.

Speaker 3 (15:32):

The fellow plays a very key role in terms of the operations for us from medical services. And you mentioned the residents. Can I ask you to talk a little bit about your role in terms of working with the residents and, and how you see helping them learn as you work and try to help the patients out that are needing the blood?

Dr. Prus (15:51):

I will start out by saying that from day one here, I have felt like a part of the team. And felt like a really important part of the team. Someone that people felt comfortable going to and asking me questions. And you know, from day one if there was a question that I didn't know the answer to, which obviously happens when you're trying to learn, I always felt like I had such great support from all the attendings, you know, not just Dr. Oh but everyone. And it's been absolutely great and I think that's why I've learned so much. So thank you for that. But you know, as part of my role it is to really teach the residents and the other fellows and anyone else that comes through. And it's a lot of fun to really be able to work through these cases because when you're in a fellowship of one, you're kind of by yourself, you know, it's, you can bounce ideas off the attending if you want to, but sometimes, you know, you don't wanna bug them. You wanna be able to figure this out on your own. And you know, in my other previous training programs, there were always a bunch of other people around, you know, in my fellow in my first fellowship, there were four other people in my class, in my residency, there were a whole bunch more. And so having that resident is actually really nice to be able to talk, to, figure out, you know, what is this case that we're working with and make sure that we've kind of covered all angles before we, you know, go to the the boss and say, Hey, this is what we're thinking. Do we miss anything? Because I, it makes just everyone's job so much easier and, and happier really when you get to really think through it. And so it's been great because I kind of have that resident to, you know, kind of dig into the case first and get all the details and figure out what's going on whether it be apheresis, whether it be a complicated workup for a patient who's might be having a reaction. And then they can come to me and we have this conversation discussion about, right, what do you think's going on? And it's not just a, you know, you tell me and oh, this is the answer, you know, move on. It's, let's talk about it together, let's make sure that we're thinking through every piece of it. And you know, I think that it's really fun to be able to be able to, to do that and work through it and be able to have these really complicated cases because sure, you're gonna have the really easy ones where it's very obvious, oh yeah, you had an allergic reaction to this blood cell unit, let's move on. But then you have sometimes where it's like, oh, the testing is not looking exactly like we want it to and maybe we could pass it off as nothing, but let's look into it just in case. And then it turns out to be something unexpected, like a cold antibody out of nowhere. And it's really fun to be able to, to kind of work through that and then to have someone else to challenge you. So I, you know, you're talking with, with a resident with another fellow and they're like, oh, well I don't think that that makes sense. I think that we need to look into it. And I, I'm like, oh, maybe you are right. Maybe I am kind of being a little close minded on this and it's nice to have someone else to think through the case with you. And so it's been a really big help and a really, you know, just key part of this program to have other people around. And then of course, you know, just the, the learning in general, the, you know, let's give each other lectures, you know, on Friday Dr. Oh is super nice and <laugh> blocks off his entire morning for me. And so it's me, him and whoever else is rotating with us. And we just have a big education morning and a lot of times the resident will be in charge of making a presentation and then it's not just like a PowerPoint where you scroll through the slides and you read them and no one's paying attention. It's, let's stop, let's talk about this, let's figure out, you know, why do you, why is it the way that this is? And then of course Dr. Oh knows everything and <laugh> and he always has some sort of historical perspective to throw in there like, oh, you know, back in the day we did it like this. And it's, it brings so much richness to what you're learning because it's not just reading the textbook cause the textbook doesn't always have those historical perspectives or those real life scenarios where, you know, he shares his experience, which is so much more helpful than just reading a book. And that's why it's been, I, I find those Friday mornings very, very valuable and I'm so happy that we have them.

Dr. Oh (19:40):

Yeah. So you know, Christina, you've really helped the program develop so much and, and we didn't start the year but doing that. And I think for me it's a relatively new hat. I've been wearing the program director hat for about three years and when I first got here, somebody else was the program director, which was great, but he decided to move on. And so when I inherited that, it really was a great thing I think for me because I have really tried to incorporate the education process into our functioning and it's so intertwined and when you're at the staff level and when you're working with the residents and to make sure that the residents are getting something as well as the fellow in teaching them getting something. So the way we have our, our week actually set up, I'll, I'll just go into really briefly. We start Mondays with a clinical update and we have a great input from our colleagues at Children's Hospital and we kind of go through interesting cases to discuss if there are any teaching points for any on-call cases during the previous week that we can get together kind of as a group of faculty to all share our experiences cause we all have different experiences. And then every morning we walk through the laboratory and again, this is something we didn't do a couple years ago and we check in with I r l hey, any interesting cases, we check in with components, we check in with distributions, how's our blood supply today? And then a few days of the week we actually talk to our, our recruiters and Alecia.

Alecia Lipton (20:59):

Yes.

Dr. Oh (20:59):

As part of our PR group. And we say, what's going on this week? How is the collections looking? You know, are we expecting any issues in terms of of blood supply, any, any really worrisome things, any really cool promotions we should be aware of as they're kind of going on. And so that I think gives us flavor for the whole operations. And then we, we have a special session with therapeutic ahe because that's a big clinical part of our, our operations. And so Dr. Alquist is always, always rounds with us as well, which is great cause we have two staff at least who are there every day. And and we talk about cases and patients that are gonna be have therapeutic Aras for the day. So every day we have that in the morning and a chance to catch up. And then any calls that come through we can discuss and we set as we get new calls, we set the residents on them to get information and to help to troubleshoot and provide everything in context. And then and, and Dr. Prus actually for the first month that she was here, really functioned to understand all the calls that the residents would be getting. And then after that it was kind of the quarterback, you know, for that for the residents as they come through. And I think that by teaching, we learn.

Alecia (22:05):

You've been listening to in the Know with Dr. Oh, our guest today was Dr. Kristina Prus.

 

Alecia Lipton (00:11):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. This is part two of our podcast with Dr. Kristina Prus.

Dr. Oh (00:20):

So our process for ordering platelets for when patients are not responding as well as we would like them to, we have had a process and it's worked, but Kristina brought a level of wanting things to be smoother for sure. And so she spent a lot of time trying to figure out how are we getting these orders? Is there a better way to do this? Can we make sure that we are following up appropriately? We have a different number of different methodologies that we didn't have four years ago that we have implemented here to try to, to, to provide more information in terms of and to provide the best platelets that we can for patients who are just not responding as well. We would like, so I, I don't know how in depth we want to get into this, but Christina, maybe you talk a little bit about how you approached it or the types of changes you wanted to kind of at a higher level.

Dr. Prus (01:10):

Yeah. So as I went through the year, I realized that the point person for these processes is really me. And so I wanted to make sure that I had a really good handle on everything. And, you know, it was hard at first. You know, when you're thrown in, you're only here for a year, and everyone was still kind of used to the, the previous fellow, and they just expected me to know everything. And I was like, I don't know everything. Please help me <laugh>. And I was able to get it all worked out because, you know, everyone was a team player and kind of helped walk me through it. But as I went through it, I realized that there were pieces of the system that had holes that could happen. And ultimately I never wanted it to affect a patient. And so I wanted to make sure that the platelets were always available when we needed them, and that they never got, you know, lost in the shuffle. So it goes. And so as part of that, I realized that we have computers and we have, you know, this, this great system of being able to track where everything goes and that there's more efficient ways in order to keep track of where our platelets are coming from and where they're going. And really, it just came down to communication. And I felt like while there was communication, there was a better way to communicate and one where it was less fragmented and more all in one place. And I think that part of the pandemic also kind of accelerated this because there was so much less time being spent in, in person and so much more time on computers. And through that we have this great software in our, in our computer is that we use to communicate safely and confidentially with one another. And because of that, I realized that we could use that tool to make the platelet process a lot better. And so everything kind of rolled out from there where I wanted to get everything in one place rather than have one email group for this, this and one email group for that. And, you know, some other spreadsheet somewhere else. Like I wanted to bring it all together. And that's where it really stemmed from. And that's how I got it all together. And it was also a really great learning opportunity and understanding how to work with multiple different teams that have multiple different needs. And that was probably barrier number two is that, you know, I wanted to do it this way, but then, you know, this department said, oh, we can't do it that way. It doesn't work with our flow. And then I wanted to do other things this way. And they're like, oh, no, it doesn't work that way. And it was really nice to be able to, to be in a sort of team situation where people were very open and honest and and willing to kind of work with me. And, you know, because of that, I, you know, said, you know, let's work on this together. Let's find a way to get through this. And we finally did, and you have no idea like how happy I was <laugh> when, when I saw the big TV screen go up in, in donor testing, because that was something that was a big part that I wanted to change. I wanted to loop them in and have them be a whole part of this and not just have it be phone calls back and forth. I wanted something digital that we could all look at and be aware of. And when I saw the monitor, I'm like, oh my gosh, <laugh>, like this is actually happening. And then I saw, you know, the memo go out saying like, Hey, we're changing this for sure. And, you know, just going through all the different steps, it's been like absolutely just so great to see it happen. And I still, I'm still shocked that that I've made it all happen and got it all together before I left. So I'm really happy. <Laugh>

Dr. Oh (04:28):

Well, Kristina, I think one of the things I've been most happy with, I think with your coming here is not only just the technical expertise you give in terms of immuno hematology, but you really like the aspects of teamwork and cooperation and we here are, are I think very good at doing that. And that's something I really work on in terms of what's, what's the role of medical director. Maybe we'll have to do that as a podcast one time. But I, I do think it's, it's coordination and teamwork and, and breaking down silos. And so you would think we're a small organization, but we have different departments. We have a collections department, we have a recruitment department, we have a processing department, we have a quality control department, we have human hematology reference laboratory. We have a department to take orders and to distribute to the hospitals and to have a process like refractory platelets, which brings in the laboratory, you know, what platelets are, we gonna try to test testing for hla. So we have a T I d department, all these different areas that we have to work together again to make sure we, we, when we collect an HLA platelet that recruitment knows what we're doing. That that then collections knows that that donor's coming in, that that unit when it comes over to the laboratory we have and don't get go into the general flow mm-hmm. <Affirmative>, those have to be sequestered and all these different steps is it's really complex and you would think it wouldn't be. And I think in the past, you know, that's been a, a, a problem like, is that, oh gosh, it'll be so easy to take care of. And, and we could have, essentially our solution was let's have our fellow sit on this <laugh> through the whole process and, and you know, call everybody 10 times a day when we have one of these requests come through. But that wasn't the, the best process. So this is really an improvement for us and we're just rolling it out. And I think it's, it's, it's really exciting. So, and I wanna thank you for that, but I think as a result of this, I think we unintentionally steered you more towards blood center orientation. So, you know, everybody comes.

Dr. Prus (06:26):

That's not true. <Laugh>.

Dr. Oh (06:27):

<laugh>, everybody comes in with with, you know, what they want to get out of their fellowship program. And I really thought that, you know, this was just gonna be a supplement to all the great stuff you do with peds Heon and all your exquisite training there, <laugh>. But I think that you see a role for yourself in, in blood center as well as continuing those other activities.

Dr. Prus (06:45):

Yeah. And I think that, you know, that's completely true that I went into this thinking, I'm gonna go back into peds heon, understanding blood a little bit better and, and continue my research and, and do all those things, but I had no idea the depth of involvement that a medical director of a blood center really has. And really just the, the role that that you play and the importance of it and all the different intricacies that go into making a bag of blood to be able to give to someone else. And because of the degree of education here and the degree of involvement and the fact that from day one, as I said, I was involved, I was doing things, I remember I showed up and Dr. Oh gave me the pager. He's like, have fun <Laugh>. Like, I've been here for one minute, <laugh>. I dunno that I'm ready for this.

Alecia Lipton (07:37):

Initiation by fire.

Dr. Prus (07:38):

I know, right. So that worked out like so well, and it just really got me involved in every little aspect of it. And, you know, I think that, and the teamwork and all the, all the medical knowledge that just goes into it just made me so passionate about this. And, you know, it just made me realize that, you know, I actually like this field and, you know, while I'm still, you know, kind of evolving and trying to figure out exactly where I want my life to go, you know, I'm just ending fellowship. I have a whole lot more years to go. I, I decided that, you know, just going forward, at least for right now, I kind of like blood and I'm gonna kind of continue to focus on that, at least for right now. And it's still, it's still works great with my research because my research is so blood transfusion oriented that, you know, it really doves hails really nicely. And, you know, I'm really excited to, to continue learning as much as I can. And, you know, I think that, you know, I I will say a little bit, the Dr. Oh was, was a influence on, on how I decided to, maybe I'll go away from clinical medicine for a little bit because it's just, you know, it's, it's just so fun here and it's just a great environment to, to work and, and be collaborative and you don't see that all the time. And so that's what makes it, makes it a great place to be.

Dr. Oh (08:50):

Well, I, I hope you don't regret that in the future sometime, but you know, one of the the great things, things for us is to train people and for them to have impact as they go out. And it's totally fine for somebody to, to leave here and go into private practice or into a private group and just, you know, benefit patients in what, wherever their location is. We've had many, many fellows do that. But I see for you with the, all the background that you have a real prominent place in educating others, you know, not now not from the fellow to resident level, but as a, a staff and a, a professor, you know as you start your academic career that you will have the ability to give presentations and to write papers, and that will really affect the field and the way we practice this in the future. So that's really exciting for us. And I, I know that here at Hoxworth, you know, that's a major focus for us and we are so pleased that you were able to continue your research with Dr. Weir and to develop new interests as well together. Really due to you, we have a, a, a letter that was published in transfusion that I think had high impact related to covid 19. And there are just so many other things that, that we've done that have been just fabulous, I think.

Dr. Prus (10:03):

And I'm happy that you guys are so open to having non pathologists come through as well. I think as I go forward and as I meet, you know, more and more trainees as I go through, I'm gonna really encourage people to, to think about this as a career option if they have an interest in blood, especially if you're, you know, peds hematology, oncology, or even just pediatrics because it's so important. You know, I feel like, I don't know how I ever practiced before <laugh> before knowing all of this. And I think that it's just absolutely crucial and there's so many issues that you just never think about, that you never really wrap your head around. I, I, I mean, gosh, I always go back to the example of I couldn't remember for the life of me what the difference between a, a typing screen and a D A T was like, it took me forever to, to, I don't even think I left fellowship, like really knowing what it was. Like I kind of knew, but then, you know, I come here and I sit at the bench with Molly and you know, she's showing me how to do all this stuff. I'm like, oh, this makes perfect sense now. Yeah. Like, you know, and now I get to explain it to all the other colleagues that call me for consults and I say, oh, yeah, this is how it works, and let me try to, you know, wrap my head around it in a way that makes it more understandable to a clinician instead of someone who's sitting at the bench doing it. So I think it's so, so important and I, I hope that more people in non pathology at least start thinking about this as a potential career. Hopefully we don't totally flood the market. <laugh>.

Dr. Oh (11:22):

Right, right. So, I know in pediatrics when I was at Stanford, I worked, had the pleasure to work with Jennifer Andrews, who's a, a terrific transfusion medicine board certified physician. But she came from pediatrics and I know Megan Delaney is the national figure who's been active in pediatrics, but there aren't a ton of people. So I, I really think that there's a role for you and people will want to hear from you and your points of view as you go forward. Those, those crazy pediatricians are so much more conservative Right. In a lot of their policies. And and, and and it'll be interesting, interesting to, to get your take on that when, when talking to the general public.

Dr. Prus (11:56):

Oh yeah, absolutely. I I hope that, you know, we continue to consult with one another. It'll be fun.

Dr. Oh (12:01):

<Laugh> Well, and then here too as well. You know, I, I have to, if we're gonna talk about people, we have to me mention Stephanie Kinney and Michael Osos and Yeah. Of who are staff at Children's Hospital and their partnership with us, you know, is just so incredibly important and really gives that great clinical experience that you already had a lot of it. But I, it it's still different, you know, in terms of of the general transfusion service and running that.

Dr. Prus (12:24):

Oh yeah. And they're, they're so dedicated. I mean, just, just two nights ago I was having a case at, at 2:00 AM and cause I was on call for, for them as well, covering their transfusion service. And Dr. Lassos 2:00 AM is sitting there teaching me on the phone <laugh> like, how are you awake enough to, to be doing this? But it was great. I mean, it was a really great case. Lots of learning. And whether it's at 2:00 AM or 2:00 PM they're always willing to, to take my call and kind of work through things together.

Dr. Oh (12:52):

Dr. Cancelas says 3:00 AM is the best time for teaching that.

Dr. Oh (12:55):

Oh, I've had, I've had a 3:00 AM teaching moment with him as well. <Laugh>.

Dr. Oh (13:00):

So, but I don't wanna scare people away from our fellowship. Actually. it's interesting, you, you mentioned day one, I gave you the beeper. So sorry about that. But in, in past years, we did not give our fellow the beeper until October because the philosophy was kind of, let's make sure that they're experts at everything before we, we, we give them beeper. But I think we felt like no, you learn through experience and we are always available for you. So we expect that if you get paged, we're gonna get paged 10 minutes later for that first month or two, you know, in terms of making sure that you're, you know, you, you, you, but we want you to make the first judgment and then we can help you, you know, from there. But if you never make that first judgment yourself, you never make that first judgment yourself. You know, and so it's very, I we don't want fellows to leave here calling me <laugh> Once you're on July 1st, you're, you're, you're done <Laugh>. You can, of course you can always call us back. But but not every night <laugh>.

Alecia Lipton (13:59):

I think that makes Hoxworth Blood Center unique. One, we're part of the University of Cincinnati. Yes, yes. But we're also a center for research and education. So yes, our goal is to collect the safest blood possible and get it to our patients, but it's also to continue that research to continue to learn, to continue to challenge. And I, I think that we do that very well at Hoxworth.

Dr. Oh (14:22):

I want to thank you, Christina, for, for doing, doing everything you've done this past year and one year is too short. It really is. We're actually fortunate here if you, if you weren't in the probably 28th grade, I would guess <laugh> that if you wanted to do initial year of fellowship, that's always an option as well. We can figure out some way to, to to, to work that out for people who are productive and who can show that they will do something with an additional year that would not be ac ACGME accredited, but you want to go on with your life and get a real job. I think so. So we'll wish you the best as you finish up.

Dr. Prus (14:54):

Well, thank you. Yeah. And if it was wasn't for my personal life situation, <laugh>, I probably would've taken that extra research here. Yeah. Because you guys just have so many resources Yeah. In such a unique area. So it's, it's, it's gonna be hard to leave you guys for sure, but I so appreciate all the education. It's been absolutely amazing.

Dr. Oh (15:13):

Great. Thank you. Thank you so much.

Alecia Lipton (15:14):

We wish you the best of luck in your future. Thank you for the work that you've done for us at Hoxworth Blood Center and for the research work that you're doing that's going to impact people you know, far beyond just the Cincinnati region you've been listening to in the know with Dr. Oh. Our guest today was Dr. Kristina Prus.

 

Alecia Lipton (00:10):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. I'm Alecia Lipton, and in the studio with me today is of course, Dr. Oh.

Dr. Oh (00:20):

Hi, Alecia.

Alecia Lipton (00:20):

Hi. And then we have a special guest today, Cara Nicolas. And a lot of you probably recognize Cara's voice, I would say her face. But we don't have this on video, but Cara handles our social media. So she gets to see a lot of comments, I mean, in from donors or maybe they're not a donor yet, and they're just looking at options. So we wanted to bring her in and talk a little bit about the fears and the myths that go around blood donation. So, Cara, what would you say is the top fear that you get from donors?

Cara Nicolas (00:59):

So, the top fear is typically just people are afraid of needles which I get. You don't usually wake up in the morning thinking, you know, what? Really wanna get stabbed by a needle today, <laugh>. But a lot of people, I think, build it up in their head that it's going to be this super painful process. So I do get a lot of questions about, you know, my gosh, how, how much does this hurt? How long is the needle in my arm? And you know, I always try to reassure them that it's really not that bad. It's just a slight pinch. And honestly, I mean, if you're donating whole blood, usually the needle's in your arm for less than 10 minutes. I personally have a bleed time of about six minutes because I'm awesome <laugh>. But yeah, you know, I think that's like one of the biggest fears is just the, the pain. But it's really, I would say it's not that bad. Right?

Dr. Oh (01:48):

Yeah. So lead time is really not a competition, so <laugh> sorry about that, but six minutes is pretty good <laugh>. Yeah, usually 10 minutes is about as long as it'll go. And, and it's the insertion of the needle. I think that is usually, you know, the, you know, tense portion of it. And then once it's in there, it really should not, you know, be continuous pain the whole 10 minutes. Right. It's really a, it's insertion. And then that's it. And then usually removing the needle isn't a problem either.

Cara Nicolas (02:16):

Yeah, exactly. So, you know, I always try to reassure people that it's not painful, it's slight pinch. And honestly, it's just, even if you do get that slight pinch, isn't it worth it to, to know that you're saving people here in the area? You know? I've heard from parents also on social media, you know, whose children are receiving blood products constantly because they're getting treatment for cancer, or people who've received organ transplants and they're saying, you know, I understand people don't like needles, but my child has to get like, needle sticks every day and like, doing, doing one needle stick to help save like someone like my child, it just means the world. So I think that's, it's like, just, it's so meaningful, you know? So I think that's the biggest fear.

Alecia Lipton (03:01):

Okay. So a lot of times when people are afraid of those needles you know, they've watched TV especially you know, TV comedies and they'll show these ginormous needles, and we know that that's not reality. But Dr. Oh can you tell us a little bit about the type of needle that's used?

Dr. Oh (03:18):

Sure. the needle actually used for whole blood is probably a little bigger than the needles that you would get for routine blood testing. So we have to collect, you know, 450 to 500 milliliters of blood every time we, we draw. And so we really can't use a really thin little needle to collect that much blood. Otherwise, you know, you might be on for a lot longer. And then there's increased risk that there'll be hemolysis or destruction of those red cells. So with our whole blood collections, the needle is a little bit larger. When you click platelets, actually the you're on for longer. So that's an hour and a half, oftentimes may, maybe even two hours. Right? but the needles used is smaller than the one we use for whole blood, so it actually is associated with less discomfort. And so even though it's in there for a lot longer it's it's usually not as, as uncomfortable with that initial stick. So

Cara Nicolas (04:11):

I would definitely agree with that. I'm a platelet donor, as you both know, because I text you every time I donate platelets. Yes. But yeah. And honestly, I feel like donating platelets is so comfortable they get you in that chair. It's a smaller needle. They got the heating pad. You can like watch your Netflix. Last time I donated platelets, I was just watching Brooklyn nine nine for like two hours. It was truly excellent. <Laugh>. I mean, it's just like, it's a little me time, you know, in the middle of the day.

Alecia Lipton (04:36):

Right.

Dr. Oh (04:37):

So donating platelets is a competition <laugh>. So we want, so we do want you to get three units Yes. When you donate. And so I've heard Cara that you are a tripler.

Cara Nicolas (04:48):

I am a triple platelet. Yes. Every time, every time I come in, they're like, oh my gosh, your platelet level's amazing. And I'm just like, yeah. Runs in the family <laugh>.

Alecia Lipton (04:58):

Cara is quite the overachiever. Not only does she do triple platelets, but she's also blood type a positive.

Cara Nicolas (05:03):

Oh my gosh. I just like to think that a plus is my brand. <Laugh>. Okay. You just imperfect in every way. <Laugh>. I'm also excellent at being humble.

Alecia Lipton (05:11):

<Laugh> that that's coming through

Cara Nicolas (05:14):

<Laugh> <laugh>.

Alecia Lipton (05:17):

Speaking of television episodes, I think probably majority of our listeners have, if they've not seen the entire episode, at least a clip of the office <laugh>, when Michael goes to the blood drive and he does what everybody is afraid they'll do, you know, he passes out in the chair. Dr. Oh can you tell us how often do people really pass out? Is this a real fear that people should have?

Dr. Oh (05:39):

So it, it, it does occur. I mean, it's in the single percentages right, of the donations that we have. But it's called the vaso vagal reaction. And different people are more susceptible to having this reaction. So if you're a repeat donor you are less likely to have a vaso vagal reaction. But for, we worry about our first time donors, so sometimes we have to give them a little extra tlc. And then younger donors are actually more susceptible, so their their pressure receptors are more sensitive, and so they're more sensitive to blood loss, acute blood loss. It's interesting, as you get older, it's kind of less sensitive. So we'll be very careful with our younger donors, 16 and 17, 18 year olds cause they do have a higher potential to have a, what we call a vasal vagal reaction or a faint reaction. We, if that happens, you know, we immediately stop the, the, the, the collection. There's a, there's a physical blood volume removal component to having the vasal vagal reaction happen. But there's also a mental component. And so for some people it's all mental. So they can come in and they'll be very anxious about donating and they'll, they'll look and they'll actually see somebody else with the needle in their arm and, you know, blood coming out. And then they'll faint. So that person has no issues in terms of volume loss cause they've already fainted before they even start the whole process. And there are others who, especially the other factor that's really large is size. So if you're a small person, then we are taking a larger percentage of the blood from you. So we ask for our donors to be at least 110 pounds with 110 pound person when we re remove a pint is essentially what we do or the volume that we remove. It's less than 15% of your total blood volume. And so we've seen that that's the, that's the level that FDA is like, Hey, that you probably shouldn't take more than that. And so we, we set our rules about what blood we take and, and based and who can qualify based on kind of those recommendations. So we never want to remove at any one time more than 15% of your blood volume. That's why some people, when they donate platelets, although they get fluids back, they don't want at any one time for there to be a certain volume that's removed from your body. So these things are all kind of algorithms that we work on. But yes smaller donors are more likely to have a faint reaction. Younger donors are more likely to have a faint reaction. Even in those cases, you know we, we, we think it's in general safe, but it, it is true. Some people will have a, a faint,

Cara Nicolas (08:11):

I think something that is, you know, worth noting, and I tell people this on social media a lot, you know, if someone, if they're new to this and they wanna prepare, a lot of it is preparation. So I've seen definitely true that younger donors seem to have the faint reaction more often. But it's also, you know, high school students and college students who aren't eating breakfast, they're not, you know, drinking fluids ahead of time. You know last year I had, I helped a girl at a college drive and, you know, she was starting to feel faint and I was like, okay, well when did you last eat? She said, I had a granola bar six hours ago. And I'm like, maybe next time you eat a big meal, <laugh> drink plenty of fluids, you know, make sure that you're, you're feeling ready. So a lot of it's, it's preparation, just making sure you're doing all of those things to make sure that you're, you're gonna have a successful donation.

Dr. Oh (09:01):

Yeah. For a while, we're actually asking donors to quick chug a, a glass of water. You know, after they've been screened before they donate the studies, there's have been some studies related to that. I think the findings are, you know, not clear cut. When I look at it one way or the other. But it's, if you are worried about it, especially, you know, having an extra glass of water before you, you donate and then after you donate, you make sure you really hydrate well before you, you leave and take that 15 minutes in our canteen area, have another granola bar, <laugh> that's the one time when you're encouraged to have salty snacks and Yeah. You know and, and really drink some, some fluids mm-hmm. So I, I, I strongly recommend that.

Alecia Lipton (09:43):

Yeah. A lot of times when you're going to the doctor and you're having blood work done, the doctor says, well, we want you to do this fasting. That is not the case with donating blood and when we say eat before you come in again, we want you to eat a healthy meal. Yes. And something more than a granola and a triple shot of cappuccino.

Dr. Oh (10:03):

Yeah. and the other thing is, you know, don't go to the all you can eat lunch buffet, <laugh>, you know, and really load up on the fatty foods. It's, it's kind of disconcerting, but sometimes when people have had a really fatty meal, you actually can see the fat in the products that we collect. Yeah. So so yeah, don't, and then all the, actually, there's, there's some consideration for if you have a huge meal, you know, all your blood goes to your gut and so you actually some people think you, you may actually set yourself up for a visible direction if you, if you totally gorge yourself before you donate as well.

Cara Nicolas (10:40):

Interesting. Yeah. Yeah. One of my phlebotomists told me that a great meal to prepare yourself for blood donation is the peanut butter and jelly sandwich because the protein and the peanut butter and, you know, you're getting a little bit of the sugar in there as well, but like, nothing too crazy. But she was like, I always just tell people, have a peanut butter sandwich before you come in.

Alecia Lipton (10:55):

That's great.

Cara Nicolas (10:56):

I know, that's great. And I, that works for, cause I love peanut butter.

Alecia Lipton (10:59):

<Laugh>. Yeah. one of the things that we see a lot and Cara and I answered this question, somebody may have been deferred four years ago, so then they get in their mind, oh, I can't donate because my iron was low four years ago. Or, I took a specific medication four years ago. Dr. Oh, can you talk a little bit about how just because you were deferred once doesn't mean you're deferred forever?

Dr. Oh (11:23):

Yeah. So that's definitely true. When you, when you look at males who donate versus females who donate, those are actually two really separate kind of groups. And we require for males who donate for their hemoglobin to be 13.0. And the normal range for males in general is actually 13.5 up to, you know, a higher number 16.5 or 1718. And so so if it's unusual for us actually to have many men who are, are low in terms of their hemoglobin if they are, you know, we really encourage them to have iron. Oftentimes, you know, we do remove iron when people donate. And so some people say that, oh, your iron is low. Right? So I don't like that cause that's a little loose in terms of the terminology. It, we measure hemoglobin and we measure hematocrit. So hemoglobin is the level of the protein that carries the oxygen. And that hematocrit is the percentage of a red cells in your blood. There's a conversion factor between those two, which is you multiply the hemoglobin by three and you get the hematocrit. It's kind of weird, but it works out. And so then, you know, we have those limits in terms of what you can donate with. So for for men it's more unusual for them to have low hema hemoglobin or hematocrit. We would recommend for them to, to take iron supplements and if it doesn't correct them to see their physician. For women, the the minimum value is 12.5 grams of he hemoglobin. And the normal range for women actually goes down to 12. And in some demographic groups it goes even lower. So African American women actually have, are often at a lower hemoglobin level than Caucasian women. And so it's not necessarily an indication of anemia in women when they come to donate, donate when we tell them, Hey, you don't qualify to donate today. Their normal range for some women may always be less than 12 and they just will then not be great blood donors as we go forward. But but that does not signal automatically anemia in in, in women, women. The other thing i, I do wanna imagine is the techniques that we use to do the hemoglobin hematocrit are a little crude. We don't want to stick you in the, in the, where we're gonna take the, the, the donation and then test you with these analyzers that we would typically use when you go to see your doctor or if you're in the hospital and they're gonna check your hemoglobin hematocrit and you do a cbc. For us, we do a finger stick. We're discussing using a a a a a different technology, which may not require a finger stick in the future, but that that's to come. Not so please don't expect that if we come tomorrow. But but with those techniques they, they're not as accurate. So I, I really try to tell people, you know, this could be error as well. Oftentimes we ask people then to wait a certain period of time if they do not qualify. And part of that is, you know, if you truly are low with your hemoglobin, you really don't expect that to correct by the next day. You know. But over time, especially if if, if there is iron associated with that that will change. So we give a, I think a couple week.

Cara Nicolas (14:41):

I think we're at two weeks,

Dr. Oh (14:42):

That's at two weeks where we try not to call you to come back in again if you failed for the hemoglobin nomatic. Right.

Alecia Lipton (14:50):

We also get some rather bizarre request at times <laugh>. So I think we can have a little bit of fun with that <laugh>. One of my favorites we got a phone call one day and somebody wanted to find out if it was true that we gave our expired blood. So blood that's passed its shelf date to the zoo for the bats.

Dr. Oh (15:12):

Oh my goodness.

Alecia Lipton (15:14):

Yeah. I feel very confident in saying we do not do that. So I hope.

Dr. Oh (15:19):

I don't know of that if, if that is happening, I'm totally unaware of it.

Alecia Lipton (15:23):

<Laugh>. Right. So I, I did a little bit of research because that was intriguing to me. So I talked to a friend at the zoo and they explained that no, they do not get blood from Howorth, so that's good. But that years ago when Cincinnati was pork opolis, the large pork producing.

Dr. Oh (15:41):

Yes. Yes.

Alecia Lipton (15:42):

That we had lots of slaughterhouses and that the zoo would purchase blood from the slaughterhouses to mix in with different foods, probably for the bats and maybe other animals as well. So that's kind of how that myth probably got started.

Dr. Oh (15:58):

So I've heard one similar for people wanting blood for their rose gardens. Oh. That, that's supposed to be helpful for the roses. Yeah. And so I bet the same source would come from animal resources.

Cara Nicolas (16:09):

Fascinating. Yeah. Yeah. No, we don't do that. I'm pretty sure any blood, well we don't expire a lot of blood in the first place. Yes. Yes. I think that's important to note. Yeah. You know, most of the blood that we collect is used. Right. but if anything is goes, if it expires, pretty sure we just incinerate it. Right. Yeah. Cause it's like a biologic.

Dr. Oh (16:28):

Yeah. Yeah. We have a, a whole disposal process and so it goes to a biological waste and then it's taken care of.

Cara Nicolas (16:33):

Yeah. Sorry to all of our fans, you cannot purchase expired blood. Yeah. But we had a great request from a guy who wanted to purchase blood to throw on his audience members at a metal show.

Dr. Oh (16:47):

Oh my goodness.

Cara Nicolas (16:48):

Because, I mean, give to admit, it's pretty metal,

Alecia Lipton (16:51):

Right? Yeah. Very metal. Again, we do not sell blood to

Cara Nicolas (16:56):

To random people <laugh>.

Alecia Lipton (16:59):

I did share with him a recipe of carro syrup and food coloring that he could use. But Dr. Oh maybe you could talk about how we are FDA regulated.

Dr. Oh (17:10):

Yes. So blood collection and distribution is a highly regulated activity. And so we are inspected by FDA regularly and they kind of follow kind of what we do with our products. I, I will say that there are you know, uses for blood that is not transfused. It's a very small percentage of what we do, but we have researchers that go on research that goes on all the time. And so occasionally we will use units for that process if it's a research that's, you know, gonna help advance science. I think the other thing I I would like to, to discuss is that your blood type does matter. You know, in terms of what products you donate. So, you know, o red cells that we collect you know, I can almost guarantee you that those, you know, will be used and not get, you know, not not expire on the shelf. Ab red cells may expire, you know, but when you donate a whole blood donation of ab, that plasma is extremely valuable for us. cause the AB then if, if you think about the percentages of people, you know, the only people that could receive ab red cells are other AB patients. But the plasma can go to anybody. And so that's extremely valuable for us.

Cara Nicolas (18:28):

Interesting. Yeah, no we get a lot of questions about blood types and, you know, what's most valuable and people wondering, you know, I'm type A negative. Yeah. Is that needed? I always say regardless of your blood type, there's something that you can do. Obviously if you're type O or type B I think we, we want those red cells as type A positive. I believe I make an ideal platelet donor. Correct.

Dr. Oh (18:52):

That that's absolutely correct.

Cara Nicolas (18:53):

Yeah. So I know we say A's and abs do platelets or if you're ab do plasma

Dr. Oh (19:00):

Platelets as well for ab.

Cara Nicolas (19:01):

Yeah. Yeah. So I mean, no matter what your blood type is, there's something that you can do at Hoxworth.

Dr. Oh (19:07):

So that's usually what I go by. B's can kind of do anything O's we really value the red cells the plasma is helpful as well, but it's really that oh, red cell, that's, we're always, you know, asking people to donate. And then for platelets, really any blood type can work for platelets. Interesting. But especially abs and so we we really preferentially actually send our ab platelets to children's hospital. Because the plasma that accompanies the platelets does not have anti-a or anti-b antibodies, so they can kind of go to anybody. And so it really is helpful especially for very small recipients to receive in terms of volume to receive the ab platelets. And so we, yeah, we're always trying to steer for sure, donors that are ab to either plasma or platelets a's can actually go either way as well too.

Cara Nicolas (20:03):

Okay. Interesting.

Alecia Lipton (20:04):

Yeah, for our donors, I think that's a very important point for them to be aware of because for example, you might have an appointment to donate whole blood, and then when you come into the donor center, the staff may ask you, do you have more time today? Can you do a red cell donation or can you do a platelet donation? And typically that's because we know of a need.

Dr. Oh (20:24):

Yep.

Alecia Lipton (20:25):

Your blood type is special for that specific need.

Dr. Oh (20:27):

Yeah. The first time people come in to donate, we, we don't know what their blood type is. We'll probably collect whole blood from them. And then after that the next time they come in, we'll have that blood type on record. So if you are asked, Hey, you would be a great platelet donor or plasma donor we will try to encourage them to do that because really again, for the ab red cells, those are actually difficult or are, are used less frequently, but the plasma is just gold for us. And I know Michael Whiting, who's our, our recruiter who we did a previous podcast with, has been trying to call those liquid liquid gold as we weekend go forward <laugh>. So especially the ab platelet donors.

Alecia Lipton (21:09):

Yeah. For those people who have donated blood before, they know that their blood goes into a bag and then that is taken up to our laboratories where they're tested and separated into different components. And if you have not been up into that area, it kind of looks like UDF <laugh>. We have big coolers and instead of juices and sodas and ice cream, we have all different kinds of blood types. Cara, I know that you've gotten a question about how we store the blood, if you would like to share that with us.

Cara Nicolas (21:42):

Oh, no. Yes. So full disclosure, we do have all the blood typed labeled, you know, it's all above board. It meets all FDA requirements. We did get a call from a very concerned citizen that we just have <laugh> four big barrels and we just throw all of the blood.

Dr. Oh (22:06):

Oh no, no.

Cara Nicolas (22:07):

These barrels. So if you're type A, your blood goes into the a barrel and if your type, oh, your blood goes into the O barrel, and then I guess they just like assumed that we like, like laed it out or siphoned it out somehow. That is not how we do it at Hoxworth.

Dr. Oh (22:22):

Yeah, that's a great question. I, I guess I never thought about that. So when you donate, you know, your, your, your product, like I said, we're highly regulated and you can we actually consider blood to be a drug. You know, and, and that's kind of part of the regulations that we function under. And so when you make a drug lot, you know, of, of, of I was gonna say Viagra, but whatever medication it is, <laugh> that is kind of large scale manufacturing. And so you have a lot of, you know of all this, these pills that are made at the same time for blood. Our lot size is essentially one unit, right? So it, it's, you donate as a donor that goes into a bag. We separate oftentimes the red cells in the plasma, and then we can transfuse the red cells and we can transfuse the plasma. Those get labeled with the same donor number, which the hospitals have no idea who that donor is. But it's a number that's unique to that lot of one product. And then those get transfused kind of on a one-to-one basis from the donor to the recipient. So I think oftentimes we give our donors an email that say, Hey, your blood was, you know, transfused or was, you know, used over at one of our hospitals. That's kind of how we track that. They do not get mixed together. They do not get, you know, and pooled and stuff. But I, I actually could see, you know, somebody thinking that that would be happening. So,

Cara Nicolas (23:47):

I mean, I could see that maybe they thought, you know, cause I know back in the day we used to do AcuDose platelets Where you could do com combined, you know, platelets from different donations. Yes. We don't do those anymore. I don't believe

Dr. Oh (23:58):

We don't do those anymore.

Cara Nicolas (24:00):

Yes. It's just apheresis.

Dr. Oh (24:01):

So those would be pooled. Occasionally we'll do that with cryo globulin. Not occasionally, but we do create pools of cryo globulin. Okay. Which is a derivative from the individual plasma getting into a lot of detail here. But if somebody donates a red cell in a plasma, we'll, we can freeze the plasma and then we actually do an additional process where we'll thaw it at one to six degrees, and then we'll be left with a little bit of solid what we call cry cryoprecipitate. That doesn't completely thaw, we'll express off the plasma. That will be cryo pore plasmas, and then the remaining solid will be cryoprecipitate from one unit. And then we'll pool those together in four or five, six units so that they can have a larger dose. And they're usually administered in a pool of five.

Cara Nicolas (24:44):

Yeah. So the pooling can happen, but we, we don't just have big old barrels <laugh>. So I think that's really important for our listeners to understand <laugh>.

Dr. Oh (24:54):

Yeah, for sure. For sure. For sure.

Alecia Lipton (24:55):

Right now we're coming off of you know, the height of the pandemic and delta variant is kicking back up. So we're getting a lot of questions about the vaccine. We're also getting ready to go into flu season, so a lot of times people will also ask about the flu vaccine. Yeah. So Dr. Oh, can people donate blood if they receive the flu vaccine and or the COVID 19 vaccine?

Dr. Oh (25:19):

Definitely. Definitely. So we will often ask our, we, I think every time we ask our donors, Hey, have you been vaccin or have you received a shot in the last, I think eight weeks, I think maybe four weeks. I, I'm sorry,

Cara Nicolas (25:32):

I think it might be eight weeks.

Dr. Oh (25:33):

Yeah. So and, and so if somebody receives a live vaccine, then we actually usually ask them to wait depending on what the vaccine is between two and four weeks. Because it, it's live, it's attenuated. But you know, we're a little bit more concerned about that because people who receive blood are often very immunocompromised. Right. And so we don't want any risk of you know, something bad happening to them. Most of the vaccines that we're receiving nowadays are killed vaccines or recombinant vaccines. So there's absolutely no risk to the recipient in terms of, you know, getting whatever you're getting vaccinated to. So we'll often ask them not to donate on the same morning, you know, that they just got vaccinated, maybe wait a day. But essentially those vaccines are fine. There have been no, you know, negative transfusion reactions that occur in terms of getting blood just because somebody was vaccinated recently, beforehand. I know that some people, especially with COVID 19 there's a lot of bad science sites out there. And there was concern or is concerned among some people about people who have been vaccinated against Covid 19. That is just not something that is a concern. There are other concerns in terms of getting blood products, but that shouldn't be one of them. Some of the people who have actually looked at donors large scale have identified that probably 60, 70% of the donors are vaccinated at this time. And if you look at both, either vaccinated or people who have probably been infected so they've formed antibodies on their own. So if you just look for the presence of antibodies, there's some researchers who feel like it's 90% of the blood out there either somebody who's been vaccinated or they've or they've had covid in the past and there should, there's no there's no negative adverse reactions that have been associated with that. In fact, that's essentially what we were giving for convalescent plasma which was people who were infected with Covid 19, and then we collected their plasma and distributed as convos and plasma. And that was it's controversial a little bit in terms of what the actual results are but thought to be helpful for a certain small subsection of people with Covid 19.

Alecia Lipton (27:52):

You brought up an important point. You said there's a lot of bad scientific sites out there right now news on the internet. And I think that's true with anything, anything that you're looking up. There's always sites that aren't necessarily factual. If any of the listeners have questions about blood banking or about transfusion medicine, what would be some sites that you as the chief medical officer would feel comfortable telling them to look at?

Dr. Oh (28:23):

Well, of course there's our website, right. Which made we feel very confident in terms of the materials that are produced there. I'm not the only physician on staff. Actually the director of the Blood Center is a very renowned md, PhD who has done a lot of research and publications related to blood. One of my favorite sites is the Blood Bank guy. And so if you Google that this is a somebody I've worked with in the past who's just fabulous and really dedicated to teaching. So with this podcast, we've been trying to concentrate on talking about blood donation more. And Joe Chapin's site. The Blood Bank Guy is really a lot about the transfusion side and and uses of blood and indications for blood use. So it's a little bit more scientific, but in terms of the transfusion side of things. But it's a great resource and I always steer people there first. He's a legitimate guy that I know. But in all, you know, you can look for peer reviewed journals. New England Journal of Medicine is a great source. Transfusion is really the industry journal that we use a lot. And so our industry major organization is called A A B B and they hold an annual meeting every year, which a lot of us attend to, to get education. We're actually doing a session this year, Alecia, you and I?

Alecia Lipton (29:52):

Yes.

Dr. Oh (29:52):

And so we're excited about that. But that's a, a great source too. So the journal transfusion,

Cara Nicolas (29:57):

I also just tell people if they have any questions, they can always message us on social media. So if they wanna know about vaccines, if they wanna know if they take a medication, if they are just concerned about, you know, what to expect, they can always message us on Facebook. Let, they're gonna be talking to me. I'm not a doctor, but I do have a lot of knowledge after working here for five years. And if I don't know the answer, I have a wealth of resources at my disposal. I have Dr. Oh, I have Dr. Cancelas, I have all of our, our forms and SOPs and resources. So even if I don't know it offhand, I can definitely find the answer for them. So, you know, anyone has any questions, they're curious, they're concerned or they're just, you know, they, they're fascinated by the field of blood banking. I always encourage people to send us a message.

Alecia Lipton (30:49):

That's great, Cara. They can also always give us a call at (513) 451-0910. They can visit us@Hoxworth.org. They can go on to Twitter, they can go on to Facebook. Hoxworth is the steward of the local blood supply. We're the only supplier to over 30 tri-state hospitals. So not only when you're donating blood with Hoxworth are you saving lives close to home, but you can also get your answers close to home. You can give us a call. Cara, thanks for joining us today. This was a lot of fun. I hope you will come back and be on the podcast with us.

Cara Nicolas (31:23):

Oh, absolutely. This is so fun. I could talk about this stuff for hours. <Laugh>

Alecia Lipton (31:27):

Great. You have been listening to In the Know with Dr. Oh, brought to you by Hoxworth Blood Center.

 

Alecia Lipton (00:11):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center in the studio today we have of course, Dr. Oh, and then we're also joined by Jenny O'Connor. Jenny is the Assistant director of Laboratories at Hoxworth Blood Center. Welcome, Jenny.

Jenny O'Connor (00:27):

Thank you, Alecia.

Alecia Lipton (00:28):

We're thrilled to have you here today. And the focus of today's conversation is to first talk a little bit about you. Tell us a little bit about your background, where you came from, and why you decided to come to Hoxworth.

Jenny O'Connor (00:41):

Well, I initially, I'm native of Illinois, grew up there. And then when I went to college, I decided to go to Marquette University, which is right over the border in Milwaukee. And I kind of fell into this career in all honesty. So I was originally pre-med, was on the pre-med track, and I was actually a biomedical sciences major. And the first week, even before we began classes, we went to this introductory session and my dad went to parent sessions and I went to different sessions and he comes back to me afterwards and he goes, what are you gonna do if you don't go to med school? And I'm like, I don't know. He goes, what do you think about this major? They were talking about how it's great for pre-med and it has a good fallback career. And I was like, okay, sure. Why not? I'm 18 <laugh>, I, I don't have much direction at this point. So I went ahead and did it and was still going pre-med route. And then my junior year of college, I was like, I don't wanna be a doctor. Kind of had that realization and I was like, I just don't wanna do it. I actually love the path that I'm on. So I, like I said, I fell into it and it was funny because my first class that I was doing blood banking, my sister was actually pregnant and she had a child that had blood banking issues. So it really connected it to my personal life and I've really loved blood banking ever since.

Alecia Lipton (02:05):

That's great. I think you bring up a really great point in that you know, a lot of people who are strong in sciences are strong in stem, they like biology. They think that the only thing that they can do is be a physician. So you bring up a really great point that there are other majors, there are other jobs out there than just becoming a primary care physician.

Jenny O'Connor (02:25):

Right. And I think a lot of the people that I've talked to, that I've met in this career, most of them have fallen into the career because they find it at college. It's not something that's talked about during high school or anything like that. So I really do think that it needs to be promoted more. It is an awesome career for people who love laboratory sciences in the biological sciences.

Dr. Oh (02:47):

So Jenny, could you talk a little bit more about specifics in terms of your training going beyond that, even.

Jenny O'Connor (02:54):

My undergrad degree is in medical laboratory sciences. I was a part of a program that is actually a three plus one program. So that means that you have three years of your undergrad training and then you actually go into a laboratory for that last year. They have other programs that are four plus one, so you do the full undergrad and then another year. But mine was a three plus one and that last year I actually spent at a VA medical center and that was a really awesome experience to be able to work with the vets and be able to help our country in that way. During my undergrad my main mentor I guess you could call him, was one of our teachers for bloord banking. And so he was one of my teachers. And then my other teacher for my blood banking was Sue Johnson. And she is incredible when it comes to blood banking. She's known worldwide for blood banking. So just having that kind of passion delivered to me in the classroom really kind of upped my passion itself. So after I graduated my first mentor, he offered me a job immediately in his blood bank as he called it. So right out of school I did mostly blood banking, a little bit of hematology and then coagulation. But my true passion was the blood banking. So not two years outta school I decided that I wanted to specialize in blood banking. So there's a few programs across the country and one of the best ones in the country is right in Milwaukee and it's at the Blood Center of Wisconsin. And so I decided to apply for it and I was told by many people, there's no way you're gonna get in, you don't have enough experience. And so I was like, you know what, I'm gonna just give it a shot. If I don't get it in first year, I'll try to go next year. And I just happened to, you know, I was interviewing with Sue Johnson who had taught my undergrad, she loved my GPA from my undergrad and she's like, you're in. And so it just went from there. Got my S B B, which is a specialist in blood banking certification.

Dr. Oh (04:56):

Tell us a little bit about that training. How long is it and Yes, intensive and what types of things did you do during that time period?

Jenny O'Connor (05:03):

So the S B B itself is a two-year program. It has weekly four hour lectures, and then there's extensive in-person laboratory experience that comes with it too. And not actually not only a laboratory experience, but blood center experience. So basically do a rotation in every single department in the blood center from recruitment to marketing to hr, all the way up to the Immunohematology reference lab and blood center of Wisconsin being a very large institution. They also have transplant immunology, they have coagulation laboratories that are specialty laboratories. So I got the opportunity to do all kinds of rotations through those different laboratories. And depending on the laboratory, you had to do different periods of time in there. So the immunohematology reference lab was about two and a a half months of training that I did through there. So very extensive program.

Dr. Oh (06:03):

And then you were able to sit for the exam. Right. Can you tell us a little bit about the S B B exam?

Jenny O'Connor (06:07):

The S B B exam is extremely intimidating.

Dr. Oh (06:12):

The worst, the worst of the world, I think <laugh>.

Jenny O'Connor (06:14):

So I had done the MLS certification, which is a medical laboratory science certification right out out of college. And that's what qualified me to work in the lab, in the hospital. So I had kind of had experience with that, but the S B B was a whole other level. So the training that you do over those two years, it's all accumulates into this one exam that they ask you very obscure questions and actually the better you do on it, the harder it gets. So you're sitting there going, oh my God, I don't know the answer to this question. And your instructors have told you that means you're doing really well <laugh>. But that exam, it's about two hour exam and only about 60% of individuals pass it on their first attempt.

Dr. Oh (07:03):

I think the qualifications required to sit for the S B B exam have changed over the years, and so it's a little easier for people, I think, to sit today than it used to be where you would have to go through a formal program like you described. But the pass rates are still just very rough. So people who who pass and have SBB after their names, I have a lot of respect for because that truly required dedication and additional training and it, it's a tough specialty and they make it so it's not an easy thing to have. So again, for the listeners out there, when you see somebody who has an SBB, that really for me is one of the top qualifiers, you know, in terms of their, their their knowledge and ability.

Alecia Lipton (07:46):

Well, Hoxworth is definitely very lucky to have you on our team with having the S B B with it being such a difficult program and a difficult track. A lot of blood centers around the country aren't fortunate enough to have folks like that on their staff. So thank you <laugh> for choosing Hoxworth. What interested you most in Hoxworth when you were looking at making a change?

Jenny O'Connor (08:10):

I had been working as a laboratory manager at a large level two trauma hospital. So I had a lot of direct reports and I had kind of drifted away from the actual laboratory science. I was basically in hr, I was dealing with a lot of personnel issues and it just wasn't what my passion was and I knew that. So I was looking to get back into the actual science and get back to the blood banking and testing and tube shaking and all those kind of things that we really like as scientists. Hoxworth intrigued me because they do have a AABB accredited immunohematology reference lab, which just by having that accreditation, you know, that they have a dedication to that field. And I had heard a lot of great things about Hoxworth from my mentor Sue Johnson and about Dr. Oh actually from her as well.

Dr. Oh (09:09):

Oh my goodness.So I, I love Sue Johnson, right. So I, I did, I did my fellowship training at blood Central Wisconsin as well 20 years ago. And Sue Sue's just been phenomenal. And so we had this opening, we wanted to hire somebody to really take care of the I R L and the way that I described it was we needed our own Sue Johnson. And so I contacted Sue Johnson and I said, who do you recommend anybody for us? We're really looking for somebody and you were the top person that she named. And so we feel so fortunate to have you come and really have a focus on education. And I think that it's so true. Your previous position as I understand it, was really got removed from the blood bank side and the transfusion service side and just the getting into these cases that are so complex. And I think that you're coming back and having that passion and then working with a great crew that we have here as well. And maybe we'll talk about our crew as well. It's such a great team and it's such a, a strength for the blood center for us.

Jenny O'Connor (10:12):

Yeah, I definitely agree. We have a fantastic team in the I R L. We are a small team. There's only six bench tucks and one manager that report up to me from the I R L, but everybody in there has a passion for blood making. A lot of them have a lot of years of experience under their belt. So they're constantly even teaching me stuff despite going through an SBB program that I didn't necessarily know before. So that they're a fantastic team.

Dr. Oh (10:37):

So we get to see cases from all the different hospital systems in Cincinnati. So we provide blood to what, 30, 31 hospitals

Alecia Lipton (10:46):

Right now, 31 hospitals.

Dr. Oh (10:47):

And in like 19 counties I believe and and so almost all of those, I think every single one of those hospitals sends all their tough cases to us as well. So if hospitals can do certain things, and maybe you can talk about this a little bit, hospitals can do certain types of workups and each of the hospitals has kind of a different level of, of amount of work that they can do or types of workups they do. But when they run into trouble or complexity beyond their size, those cases all come to us. And so it's fabulous. I think maybe you talk a little bit about that.

Jenny O'Connor (11:17):

Like you said, the different hospitals, there are different sizes and as a result they have different levels of complexity that they can do with their testing. We have some smaller hospitals that because their blood banks are so small, they have fewer staff members, they don't have the opportunity to do the more complex testing. So we'll do just a simple antibody ID for those patients or for those hospitals even. But we also have our level one trauma centers, which can do very, very extensive testing and it's just when they get to a certain complexity level that it's just not feasible for them to keep that testing on hand. So then we're able to do that testing for them, find the compatible blood for those patients and help them out.

Dr. Oh (11:58):

So many donors have been told that they're o negative, right? And so they're universal donors. So why don't we just give oneg to everybody all the patients that we have trouble with.

Jenny O'Connor (12:10):

So that's a question we get a lot in the blood banking world. But the simple, I guess answer for that is everybody knows their A B O R H type most for the most part, or at least they've heard of it. You know, if you're an Apos, an o neg or whatnot. What most people don't know is there's 50 plus other antigen blood group systems that there's just these proteins on the red cells and any one of those different antigen systems you can form an antibody against and once you form that antibody O neg is not the answer for you necessarily anymore. You have to find blood that's negative for that protein to make sure that it's safe. And if you received a transfusion that had that protein on it, then you would potentially have a transfusion reaction, which is not very good for the patient.

Dr. Oh (12:58):

So it's so interesting when I think of the laboratory even hematology reference laboratory is kind of on the spectrum of like hands-on test tube shaking, like old style science that you might think of from, from long ago. And we still keep many of those techniques. I'll see you guys as I walk by and it's like you're working on sudoko puzzles all day long and I think that that's part of the mindset is real problem solvers and you get a new case and you're excited cause you're like, oh, I don't know which way this is gonna go. And you follow all these algorithms and it's very complex. It takes years of study to be able to do that. And then when we hire a new person training for months and months and months, but then at the same time we're using DNA and we're getting genotypic phenotypes and you know, all of this other high tech information as well and we're using both of those hand in hand. It's just it's a really great feel that I guess I would encourage people interested in stem, especially women, you know, who are interested in stem. This is an area that's just so interesting. I think every day you come into work and it's the same thing that you do, but it's just surprising the results you get each time.

Jenny O'Connor (14:11):

When we get a new case, it's always a different puzzle and there's always different results that we're getting. So it's trial and error. A lot of the times it's, we think we might have this, so we're gonna go down this path and do this extensive testing and then we figure out we were wrong and then we have to reevaluate. And while that is very interesting and fun, it can get frustrating at a certain point it's like, what is going on with this case? But at the end, we know that there's a patient on the other end of that sample and we know, especially when it comes from children's or something like that, it's, it's a child on the other end. So that just gives us even more of a passion to figure out what's going on and be able to find that compatible blood for them. And yeah, we do use the old school gold standard techniques <laugh>, but we are kind of blending it nicely with the newer stuff and it's pretty exciting.

Dr. Oh (15:00):

So when we have a, a transfusion that occurs, we do all this testing beforehand to make sure that it's safe and that involves a crossmatch typically as well. And so when we can't do the crossmatch or the, you know, antibody screen is positive, then we want to do all this additional testing because if we give incompatible red cells, then those red cells can be destroyed and you know, as soon as they're transfused and when they're destroyed in the bloodstream, they can cause serious morbidity and even death. And so that's what we're kind of fighting against. And so we have to do this in a timely manner. Sometimes we know that these workups take

Alecia Lipton (15:35):

Days

Dr. Oh (15:36):

Sometimes days, sometimes, right? And so we do have to sometimes say, Hey, you have to issue blood on an emergency basis, but without all the testing that we would like to be done we can kind of sometimes steer them towards certain units that are more safe maybe, but it, it is a process and so we have to be as timely as possible with our workups. And so that's part of the challenge as well as we're trying to provide this so that patients can get blood that's as safe as possible for them.

Jenny O'Connor (16:03):

Right. The stat workups are the ones that stress you out the most because you know that there's a reason why it's stat and that that patient really needs blood right away. And you really don't wanna have to go down the route of uncrossmatched. But sometimes unfortunately, with how long testing can take it, it's necessary. And that scares us even in the blood bank, let alone on the other side of where the patient actually is getting transfused. So.

Alecia Lipton (16:26):

I know a lot of your patients that you work with are getting frequent transfusions or our sickle cell patients or patients with beta thalassemia that are coming in, you know, maybe on a monthly basis or several times in the course of the year. So these people aren't just getting one or two units, you're having to find 14 units for them or 20 units for them. What is your day like when you know that you have those individuals?

Jenny O'Connor (16:51):

So every morning the I R L gets a list of all the donors that were collected the previous day that have typings performed on them. And our techs actually look through every single one of those donors and decide do we wanna keep it in our, what we call our rare inventory or do we wanna release it a general inventory? And I know the individuals that work in product management who are over the general inventory, they think we hoard blood, but we're doing it for a good reason, <laugh>. But what we do is we look through those labels and we know the patients that we get on a routine basis, we know their phenotypes, our techs could recite them by heart. So they're looking through those units trying to find ones that specifically match those patients and we will pull 'em aside and put 'em on a separate shelf specifically for that patient. And that way when that patient does come in every month and need 14 to 18 units, we have that set aside because some of those units are so rare that it's only about 5% of the population, 2% of the population. So it's very difficult to get up to 18 units for that patient. But we're able to do it because we're diligent about looking at our donors every single day and picking out those that match.

Dr. Oh (18:04):

So one of the things just to add on, so the sickle cell patients oftentimes have to have red cell exchanges. And so this is a process where we have special devices which can withdraw red cells from the patients at the same time that we transfuse volunteer blood donations as well. And we want to, for sickle cell patients, particularly try to phenotype match for RH HK and sometimes other blood groups, to prevent them from forming antibodies and being sensitized to those red cell types so they can't receive those units in the future. So it's a big enterprise for us to be able to have this blood ready for them and 10 units at a time, 15 units at a time sometimes for when they come in. So we have to keep in close contact with our therapeutic ahe ESIS team, which actually performs those processes as another unit in the blood center and and the hospitals and their clinic appointments and when they're gonna see certain people so that we can have that blood already set aside and available for them. And it's a, it's a big undertaking cause that blood sometimes as you have have said, is difficult to find and match.

Jenny O'Connor (19:13):

So with all of our sickle cell patients we're matching extensively for them. So we do need that rare blood. So we are sending about 93 donors per week that haven't been previously typed for genotyping, where it does a whole array of DNA analysis to determine their common red cell antigens and what, what they have on their cells. And that way the next time that donor comes in, we have a better idea of what they are and who they might possibly match. And really with these sickle cell patients, it's really our great relationships with our hospitals that allow us to have these units on our shelf ahead of time and know when these patients are coming in. I get monthly emails from the different medical directors at some of these hospitals that have a large sickle cell population and they just tell me, this patient's coming in on this date, they have a calendar made up basically. So I know exactly when these patients are coming in and I communicate that to the tech so they know when they need to have that certain amount by.

Dr. Oh (20:15):

Yeah, we know by being aggressive with red cell exchange, especially in the pediatric population, we can head off a lot of really bad things, you know, increased strokes and you know, other, other types of, of reactions that can occur when they have too high of a level of sickle cell hemoglobin. So our processes are all oriented to, to having a better outcome for them.

Alecia Lipton (20:37):

Thank you for joining us today. We hope that you'll come back and join us for a future podcast you've been listening to in the Know with Dr. Oh brought to you by Hoxworth Blood Center.

 

Alecia Lipton (00:11):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. In the studio today we have of course, Dr. Oh, and then we're also joined by Jenny O'Connor. Jenny is the Assistant Director of Laboratories at Hoxworth Blood Center. Welcome, Jenny.

Jenny O'Connor (00:26):

Thank you, Alecia.

Alecia Lipton (00:28):

Dr. Oh, you had mentioned that we work with over 30 hospitals, but you're also working nationally to help find patients in other areas of the country that need a rare donor. Can you talk a little bit about that?

Jenny O'Connor (00:40):

Yeah, so any I R L or IMMUNOHEMATOLOGY reference lab, that is AAB B accredited, participates in the American Rare Donor Program or A R D P. And what that system is, it's basically anytime you find a rare donor, so one of our 93 per week, if it ends up being one in a thousand or less, we submit that donor to this program, A R D P, and they keep track of that donor, then the donor would communicate with them if they move or anything like that, so that then the A R D P can communicate with their new blood center that, hey, you have a new rare donor in your area. But then A R D P also accepts requests. So if you have a rare request, you can put it out there to A R D P and they will help you find a donor that will help fi satisfy that request. So it is extremely rewarding when you're actually able to ship a unit across the US to be able to help another blood center out.

Alecia Lipton (01:38):

What are some of the most fascinating cases that you've worked on through the years that, you know, at the end of the day you can just be like, wow, I, I can't believe we worked on this and that we were able to positively impact that patient's outcome?

Jenny O'Connor (01:56):

I think the, the most amazing case that I've seen in my short time at Hoxworth has been our Bombay patient. So it actually arrived, the sample arrived on this patient just a few months after I had started. And of course I'm brand new and my manager is on vacation, so <laugh>, it's all up to me. But we were working up the case and my tech just happened to mention the reaction she was seeing and mentioned her name and the Bombay phenotype is more common in those of Indian descent. So it sounded somewhat like an Indian name. So I was like, whoa, what do you think about running this cell? Because the hospital had initially thought it was a completely different type of case workup. And so we ran it and it ended up being negative, which indicates that it is a Bombay and this was only within like 10 minutes of receiving the sample. So it was a very quick idea of this antibody and we're all just staring at the case. We're like, what? We were completely in shock, but it ended up, yes, being a Bombay. And what Bombay is, is they lack a certain antigen that pretty much everybody has their red blood cells, it's the H antigen, and with that it's basically like a new A B O type. So it's not a, it's not B it's not, oh, it's Bombay, meaning they can't receive any other blood except Bombay blood. And if they were to receive that, it would be like receiving an O person receiving an A transfusion. It would be that sort of bad transfusion reaction, <laugh>, bad <laugh>. So it was just really exciting that we were able to idea it. We were able to ID it extremely quickly. So in order to find blood for her, we did have to reach out to the A R D P program and we were able to find units for her both frozen and fresh units. So that was really awesome. We have some great ties with other blood centers that really helped us to find those quickly and get them for her.

Dr. Oh (04:00):

We can give Kentucky Blood Center a shout out, I think <laugh>. Yeah, so they, they had a donor who they have identified who is who has in the past donated a lot of blood in the very, very needed across the country, so I was excited to see this case too, cause I hadn't seen one in person either.

Alecia Lipton (04:18):

Yeah. How rare is the Bombay?

Jenny O'Connor (04:20):

About one in 3 million, I believe.

Dr. Oh (04:24):

Yeah. I, you know, the numbers are, I,

Jenny O'Connor (04:26):

It depends on where you are in India. I know it's about one in 8,000, so it's more common out there, but around UK and the United States. I believe it's about one in 3 million. Yeah.

Dr. Oh (04:37):

Bombay is kind of that case. That is just the classic that you always hear about and just very difficult to manage, you know, clinically. So so yeah. So that was, that was something else. I think

Jenny O'Connor (04:50):

It was extremely exciting. I, I told everybody I could <laugh> <laugh> at the blood center that we had that case. And so,

Dr. Oh (04:57):

I think you brought it up at first it was like, oh, this is gonna be a bomb, and we're, you kind of joke about it, right? Yes. What do you kinda, oh, maybe it's a Bombay, you know, and then it's like, oh my goodness, it's a real Bombay.

Jenny O'Connor (05:06):

Yes. So when the tech was working on it, that was the first communication I had with her. I'm like, oh, it's just a Bombay <laugh>. And it was completely off the hand joke and it ended up being that, so,

Alecia Lipton (05:15):

So not only were we able to treat a patient that was Bombay, but we were also able to find those donors that were in the area so that you could meet those needs quickly.

Jenny O'Connor (05:27):

Yes. And actually she's come back since so <laugh> Yeah. Yeah. We've been able to continue being able to support her.

Dr. Oh (05:33):

Yeah. Yeah. It's, it's fabulous. A lot of times it's just having the blood available. Right. It does, doesn't even necessarily get transfused, but that we have it on hand in case it's needed, so.

Jenny O'Connor (05:43):

Right. Exactly. Especially with a Bombay, I mean, because no other blood type is even close to being safe. Yeah. Just having it available in case of need is extremely important.

Dr. Oh (05:53):

Are there any other things that we've done in reference lab since you've gotten here that are, it's kind of interesting.

Jenny O'Connor (06:01):

We have brought up a bunch of different systems that have improved our processes. We have a new billing system. We are moving towards a new blood bank establishment computer system, our new Becks. And yeah, we've definitely made a lot of changes and I think they've improved our processes and made the flow of testing a lot easier for our techs.

Dr. Oh (06:25):

So Jenny, I think since you've gotten here, I think we've tried to emphasize education as kind of one of the things that, that we want to continue to excel in and to kind of do more of. And maybe you could talk a little bit about the Master's program and the role that we're going to play in that starting in January of this year. As well as participation in a b b and submissions that you've had there.

Jenny O'Connor (06:52):

I let Dr. Oh know that I had really do have a passion for education. In addition to my S B B I do have a Master's of Science and Transfusion Medicine with a specialization in education. So it's been something I've been focusing on throughout my career. And so he has given me the opportunity to help out with the master's program. So uc has recently started up a Master's of Science on Clinical Laboratory Science. And so as part of that, they have different tracks that you can go down and the transfusion medicine track is really Hoxworth centric. And so we are creating different courses for that track. And so we have been creating lectures and assignments and it's been really exciting to be able to be part of it.

Dr. Oh (07:37):

Yeah. It's been a lot of work. Right. And so and you know, initially years ago, Hoxworth used to have a master's program and people could sit for SBB after complete this master's program. Unfortunately, that went away before I got here. I think I don't know if it was five or 10 years ago. But we are, we're trying to bring back additional educational opportunities. This master's program track is a really, a laboratory leadership program through Allied Health at, at University of Cincinnati. And we wanted to provide transfusion medicine cell therapy track that we can offer through Hoxworth. People who go through this course probably is not enough alone to pass an SB to be realistic, but we can lay the roadmap for what they need to address and to study and to read more about. And then really if they are in a situation where they're working in a, in a reference laboratory immune hematology reference laboratory, and they have the lab expertise that they would be able to sit for the SB B and this may be able to help them to, to pass. Cause it's, it is such a difficult course, but we're not labeling it or trying to advertise it as an SB B program at this point. And I think that we are continuing to talk, talk internally about, you know maybe eventually working to have our N S B B program again, but that's that's a little bit further in the, in the future.

Alecia Lipton (09:04):

Yeah. Jenny, we're thrilled that you were able to come in and talk with us today. And you know, so many people donate blood to Hoxworth and when you're donating with Hoxworth, you're saving lives close to home and the I R L and your department just enables us to do that even more and help those really difficult cases and those patients in the area that have extreme needs and different needs of blood types. So thank you for what you do and what you bring to the community.

Jenny O'Connor (09:32):

Thank you for having me.

Alecia Lipton (09:33):

You've been listening to In the Know with Dr. Oh, brought to you by Hoxworth Blood Center.

 

Alecia Lipton (00:05):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. I'm Alecia Lipton, and I am here in the studio with Dr. Oh. And we have a special guest today, Dawn Berryman, who lives in Mason, Ohio. And Dawn is a member of our community advisory board and also works for L L S, which is Leukemia and Lymphoma Society.

Dawn Berryman (00:27):

Thanks for having me.

Alecia Lipton (00:28):

We are thrilled that you're here with us. And Hoxworth Blood Center is a not-for-profit organization, so we do have a community advisory board, and that's made up of Dr. I believe we have 20 members on that.

Dr. Oh (00:40):

I think it's 24, I thought.

Alecia Lipton (00:41):

Okay. 24 members varying different backgrounds, organizations that they may belong to or work with. And you've been on our community advisory board for three,

Dawn Berryman (00:52):

Three years now? Yeah.

Alecia Lipton (00:53):

Okay, great. Great. Our community advisory board of course advises us as the name of things that we should be doing for the community, maybe places that we should be holding blood drives, groups that we should be meeting with or educating. Can you tell us a little bit about what you've done on the Community Advisory board thus far?

Dawn Berryman (01:14):

Well, I'm very passionate about blood donations, so I was excited to be asked to be on the board a couple of years ago. And I've really focused where there are kind of some synergies and where when I'm going out to talk to different organizations, whether that's a company or whether that's a school, trying to bring in not just the part that we're looking for them to do for the Leukemia Lymphoma Society, but also talking to them about blood donations and how they as an organization can make a pretty big impact if they were to, you know, be interested in hosting a blood drive of some type. And I know that we've been able to bring a couple of new companies on board in the last couple of years, and we've also had some conversations with some schools that were trying to get back involved as well.

Alecia Lipton (02:00):

We really appreciate that. We were able to bring a brand new bank on because of your relationship with them, and I believe they hosted like three drives at their different locations, which that was phenomenal. Yeah, each drive, I think collected around 50 units, so 150 units, and that goes a long way. And then the high schools, we appreciate your help with that as well. Before Covid, we were probably collecting about 10 to 12% of our blood products from high schools, and that would be either going in and setting up in their gymnasiums or bringing one of our buses. When Covid came, of course, the kids went home. Or they restricted visitors onto campus. So we're just now starting to get back to those high schools.

Dawn Berryman (02:44):

Yeah. Well, we definitely have some work to do there. I did, I was actually excited yesterday I heard that Healthcare Carousel had done a blood drive just maybe last week,

Alecia Lipton (02:54):

Right? Yes.

Dawn Berryman (02:55):

As a result of their kind of fight against cancer and working with the Leukemia Lymphoma Society and Susan g Koman. So I was excited to hear that we finally got them involved and engaged as part of their cancer initiative as well.

Alecia Lipton (03:07):

Yeah. And they had a great turnout. I think they had like 35 individuals donate that day. There were some people who couldn't just because they were needed in other various places of their job, but then they signed up to come donate. The great thing about that is anytime you donate blood, we'll always ask, well, are you donating on behalf of anyone today? So you can donate on behalf of an individual, or you can donate on behalf of your school or your company you work at. So at the end of the year, we can come back and say, oh my gosh, look, we had 500 people donate in the name of Procter and Gamble or 200 people donate in the name of Health Carousel. So that's always something that we ask people when they come in.

Dr. Oh (03:51):

We really appreciate working together with LLS. Especially for us, we're, we're a regional blood center, and so we really have our focus on the Cincinnati Tri-state area. And when we started talking with LLS, it was really interesting how it seemed like our missions really overlapped a lot, including geographically. Yes. So, I don't know if you could talk a little bit about LLS is regional presence here in terms of this chapter, it's been great so that we can work with a, a local chapter instead of having to work at a national level with an organization like this.

Dawn Berryman (04:25):

Absolutely. We are regional as well. Primarily our Cincinnati market is is the tri-state area as well into northern Kentucky, a little bit of south and east Indiana. And, you know, we actually include Dayton as well and go up all the way to Columbus and even further into Kentucky. So it is a perfect mesh as far as our geographic location. But obviously also the patients that we serve are the same patients that you serve. So many blood cancer patients rely on blood transfusions as a part of their treatment. In particular, our leukemia patients require that as part of their treatment just because they need those, those red blood cells, those white blood cells and the platelets as part of their treatment. And then some of the other diseases are lymphomas and are myelomas because of the chemotherapy that they use that suppresses their immune systems and also requires them sometimes to need the blood transfusions as well. And then of course, we have our stem cell transplant patients who receive so much high level chemotherapy prior to their stem cell transplant, that that temporarily also suppresses their blood cells and they're in need as well. So it's just such a perfect fit both geographically and who we're both serving.

Dr. Oh (05:40):

Yeah, it's, it's the vast, vast, vast majority of the patients who are, you know, being helped by LLS really do use blood products and, and they're kind of one of the highest populations that we help to serve. So I know that about the time you started serving on our community advisory board I was able to join the local board for LLS as well. And it's been a great experience for me this past three years and and seeing kind of where we can collaborate and work together and really as two nonprofits try to synergize together and and really serve the community.

Alecia Lipton (06:13):

I know that LLS does several fundraisers through the year, and then that money is used for research for cancer patients, leukemia patients. One of your largest is your light the night walk, and you just had that recently. The first light the night I went to while working at Hoxworth was back in 2008, and it's amazing when I was there this year some of the same families that I met in 2008, you know, are, they're still coming back and they've gone through their regimen of treatment and they're now considered cancer free and they're cured. So getting to see them come back to that event, it just makes your mission and our mission just kind of come together.

Dawn Berryman (06:57):

Absolutely Light the Night is our nationally, our biggest fundraiser for the Leukemia Lymphoma Society, and it really is all about bringing light to the darkness of cancer and really celebrating survivors. And remember those who, who weren't so fortunate to beat their cancer. And so having you guys there is such a perfect opportunity because obviously blood cancer patients and their families know about the importance of blood donations, but maybe not necessarily their friends or their extended family. And so having you guys there to help create that awareness for what you do and to talk about that as well, you know, it's, it's one more voice reminding them how important that was as a part of their own treatment or their friend's treatment. And so it's, it's a great match. And I have to say, this year we put out a survey after the walk and we had lots of positive feedback on Hoxworth being there and the fun socks that you're passing out.

Alecia Lipton (07:53):

Yes. We did light up socks this year.

Dawn Berryman (07:54):

So we had a lot of positive feedback and love having you there because, you know, we both need to increase the awareness for who we are and what we do. And that's a perfect, you know, synergy right there at that event.

Alecia Lipton (08:07):

When did you get involved with LLS? And you know, there's lots of wonderful organizations out there. Was there something that made you decide, LLS that you were like, this is an organization that I need to be part of?

Dawn Berryman (08:19):

Yes. 19 years ago, almost this December, my then three year old was diagnosed with leukemia. And I remember that very first evening, we weren't in the hospital for an hour, and a doctor came to me and asked me to sign a piece of paper saying my daughter needed both a blood, trans blood transfusion and platelets. And, you know, my immediate immediate response was, well, can I donate? Can I give them to her? And, you know, quickly explain, she needs them now. Right. You know, yes, there'll be an opportunity for you to donate in the future, but, you know, we need to find out what her blood type is and, and we need to get this blood products into her. And she, the first week she was in the hospital, probably required four or five blood transfusions and a couple of platelet transfusions. So right away I knew about the importance of blood transfusions and blood donations for cancer patients. But then obviously I got very involved with LLS, just learning about how far the treatment had come. The very first thing the oncologist told us that evening was, you should feel lucky because 25 years ago, this would've been a death sentence. And I didn't feel lucky, I'm not gonna lie. But as time went on and I was able to educate my little myself a little bit about the treatment that my daughter would be receiving and how far it had come, I did realize what he meant. There was a reason to ha to, to be hopeful and to believe that my daughter could win this battle with cancer. And she did. I'm excited to say that she is 22 and she's a student at the University of Cincinnati, and she's doing great. So very fortunate. But, you know, I started volunteering a lot with LLS, and when I had the opportunity to go back to work when my daughter's treatment wasn't quite as intense, I knew that, you know, I wanted to do something that I was passionate about, and LLS had a, a position and I was able to step in.

Alecia Lipton (10:11):

That's great. I think a lot of us that work in any type of healthcare, whatever area we're in, there's that personal connection of somehow we saw the importance, it, it benefited our family in some way.

Dawn Berryman (10:26):

So absolutely.

Alecia Lipton (10:27):

Thank you for sharing that. Yeah. And glad that your daughter's a fellow bearcat.

Dawn Berryman (10:30):

Yes. <laugh>.

Dr. Oh (10:32):

You see, that's fabulous. Yeah. That's, but what, what a, what a touching story that really personalizes this whole process. I know you mentioned research a little bit and I, I, I was surprised as I joined LLS board how much research is being supported through LLS. And even I found out that years ago some of investigators at Hoxworth received funds and helped to develop their research based on LLS funding. So could you talk a little bit about that as a focus for LLS?

Dawn Berryman (11:06):

Yes. Our mission is to find cures for blood cancers and to improve the lives of patients and their families. And, you know, what people might not know about blood cancers is that there's, there's really, we don't know exactly what causes these different types of blood cancers. And because of that, we can't prevent them. And there is no early detection for a blood cancer. You typically don't know you have it until you've been told you have it. And because of that, research is one of the most important things we do. It's finding cures or treatments that will allow people to live with their disease and still have a long, good quality of life.

Dr. Oh (11:40):

Yeah. I think the physician who treated your daughter was absolutely right. Leukemia, for example, is a fantastic area for research and the organized and really focused type of research where people who are diagnosed typically get put into a study of some sort. And the experience of every single person adds to the knowledge that we have. And really the successes, especially with childhood leukemias is, is striking because of the importance of studies and importance of funding research. Another thing that's interesting about leukemia's, lymphomas is that a lot of research is done on them. And because we can look at the cancer cells right in the blood and we're able to access that easily and to look at those cells and try really try to analyze them for other types of cancers that are harder to access, it is harder to learn more about those types of cells. So a lot of the research that's focused with LLS is focused on the blood cancers. But I believe that you've actually changed your logo or your tagline a little bit to say that it is just cancer that you're trying to address versus specifically just blood cancers.

Dawn Berryman (12:48):

Absolutely. you know what, another thing that we're very proud about to be able to share and, and people might not realize, you know, since 2000, 50% of all drug cancers approved by the fda, almost 50%, actually, it's almost, I'm, I'm overselling that a little bit. <Laugh>. It's about 40% of any drug approved by the FDA for cancer was first and foremost approved for a blood cancer. You know, we're just such a small piece of the cancer world, though really, blood cancers only comprise about 10% of all the different types of cancers. So knowing that the fda, 40% of their drugs are first and foremost approved for a blood cancer is huge. And then over 50% of those drugs do go on to be used and tested and treated for all different types of cancers. You know, you can just go through the body, it's sprain, it's breast, it's colon it's bone cancer. And so that's the why we can say we're not just finding cures for blood cancers. We're, you know, we're finding cures for all types of cancers.

Alecia Lipton (13:49):

Dr. Oh could you talk a little bit about the blood and platelets that are used for cancer patients and why it's so important that we have that on the shelf?

Dr. Oh (13:57):

Yeah. So one of the frequent therapies I think we can talk about a little bit is, is actually a stem cell transplant. And for people who, who have stem cell transplants, typically there are drugs administered that help kind of stop production of those blood products that people need. And so we have to supplement while the new marrow or a person's own marrow is re given to them after a pretty intensive chemotherapy, we have to support them through that process when their body isn't creating their own blood product. So, especially with red ceLLS and platelets immediately following a transplant episode. So those patients receive many, many blood products from us, and it's, it's really important for us to, to have those donors come out and provide products and, and help to support really intensive therapies. I think that's one of the reasons I wanted to make sure that we worked with LLS is, is that so many of the patients are affected by blood transfusion or families are affected. And that can help them as they go through walk the night or light the night, excuse me see the booth and be, and think, oh my gosh, we went through that where we needed blood. And I didn't know much about how that happened, and I was just thankful that it was there. Maybe I'll help to organize the drive at with my church or with my work or wherever and try to give back to other families that are kind of going through the same things that we did.

Dawn Berryman (15:24):

We've had several families, I know at Alecia, you've worked with several of our families, obviously patients who've had a successful outcome, but even patients who didn't have quite as successful of an outcome, they, they really want, you know, the passing of their loved one to not be in vain and they wanna keep their memory alive. So I know we've had several or of our families do blood draws and memories of their children. Yeah. And people want to help support families like that. And so it's, it's just such a great platform for them to be able to stand up there and say, here's how you can help support me and my family now is to give back and to donate blood because my child used a lot of blood products in her treatment. And so I just think that's so touching that these families still recognize that and, and wanna be able to give back.

Alecia Lipton (16:10):

Yeah. That is amazing that families will do that. They might start holding those blood drives, you know, early on while the child is getting that product, but then they continue to have it year after year. And even for those children or adults that may have passed away, the one thing the family members always say is, it may not have saved their life, but it gave us one more day or one more year. And I think that's the same with the treatment too. It may not have been, you know, the treatment that gave them 30 more years, but it gave them, you know, another year with family.

Dr. Oh (16:45):

So one of the things we, I, I think we've, I've seen here with Hoxworth is that we, we try not to, when a family is going through an immediate crisis like that to make them feel desperate, you know, in terms of trying to get blood for them. Some, some, sometimes you'll see other blood centers that oftentimes families are so distraught and they're just looking for anything that they can do during this acute period where they know that their loved one needs blood. And right now there's a huge blood shortage across the country. Right. And so anything that, you know, some of these blood centers can do to get people to come in and donate, they're, they're trying cuz that blood is really necessary for everybody. But we, those families are going through so much, you know, at that time. And the last thing that they have to worry about, i i, that I want them to worry about is, oh my gosh, I gotta organize this blood drive myself and line up all these donors, otherwise my child is not gonna get the blood products that they need. Right. So, you know, I always think that our job as a blood center is to make sure that those products are available when they're needed. And then we have to have a communication with our donors and the people who help to organize drives with us so that we, we can in a organized, thoughtful, non panicked process hold drives to be able to help their loved ones. And, and so we have to provide the reassurance that those blood, blood products will be there because other people have put in the time and effort and, and and to, to make sure that those blood drives are being held.

Alecia Lipton (18:07):

And I think when we were tallying up some numbers, it was about this time last year, about 80% of the platelets we collect when those are distributed actually go to cancer patients. Patients that might be at Cincinnati Children's Hospital or Jewish Hospital, St. Elizabeth's Hospital. We have several medical facilities in the area that do extremely good cancer care programs. 80% goes to just cancer patients, which is

Dr. Oh (18:34):

Yeah. Yeah. Oftentimes you think about platelets for urgently bleeding people and you kind of, and you have in your mind this picture of somebody bleeding and needing platelets. But in actuality, you're right, it's people who are undergoing chemotherapy who just have very low platelet counts because they're not producing them. And we give those platelets prophylactically when there isn't major bleeding going on to prevent bleeding episodes from happening. And that's where a large number of our products do go.

Alecia Lipton (19:01):

One thing that I've heard about LLS from the families is what a wonderful support your organization is to them when they're going through learning about the diagnosis, going through the treatment. So you do all this great work with fundraising, but can you tell us a little bit about what you do for these families? These local families?

Dawn Berryman (19:20):

Absolutely. You know, our, our mission is twofold. It's funding research, but it's also improving the quality of life for patients and their families because we realized that as that oncologist told me, we should feel lucky because now people are living longer with these diseases and so we wanna make sure they're having everything they need to be able to live that long good quality of life. So we have a robust kind of patient services side of what we do, and that involves an information resource center where our patients and caregivers and even healthcare providers can call in and ask questions about their disease and get free information, whether it's about their disease, whether it's about clinical trials, whether it's about how to navigate insurance and, and pain for their treatment. And that's, so that's a great resource. It's the first thing we always share with patients and caregivers when they reach out and say, I need help because it's staffed by master level social workers. You know, we have a clinical trial navigator side who does all that for them, and then they really listen to the patient or the caregiver and find out what they need. You know, other things we provide are, we're the largest source of free information for these patients and, and their caregivers. But we also offer financial assistance as well through our urgent need program or through our copay program. Some of these people are on drugs, expensive drugs for a long time. And so, you know, we help cover the cost of those copays for 'em. The one thing we never want to happen is for a patient to say they can't afford to continue treatment, so we need to make sure that they can afford it and then they have access to it. And that's kind of the advocacy side of what we do. We have 50,000 volunteers around the country who advocate for, you know, different to their, with their lawmakers, making sure that there are laws passed that allow medicine to be affordable and to be accessible to everybody who needs it.

Alecia Lipton (21:18):

That's wonderful. And I think having that information available is priceless because when you get a diagnosis of anything, it's scary. And the world we live in today, it's so easy to get information, but that doesn't mean it's the correct information. So you can go on and google something and it might not be correct at all. So that you have those resources to share, I think is huge for the families.

Dr. Oh (21:43):

Yeah. It is such a nice partnership I think that two organizations have, so you can really help us in terms of making sure we have the blood products that are needed for patients who are going through leukemia lymphoma, and we can try to help you with connecting our donors to kind of the mission that you have and, and helping in other ways other than just blood, blood donation and making both, both organizations stronger.

Dawn Berryman (22:09):

Absolutely. And it really is one of the things, you know, in our local market that when, because as I said, the I R C can be caregivers calling in, a lot of times they're really just calling in to find out how can we help this family? And having gone through it personally, it's one of the first things that I make sure they know of Donate blood products, you know? Don't be afraid. Go out and do it. It really is gonna help save a life of somebody. And so making sure they know that from the, from the beginning, that it's a way to support a family is really important.

Alecia Lipton (22:41):

Dawn, I know that with covid, the world changed for a lot of people and how we do business, but I know prior to that, LLS had a program with the schools where you did pennies for pasta or pasta for pennies.

Dawn Berryman (22:53):

Yes.

Alecia Lipton (22:53):

Is that going to be kicking back up again with Covid going away?

Dawn Berryman (22:58):

It's gonna look a little different. The official program Pennies for Patients was retired, and that program is actually rolling into now our light the night, more of our community initiative. So we are inviting the schools and the students to actually come out to our light the night walk if they're able to and be a part of that bigger experience. But we've also developed a virtual program for the schools, so if they want to have some type of a walk at their school in their community, they can do that as well. So, you know, still fundraising for the cause and the mission that mean has come to me, mean a lot to them, but, you know, the execution of it all look just a little bit different as we move forward. But yes, we have definitely been able to talk to some schools. They're excited to get back on board. You, you know, in some schools we're a tradition, they, they do their program every year. They do the same thing. The kids get excited to, you know, learn about it and know that they're helping someone, you know, who's maybe their same age or lives right there in their community. So we're excited that schools are definitely opening back up and more willing to talk and, and listen and, and run their programs again.

Alecia Lipton (24:06):

I know my own children, when they were in elementary school, they had classmates that were fighting leukemia and that was something that they could do as kids to help their friends. And, you know, the schools would have, you know, like a pep rally around it. And so that's exciting to see that they'll still be opportunities for the kids to, you know, show that they care and do that altruistic activity at a young age.

Dawn Berryman (24:32):

Absolutely. Yes. And to realize that pennies make a difference. When you add 'em all together. So we have two different programs in the schools really. We have our pennies for patients, which again, is kind of rolling into late the night. But we also have our Students of the year campaign, and it's in the high school and it's where one to three groups of students work together in kind of a leadership form to raise as much money as they can over a seven week campaign. You know, these one to three students. It's really up to them to kind of pull a committee together of fellow students and adults and put together a plan for how they're gonna raise as much money as they can over that period. We give them sponsorship opportunities so they can go out and they can present to bus local businesses to, to ask for their support. And let me tell you, it's just so impressive what these kids are not afraid to do and ask for, whereas some adults are, they go out there and they put together these immediacy committees and these student teams are raising 50 to $125,000.

Alecia Lipton (25:34):

Oh, wow.

Dr. Oh (25:35):

Amazing.

Dawn Berryman (25:35):

It's, it's amazing. Very impressive. You know, we're asking 'em to commit to 20,000 plus and they're blowing those numbers out of the water and it really is, you know, obviously the parents are a part of it, but we really encourage 'em to let the students run it and it's impressive and it looks great on their resumes for, you know, for school trying to get into college and there's a scholarship attached to it for the winning team as well as just some community pieces if they, if they fill out a little application and write an essay that they can earn as well. So it's a win-win for everybody for sure.

Dr. Oh (26:10):

Alecia, we have programs with our high schools, right. In terms of student leaders.

Alecia Lipton (26:14):

We do.

Dr. Oh (26:14):

Can you talk about that a little bit?

Alecia Lipton (26:14):

We do. And actually we're revising our program this year just because with Covid we weren't having blood drives and going into the high schools, but this year we are changing it up again a bit. And high schools can be awarded grant money at the end of the year and they're not necessarily competing against each other, they're competing against themselves, so to do more blood donations than they did the previous year. So if a school had three drives, if they have just one more, they could earn up to $500 and then the school can use that however they want. It could be used for curriculum, it could be used to pay for a scholarship, it could be used to by equipment. I know one school who does philanthropy projects was then going to take that money and then turn it back over as a donation to a different philanthropy. So it is something that we want to be able, you know, to have that award out there to recognize those groups that are doing really well. Well, Dawn, thank you for joining us today. We'd love to have you back, especially as different programs ramp up with LLS and you can keep us updated on fundraising opportunities and research.

Dawn Berryman (27:29):

Absolutely. Thank you for having me. This is great. You know, we love our partnership with you guys and the synergy is, is pretty amazing and, and excited to not just be able to work at LLS and talk about it to, but to be on the community advisory board of Hoxworth as well.

Alecia Lipton (27:44):

You have been listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center.

 

Alecia Lipton (00:11):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. I'm Alecia Lipton, and with me in the studio today is of course, Dr. Oh.

Dr. Oh (00:19):

Hey Alecia.

New Speaker (00:20):

Hi. And our special guest today is Jackie Marschall. And Jackie is our public relations specialist at Hoxworth.

Jackie Marschall (00:27):

Hello. Thanks for having me, <laugh>.

Alecia Lipton (00:29):

It's great having you here. Jackie. Over the past several weeks, several different podcasts. We've had a lot of different employees in, A lot of those folks have been in our medical fields where they've studied, you know, different levels of biology and science, but that doesn't include you. You went a different route and we thought it would be great to talk to you a little bit today about how you started out and what made you come to Hoxworth.

Jackie Marschall (00:55):

Yeah, absolutely. I stumbled across Hoxworth, kind of randomly in my job hunt for public relations jobs. So I was working in retail previously to this in management and I had to get out. So <laugh> I was, as you can imagine, and not that I like disliked it or anything, but it just wasn't me. I wasn't doing what I loved and I felt that every day. So I told myself, I'm going to hit this job, hunt hard, or I'm gonna go back to school. And I landed at Hoxworth, which gave me the opportunity to do both opportunities that I didn't even know existed. So it was honestly the best thing that could have happened to me at the time, for sure. So since then, it's been an amazing ride. Absolutely.

Alecia Lipton (01:41):

<Laugh>. And were you studying public relations while you were at N K U?

Jackie Marschall (01:44):

Yes. Yes. I got my undergrad in PR at the N K U go Norths for sure. <Laugh>. And I love 'em. I had a great time there. Took me a few years post-grad to find this job. So I was feeling very low, like when I was on the hunt, like, like you can imagine a couple years I've been trying to get jobs, this and that. And of course, you know how the job market is as soon as you graduate, they want five years of experience and well, you know, this isn't the case. I interviewed with the amazing Alecia and Cara who is here a few weeks ago and we just hit off. I feel like we really connected and the rest is history. Yeah. <Laugh>. Well, here we are.

Alecia Lipton (02:20):

Yeah. We love having you with us and we love having you on the team. And from the day that you were hired to what you do now, your role has really kind of morphed a lot based on the skills that you brought to it. It was a new position, so we kind of had that flexibility to do that, but in public relations. So for folks who are listening, I can honestly say with public relations, your day is never normal. You can't look at your calendar and think, okay, Wednesday is going to be this, this, and this, because it can change at the drop of a hat especially in blood banking if we need more blood or if there's a special promotion going on. So can you give us just a little bit about what some of your favorite things are that you're working on?

Jackie Marschall (03:05):

So, like you said, I got to kind of create this position out of the things that I love to do, which is an amazing experience. In itself. I kind of see myself as more of like a community relations type person. I love working with the community and like connecting with people in the community, like from all sorts of backgrounds, from all over the place and just building those connections to kind of relate on how we can build a partnership and donating blood that's unique, not just the same things that we have done over and over again. So that kind of idea kind of came from your ci the Cincinnati Favorites blood drive tour. So I took that idea and was like, what are the things that I love to do? What are the things that people from my generation love to do? And so from that we kind of spawned, we got our brew tour going now. Yes. our minority owned blood drive tour. And then we also have some of the music hall blood drives that we're gonna get into and talk about today that kind of combine community and community outreach and social equity in a way, and connect it to blood donation because it all connects. It really does.

Alecia Lipton (04:10):

Yeah. It really does. Jackie. And I think that you've done a really good job of making blood donation and event, you know, something to come to, not just, I've gotta go donate blood today, but you're making it into something fun and something where people can connect with each other.

Jackie Marschall (04:25):

I really want people to walk away with an experience so that it's not just, Hey, I donated blood and I saved a life today, but like, hey, I came to this event and I donated blood here and I got this, this, and this, and everybody was excited to be there and I also saved three lives today. So like, it's about walking away with something that feels really good and a memory almost

Alecia Lipton (04:45):

And I think that our listeners can tell that, you know, you're a very personal person. You're, you're very outgoing, you're very gregarious, <laugh>. And that's great. And that's also helping out internally at Hoxworth. I know that you're heading up the employee activity committee, which will be planning different employee events. Can you tell us a little bit about not to, you know, give anything away, <laugh>, we don't wanna throw any surprises out there, spoiler alert. But some of the work that you're doing internally.

Jackie Marschall (05:14):

I consider myself a leader no matter where I am in any type of position. So it doesn't really matter if I'm a manager or not. I, I consider myself somebody who can lead from any position. So from that, I want to lead by example. I have a bunch of tattoos and one of the tattoos that I have says, be the change you wanna see. So I have an expectation of the kind of workplace that I want to work at. And if I want to work in that type of place, then I have to represent and be that so people will understand and know what that means. So just doing that and being that kind of cultivated me into this role of being like an employee relations type person, just by chance, I guess, because I love doing it and I love working with our people, but it's, it's also a different kind of thing too, is like when you see our employees light up about what we do, I want everybody to see that. Like I was in the donor center yesterday. One of my friends came to donate and one of our employees there was talking about how she's got to see red blood cells split into like eight different units for a single child. And she should have seen the way that she was lighting up talking about this. And that's just the type of stuff that I want everyone to see and come through. Like, not just me, like of course I'm getting chills talking about it <laugh>, but I want our donors to see how excited we are to do what we do. And that comes with just making sure that this place is a place where people are excited to be and enjoy being and feel supported and respected. And so that's what I try to bring to the table with that.

Alecia Lipton (06:43):

One of the very successful events that you've worked on now has been our arts blood drive. It's been held at music hall, it's gone twice. I believe you're also working on planning a third, and you brought all the arts communities together. So the ballet, the symphony. And it was also unique in that it also brought some community members together and that would be our L B G T community. And the reason that that was important, Hoxworth blood center, like all blood centers are regulated by the fda, and the FDA has certain rules and regulations that we have to follow. And some of those are based on travel restrictions, medications, or even lifestyle restrictions. So for several years since the eighties, there had been a restriction in place about men who've had sex with other men and their deferral from donating blood. And Dr. Oh, could you tell us a little bit about that deferral?

Dr. Oh (07:41):

So this is from my memory. So hopefully I think it jives with reality pretty well. But in the eighties, of course, HIV was top of mind, right? In terms of blood safety, and there was no good test for screening blood donors until 1985. So before the development of that test, once we identified that HIV was an issue related to transfusion recipient adverse reactions, we had to figure out how can we make the blood supply as safe as possible before we had a, a good test available. So the idea was let's identify populations that have the highest prevalence of HIV and have them not donate blood. So since there's no screening mechanism that's possible, we want to ask donors and, and make sure we're collecting from that population of donors that is the safest related to HIV risk. So initially, I don't know if everybody will remember this, I, I've got enough gray hairs, I guess where I, I'm the historian now. But people from Haiti were not allowed to donate because that was one of the regions where we really saw a spike in HIV cases once it was identified as what it is. And then individuals who engage with MSM or men who have sex with other men. And so we started asking all of these really crazy personal questions of people to try to reduce again, the prevalence of HIV in the donor population, which by the mid eighties, we clearly recognized was a, a real public health hazard. So we started asking all these intimate questions and one of the questions related to MSM was, have you had sex with another man even once, since 1977? And so that makes sense when you're in 1983, right? <Laugh>.

Alecia Lipton (09:32):

Right, right. And that was a long time ago.

Dr. Oh (09:35):

But once we set these rules in place, they kind of remain etched in stone, you know? And so essentially 1977, you know, it became not just five years ago, it became 10 years ago, 20 years ago, and you know, until recently, so 30, 40 years, you know, so that just didn't make sense. But once you set a rule in place or a kind of this requirement, it's really hard to then backtrack because you're like, oh no, we're, we're experiencing this level of safety now, and you want to, how can you prove that by removing this question that you're not all of a sudden not gonna increase the hazards that are there. In the meantime, I think one of the biggest things that was developed was an antibody test in 1985 to detect antibody to hiv. And with that test, the risks dropped really dramatically. Another test that was developed in 1989 was the anti hepatitis C virus antibody test. And with those two things, and then in the year 1999, approximately the year 1999, we started doing nucleic acid testing as well. So that actually looks for the DNA or the RNA of hepatitis C as well as hiv. And with those advances, currently the risk for recipient receiving blood is one in 2 million for either hepatitis C or hiv. And I actually think that the risk is actually less than that. But those are the projected risks since 1999 when H C V nucleic acid testing was implemented, I think there have been one case of, of transfusion transmission transmission for hepatitis C and for HIV fewer than 10. So it's, it's just an extremely rare incidence now. And so the question now becomes, gosh, you've got this policy in place, which is really restrictive and really overkill now that we have, you know, all these tests that are available and how do we change the way that our questions are, are structured. So FDA does have a large role in terms of accepting and acceptable donor history questionnaire process. There have been other countries that have actually now looked at asking different questions of people rather than just msm. I think a lot of gay activists have actually felt that the MSM is discriminatory. I actually agreed that <laugh>, if we go back all the way to 1977, that truly it, it seems like that doesn't jive with the current science. Right. A change was made several years ago to decrease that from 1977, even once to 12 months. But for people who are sexually active, right, 12 months versus 1977, it doesn't really matter. It's just a crazy long number. And so changes that are being proposed and actually adopted in Britain or in in the uk at this time are, instead of asking about specifically about MSM activity, you would ask about sexual activity within the last three months as having more than one partner or a new partner in the last three months. And then follow-up questions can be asked at that point to ask about sexual activities that are related to higher risk of TR HIV transmission.

Alecia Lipton (12:44):

And those questions are the same regardless of your gender, correct?

Dr. Oh (12:49):

That is correct.

Alecia Lipton (12:49):

Okay.

Dr. Oh (12:49):

That is correct. So it actually may lead to increased female don't deferrals. It should be a very small percentage, I think. We, we will see that same question has been implemented. I'm not sure when they implemented it, but the data they just presented at the ABB conference, which was held just early in October, showed that there was no increase in risk for transfusion recipients related to HIV risks. The current testing, I should say for HIV just is so great because from the time a person contracts HIV to the time that our tests should turn positive is less than 10 days. So really we're worried about a very small window period at this point with the incredible sensitivity of our tests. The same type of question has been examined in Canada as well, and they have submitted for that change to be accepted. And they are actually expecting that they may be able to change their questionnaire by the end of this calendar year if all goes well. And groups in the United States have looked at this as well. And we are not quite as far as those other countries, but I do think that this is a change that may occur in the next year or two.

Alecia Lipton (14:00):

That's great. It is opening up a window of opportunity for people to donate that have been excluded from that in the past. And that kind of brings us back around to Jackie. So being in public relations office, we're often the office that will get the phone calls when people are asking about a blood drive or they're curious as to who can donate blood. So usually every year we get several individuals who will either call or write us and say that they feel that our practices are discriminatory because of the deferral for men who've had sex with other men. Of course, we explain to them that, you know, it's not a Hoxworth policy, it is an FDA policy, and we have to follow that. We do understand their concerns. And the Alecia, Alecia Lipton <laugh> is thinking, you know, any policy that was established in 1977 should be re-looked at. So, you know, we champion that. I'm along with A B B and the American Red Cross. Those things should be looked at and reviewed. So Jackie, you came up with an idea to kind of bring the community together and celebrate the arts, but also give the L B G T community a place to come in. So can you tell us how that worked?

Jackie Marschall (15:12):

Yeah, absolutely. I wanna backtrack a little bit too. Like when I got hired here, I had no idea about the MSM deferral. It wasn't something that I was aware of. So you and Cara educated me on that. And in my first week I remember getting multiple comments, like negative comments through our feed as we typically did every now and then of people who were upset about the MSM defferal. I didn't really know how to handle it at first. You know, I was a little, I was uneasy cuz I could feel, I could tell people were hurting and people were upset, and I knew that it wasn't us. So I had to like listen and learn a little bit in I was in a community conversation with an LGBTQ group or LGBTQ group here talking about the MSM deferral. And I was listening to the story that someone told about this person who was a uc student and super excited to donate and get the bobblehead that we had. At the time, and this was Preme, this was a while ago, <laugh> <laugh>. But they were talking about their experience and he went in to donate, super excited. Right. Obviously he was unaware of the MSM defferal goes in, fills out the questionnaire, and then once he gets to the point they reject him. And he was talking about how, just like, how that felt. And I don't think people blame Hoxworth, obviously they would, they understand, but I, I just, he was just talking about how I felt and like, just how that practice. It had nothing to do with Hoxworth or anything. It was just about how somebody walked away and how they felt from that interaction. So hearing that and learning that, I'm like, how can we avoid that interaction? Like, it puts ourselves in a weird position. And obviously the donors who walk out thinking that they're going to have this really amazing giving back experience, but we're rejected because of their sexual orientation. So with that in mind, the Music Hall Blood Drive, they came to us with the idea. So the music hall and Cincinnati Symphony Orchestra and the Ballet and Opera and May Festival, and all of them are have a lot of involvement with the LGBTQ community and they were a little hesitant about hosting a blood drive with a lot of the people that are patrons of theirs being excluded from that. So we were like, how can we include and also advocate? So we came up with the idea of, of doing the petition cards, the, we all bleed the same cards. So we not only invited donors to, they have, it has a message on the back that we sent to the fda and you are welcome to write a message or sign your name or just say, Hey, these are outdated, it's time to renew and update these regulations. And people from the streets came in to sign those donors came in to sign staff members were signing them. And from there we kind of like, from the positive feedback that we got just from everybody, we've, I don't think that we received a bit of negative feedback from that, from anyone.

Alecia Lipton (18:11):

No, no.

Jackie Marschall (18:11):

From there we decided to adopt that and put like just different practices to continue that advocacy. We put those cards in all of our donor centers. Now, multiple blood drives, ask for them every time City of Cincinnati, the arts organizations when they do their own blood drives. So we have one coming up at the art museum, they're gonna have those cards there for people to sign as well. And so we send a stack of those every few months to the fda and we continuously do that over and over and over again. Like I said, the feedback, I don't see those negative comments like I did before because I think people can see what we are doing to advocate for them. No, they can't come in and donate. We can't ask them to come in and donate blood, but we can say, Hey, we acknowledge this and this is what we're gonna try to do to change this for you. And I think that that is just very important in addition to making sure people know about this deferral. So like I said, what we want to avoid is people coming into our donor centers and experiencing that. So I've just been trying to advocate and let people know that this deferral exists. So we do a lot of campus stuff and I find that those places are like the hotspot of where we gotta talk about it. So onsite recruitment, those cards are always there. So people say, Hey, what is this? You tell 'em what it is and then how they can contribute to the advocacy part of it as well.

Alecia Lipton (19:29):

Communication is definitely key. And so I think that Jackie, both you and Dr. Oh have done a great job with getting out there and speaking about it and addressing the concerns when they come through, letting them know what the policies are, why the policies are in place, and then giving them a forum that, you know, they, they can write to the fda they can share their concerns with the f d I think one of the most powerful things that I saw at the music hall, blood Drive, a man came in to donate and he had a friend with him from work and his friend was female and she donated, he did not. And then on his card he wrote down, you could have had two donors today, but instead you just had my friend. And that just really spoke a lot. And he shared his story that when he was in high school, he was a blood donor and it was something he always wanted to do because his mother had had cancer and had used blood. And so that was a way that he felt that he could pay back the kindness. And then when he was unable to donate again, he said it just really kind of hurt that he wasn't able to continue on with that. So we really appreciate what you're doing, Jackie, out there in the community and getting the message out.

Dr. Oh (20:41):

So let me clarify a couple things then I'll, I'll give a shout out to FDA because they're our partners in making blood as safe as possible. And they, I think have, have, have really done an amazing job in terms of working with the blood communities. And they actually did reduce the deferral time period from 12 months to three months in December, I believe, of last year. And I think that people talking about this and kind of bringing up, you know, why is this a 12 month deferral? You know, when we are very confident with our testing that we can pick this up within, you know, 10 to 30 days for sure. 30 days max, max, max. So a three month deferral seems to be more appropriate. And at that time they actually did re reduce many of the r reasons people were deferred for 12 months to three months. So receiving a blood transfusion, having a tattoo in a state that is not regulated well in terms of the tattoo industry, those are still deferrals, but they went from 12 months to three months. These changes were in the midst of pandemic as it was occurring. And in an effort to help us at blood centers to not have to be under the yolk of these regulations and time restrictions that are really not appropriate anymore. I think the other thing that old timers like me will say when cuz we've had been asked this MSM question many, many, many times, is that we try not to interpret this as an anti-gay type of a requirement. Lesbians are sexually active, lesbians are eligible to donate it, it is this specific MSM activity that has been associated with increased transmission. And really for fda, if the way we look at donor testing for infectious disease markers, the donor testing is much more effective when you have a very low prevalence population that's donating. So we have more reliance in what we call negative predictive value of our tests that are negative for anything that we test. If we know that the population that's being tested is actually have very low prevalence. So if we were to have a blood drive with a population where maybe half the donors were HIV positive and we tried to just recruit any donor who to come in and oh, we'll catch everything on the testing you're gonna have when you have a very high number of people who are positive or actually infected, you're gonna have more rare, rare, rare incidence where you would have a negative test result but actually have a positive value. And so part of the safety network is a, is to make sure that the donors who come and make it to the donation step actually are very low prevalence for a lot of things that we're worried about. I do think that FDA is looking at the data from the other countries and at this internal study that's being processed right now. And, and I think that they will make a decision based on the science. They have to feel comfortable that we're not jeopardizing the blood supply. And for that they really wanna see data

Alecia Lipton (23:39):

And we want always want it to be safe for the recipient of the blood, but we also want it to be safe for the donor too. So that's why there, there are restrictions in place with medications. If somebody's on a blood thinner, you know, we certainly don't want them donating blood. Yeah. So that's why all the questions come about when people are coming in to donate.

Dr. Oh (23:56):

Thought about this. And I don't know if this is really true, but I think that part of the motivation for people to come out and donate blood is they, they want to help other people and they want to help as part of the community. And I, I feel like it's especially painful for, for people who are deferred for MSM cause they just wanna help the community. And it's, it's another example of the community saying, no, no thanks, you know and I, I think that's that's a difficult message and I really feel compassionate for, for all those who are, are unable to donate through msm. But those are the regulations that are in place right now and, and we try to do the best we can, you know with, with what's happening. And I'm hopeful that changes will occur.

Alecia Lipton (24:39):

Jackie, thank you for putting together an event where the community can come together and for giving a voice to people to reach out to the fda. So we really appreciate that.

Jackie Marschall (24:49):

Yeah, Absolutely. And we'll continue to do so.

Alecia Lipton (24:50):

You have been listening to, in the Know with Dr. Oh, brought to you by Hoxworth Blood Center.

 

Alecia Lipton (00:10):

You are listening to in the Know with Dr. Oh, brought to you by Hoxworth Blood Center. I'm Alecia Lipton, and with me in the studio today is of course, Dr. Oh.

Dr. Oh (00:19):

Hey Alecia.

Alecia Lipton (00:19):

Hi. And our special guest today is Jackie Marschall, and Jackie is our public relations specialist at Hoxworth. I think we're gonna segue a little bit into another thing that you've been working on. You mentioned it briefly, and that is our Minority blood drive tour. And when we look at minority blood donors, we always need more. In a perfect world, we would want the blood on the shelf to match the diversity of our city. And that is not happening. And Dr. Oh, could you explain to us the importance of having the minority donors as it relates to patients who are needing those transfusions?

Dr. Oh (00:56):

Sure. I'll reference a podcast we did recently Yes. With Jennifer O'Connor and trying to find rarer units. And so even though everybody's aware of ABO and you know, your ABO type, hopefully there are many minor red cell antigens, which are also important for specific patients who have developed antibodies to these minor red cell antigens. So they cannot just get O units and be okay with it. They have to match on o as well as Kel and all these other letters that I could go through, which are represent re cell antigens. And so those units are more likely to be found in the African-American population, especially for sickle cell patients who are typically African-American and are gonna have much more likelihood of having a compatible blood once they develop many antibodies. So it's very important for us to be able to have these units available for them. Sickle cell patients often receive many, many, many transfusions over their lifetime. And so it's a constant task for us to make sure that those specific blood units are available for really the specific patients that we follow. And we know that we will see multiple, multiple, multiple times a year for red cell exchanges.

Alecia Lipton (02:09):

Some of the parents of sickle cell patients that I've talked to, they'll talk about that they might come in monthly for a transfusion and it's not just a one or two unit transfusion. It could be a 12 unit transfusion.

Dr. Oh (02:24):

So yeah, we actually, we actually call those red cell exchanges. So we're actually removing much of the blood that contains the sickle hemoglobin and exchanging with donated red cells that do not. And so frequent red cell exchange has been shown to decrease adverse events in especially in the pediatric population including strokes and, you know, other really things that we want to avoid.

Alecia Lipton (02:50):

So Jackie, you came up with the idea of the Minority blood drive tour to increase minority donations. Can you tell us a little bit about the thought process behind that and then how it, how it came to be?

Jackie Marschall (03:02):

Yeah. I was really excited about this tour idea. So I've been trying to think of different kind of groups of people that we can do the tours with. And I had this idea for doing like a black owned tour, like getting a bunch of black owned businesses and stuff. But I wanted to be very intentional about it. And I didn't wanna just try it and without, you know, consulting some people. So at first I started to network reaching out to some other public health advocates in our community, and I just threw out the idea. I was like, Hey, I kind of have this idea. And as I started presenting it to multiple people, like they just seemed really excited about it. So it just inspired me to go for it. And I was like, what are the steps I need to take? Blah, blah, blah. So as a millennial, I slid into the owner of Black owned his dms on Instagram <laugh>. And I just presented this idea to him. I, I knew that I wanted Black owned to be involved. They're incredible advocates for the city.

Dr. Oh (03:58):

So, it took me weeks before I realized the black owned was a company and not a general term. So, yeah. How is that spelled Black owned? Is is

Jackie Marschall (04:07):

It It's it's bla it's spelled black owned, but some of the letters are uppercase and lowercase.

Speaker 2 (04:12):

Oh, okay. Yeah.

Jackie Marschall (04:12):

That's the, the fun part of it.

Speaker 2 (04:14):

So this is a what company is

Jackie Marschall (04:17):

Black owned retail store. They're celebrating their 10th anniversary, I believe this month's big celebration for them. And they're also owned black coffee company right on the corner. Reached out to Means who's the owner of Black owned. And just told me about this idea. I was like, Hey, I want to get multiple partners on, we need minority donors. Like this is a real need because of x, Y, z of the things you explained. I mean, I reached out to him and he was all on board and like, I've started reaching out to multiple people and everybody was connected to this cause whether they had somebody in their family who had Sickle Cell or they knew somebody had Sickle cell, like they were greatly affected by this. And it was a no-brainer. Like when I reached out to me and he replied to me within hours and all in, in, he was like, heck yeah, let's go. Let's do this. It's very important. And I've, I was just buzzing since <laugh> basically connected me with his business partner Gil, who is amazing. I actually ran into him at other community things like not knowing who he was and then meeting him and then realizing that we navigate a lot of the same spaces. So we we really hit it off and it just like builds a really solid partnership. So through that we got handful of community partners. So black owned and black Coffee of course. Cream and Sugar Coffee Lounge, another one of my favorites. Allen Temple, which is a church that we do stuff with every year. Some of these partners are continuous partners. We do this year round every year. And then the Urban League and some others as well. So we got all these people on board, and I also wanted to kind of create an incentive that really drew people in that was unique to some of the things that we did. So we partnered with a designer at Black owned, since they're a retail shop, they have all of the sharpest cloves, <laugh>. So we partnered with a designer there and collaborated on making a t-shirt because what do we do best at Hoxworth <laugh> t-shirts. Yep. So we, we created this really cool t-shirt that I'm wearing now that says we all bleed the same. And that was our incentive. So it was really cool to kind of partner with a black artist on it. And so since then we, we partnered with a couple of other people to help promote the drives, and then we just went with it and like, it was very well received, you know, it was Covid times too. So I have a whole list of ideas on things that we could do post Covid. So I really want this to grow and continue to grow and, and it's just a way to really connect with a different group of people in a different way and educate. And like I said, a lot of these people are connected to this cause already, and it's just like making that connection being accessible, coming to their neighborhoods, like in OTR and Walnut Hills, you know, these are places that we frequent a lot, but it's, it's just a, a different way of connecting with a group of people that I think is really meaningful.

Alecia Lipton (07:02):

Well, and I think one of the things that you said that's so very important is that all of these people that you talked to, whether it was the people organizing the blood drives at their business or people who were donating you talked to, they all had a tie to it somehow. They had a family member with Sickle Cell, they had a neighbor with Sickle Cell, so they came together as a community. And that's what makes it so great. We always say that when you donate blood with Hoxworth Blood Center, you're saving lives close to home. And this black minority Blood Drive tour really showed that, that, you know, when they're notating it is going to be treating a patient here locally.

Jackie Marschall (07:40):

Yeah. And we've partnered and we talk to a lot of people over at Children's Hospital, and we have a large sickle cell patient or sickle cell population here in Cincinnati. And what I try to communicate with these donors is that you literally are like helping their livelihood, their everyday navigating this world, and it's in your arm right now, like, it's the power in your veins. And like you have the power to be able to give someone like a better quality of life. And it's unique and it's necessary and needed. And you know, on our part too, it's a, it's finding different ways to communicate too. So the minority owned Blood Drive tour is just one way and we'll continue to come up with a ton of different ways as we have throughout the years as we've been doing this work.

Speaker 1 (08:23):

Well, I know that you are in the works right now, planning for the next one, and I believe you're going to kick everything off with Dr. M L K day. Is that correct?

Jackie Marschall (08:31):

Yes. You know, we have our annual M L K day drive at the Freedom Center. Mm-Hmm. It's always a huge one. It's always a hit. And we're gonna be kind of doing this whole year long thing and I, I hope that April is Minority Health Month Center for closing. The Health Gap hosts a huge event there. They haven't been able to the past few years cause of Covid. So I'm hoping fingers crossed that we can have that event down at Washington Park, or I believe it was originally at Washington Park.

Alecia Lipton (08:59):

Yes.

Jackie Marschall (08:59):

And we can host a blood drive there and, and kind of tie that into all of the multiple blood drives that we plan on doing for the tour.

Dr. Oh (09:08):

So Jackie, it's been really fun talking to you today. I actually heard that you started getting involved with one of our operational groups internally related to platelet collections. And my understanding is that we wanted to bring somebody in who was not in the operations, you know knee deep. We deepen the operations side for an outside perspective and for somebody to bring some positivity to the group and some momentum and as, as we try to figure out internal processes and policies to really increase our platelet donations as much as possible. So I heard that the kickoff meeting went unbelievably well. And so I wanna thank you and, and for your contribution in, in that area as well as the external P PR stuff.

Jackie Marschall (09:52):

It's probably my most looked forward to meeting at the week.

Dr. Oh (09:55):

Oh, that's great.

Alecia Lipton (09:56):

Wonderful. That's great.

Jackie Marschall (09:57):

I know, I don't know why I love sitting in those meetings and brainstorming and just being, having that open conversation to like, whatever we can do is possible and we have a team here that can make it possible. So it's, it's really fun being in an atmosphere where you can throw ideas at the wall and know that you are supported in whatever sticks will stick and we will follow through and we have an amazing team to do that. So it's, it's really exciting to be a part of that and to come up with different things.

Alecia Lipton (10:24):

Jackie, thank you for coming in and being with us today. Thank you for bringing your enthusiasm and your excitement to the podcast, but also to your work you do everyday.

Jackie Marschall (10:32):

Thank you for having me. It's exciting. We're gonna be doing some fun stuff, so hopefully we'll see a lot, a lot of people come out and be part of our mission.

Alecia Lipton (10:38):

Great. Hey, you have been listening to In the Know with Dr. Oh. Our guest today was Jackie Marshall, brought to you by Hoxworth Blood Center.

 

Dr. Oh (00:12):

Hello. Thank you for joining us. My name is David Oh I'm the Chief Medical Officer at Hoxworth Blood Center, and you're listening to, in the Know with Dr. Oh. We've taken a little bit of a break and are now coming back to you. I've got two guests that I'm really excited to bring to you. Lisa Cowden, who is our Customer Experience Manager, and Jackie Marshall, who is our Public Information Officer. So we wanted to talk a little bit today after this long hiatus that we've had about our donor experience. So, I'm gonna hand it over to Lisa Cowden and she can tell us a little bit about how she thinks about experience. Lisa joined us about a year ago and has really helped us to better define what our donor is experiencing and how we can make that experience as good as possible.

Lisa Cowden (01:05):

Well, thanks for having me, Dr. Oh Again, my name is Lisa Cowden. I'm the experience manager for Hoxworth Blood Center, University of Cincinnati. I've been on board for about 13 months, and so my journey started interestingly because, you know, I think Hoxworth identified that this was really an area of focus for the organization, which made me super excited because it's been most of my career being on a, or in a leadership position to drive experience for customers and employees. So, 13 months ago I arrived, right, at Hoxworth Blood Center. It's been a fun journey. What's been interesting for me is, you know, I come from a hospitality managed care, long-term care background, and so now I'm going into, you know, what we do. So learning a little bit about, you know, being the, supplier of our community blood supply and what that means, and then digging into the, the donor journey, you know?

Dr. Oh (02:15):

Yeah. So let me interrupt you for a second. So when you came on board 13 months ago, I think it's interesting to kinda look back at that, you know, at the time you think we have been in business since 1938, right. And you would think we'd have honed in exactly what we needed to do with our donor experience. I mean, goodness gracious, we've been doing it for so long, but I think we lacked a formality in terms of how we looked at the issues and the experiences and people change over that time period as well. Donors have different motivations as they come through. So when you came to us, what do you think, in terms of impressions and what you wanted to work on?

Lisa Cowden (02:52):

Yeah, no, it was great. I mean, it's probably what intrigued me. I thought, you know, wow, they're, you know, recruiting for a customer experience manager and what does this really mean to their organization? And so what my interpretation or perception of before I arrived and when I arrived are very different things. I was really excited. I really applaud, you know, Hoxworth leadership for going, there's a real gap in, in this. And I think the gap for me is really, and the real need, the real, I think, magic sauce to this, is, for a lack of a better word, is really connecting our donors to the purpose. And though we do that in lots of different ways, and Jackie can speak to this, I think what you said was a spot on a formality. Bringing all these things together that really creates an experience.

Dr. Oh (03:51):

So when people interact with our brand, whether they're on the website, you know, booking an appointment, or they've, you know, heard an ad on TV or the radio, and they're like, Hoxworth, this is something I really wanna do, and they're researching us, or they actually make an appointment to come in and donate to save a life, I think it's really important that everyone has an experience that makes them feel welcomed, respected, valued, and makes them want to return. So I think that's a pretty tall order to accomplish across a brand. And so you have to start somewhere, but you have to make sure you're tackling that everywhere. And so for me, it is really about making sure people are very connected as soon as they interact with our brand of why they're doing what they're doing. And I think that's the real challenge for us. I think we all know the benefit, but donors really making sure they're very connected to the end result, which is saving someone's life.

Dr. Oh (05:01):

So Lisa, since you've joined, I've just really enjoyed working with you. It's made me think a little bit different. A lot different actually about how we work with donors. And, one thing that you always bring up that I think is really interesting is the difference between customer satisfaction and customer experience and customer service, right? Because, so most of us think about customer service, and I think that's kind of where we were right before you came.

Lisa Cowden (05:27):

Oh, absolutely.

Dr. Oh (05:27):

That's what our focus was, traditional customer service. And now you are having us think a little bit more broadly about the customer experience. Maybe you could differentiate those two for us.

Lisa Cowden (05:36):

Yeah. Thank you for bringing that up. So it's one of those things that I think is important for people to understand, especially in our industry and why the customer experience is so important to us. Customer service is more about the acts of things we do to service a customer that's just in a general term, universally, anyone, when you think of customer service, it's really the acts we do, we perform to provide a service or product to the customer. Customer experience is really, it's a collection of interactions and feelings that somebody gains when they interact with your brand. You know, whatever your brand is, whatever your organization is, it's a collection of all of those interactions that give you a feeling. As humans, we make decisions, first on emotions, and then we back it up with, you know, rationale and logic.

Lisa Cowden (06:34):

And, so feeling is important in this business and in really any business. It, and I think you've seen a shift in business over the past several years where customer experience is really driving the marketing, the strategy of an organization, because I think everyone is landing in the spot of it is really about how you're making people feel and building that relationship quickly and building that loyalty so they continue to come back. And that's really instrumental. It is important to us as a blood supply for our community. We want people, because an important fact, what is the national average of, you know, people in communities across the nation, that donate blood?

Jackie Marschall (07:30):

Yeah. So I think 30% of people are eligible to donate blood, and of that only 10% do. And I think that comes out to what, like 3%.

Lisa Cowden (07:40):

Correct.

Dr. Oh (07:42):

Yeah.

Lisa Cowden (07:42):

3 to 5% on a national average. And that's, so for us as an organization, as the community blood supply, it is not just important to how we make people feel, but it's also important, which is a whole other topic about when people don't feel great or maybe don't have the best experience because, you know, we like to keep it real. And sometimes that happens and that's even more important about what we do and how we make people feel about making things right. So I think, you know, for me in working in, in several different industries the customer life cycle and the experience is so different here because there's not a product that our customers need or our donors need. They're the ones providing the product needed for the patient.

Dr. Oh (08:37):

Yeah. Thank you, Lisa. So I'd talk about this all the time, right? So, before coming here to Cincinnati, I was out in San Diego at the San Diego blood bank. And, there we talked about having to provide a customer experience that rivals that, of going to the beach, or going to Disneyland or going to Lego land, because people, our donors, have a choice on a Saturday when they wake up, if they're gonna go and go to the donor center and have people ask 'em all types of questions and stick a needle in their arm and for a couple of cookies and some chips afterwards. Right? So how does that compare and how do we get donors to say, I would rather do that than take a stroll by the ocean. You know? And so I think one of those things is really to understand, you know, why our donors come, why they come back, and to provide them with that experience, which will make our donors feel like they did a great thing.

Lisa Cowden (09:39):

Absolutely.

Dr. Oh (09:40):

That they feel like they were truly thanked. And we do truly thank them, but we have to make sure that they know that and they feel it when they walk out the door. So that they say, Hey, I wanna come back again and donate. I think up to a third of our donors, and this is true for all blood centers, our first time donors when they come through. So we do have repeat donors, and that's kind of what we really depend on. And every time we have a first time donor who comes and doesn't get that feeling, you know, when they leave, we've probably lost them for, for quite a while and maybe they'll come back and try again. But we need to hook them from the very beginning and make people realize when they come in to donate what's happening.

Dr. Oh (10:21):

And, that by donating they're helping others and by helping others, they're actually helping themselves as well. There's a lot about psychological wellness that I think is really there for our donors because in this day, with all the political strife and, you know, all of the worries that we have, it's really something to be able to do an activity like donate blood and knowing that you're completely selfless in your actions and that your blood is going not to somebody specific, that you feel an obligation to help, but to your general man, you know, and.

Lisa Cowden (10:56):

To your neighbor.

Dr. Oh (10:58):

To your neighbor. Yeah. And,

Jackie Marschall (10:59):

Love thy neighbor, one of our campaigns.

Jackie Marschall (11:02):

Somebody here in our community.

Dr. Oh (11:03):

Yeah. And here we love that, you know, when you donate with Hoxworth, you're saving lives close to home because anybody, you know, who goes to any of the hospitals in the area, Mercy, UC Health, Christ, TriHealth, in this area, 30 hospitals in 18 county radius or so around Cincinnati, they're getting blood from Hoxworth Blood Center. So, that donation is gonna help somebody in the community. And I think that's a real power that we have to be able to connect people. You are actually literally giving of yourself, literally giving of yourself to help your fellow man, and there just are not that many opportunities to be able to do that type of thing.

Jackie Marschall (11:42):

Anybody free of charge too, right? Like, you know, being a younger person here, finding a way to give back that doesn't always put a dent in the wallet is something that's very nice. You can donate blood and you're not out anything financially. Right? <Laugh> Usually walk away away with something fun.

Lisa Cowden (12:03):

It's so funny you said that, Jackie, because I was with our Director, CEO, Dr. Jose Cancelas and our Chief Production Officer, Judith Gonzalez, this weekend at the Hispanic Volunteer Day. And it's so funny you made that statement, because it kind of falls in line with one of the spokespersons and, you know, chairs of this event. And he said, you know, when we're asking for donations for Hoxworth, you know, when we talk about that, it's not, you know, asking you to get in your pocket, it's asking you just to show up and donate. It costs you nothing but a little bit of time, but you have the biggest impact you can possibly make. And it really is true. I think everybody, we say this often, you hear this term used a lot, you know, superpower. Everyone has a superpower and that's your superpower to go out and help people in your community. But I think fear is obviously a big barrier. I think so many more people want to do it, .

Jackie Marschall (13:12):

But there's taking the leap. You gotta take the leap.

Lisa Cowden (13:14):

And what are they scared of? Dr. Oh?

Dr. Oh (13:18):

Well, it's the needle.

Jackie Marschall (13:18):

Yeah. Yeah. I swear it's true that the finger prick is the worst part.

Dr. Oh (13:22):

Okay. So it's

Jackie Marschall (13:24):

It's true.

Lisa Cowden (13:24):

So, call Jackie when it's not the finger prick. But, but no, I think that's right. We were with 200 people this weekend and went out and talked to everyone about donating blood and they're like, every single person says, I'm scared, I'm scared of the needle.

Jackie Marschall (13:42):

Yeah. But when, you know, I always tell people too, like it's an hour long process, but that needle is only in your arm for less than 10 minutes. So it takes an hour of your day. Sure. But very short period of time where that needle will be in your arm. And like I said, the finger prick is the worst part. If you can get through that, you're gonna be golden.

Lisa Cowden (14:02):

But, and you're right. But this is where I wanna make the point about donor experience. This is why it is important for us from the minute they come through the doors that we are making them feel welcomed, comfortable, educate them, help them navigate the experience because they're scared. Even experience, who likes to go and have a needle put in your arm? No one.

Jackie Marschall (14:31):

It makes me nervous every time, still. I look away. I still do it. But I look away. That's for sure.

Lisa Cowden (14:36):

So that is why you build a donor experience around how we're making people feel. We wanna help them overcome that fear, become relaxed and comfortable so they come back and do it again. So they're like, oh, it wasn't bad like this. This is cool. I saved a life today.

Dr. Oh (14:53):

So Lisa, I think after you joined us, I think originally you may have, were probably hoping that you could roll out a bunch of initiatives immediately for the donors. Because you, I know you had a lot of ideas that you were percolating. But I think that we took a step and we looked at our basics when you came. And one of the things that you pointed out was really that we have to make sure our employees are understanding what we're doing. And it's a year later and we're still working on it, I think we're still working on it, but maybe you could share a little bit of your thoughts in terms of how we help our employees with our donors and how to manage their experiences.

Lisa Cowden (15:36):

Yeah, that's interesting. I think anyone that does what we do or does what I do, you would have to start with, you know, these are your experience champions. Our employees are our greatest resources, hands down and they are, the donor services division, is the customer facing staff of our organization. So it was really important for me to immediately help them understand that with the uniqueness of our business, right. That, what is it, 3% maybe on an average three to 5% of our community is donating. So it is really, we're really invested in making sure that when people walk through our doors, we're giving them a great experience. And if for some reason we fail to meet the donor's expectations, that's okay. But we have to take action on that too. So for me, it's just helping them understand that it's okay when those things happen, but we have to take action and we have to dig in and we have to be very invested in what we're doing.

Lisa Cowden (16:53):

But in the same sense, we have to do the same thing for our employees. And I think though, one of the first things that we did when I joined over, you know, a year ago was to create an onboarding session that is still evolving and needs to, but one of the first things we wanted to do is every new hire that came through, we wanted them to have the experience we want the donor to have when they walk through the door. But we also wanted to connect them to the mission. And I think that's just really key for an organization. If your teams, if your employees do not understand how they impact our mission, then you really are not gonna be able to move that forward. And I think that's really what we've spent the last 13, 14 months doing, is connecting new hires, our employees to the importance of what they do and how that helps us deliver every day in serving our mission to our community and our patients.

Dr. Oh (17:53):

I think it's very challenging in this day and age, right? With the great resignation that's going on.

Lisa Cowden (17:59):

Absolutely.

Dr. Oh (18:00):

We actually are very actively looking for a new staff to join our organization. And when they come, we wanna make sure that we're onboarding them the right way. And so that from day one, they're kind of understanding the importance of experience for our donors and everybody that they interface with, including internal employees as well.

Lisa Cowden (18:22):

It's really an omnichannel effect right. In all of this. And, and even with the new hires, it's now working, we're at a stage where we're working with our existing staff on the importance of when we bring new team members on, why it's important for us to work together to give them a great experience. So in the end, if we're hitting it on this side of the employee experience, our success rate's gonna be higher with expecting them to deliver to the donor. And it's really the only formula that really works. You know, I can look back and, and see progress and see change, but also look ahead and see the goals that we still need to achieve. So, that freaks me out a little bit. <laugh>

Dr. Oh (19:07):

That's it. Exactly. Right. But, Lisa, I'm just so glad you've joined the organization. You've been a part of us trying to improve, you know, as we go forward and we're always, we're always striving to be better. I think another challenge for us, or maybe this is not a challenge so much is a uniqueness of us, is that we are part of the University of Cincinnati. So our mission is not just blood collection, but it also includes education and it includes research. And so, sometimes it's more challenging when you're trying to say all of those things to our employees in terms of all the different things we do. But that's the organization we are, we do many multifaceted things and some folks are gonna be completely donor facing and other people are going to be more test tube facing as well. So, it is a, I think an organizational challenge that we have, as we're trying to talk about experience.

Lisa Cowden (19:57):

Yeah, it is. But I think that is what it is so cool about Hoxworth Blood Center. I'm gonna tell you for being, I'm sitting at this table today, I'm one of the newer staff members here, and I will say, I know of Hoxworth, but to really know what Hoxworth does, our footprint nationally, locally, I always say we're so much more than a blood supply. I mean, we are doing some really amazing things in research and education and patient services. And I think that's one of the best things I love in the last year that I hope I bring and I continue to expand upon, is connecting, kind of breaking down silos within the organization and connecting everyone to what we do in the 21 departments that make up our organization. And I think that's been really great to see as people being able to connect to different areas of the organization. Because I think that gives you a sense of pride that gives you a connection into something bigger than what you do. And I think that's what kind of fuels people and motivates people. Right.

Jackie Marschall (21:12):

Inspiration, if you will.

Lisa Cowden (21:12):

Yes. <laugh>. Yes.

Dr. Oh (21:14):

Excellent. Excellent. Well, I think this is a good time for a break. So, it's been a while since we've done a podcast, crazy things happening, right, with, COVID 19, but we're finally back in the studio and I'm really glad and thank you so much, Lisa Cowden and Jackie Marschall for joining us today for this podcast.

Dr. Oh (00:13):

Hi, we're back with another episode of the podcast. I'm David Oh, I'm the Chief Medical Officer for Hoxworth Blood Center, part of the University of Cincinnati. And this is In the Know with Dr. Oh. We've got Jackie Marschall today. Yes, you're a Public Information Officer and we also have Lisa Cowden with us today, and she's our Experience Manager. So we wanna talk a little bit about an issue that we get asked about all the time, and that is promotions and how do we choose our promotions? Why are you doing this promotion? Why can't I get paid to donate blood <laugh>, all these types of things. So Jackie, why don't, why don't I have you kick the ball and, and start us talking about this really interesting topic.

Jackie Marschall (00:57):

Yeah. We love our promotions at Hoxworth, don't we? All of the T-shirts and the random, the barbeque sets and the, and the zoo tickets and all sorts of experiences that we, we get to offer. It's a super fun part of the, part of the job for sure. One of the funnest things is always seeing, I, I run the social media accounts for Hoxworth, so I get to see all of the people post the photos and, and give the feedback to their groups of people that they're posting to. We always take note of the ones that get a lot of love. For example, in was it 2021 when we did the cicada shirts, I think? One of the most popular.

Dr. Oh (01:32):

Oh yeah. The cicada shirts so popular.

Lisa Cowden (01:35):

Yes. It was before my time, but I've, I've witnessed those t-shirts. <Laugh>.

Jackie Marschall (01:39):

Yeah. That was a, that was a really fun spontaneous one that we took advantage of with the, the 17 years cicadas coming out.

Dr. Oh (01:47):

So what, what's the tagline on that? Don't wait 17 years to come back or something like that.

Lisa Cowden (01:52):

Oh, that's brilliant.

Jackie Marschall (01:53):

<Laugh> don't wait. 17 years to Donate Blood.

Lisa Cowden (01:55):

Oh, brilliant. Okay. Loving that. I need one of those to wear <laugh>.

Jackie Marschall (01:59):

Yeah, that's a Hoxworth marketing trademark right there. <Laugh> <laugh>. But yeah, so, you know, picking the promotions you know, we're about a year in advance when we do those. So we already have, we're already thinking of Halloween next year, but we always take feedback from our, from our donors and kind of see what they love the most. I think so far this year, fan favorites have been the tie dye T-shirts.

Lisa Cowden (02:23):

Tie dye t-shirts. I am telling you, they have to repeat next year, but..

Jackie Marschall (02:31):

Don't, don't tell our donors that

Lisa Cowden (02:32):

They, I I am telling you, I was on vacation in Georgia <laugh> and got stopped about my t-shirt and strangely enough, in Tybee Island, Georgia and I, there were three families surrounding me when they heard Hoxworth Blood Center. They had some connection with the University of Cincinnati and Hoxworth. And that, that's great too. I think our promotions, Jackie, I know you cuz you're out and about

Jackie Marschall (03:02):

Oh, I can see people from a mile away wearing a Hoxworth shirt.

Lisa Cowden (03:04):

Jackie is out in our community always representing Hoxworth at events, and that is the one thing I will say, people really are drawn to a Hoxworth t-shirt or an affiliation with that. So that's very cool. And, and be very prideful for me when I'm out and they're like, oh, you're Hoxworth. Yeah. Are you a donor? They're like, yeah, <laugh>, and you're like, you know, a great connection there.

Dr. Oh (03:30):

Yeah. I think that's one of the things we really love about the t-shirts is that it stimulates conversation, right? Yes. People are wearing them and Yeah. And always ask, oh, do you donate? And, and hopefully, you know, oh yeah, it's a great experience and and you should come through and, and donate yourself. One of the things I guess we should talk about a little bit are the parameters around the promotions, right? So how do we kind of make choices of, of what we do? We really think of our promotions as thank yous to our donors, right? And it's not payment, right? So there are real clear rules from FDA and blood collection and distribution is a highly regulated area, so we don't want to go outside of what the FDA wants us to do. And they are very clear that we put on every unit of blood that we collect, that it comes from a volunteer donor.

Dr. Oh (04:17):

And if you decide you want to give a donor cold hard cash, then you need to put on each blood unit that you distribute, that it comes from a paid donor. And so this is something that we don't do, we don't think our hospitals really wanna get blood from people who are paid for their donations. And so in that light, we cannot give our donors cold hard cash. We do actually provide some cards that they can redeem for, you know, a certain amount of money. Those are non-transferrable, and they go to the, the donor. So part of the rules is that it can't be easily transferrable into cash. And then one of the things that they're fine with is us to give thank you gifts and promotional items. We try to keep the value of these things at a very reasonable rate.

Jackie Marschall (05:03):

So yeah. And it's, it's different for like raffles and stuff too. So we're like, for example, the Mini Cooper. So we're able to do something like that when it's, when it's a raffle type of things. So that's different differentiate those types of things. But Dr. Oh, can you kind of explain the difference between us and like a plasma center? So we have a lot of donors that'll come up and say, I, I donated plasma, I got paid a lot of money in college to donate plasma. How does that differentiate between a blood center like us and a plasma center like those?

Dr. Oh (05:32):

Yeah, that's a great question. So you people can donate and get paid for their donations when they go to plasma centers. And that donation that they provide there actually most of it gets exported to Europe, interestingly, right. And manufactured there. The blood is processed and separated typically for factors that are of importance. So they can make album of it, they can make different blood products that contain coagulation factors other types of derivatives from plasma. Those donors are able to be paid. Those donations then get sent and used in Europe. But much it gets back to the United States as well. And those are necessary products that are helping people. What we do is to truly concentrate on red cells whole blood plasma that's directly transfusable and crab precipitate for our our local patients.

Dr. Oh (06:29):

And so when you donate to Hoxworth blood center, those blood products will go and they will, we, we always say save lives close to home or saving lives close to home. So when you have a loved one in the hospital, they are going to be receiving blood products from Hoxworth that will help them in their recovery. They may also use plasma derivatives as part of their, their healing process. But that blood then is, is mass manufactured and spread out all over the country. So really what we need are local donors to come and donate those blood products that, that Hoxworth provides because those are not easily obtainable from the hospital except through the reliable blood center and blood provider.

Jackie Marschall (07:12):

AKA: Us <laugh>.

Speaker 1 (07:14):

Exactly.

Jackie Marschall (07:15):

That's awesome. No, I think that Hoxworth is such a special place. Like the community is literally helping the community and Hoxworth touches almost every single person I think in the area that we serve. Whether you're a donor or you know, someone who's received blood. I think that we pretty much get some pretty close to a, most people here. I mean we've, we've got a pretty amazing donor base, no doubt. So, yeah.

Dr. Oh (07:41):

One, one of the big differences is that we are a non-profit organization, right? So any revenue that we we get is, is absolutely necessary for us to put back into the organization so we can improve our facilities and improve our equipment and hire people who are calling people, you know, to come and donate. They're calling people, they're meeting people and drawing their blood. They're processing the blood and the blood center. So all of these things don't happen for free, but we are a non-profit organization, so any any revenues that we would get from, from blood actually goes back to make sure that we can continue with our lifesaving mission for plasma manufacturers where donors are getting paid. They actually are for-profit organizations. And so, so the revenues that they get are helping them to share profit among their shareholders.

Jackie Marschall (08:32):

That's interesting. I I did not know that. <Laugh> I'm now in the know

Lisa Cowden (08:39):

She's in the know with Dr. Oh.

Dr. Oh (08:40):

As are you listeners.

Jackie Marschall (08:42):

<Laugh>. So if you're ever wondering why we don't give you $50 for a platelet donation, it's not cause we don't want to <laugh>, it's because we're not allowed to.

Lisa Cowden (08:50):

No. But I think to go back to our promotions, I, you know, I wish I could call them, you know, thank you gifts instead of promotions because they really are intended just to be, you know, a way for us to express our gratitude for what our donors do. And we really do put a lot of thought into that, right, Jackie?

Jackie Marschall (09:09):

Yeah, we do, we do.

Lisa Cowden (09:10):

Like, I mean, we really try to go for good quality t-shirts or anything we do to make sure they're quality and that we're mindful because it really is important to us. I mean, it's a part of the overall donor experience.

Jackie Marschall (09:26):

Yeah. So, we want people to actually wear the t-shirts <laugh>, right? So we, we're not the type of blood center that'll only get large t-shirts. Like we want all the sizes for every single person.

Lisa Cowden (09:34):

And we do.

Dr. Oh (09:36):

Yes, yes. Very important to me.

Lisa Cowden (09:37):

We do <laugh>,

Lisa Cowden (09:38):

We do, we get all the sizes. No fear. We do work towards that. Yeah.

Dr. Oh (09:43):

So, so let me ask you a little bit about logistics. So I'll, I'll be honest with everybody here. Like, I probably am not the, the, biggest fan of a lot of our promotions that we have, but I'm but what's important to me is to make sure that the donors get a thank you. Right. And I really feel that. Thank you. But maybe you could talk about some of the logistical issues that come with providing a t-shirt. For example, it's a common one.

Lisa Cowden (10:08):

<Laugh> Size. It's a size.

Dr. Oh (10:09):

it's not size, it's sizes. Right.

Lisa Cowden (10:12):

Well, because right Jackie, every, when we're running a t-shirt promotion, we have an amazing promotions manager that works behind the scenes. She's kind of like the Oz, right? Oz. She's behind a curtain. Nobody sees her except us, but she

Jackie Marschall (10:30):

The logistics queen <laugh>.

Lisa Cowden (10:31):

Yes. And she's, and she's dedicated 15 years of her career to Hoxworth, which is amazing. And so she has, you know pretty much a cadence of what happens when we do these t-shirts. She sends a certain inventory of sizes to every location throughout the tri-state that we have seven. And then when they are running low on sizes, they contact her, she ships more to them, or they reach out to me and I work with her and we get it shipped to the donor. We do, we make every effort possible to serve everyone with every size. But we also, let's just not forget too, in the last couple years we've had a supply chain issue where that's kind of been a little bit of a barrier at times when we've ran promotions and getting promotions on time or getting all the sizes that we want. So there's, there's challenges that are outside of us that we've had to manage through too. But we will make every effort possible to make sure our donors walk away with the right thank you gift.

Dr. Oh (11:34):

Yeah. So we talk about t-shirts. You're talking small medium.

Lisa Cowden (11:37):

Yes, yes. We are. Dr. Oh.

Dr. Oh (11:39):

2XL Yes.

Jackie Marschall (11:40):

Three XL Four, four XL

Dr. Oh (11:44):

They have that every single donor center that we have, and then when our mobiles go out too, right? <affirmative> and those are not small things. You know, so, and then you have boxes of of these come, come in.

Lisa Cowden (11:54):

Our mobile teams are real challenged with our promotions and they really have to do some different moves to make those happen. So we're always grateful for our mobile teams on these promotions, cause that's not easy.

Dr. Oh (12:08):

Yeah. So the other things that we have to keep in mind, our size, right? So when we give like, larger thank you gifts that like physically larger <Affirmative>, we have to have space for all that stuff, right? <Affirmative>. And we have to get it in ahead of time because we really don't wanna start a promotion, not having the materials, you know, in hand. And then we have to distribute it, you know, to all the different places. So there's a lot of logistical stuff that kind of goes in. I kind of like the idea of of the gift cards. I know a lot of the donors like those, and then it's, it is flexible for them that is acceptable. Our understanding is that acceptable to FDA as, as long as it's a gift card and not, you know, cash. So I think it is possible that maybe in the future we'll see more of those things and then make the promotions special when we have them and and so that's always constantly if you, if you disagree with that <laugh> send Lisa emails. <Laugh>. I was gonna say send Lisa or Jackie emails.

Jackie Marschall (13:09):

No, I was gonna add on to that too. I, and what you said make the promotions a little bit more special. I think one of the things that I'm trying to do is really connect us with the community and community partnerships and kind of make collaborating with different areas of our community and turning that that into like a very special, inspiring way to give back, for example, this Make-A-Wish partnership that we are recently had just launched with a local leukemia patient who decided to use his wish not on a Disney trip or a trip to Hawaii, or literally anything he could've wanted, he could've gotten, but instead he decided to give back to the community. I mean, that's just like a golden opportunity that you don't always get. But having those connections with these organizations within the community, I think just elevate us, not just this one, but LLS and Life Center

Lisa Cowden (13:55):

Really highlights the importance of what we do for our community,

Jackie Marschall (14:00):

The mayor in the city of Cincinnati and what they're doing. I think that these people really allow us to, to put a face to what we do. And I think that that's really important for our donors. I, you know, we're a machine at Hoxworth, we're taking all the blood, but I think that it's always a special thing to be able to show the life that our donors are actually providing to somebody.

Lisa Cowden (14:22):

I agree. I agree. They need to see that more. They need to connect with that more. And there'll be more to come on that with our thank the donor program that we are gonna spend the next year really building up with our hospitals.

Jackie Marschall (14:34):

Which is a great program

Jackie Marschall (14:37):

You can follow Thank the Donor on Instagram. So you should go do that if you can

Lisa Cowden (14:40):

Absolutely. Follow us on Instagram. Jackie, come on. <Laugh>

Jackie Marschall (14:45):

First follow us, then follow Thank the Donor. It's a very, very touching and rewarding thing to see.

Dr. Oh (14:51):

I think those organizations are fantastic. I know the Make-A-Wish thing was, was awesome and LLS just had their light the night recently and we were able to have a presence at that as well and have one of our mobiles there. And, and, and we weren't actually collecting blood where people could actually walk through and ask us questions and,

Lisa Cowden (15:09):

But people were trying to, they're like, are you gonna collect? No, no. You're getting ready to walk. No, we're not gonna collect today, but book an appointment. And we just wanted you to, I think bringing the bus out, bringing out in the community is hopefully helping relieve some fears of people and, and getting people more comfortable. We're not just showing up to put up a table and hand out stuff. We really wanna get people connected to what we're doing.

Jackie Marschall (15:35):

Yeah. We're Vampires, but we're nice vampires. We wanna be your friend.

Lisa Cowden (15:38):

There you go. <Laugh>.

Jackie Marschall (15:40):

We don't bite on the, at first, I guess <laugh>

Dr. Oh (15:44):

One of the other things that I think that is great in terms of emotional items and that's been successful for us has been Cincinnati favorites. Oh yeah. And that maybe Jackie you could talk a little bit about that.

Jackie Marschall (15:52):

Yeah. Yeah. So we started Cincinnati favorites back in 2019. That was our first go about our former public relations director really came through with some of these great partnerships with Skyline and Graeters and Larosas and Frishes. All, literally all of the Cincinnati Favorites. Yes. Somebody get the conies <laugh>. She put together this program that's.

Dr. Oh (16:19):

So Alicia Lipton were giving away a shout out. Thank you.

Jackie Marschall (16:22):

Yes. For helping out. Shout out Cincinnati favorites cuz it, it's not just led to Cincinnati favorites, it's led to other tours and other large groups of mobile blood drives. But this one specifically you know, the summertime is a hard time for blood banks across the nation and we're included in that. So, you know, people are out and about doing all the things. Probably not donating blood, but partnering with these places really allowed us an opportunity to be in front of those people who are busy, busy, busy and we're coming to you. We're making it convenient. And we're also have very fun giveaways, like a free Frish's Big Boy coupon, or a free Cheese Coney coupon or free ice cream from Graeter's and a whole pint of ice cream from Aglamesis. I think those partnerships are invaluable. I think I added up over a thousand lives saved from those blood drives every summer more than that. And to be able to do that every, every summer with these partnerships, it's just, we don't even have to try as much anymore. People are lined up to, to donate at these.

Lisa Cowden (17:23):

I get lots of emails, <laugh> and calls. When is that Cincinnati favorites. When is that happening?

Jackie Marschall (17:29):

We dad the tye-died t-shirts this year for it. And so I think that made it even more exciting. People love Cincinnati favorites. And, and out of that, out of that kind of model of this like packaged tour type of thing, we did the brew tour. You know, we had a little bit more resources back about a year ago in terms of staff, so we were able to stack up more. But we did the brew tour, the minority owned, black owned tour. And these are all things that I just want to see continue to grow. Cause I mean, doing those mobile blood drives makes donating blood more convenient for people. And I think that's really important in the, the busy busy lifestyles that we all live these days.

Dr. Oh (18:04):

Yeah. We have had our challenges with COVID 19 and in terms of staffing and getting our, we are working right now to getting our staffing back up. So unfortunately the number of mobile drives that we've had has really decreased. We're so thankful that the donors are responding to coming into the fixed donor centers that we have. And so those are, are busy, but to have the additional staff to go out on these other mobile drives is very challenging for us. And unfortunately, I know a lot of folks have been disappointed because we haven't been able to host you know, drives that they, they have wanted to do. We're trying to do as many as we can.

Lisa Cowden (18:42):

Trying to be creative. And I think our recruiters and our mobile team have really been creative in the last couple of years when we've been going through these challenges to bring about virtual blood drives and or driving to the neighborhood donor centers. And we're trying to be creative. I thought this was really cool. Fun fact. I was on the elevator. Don't ever get on the elevator with me because I'll be the one to talk to you, <laugh>.

Dr. Oh (19:07):

Next, I'll take the next one.

Lisa Cowden (19:09):

I know, right?

Lisa Cowden (19:09):

<Laugh>. So, you know, of course I'm headed up to Hoxworth and following this young lady on the elevator, she hits the fourth floor where we're at our Hoxworth Central neighborhood donor center. I said, oh, you're going to Hoxworth, are you donating blood today? And she's like, I am. I said, well, thank you so much. I'm the customer experience manager if there's anything I can do for you. And she said, well, they were at my company this week and all the appointments were full. So I decided to come over here. And I said, oh, fabulous. Do you wanna hug <laugh>? She's like, no. And I said, well, but thank you. So I think that's even amazing. I think that's two things that our community partners are bus the business is out in the community that partner with us. To, to hear that, you know, the schedules were full is amazing. So Thank you. Yeah. To all of the businesses and partners in our community that, that support us. And that an even bigger thank you. That, you know, you felt it was important enough. Peer pressure. She's like, well, everybody donated but me, you know, I'm like <laugh>, I love the peer pressure.

Jackie Marschall (20:14):

I love it. What a good reason.

Lisa Cowden (20:14):

I love stories like that. You know, just what's awesome lengths people will go to, to donate. I think that's amazing.

Dr. Oh (20:21):

Yeah. That's so awesome. So, you know. Yeah. Oh, I'm sorry. So yeah, it is a reminder, you know, when, when folks come to donate, sometimes you, you can come and if you can't make an appointment ahead of time, you know, you can walk in, but you, you may experience a longer wait. Right. So we really are are trying to get folks to, to make those appointments. Yes. Ahead of time. Go to online@Hoxworth.org and make those appointments and the whole process runs a little bit smoother.

Lisa Cowden (20:45):

It is for us to give you the best experience. It really is to, to make an appointment. Our donor services staff is amazing. They really work hard to try to fit you in if they can, but if they can't, then, you know, we'll do everything we can to schedule an appointment convenient for you. But to schedule an appointment's really gonna give you the best experience for sure.

Jackie Marschall (21:07):

And now you can skip the line by doing quick pass at Oh yeah. Home. Oh yeah. That's great. Yeah, so you can do your questionnaire the same day as your appointment at home or on your phone or anytime before you come to your donation appointment. So that'll allow you a little extra time as well. So hop onto our website, you'll see it there called Quick Pass. So if you haven't done that yet we've been getting some really good feedback and how convenient that is. So dive in.

Dr. Oh (21:32):

Well, thank you guys so much for joining. This has been a great podcast. I think as we go forward I will try to make every podcast if I can and I think at least either Lisa or Jackie will have at least one of you hopefully both of you.

Jackie Marschall (21:47):

Expect some special guests. Yes, too. Yes, absolutely. Some community members, some familiar faces, some unfamiliar faces. New friends. Old friends.

Dr. Oh (21:55):

So we, we have many of these scheduled to to go. So we're getting back on the horse. Yes. And we're gonna ride that sucker and produce more, more content here. Well, thank you very much. That's it for In the Know with Dr. Oh.

Dr. Oh (00:11):

Hi, this is David Oh and you're listening to In The Know with Dr. Oh. We have a very special guest today, I think, as we've been talking about this podcast. You know, one of the things that's been a little bit missing for us is actually the donors. So we wanted to have one of our great donors come in today and talk a little bit about what motivates him and some of the interesting things about about him as a, as a donor and as a philanthropist here in the Cincinnati area. So, we have with us today, Fluke Skywalker as our special guest. Jackie Marschall is here as well as a, as co-host here. And Fluke has a really interesting history. I got to meet Fluke outside of his Star Wars persona involvement. We actually both live in Loveland right here in the Cincinnati area, and his kids go to school with, with mine. And now my kids are at UC. Go Bearcats. And so <laugh> are his kids. His oldest is actually a drum major in the marching band, and my daughter plays in the marching band, and his son is in ccm which is fabulous. He's a, he's a drummer, and he has actually accompanied many of the musical accompany productions that they've had. So we've had a lot of fun with Fluke and his family since the time we've come to Cincinnati and the Loveland area, and I think before the whole Fluke Skywalker thing started. So Fluke. Can you tell us a little bit about your history and here in the area as well as how you got into being Fluke Skywalker?

Fluke Skywalker (01:45):

Sure. Thanks for having me on first. Appreciate that. Let's see, 23 years ago, yesterday I married my wife and moved to <laugh>.

Dr. Oh (01:54):

Good move. Good move. <Laugh>. Yeah.

Fluke Skywalker (01:56):

Yeah, exactly right. She's awesome <laugh>. And then so in 2006, the her friends at work said, Hey, you know, we go down to Ronald McDonald House and we make these brunches on Sunday about five or six times a year with these other families. Would you like to join us and bring your kids? Right. And our kids five and six then, so, sure. So we go down there and, you know, they're, they're flipping pancakes, little kids thinking, oh, I'm growing up. And we did that for 10 years. And in 2016, Ronald McDonald House hired some professional chefs, which is a good move. It's better nutrition for the families. So that opportunity volunteer kind of switched up a little bit. It's like, okay, now what do we do? So between 2016, August and August of 2017, I lost 90 pounds. And I had short hair, no beard, walked into the Lowe's in Milford, and that's the first guy that ever went, Hey man, anybody ever tell you, he look just like Mark Hamman <laugh>. So I laughed too. Right, guys? Fat. Right. So, and then whatever movie came out that summer, we went to see a Star Wars movie, and we walk into the movie theater. It's the kind, we kind of turned a bend there, and this guy's sitting in the chair that goes, Hey, Luke Skywalker. Wow. Oh my gosh. Still, still short hair and no beard. I'm like, oh, okay. Maybe there's something to it. And so I told my wife, I said, well, my birthday's coming up in October, so why don't you buy me the white costume? I call that day, wear the black one's, evening wear. I call that <laugh> since to a movie. And I'll go up at Christmas time and we'll take Star Wars toys, Christmas 2017. We'll see how goes. And we knew the people there. I said, come on up. You know, we've been volunteering here 10 years from everybody. So we did that, and it was a big hit, right? So the kids love running around, beating the heck outta each other. Light savers, right. <Laugh>, they're a good time. You know, they're not doing that. And mom and dads are really into it, and they're like, they know who Luke Skywalker's, a lot of little kids don't. There's a ton of little kids. Oh, yeah. But teenagers know right out the gate and stuff. And they started doing something that has never stopped, which was, Mr. Hamill, thanks so much for coming, coming here. I appreciate your time. And I'm like, oh man. Now what. <Laugh>.

Dr. Oh (03:47):

<Laugh>.

Jackie Marschall (03:47):

<Laugh>

Fluke Skywalker (03:48):

So, you know, I just like that. Or Guy runs up with his phone like that, Hey, hey, Mr. Hamill, say hi to my cousin Jimmy, that <laugh> <laugh>. Hi, Jimmy. What do you do? Right. So, anyway, and then that just took off from there. They said, come back. So every three months without fail, even through Covid, we stop up there and drop off toys. Star Wars toys used to be in costume more before the COVID hit, but, you know, it's, it's switched up a little bit. And I'll I'll do that again. Yeah. And then it's just kind of escalated up into me doing different events. And then, so I don't take any money for this. So I say, somebody says, come to our party or whatever, I said, fine, donate a check to Ronald McDonald House and I'll come do that. You know, it's tax deductible, and, and you guys can, and that's the way I can volunteer. Right. So, and then it's even gone and spread out to where I'm actually marrying people. Now they have a Star Wars things wedding, and they, want Luke Skywalker there.

Dr. Oh (04:36):

So you're not, you're not actually taking them as a wife. Right. <Laugh>, you are marrying them. In what sense are you marrying them?

Fluke Skywalker (04:42):

Right, right now, I, I got a minister's license and I gotta certify that state of Ohio. And they say, that's awesome. Can you marry? Says, yeah, but you gotta write a check to Charity. And so next year's gonna be the Ultimate wedding's. Really cool. I, I don't know if I could talk about it yet, but it's the coolest thing.

Dr. Oh (04:54):

<Laugh> no spoilers. Right. No spoilers. You can talk about some of the previous ones you've done. I've, you've, you've described them to me and I've always thought them really cool with R two D two and some of the friends you've made often work, work these gigs with you.

Fluke Skywalker (05:07):

I'd say probably the most fascinating person I've ever met was Tim O'Sullivan. He's up in Dayton. And Tim is a survivor from the war over in Afghanistan. And he he's actually in Basra in 2004. And his Humvee rolled up on an 80 pound ID and blew off right underneath him. So much so that on, if you know anything about a Humvee, probably most people don't, but on the walls to save space, they bolt on stuff like first aid kits and all that. When he woke up and came to all that was on the ground, because the shockwave that went through him split those bolts laterally. Long ways. Wow. Not silent long ways. That's how big of a way that hit. Wow. So he had to retrain a lot of that, but he's okay now. I think he gave him superpowers because <laugh>, he's one of the best makers ever. He's, he's built C3 pos, R two D two s. He's got a, a remote control gro go. That just does everything. I mean, it talks and, and Waves actually blinks his ears wiggle. And on and on. He's got all these, and then he coj plays inside C3 pill with me, and we do a lot of vets events for disabled veterans to try to raise money for them too, so. Mostly it's, it's either infirmed children or disabled vets or recipients. But if's somebody says, Hey, go do this. I'll do that. So like, come here.

Dr. Oh (06:15):

Yeah. That sounds awesome. So, so cool. So you also were a blood donor, so that's kind of why we were asking to come here. How long you've been donating blood and how'd you get started?

Fluke Skywalker (06:24):

I started when I was younger, but then just took off for a while. And then I think let's see, you and I were talking maybe I said, I think I need to do this. And then started donating for sure at the show we did at the, the Comic Expo in 2019. I think I stood out in front of your booth. Yeah. And that was kind of neat to actually see people walk up, either sign up or walk up and get hooked up to donate right there on the spot at the show. Like, that's pretty cool.

Dr. Oh (06:49):

So that was one of our mobile drives that we had, which was really, really fun drive. And it was 2019. So this was before COVID. If there was a time before Covid. Right. I think I remember that <laugh> and and Jackie, I don't know if you were, if you were involved with that drive up as well.

Jackie Marschall (07:04):

Yeah, definitely one of my favorites. <Laugh>.

Dr. Oh (07:06):

Yeah. And so that's just a fun drive, right? And so it, it, so I come from San Diego, right. And so we do the San Diego Comic Con there. Right. And so that has had a, a long, long, long, long, long history of having a blood drive associated with that comic convention. That actually is the Heline Drive because he was asked to be a feature speaker early in the days of ComicCon when it really was comic books. And he said, yeah, you know, but the only way I'll do it is if you hold the blood drive at the same time and, and you know, in honor and, and I'll come in, then I'll speak. And so ever since that time, there's been a blood drive that's been associated with that, that, and it's become huge. So actually in San Diego, it's not only every day that they have the ComicCon the day before as well. And and I know that fluke, you have a great story about going out to San Diego area. We were trying to get you hooked up to be at the, the San Diego Blood Bank Drive. And unfortunately that was, that was Covid, I remember that. Yeah. And the, the plants got kind of screwed up there.

Fluke Skywalker (08:02):

I still wound up donating blood out there.

Dr. Oh (08:03):

Oh, did you?

Jackie Marschall (08:04):

Oh, did you?

Fluke Skywalker (08:05):

Yeah. There was nothing that was highlighted in that sense, but I did that.

Dr. Oh (08:08):

So tell, tell us a little bit about your California experience there with

Fluke Skywalker (08:11):

Well, that was something else. So the oldest my daughter who I call Wedge, because Wedge always has Luke's back. And when we're at somewhere, I don't want her to go, Hey, dad, because that blows the magic I'm trying to create. So she says, Hey, Luke. And I say, Hey, wedge.

Dr. Oh (08:22):

So, so one important thing is that you are not trying to make people think that you're actually Mark Hamill.

Fluke Skywalker (08:27):

No, I'm trying to do the opposite of that and get the name Fluke Skywalker out there. Yeah. Cause it's just a fluke. I looked this way and I thought, that's a fun name to use, <laugh>. It is just a fluke of nature. So, yeah. And it's more important for me to try to be selfless in the pure sense of the word of selfless. That's why I don't use my real name. I just, I don't, I'm really careful what words or accolades, it's just never understand that a bit. I just want to see if I can help people using this fluke of nature. So so anyway, wedge as our high school graduation present, we went out to Comic-Con. Yeah. And she's isn't really into art and, you know, comics and all that. She likes that as well too. So we went out there and we were volunteering at the time because there's no tickets, but you can volunteer and they'll let you use your past the rest of the day to see all that. So that was day one, day two when they kind of saw me there, they said, oh, you need we didn't want you as a guest experience, so we're gonna bump you up to that. So I was there greeting people, coming in, taking pictures. And then later in the day we went we were walking around typically and into a few photos, and then wound up by the backside of the Hasbro booth that had a big giant Star Wars sign. Right. A couple Spider-Man were taking pictures, they don't know why. And anyway, so when, when they left she said, can we get a photo here? And I said, sure. So went over there and started taking pictures and a Darth Vader walked up and said, can I get one with you? Yeah, of course. And just a chance, I have Ale walks by. So we were there, all three of us were going. And people just started coming over and getting pictures and more and more and just built and built and built. Everybody wanted to get a selfie, but they all wanted it once. So it was like a crowd of three or 400 people. Wow. And the securities, you know, keep moving, keep moving cuz they're blocking all the fire exits or the doors as it were. And everybody there thought, this is Mark Hamill, I'm yelling at the top of my lungs. I'm not Mark Hamill, I'm Harrison Ford

Dr. Oh (10:04):

<Laugh>.

Jackie Marschall (10:04):

<Laugh>

Fluke Skywalker (10:06):

And a guy yells back even better,

Dr. Oh (10:08):

<Laugh> <laugh>.

Fluke Skywalker (10:10):

So anyway, the Hasbro people said, oh man, you know, you wanna come up to the stage cuz you know, they, they went to them and say, you gotta move your guy. And he is like, he's not our guy, <laugh>, you gotta move him. So he's just here, we went off the stage and, and we did you know, I just took pictures and stuff up there. So that's kind of the introduction into it. And, and Mark Hamill just shortly after that started following me, but I think it's more on, on Twitter, but I think it's more of not so much, Hey, you're great, but more like, I got my eye on you.

Dr. Oh (10:35):

That's so funny.

Fluke Skywalker (10:35):

This guy's Sterling reputation does wanna ruin by some joker in Cincinnati. So I don't, don't blame him for that, but he's always been very nice to me and he's a good example to follow. He's very much into charity.

Dr. Oh (10:45):

I think his posts have been very positive of the work that you've been doing. And I think he recognizes there are so many people and I think you're trying to use your power for good. So I think that that's really a great thing. So Jackie, can you tell us a little bit more about the ComicCon that we not, it's not ComicCon, right?

Jackie Marschall (10:58):

It's a Comic Expo <laugh>.

Dr. Oh (11:00):

Thank you very much. I'm gonna get sued by somebody <laugh>. Yeah, no. But but here at Cincinnati, which is I think a great event as well. My, my daughter wanted to do it this past year, every day that was open. She had a great time.

Jackie Marschall (11:10):

Oh, I'm jealous. Yeah. It's one of my favorite things that we get to do at Hoxworth. And I pretty sure that's where I met you for the first time was the comic expo blood drive back in 2019. I think we did. No, I guess we haven't done it since 2019, unfortunately. But yeah, so we set up shop right there in the Duke Energy Convention Center, kind of right at the entrance of, of the comic expo. And a lot of people come and donate all throughout the entire weekend while they're there. But, you know, there's a usually a huge line when people come in and then like early access and a lot of people standing in line will just come and donate in their full costumes. And we encourage our staff to dress up. Like we got a couple Batmans <laugh> and all sorts of different things. All the photos that I have are, are fantastic of different costumes that people wear.

Dr. Oh (11:57):

And I, I went as a Pokemon trainer.

Jackie Marschall (11:59):

Yes. <Laugh>.

Fluke Skywalker (11:59):

Oh yeah, I remember that.

Dr. Oh (12:01):

<Laugh>. We have, I have some good pictures with Fluke.

Fluke Skywalker (12:03):

When I was donating blood there, I put the picture out and encourage people to, and somebody said, so I get Jedi powers?

Dr. Oh (12:10):

<Laugh>.

Fluke Skywalker (12:11):

Oh, It's funny.

Jackie Marschall (12:12):

Jedi infused blood.

Fluke Skywalker (12:13):

Yeah, the Midi-chlorian.

Dr. Oh (12:15):

Midi-chlorian, right? Yeah. Yeah. I was gonna, we're gonna talk about that in a little bit. How to keep your Midi-chlorian at a high count here. Yeah. So yeah. So I think that's been a great event for us. Unfortunately in this past year we were not able to do it. We're kind of going through stuff like everybody else's with with pandemic and we're, we're trying to hire folks to help us. And, and right now we actually do have a, a need for donor services folks to join our organization. So if you donate blood and you're like, oh, I wonder what it would be to be on the other side of that needle, please contact us. Go to our website and I think you'll be able to find information about applying for positions as well. So yeah, unfortunately this time we were not able to support that drive, but we'll look forward to doing that again.

Jackie Marschall (12:53):

Oh yeah. It just means we'll come back with a vengeance. We're excited for the next year for sure.

Fluke Skywalker (12:59):

I'll be there,

Jackie Marschall (13:00):

<laugh>. Yeah, you will.

Dr. Oh (13:02):

So let's talk Fluke a little bit. So you've donated red cells a lot, you're, what's your blood type?

Fluke Skywalker (13:07):

A Neg.

Dr. Oh (13:07):

A neg. So Jackie thought it would be fun if we talked a little bit about blood types. So a neg, it's great for you to donate red cells. Any a donors, we will actually make great platelet donors. So if you've donated red cells a few times, we like to convert you over to platelets and it's a longer donation, but you come in more frequently. So wait, is that a deal? You come in more frequently and it takes longer, but but I think if you like donating blood, it's a great deal. And it's, it's actually a, a super way to, to help folks cause the platelets are always in short supply as they only have a seven day shelf life and we're actually not able to even ship them out until day two or three. So There's a lot of complexity in them and they, they're more like the fresh produce in the, in the grocery store, <laugh>. So we're always looking for, for platelets. And many of our platelets actually go out to children's Hospital, and that's for kids who are getting chemotherapy and other treatments and they need platelets so that they, they don't have bleeding episodes. But when somebody is an A negative, then it's like, oh, red cells are good in that situation as well because we like the RH negative. So the negative is, is the Rh and for those of you, here are blood bankers, that's the d So if we're, we're, we try to give neg rh negative products to recipients who are RH negative. And if they're a negative then, then we really try not to give them a pause. It's actually not a horrible thing for men or for female not of child bearing age, but but it gives us much more flexibility and we're always looking for red cells that are oh, negative and a negative as well. So those are good products to keep in mind. So donating red cells is awesome for you. And again, I'm sorry, I, I think that at one point we were talking about Midi-chlorian, right? And you were unable to donate because when we did your your, your finger stick to see if you qualified that day, your iron was a little bit low. And that's kind of, it's actually the hemoglobin or hematocrit is low, but one of the major causes for that is iron and low iron. And so I actually had thought, oh, maybe we should do a video with you saying that your Midi-chlorians are low, saying that your, your hemoglobin hematocrit was low and that you needed to take a daily supplement with with iron to, to make sure you could donate in the future. So after you had that, did, did you end up taking iron?

Fluke Skywalker (15:25):

Oh yeah. So that's a suggestion of Dan. Up in Blue Ash, he's so good to work with. Oh, I love Star Wars fan. Dan said, Dan Cunningham is what you do, you want to get the count up. I think it was like 37 what? 38 maybe the minimum. You wanna get your count up. So he said take an iron supplement every other day, but do it at bedtime so that it doesn't leave your body right away. Within an hour or so it'll absorb into your bloodstream. So he is right. So last few times it's either been like 40 or 41, I said, I'll, I'll try for a hundred percent. He says, now you don't wanna do that

Dr. Oh (15:52):

<Laugh>. Yeah, a hundred percent is not, not be good.

Fluke Skywalker (15:55):

Not be good. But I am ironman!

Fluke Skywalker (15:58):

So solid iron. So yeah, that's worked out well. And then, you know, go nonstop to either donate blood or I've done plasma the past two. I know it does take a little longer. So trying to do back and forth of this time, blood, next time plasma like that. So either way it's, it's okay.

Dr. Oh (16:13):

That's that's great. One of the things we always say is, you know, daily multivitamin with iron is a, is a good thing, especially if you're donating blood frequently. Even if you're donating platelets we give you all the red stuff back. But we do take some of that when we collect your tubes for testing. So there is some loss that continues over time. So anybody who's coming in frequently to donate, we recommend you take a multivitamin with iron in it.

Fluke Skywalker (16:34):

That's every day too. And in addition to that this morning, you know, the oh, old man Centrums, you know, silver

Dr. Oh (16:41):

<Laugh> one, one of the things we do encourage for men is especially if you're in that age where you should be getting a colonoscopy regularly. So, you know, we don't want you to take iron and mask sometimes when the symptoms for colon cancer is the decrease in hemoglobin hematocrit. So that is something you should definitely regularly do, especially if you're donating blood, because if you are taking a supple both iron, that'll kind of mask that, those losses as well. And we would hate to have something missed as well. So so I guess the purpose for this is not to tell people to get a colonoscopy, but yeah, go ahead and get, get a colonoscopy as well. <Laugh>, <laugh>. If you're in the right age group and, and demographic. Jackie, do you have anything you wanted to?

Jackie Marschall (17:21):

Yeah, I, I'm curious, you are so involved with many different charities and stuff and I'm wondering like what inspired you to want to use your Fluke Skywalker superpowers to give back and do that and advocate, I mean, we're on the receiving end of a lot of the advocacy that you provide. So is there is why, like what inspires you to do that?

Fluke Skywalker (17:42):

All the cash

Dr. Oh (17:43):

<Laugh>.

Jackie Marschall (17:44):

<laugh>

Fluke Skywalker (17:47):

I haven't taken a Penny <laugh>. Well, you know, I've been pretty much a volunteer all my life just built into the DNA as it were. So, like, you know, remember J Lewis had telethons as a kid you could ride your bike and get so many cents per mile, you know, you did that. So I, I've started off as a kid doing stuff like that and stuff through the years and then like I said with my wife's friend at work or my wife's friend told her, Hey, come down and help us do this. Right. It just seemed like that's an easy thing to do. We can do that and the kids would like it. And, and so it was very enjoyable as a family activity and help out these other families. And once you get to meet the families and their kids and you hear their stories, you're just like, oh man, what can I do to help you? Cause you're just going through the absolute worst thing you can imagine as a parent, right? You got not only bill's just piling up like crazy. But you know, you've got a sick kid. And then, you know the ultimate question, worst thing you can think of as a parent is, is this kid gonna come home with me? Thankfully they're at Cincinnati Children's Hospitals, which I consider one of the best in the galaxy. Everything's the galaxy, right? <Laugh>. So there's a really good success rate there. And kids that would've perished somewhere else came here and they saved them. I know that for a fact. I talk to some parents, so like I said, once you see their stories, you're like, Hey, what can I do to help? Cause they're really going through some tough, tough times. Just a, a living nightmare for a lot of 'em and looking cool about doing it. But, you know, in reality is just punches 'em every day in the, in the T. So that's my incentive to keep going. And it just kind of, you know, it's tough to say no when somebody says, you know, do something for blood or whatever. I'm like, yeah, I'm there. I can do that. Cause if I can use this look to help somebody out, that's the easy thing to do. I I had to do is sh as I say, show up be unbelievably handsome and over about it. <Laugh>.

Jackie Marschall (19:26):

<Laugh>So easy.

Dr. Oh (19:27):

We have a a recent focus patient who was just amazing make-A-Wish Ambassador as well. And Jackie, maybe you could talk a little bit about William and I think that Fluke what you do is a great opportunity for us to overlap with other charities and work together and, and really synergize with some of these things. So can you talk a little bit about William?

Jackie Marschall (19:46):

Right now we are in the process of partnering with make-A-Wish on William's Wish, who William is a 18 year old Fairfield High school student who is battling leukemia. And instead of doing anything in the world that he wanted to do with the Make-A-Wish that he was offered, he wanted to give back to help other kids like him and host a community blood drive. And right now I looked up this morning almost 600 donors have donated in his, in, in his honor in about 20 days. Wow. So far I think it's been, so not even like just a little over two weeks. It's been an incredible thing and, and Fluke I know that you're involved in and Make a Wish. And I think part like this partnership for me has been really incredible cuz you kind of just, you see the full circle of it. You know, I've, we've been, I've seen recipients met recipients, but you know, I don't think I necessarily know the deep dive on what everyday life is like for them. Last week mayor Aftab was able to come and visit the donor center and William was able to FaceTime with him while he was getting his chemo treatment.

Dr. Oh (20:49):

That's so awesome.

Jackie Marschall (20:50):

That's just really incredible to me that he has this energy to be able to want to do that. So I get inspired by stuff like that, just the kind of the same way you do, you work with Make-A-Wish as well. I, we were part of the Blink Parade. I saw you in the Blink Parade. We were there too, which was super fun. So I love that we are semi connected in this. So if you feel free to talk about what you've done for the Make-A-Wish Foundation and, and folks who are inspired by Star Wars.

Fluke Skywalker (21:13):

Sure. Sure. So as I said previously, I don't take any money for this. So if somebody says Come do this event, I say, okay, but you're gonna have to donate something to charity. I'm not gonna, you know, let it just go fallow. So I've done events where I, that said write the check out to Make A Wish when I'm married a couple as as Luke Skywalker in their Star Wars theme wedding. That was part of their money. Went to Make a Wish on that too. Oh, to, to donate. That's tax deductible. So, you know, they liked doing that as well. And so last May the fourth, just before that, the FC Cincinnati soccer team PR lady called me up and or sent me an email and said, Hey would you, we'd love to have you for Star Wars Day, would you come down and do that? I said, of course, but I want you to take Harrison some Make-a-Wish families. So they said, that would be great, we'll do that. So I showed up, that was my third event that day, cuz you know what Christmases to Santa Voice to me, right? That's my busy day of the year, like sun up to sun down. So it was my last event of the day and I went in tired, but happy to do it. And so we went to Washington Park, I took pictures, first walked over with the fans, you know, to played the drums and do all the smoke and stuff. I was leading the way with the lightsaber going and off Went over there and then went to the stadium and went up to some of the boxes and took pictures with fans up there and went down to meet the Make-A-Wish families. And they had two of them there right on the field, I mean on the field like that, the best seats in the house. And they gave them, you know, the tickets and then lots of swag and treat 'em every, they gave 'em a real nice day out. I mean, they did an excellent job. So I kudos to them, you know, for taking care of it. So that kind of stuff is there. And then again, there'll be at events where I try to bounce a check either to Ronald McDonald House or Make A Wish or Blue Skies for the good guys and gals. And those are paratroopers who help out disabled veterans. And so if I can do any one of those events or, or support any one of those, I'll do it. Or even donating blood, you know. And then actually I, I usually tweet out a photo or video of myself doing it and saying, you guys can do this. You should do it. Get off your bus. Come in here <laugh>. And, you know, it really does save a life. When I put that out there, a lot of people come back and say, I'm so glad you're doing this because I really needed this. I was in the hospital for, you know, whatever reason, and I would be dead today if it wasn't for people donating blood. And that really was what comes down to is I'll never meet the people. You know, it's like lots of toys that I drop off every three months for their toy closet. A lot of the kids that get those, I'll never meet 'em. But I know in reality that they're, they're having a good time and they're, you know, they get a new toy and that helps 'em post chemo for surgery. So I'm happy to do that. And there's a lot of people who like supporting what I do. Every year on Giving Tuesday, which is the second Tuesday after Thanksgiving, or excuse me, first one after Thanksgiving. It's November 29th this year, everybody's encouraged to do something. It's the giving back. So I always have, since I started is put online, I say, if you want to help me out, today's the day. And I always put a target goal of I want to do this much so I can buy this many toys over the year. And then 2019, we bought, sorry, 2020 we bought Ronald McDonald House, a brand new pinball machine, star Wars machine for the game room. Awesome. The year after that we helped get Ricky his van, big Star Wars fan. His he was a kid in a wheelchair and his van was 19 years old and broke it down, oh gosh. Leaking gas right on the muffler. So you know, mom had so much of it. And then we said, well, let's do what we can. So we, a couple television interviews and like two weeks later they got the van. So that was there. And then this year we're gonna put a Mandalorian machine in next to the Star Wars machine so the kids don't have a line wait in, cuz they've all seen the DSS in the room and, you know, all that stuff. Playstation, but they've never seen a pinball machine. It's like, wow. They'd be lined for that. So they're, they love playing that <laugh>. So that kind of stuff is always helpful when people wanna say, yeah, we'll help out too.

Dr. Oh (24:49):

Hey, is there a Instagram or a Facebook that you want to get plug out? Where can people follow you? Should they just,

Fluke Skywalker (24:55):

All you have to do is Google Fluke Skywalker, Luke, that's it. Just like Luke will put an F front.

Jackie Marschall (24:59):

He's the one and only.

Fluke Skywalker (25:00):

Typically it jumps right to my, my webpage. Awesome. And then if somebody wants me to come and do their event at the bottom, it says, email me. So they can email me and say, yeah, well I've got my son's this massive Star Wars fan and want you to come to, you know, his wedding or birthday party or corporate event. I just went to somebody's event downtown. And the boss was a big Star Wars fan, so we surprised him on his birthday. And then that guy donated made a donation to Make-A-Wish, as a matter of fact for, he did 250, which is really nice. Right. Awesome. I was there about an hour and that's, that's about about right. You know, but he gets a tax deductible donation and usually people will chip in. So it's not so much a burden on one person, you know, $20 for, you know, 25 people or whatever, you know, $10 or something like that. So that's, that makes it happen, like, cool. And you know the charities win and I get to volunteer and, and that's a lot of fun. People really like it and their faces just light up. Aw. And I know the reality. They'll get pictures and here's what happens. They go home and go, guess, who was at our Work today?

Dr. Oh (25:58):

<Laugh>.

Jackie Marschall (25:58):

<laugh>.

Fluke Skywalker (25:59):

And they're, they'll like, you know, do the wink wink thing. I know that happens. I've never met a guy a couple years ago. I do a music hall every year when they do Star Wars stuff and he says, were you the guy done a music hall, the Luke Skywalk down there a few years back? And I said, yeah. He says, you know, I've got a picture with you and my son. It's on a refrigerator. Now that doesn't get surreal at you and somebody you're on the refrigerator. Like, oh. So I'm sure that happens quite a bit of like, yes sir, I got a shot with you. And they'll do the Haml thing on the Sure. But I, hopefully that's not too often and I, I try my best not, you know, to tell everybody I'm not Mark Hamill. It's just, it's just a fluke look a little bit like him. So <laugh>, if I can use that for the powers of good, I'll do it.

Dr. Oh (26:35):

Well, fluke, I wanna thank you again for joining us today and, and for using your advocacy powers for, for Good mm-hmm. <Affirmative>. And we really appreciate it and, and you're kind of what, what we love in our donors. So thank you so much for talking to us.

Fluke Skywalker (26:47):

Hey, thank you for having me. I really appreciate it. This is a great show. Look forward to hearing me.

Dr. Oh (26:50):

Thank you. You're listening to In the Know with Dr. Oh.

Dr. Oh (00:09):

Hi, this is David Oh. I'm Medical Director of Hoxworth Blood Center. You're listening to In the Know with Dr. Oh. So we thought we'd do a real quick podcast here

Jackie Marschall (00:18):

A quick hit,

Dr. Oh (00:18):

A quick hitter. Yes, <laugh>. And talk a little bit about some of the deferrals that are more common. So so Jackie, what should we, which ones should we talk about?

Jackie Marschall (00:27):

Yeah, so there've been some recent changes in the blood banking world that have opened up some doors for recent deferrals, like Mad Cow Disease, Breast Cancer, some of the men who have sex with men deferrals. A lot of updates have happened over the last handful of years. People who have been deferred once before may not be deferred anymore. So I think one of the biggest changes that we've had in the last, like most recent years are the mad, the mad cow disease deferrals. So Dr. OH, if you want to go into that and what has changed on that?

Dr. Oh (00:55):

Yeah. So thank you. Yeah. So, gosh, I'm trying to remember what year they instituted these changes. I think in the early two thousands we were seeing an increase in, in bovine bunch form encephalitis over in in England or MaD Cow disease. And so FDA was really concerned because it was associated with eating beef and other other foods that, that may have exposure. So F D A decided to require that we start asking donors if they have any significant risk factors. And so unfortunately those included travel and they included eating food on US military bases as well. So there are all these different types of questions, what countries you were in, in Europe, and and we ended up losing, I believe the number was like five to 10% of our eligible donors. I mean, it was a, it was a huge percentage. So more recently we've seen those cases really coming down to zero new cases of, of of Mad Cow Disease and you just don't hear about it on the media as much. But we still had these deferrals that were still lingering. So FDA reviewed the data and felt that the risks were, were so low now that we could actually allow a lot of these donors who had been deferred previously to come back and donate. Enough time had elapsed where we would expect for symptomatic folks who were in a developed disease, they would've developed it by now in many cases. And, and this was a tough one cuz it took 10, 10 to 20 years for some of these things to, to be seen as well. So changes were made and so now we are not asking those questions anymore. Or actually we still are asking the questions, but we're not deferring people until we can change our donor history questionnaire to align with the, the requirement for no additional questions. So it's a little complicated. You still, when you come to donate, you may be asked those questions, but we're not gonna defer you if you say you've spent time in Europe for a risk for a variance. So if you have donated previously though, or attempted to donate and you do have a deferral in place, we're asking you not to go directly to the donor centers or to a mobile drive and attempt to donate. We actually have a process where if you give us your history or call us at Hoxworth, dot org, find a phone number and call us that, we will then remove that deferral. And, but we have to kind of go through that process because the deferral code we used was not just for these specific things. So we wanna make sure we're not removing that deferral code inappropriately. So there is a two-step process if you have been told not to donate previously at Hoxworth, you should be able to very shortly come on in and donate blood.

Jackie Marschall (03:37):

Yeah.

Dr. Oh (03:37):

One of our people who.

Jackie Marschall (03:39):

Yeah. We're excited to have you back

Dr. Oh (03:39):

Yeah. One of these people who was really excited about this was our CEO and Dr. Cancelas. And he had lived in Spain for a period of time, and so he was ineligible to donate. And so he was so happy to be able to be eligible again. And so if you've been self deferring because of this or you've been told not to donate, we would encourage you to kind of look at that deferral. If you have occurred deferral call us. We'll try to remove that deferral. And if you have never been deferred and you just stayed on way on your own, you can come on in and, and and you should be able to do it unless you're deferred for a different reason.

Jackie Marschall (04:10):

You know, we're on the tail end now of breast cancer awareness month too. And that's one of the ones that changed. I've only been here for about three and a half years now, so that was one of the ones that changed during my time. And I, people are still come like over the weekend a lot of people were like, well, I, I had breast cancer, so I can't donate, but you can now. So that's a recent change as well. Right?

Dr. Oh (04:31):

Yeah. So before I got here, I, I know that we did have some, some longer deferrals for some of the cancers that we have. It has been 12 months now for the vast majority of, of cancers that you've been cancer free. So we want you to kind of monitor that time from either a curative surgery or kind of the end of significant chemotherapy. If you have questions about what additional care means you contact us and we can try to, to go through that process. But yeah, 12 months typically now for most cancers. And that really is for the safety of the donor just in case there's a recurrence and we don't wanna, you know, have taken blood from you if you're, you're gonna need it in the near future. There have been really no cases of adenocarcinoma that have been documented to be transmitted from a donor to a recipient. We actually would've thought that we would see that for sure if that was something that happened commonly. So that's somewhat reassuring I think, for us as well. And so really, yeah, the, the deferrals for the donors and their donor safety, and so that now is 12 months.

Jackie Marschall (05:35):

That's great. And then another one of the, the common ones that we've talked, you, we spend a lot of time talking about and advocating for the men who have sex with men, deferrals or MSM as we call it here in the blood banking world. There has been multiple, they've uplifted the deferral multiple, not uplifted, but changed the deferral multiple times in my time in the blood banking world. So

Dr. Oh (05:54):

Yeah. So that deferrals put in place kind of really as a result of HIV infection in the early eighties. Right. And so before there was really good testing we, we asked these questions so that we would decrease the number of donors who were HIV positive. And that was really important especially in the time before testing was, was widely available. Our testing now is really, really good. It's not foolproof. There are still cases where an especially if infected very closely to the time that they donate that it's possible that the test may not detect an infection. Really that's been incredibly rare. Some estimates out there are that the risk of of receiving HIV or hepatitis C as a result of a blood transfusion are about one in 2 million.

Jackie Marschall (06:42):

Oh, wow.

Dr. Oh (06:42):

So those are pretty good odds and I actually think that the odds are much, much less. Though that was kind of a theoretical projection and since really nat testing or nucleic acid testing has, has really come as standard in the year 2000 up through today, 23 years, and there have been only a handful of HIV transmissions that I'm aware of, and I think only one or two hepatitis C virus transmissions in that entire time period which is really remarkable. So as a result of that, the MSM deferral period is about three months now from the time of the last high-risk activity. There are a number of studies that, that have been performed. A number of countries have actually changed those policies because they, they do not want the deferral to be based on sexual orientation and sexual and prac those practices based on sexual orientation. And so the new criteria are really frequency and a new partner's status. And, and so we may be seeing changes with that. We're, we're actually expecting changes to be approved by FDA to allow blood centers in the United States to change some of their deferral criteria related to to that MSM. Great. So we're, we're waiting for that still. Yeah. And I know you've been asked a lot about this Jackie as as a as kind of a spokesperson in, in this area. And so yeah, we're still waiting for those changes to get to get finalized. The other thing for deferrals is that we used to have to defer for 12 months for travel to malaria and a number of different risk factors that have all been decreased to three months.

Jackie Marschall (08:18):

Oh wow.

Dr. Oh (08:18):

And that was during the covid 19, the peak of the covid 19 epidemic and an effort to make sure that we still had enough blood donors to keep coming. And I think fda, when they viewed that 12 month versus three month deferral period, for a lot of those, it was a little bit of overkill. And I think they, they saw that this was an opportunity to kind of correct that time period. Since that has happened, we really have not seen any type of blip in terms of, of harm done because of the decreased deferral periods.

Jackie Marschall (08:47):

That's great to to know that it's reassuring on our end. Right. Especially for the donors <laugh>.

Dr. Oh (08:51):

Exactly. So I guess if there are any questions at all, you, you can go ahead and call us at a number through hoxworth.org and ask ask us and we'll be able to answer your specific questions in terms of eligibility before you come in.

Jackie Marschall (09:05):

Yes, absolutely. So if you do have any questions or you are confused or you, you have no idea, or maybe you traveled somewhere that one point it deferred you or, and now it may not, you can always give us a call. It's 5 1 3 4 5 1 0 9 1 0 or you can give us a Google.

Dr. Oh (09:21):

Great, great. I'm always just go to the website <laugh>, but, cause I can't remember phone numbers.

Jackie Marschall (09:26):

We have options here <laugh>

Dr. Oh (09:26):

That's awesome. Those are the big things we wanna talk about in this kind of short,

Jackie Marschall (09:31):

The deferral. Quick hit.

Dr. Oh (09:33):

Yes, exactly.

Jackie Marschall (09:34):

Yeah. Recent changes. So you may be eligible to donate and if you think that might be you call us, ask us. We'd love to have you back.

Dr. Oh (09:41):

Thank you, Jackie, thank you very much for joining us.

Dr. Oh (00:13):

Hi, welcome back to In the Know with Dr. Oh. we have a really special guest today, and I'm going to queue up Jackie Marschall to, to give an introduction.

Jackie Marschall (00:23):

Yes. We're super excited to have Dr. Sanjay Shewakramani with us today. He is the physician lead of Performance Improvement for Emergency Medicine at UC Health, specifically Westchester. And I got, I got that. All right. And not only that, but he is the president and co-founder of Revive Strength and Wellness, an associate professor of emergency medicine at UC, and a member of Make-A-Wish, Ohio, Kentucky, Indiana Advisory Board. I mean, when do you sleep?

Dr. Sanjay Shewakramani (00:52):

<Laugh> I find the time somehow. Yeah. I was happy to get some last night.

Jackie Marschall (00:56):

Not only that, but Dr. Sanjay is also an avid blood donor and advocate for blood donation. So we're super excited to talk to you about all of the things, literally all of the things. So tell us a little bit about you, how you got started in emergency medicine and, and all of that fun.

Dr. Sanjay Shewakramani (01:12):

Stuff. Sure. So I went to med school in Boston University, and I graduated in 2003. I didn't really know what I wanted to do in med school, but I loved every part of it, which kind of logically made the emergency department make sense to me, although I'd never been in one. So in my fourth year of med school, I did my emergency medicine rotation, and I was scared the entire time, <laugh>, and I was really bad at it. And it was one of the few things I had done in med school that I was bad at. And I was like, you know, I don't think I'll ever get bored of this field <laugh>. And so I chose it, which is very much unlike me at that time in my life. I, I liked comfort and I liked like doing things I was good at, and this was something I was wasn't good at. But over luckily I've had the, you know, over 19 years since then, I've had the benefit of experience to, to I hope be pretty good at my job. And so it all started there. I trained in Boston at the Brigham and Mass General, and then I've since worked as faculty at the University of Michigan at Georgetown University. And then I came to the University of Cincinnati in 2015. So it's been seven years now. And that's kind of my story. I've been the medical director of the Westchester Emergency Department since 2018. And then I've I was given that role and I'm, I'm proud of that role of performance Improvement director for emergency services this year. So a lot of stuff kind of building through my career.

Jackie Marschall (02:33):

Yeah. Congratulations on that. That's exciting. So, can you talk a little bit about like your role in emergency medicine and how you see blood products used every day?

Dr. Sanjay Shewakramani (02:44):

Yeah. So, you know, in, in general, when I tell people that I work at a level one trauma center, the only thing they think when you work in the ER is you see car accidents, stabbings, and gunshot wounds. And that's such a, it, it is a large part of it and a, a large part of how we use the blood products, but we also see a ton of other reasons for patients needing blood products, gastrointestinal bleeding, vaginal bleeding other types of internal bleeding. There's a, and, and just anemia from other causes. And so, you know I have to be familiar with blood and and I'm grateful for all the Hoxworth donors for, you know, providing that blood that we get to use to save lives every day.

Dr. Oh (03:21):

So, Dr. Sanjay, let me I ask you a question. Go back for a second. So you're primarily at Westchester, is that right? But you also cover for U C M C. How does that work and how, what's the relationship? This is something I get asked all the time. What's the relationship between UC Health and your position with UC?

Dr. Sanjay Shewakramani (03:41):

So, my role because I'm a medical director at Westchester, I work 80% of my shifts up there. And so I still have to work or I, I get to work actually 20% of my shifts at the main campus. And through that I get my trauma experience. Although Westchester is a level three trauma center, we have, you know, we have to activate massive transfusion protocol fairly often up there too for patients that need a ton of blood, we see, we still see trauma. And so we get to work at both. And I'm, I'm happy for that cuz we get to see two different patient populations, two different types of injury mechanisms at both campuses. And it kind of gives you that broad range of experience. As far as uc, health and uc, it's you know, for the most part, I work for uc as a, as a school. But also then you have a different subset. But we work within uc Health, and so they all work together to provide patients with the care they need. It's complicated, but it, it works well at the same time between all the service lines.

Dr. Oh (04:40):

See, you explained that. Terrific. And so let listeners know I have a similar situation, right? So I, I am a uc employee, right. University of Cincinnati but then I have a position at U C M C and I hope to, to run the blood bank there. So it's a complex cooperation, I think and Hoxworth Blood Center is actually owned by UC and run by the university, not uc Health. And then we provide blood products to all of Cincinnati, including Westchester and UCMC, but all the other hospital systems as well. So it's, it's a very interesting setup. So I just a little sorry, just a little bit of flavoring for us in.

Dr. Sanjay Shewakramani (05:18):

Well, that's something I just learned today.

Dr. Oh (05:19):

So UCMC has a trauma level one, so you have an experience working in there as well. And I think it is interesting with Westchester, because many of our trauma surgeons and er surgeons will cover both of those settings. And so they're very different. But we have to provide blood products for both of those different systems. And so it's sometimes it's challenging up at Westchester because you know, trauma level ones where you really want the, you know, high level complexity cases to go. But if the accident happens near Westchester, you guys have to handle that you know, first.

Dr. Sanjay Shewakramani (05:50):

Yeah. And, and we've had to improvise on the scene and, and even courier services have been used to bring blood products up. And so it's, it's great that we have the relationship with the main campus up at Westchester. It's, we very much work together. We're the same er doctors between both places. The trauma surgeons, like you mentioned, are the same trauma surgeons at both places. So you get that same quality of care. And we also have the, the benefit of the blood bank in Hoxworth in general to to work with between the two in a very collegiate way.

Dr. Oh (06:19):

Yeah. It's fabulous for us at Hoxworth to be able to supply to all the different hospitals in the area so that there is consistency. And then the hospitals are used to then working with us as, as you know, their blood provider, making sure that they'll have the appropriate blood products where wherever they are, of course, Westchester is gonna have fewer blood products on hand, you know, directly available than U C M C.

Dr. Sanjay Shewakramani (06:39):

We certainly, yeah, we have less blood products, but certainly I've always felt comfortable at Westchester. I can, I, I worked in another system locally in the, in the distant past where we had one unit of, oh, negative onsite. It was a standalone emergency department. And we had a patient that needed massive transfusion and I was stuck with one unit. And that, that was difficult. And I'm, I'm happy to say that we've always had everything we've needed at West Chester, which has been nice.

Dr. Oh (07:08):

Yeah, this is great. So, you know, Hoxworth, we have to deal we have to work with every single, you know, hospital in the area, 30 hospitals in 18 counties here, right around this Cincinnati, tri-state of area. And so we work with each individual hospital to determine how much blood they need on hand, you know, and really it is, you can look at averages in terms of how much they use, but it really is that, oh, what's the maximum use we get in a year or two or five, you know, to make sure that they have enough. And then we have time to supplement their, their supply before they get there. So hospitals that don't have a trauma service, you know, or the ER services that we have here really, you know, probably don't need quite as much on hand for unexpected things that

Dr. Sanjay Shewakramani (07:48):

The only time I ever needed blood in that hospital, I needed bad. But luckily with our, you know, our relationship with air care they have more blood in that helicopter, which you guys supply as well, which

Dr. Oh (07:58):

Yes. Yes

Dr. Sanjay Shewakramani (07:58):

We did fantastic service too, cuz that, that came quick

Dr. Oh (08:01):

<Laugh>. Oh, that's awesome. That's awesome. So let's ask a little bit about your history as a blood donor and kind of how that happened for you.

Dr. Sanjay Shewakramani (08:09):

For the longest time, I, I, I think I had given blood two times in my life before I moved to Cincinnati. Oh. It was, it was rare. It was few and far between. And I think, you know, my mindset early on was, well I just, I, I've gone through all this training, undergrad, med school, residency, all this work. A lot of what I do like is high value stuff and I don't have so much time for other, other stuff, especially if I'm quote volunteering. And that was kind of the, the mindset I had. I was like, if I'm gonna do work, pay me for it. And I, you know, I went through a, a change about five years ago where a lot of the change was intentional on my part cause my life wasn't where I wanted to be, mainly socially, I'd say. And I, I had had a change of mindset in how I wanted to live my life. And so I had to get intentional with it. And one of the, one of the things I did was list the things I wanted to do as far as how I wanted to be. And so I had four things actually, and they're still on my whiteboard somewhere in my house, house, which was value life, give, heal, and serve. And those were the four things, the kind of pillars that I wanted to grow my new self from. And in that, you know, we would get notices from Hoxworth all the time, like, we need blood donors. And I was like, oh, I should, I should try that. I should go back to it. And I got some, I got like a really nice t-shirt when I donated <laugh>, and I found out that day and I, I, I always like, I think I'm a positive, I'm o negative.

Dr. Oh (09:40):

Oh yeah.

Dr. Sanjay Shewakramani (09:40):

And I was like, when I found that out, I was like, oh my God, I am a universal donor. Yeah. Why haven't I been doing this? And so that was part of my change into, into my donation thing. And the other part was, I knew there were shortages all the time, but I, I always kind of just, you know, the blood always appeared. Yeah. But I, I really got to see, you know, especially speaking of the teachers, the swag, it's, you know, you can't buy blood. That's the something that really hit me is you could have all the money in the world and people could still die of blood loss. Yeah. And we're helpless and right now, you know, hopefully times will change where we get other options, but right now, that's all we got. And the other thing is my blood cells are just dying every, you know, what am I doing with them? And, and they regenerate anyway. My body is made to give this stuff away. And so I had to change my mindset and, you know, it first started from a thing of intention of changing my life and the, the then it became, well, this is cool. I get some free stuff. And now, now it's just something I do. And so it's every eight weeks for me, although I, I try to give the, the red cells, red cells uhhuh as much as I can too. And so I got my gallon pin I'm waiting for, I'm probably pretty close to my second gallon right now. And it's just been, it's been great. So that's, that's my donation and I just, it's a regular part of my life now.

Dr. Oh (10:58):

That's so fabulous. I love the one of your tenants give and you're living in that. So that's really awesome. That must be how you and Jackie met right? Through Make-a-Wish

Jackie Marschall (11:08):

Yeah. Through Make-A-Wish, all of the giving things. Yeah. part of, I'm part of the Emerging Leaders Board over at Make-A-Wish and that's where I got to meet the fabulous Sanjay.

Dr. Oh (11:17):

<Laugh>. And we're calling you Dr. Sanjay <laugh>. You, you, you said that that was good for us to, to go ahead and use that.

Dr. Sanjay Shewakramani (11:23):

Absolutely fine. <Laugh>

Jackie Marschall (11:25):

<Laugh>. So one of the things like you mentioned wanting to bring this up and everything, but like, is it worth it? Is donating blood worth it? And how you see that come all the way through on the other end?

Dr. Sanjay Shewakramani (11:37):

I could talk all the time about my job, you know, cuz every time I meet someone and I, you know, they ask what I do and I say I'm an ER doc. They're like, oh, what's the craziest stuff you see? Cuz people imagine the crazy stuff. And I could tell you all the world, yeah. We get, you know, stabbing victims and they need a bunch of blood or, you know, there was a person, this actually happened last week at, at Westchester, who was someone who was vomiting blood and were in the brink of death. But the blood, you know, supplied by Hoxworth saved their life. But it, it gets more personal than that if I just told you stories. It's just entertainment. You know, I have a fairly close friend who suffered a miscarriage probably over a year ago, but in that setting, she hemorrhaged and was, you know, on the brink of death herself and needed a ton of blood products. And it's, and she came back, I saw her I, I didn't take care of her in the er, she was, you know, she was taken care of by someone else, but white as a sheet and, you know, and it's scary and without blood, again, I, I hope in the future we have other options, but without blood she would not have made it. She had passed out before coming to the hospital. That meant, you know, she was super low and I only got her back, thank God. But that's, it's, it's stuff like that that says, yeah, you know, we're doing what's needed right now to help people. So yeah, I'd say it's worth it.

Jackie Marschall (12:56):

<Laugh>. Yeah. And I love that you brought up like something, I don't wanna say as common as like pregnancy and hemorrhaging and stuff, but when you think of the er, you always think of like the dramatic things that you, like, you keep saying, but these are everyday things that everyday people go through all the time. And volunteer blood donors help those people every single day. So I think that's incredible.

Dr. Sanjay Shewakramani (13:18):

Again, I, I know I talk a lot about uc and I realize Hoxworth helps the entire community, but especially at uc, we're seeing state-of-the-art transplant, state-of-the-art, hematology, oncology care, and all those patients need blood. You know, the liver transplant needs a ton of blood to get through. And so it's not just the er, but the patients we take care of. And, you know, with the blood loss, these patients suffer that. Yeah. Beyond important as far as their care.

Dr. Oh (13:42):

Yeah. I, I'll often, that sounds a little corny, but I'll often compare a blood supply for the hospitals to like a clean water supply for a community. So I spend a lot of time out in California and we worry about the environment. You know, if you don't have a quality blood supply that that is available and, and you can't really do so many things at the hospital. You can't do cancer care, you can't do emergency care, you can't do traumas, you can't do cancer care. You can't do pretty much any service in the hospital comes back to, even if transfusion isn't used, it's available and it's and it's there. And especially for new technologies as they come along, right. So transplantation, right. That whole field would never have been able to progress or many, many scientific advancements. We always think of, oh, it's gonna use less blood. And that happens over a long period of time, but initially it uses a lot more of these resources. Right. So it's, it's very interesting as we go forward. Yeah. So, Dr. Sanjay, I, I'd like to ask you to go back again to the four tenants that you, you talked about I'd like to spend a little more time like learning more about you and, and thinking about those, those, so I know Give was one of them.

Dr. Sanjay Shewakramani (14:52):

Sure. So the first one's value life and it's you know, I have a little tagline, but beside all four of 'em. But value life and it's yourself and others. And, and so it's just, it's just honoring, you know, life in general. And how amazing it is and, and what a, what an opportunity is to just experience this life. Then it gets down to a lot of spiritual stuff in general, but really honoring the every day, the places that my life has taken me to, to be able to create a better life for others is a huge thing for me. I, you know, I, when it comes to mindsets, I used to have a very much a scarcity mindset of like, you know, I'm making this money and it's mine and, you know, this is, these are my achievements and now

Dr. Oh (15:35):

Only one winner, right? There can't be everybody a winner.

Dr. Sanjay Shewakramani (15:37):

It's a win lose kind of situation for everything, you know. And again, intentionally created an abundance type of mindset is like, like I said, I, I have all this blood, why not, why not give it out? It's just a little poke every eight weeks, you know, it's fine. But in general, that's the, it's the realizing that everybody else is living a story as well. And being able to hopefully help that along too. Cuz I've, I've been blessed with a lot of stuff in my life and other people haven't and or are going through a tough time where I can help them. And I'm, you know, I'm at a very good place in my life where I can, where I can do that. So that's value life.

Dr. Oh (16:12):

I, I absolutely love that. So, you know I people who know me actually know that I'm not explicitly religious in terms of a a formal tenant one or the other. But I do have fundamental respect for life and, and really do value it. And I think about blood donation and just the beauty of the model. I mean, it just is like this, we talked about giving, it's truly one of the only ways you can give of yourself, of your body, of your physical presence to other people. And when you donate blood through an dependent blood center, you don't know who's gonna receive that blood. It's this brotherhoodhood of man, you know, and it's, it's really beautiful when you think about it in the abstract. And when I, when I donated as a younger person, I never thought about it. You know, I never, I was like, oh, I'm just gonna do any blood and it's just gonna go to this whatever factory or something that, that happens, <laugh>. But then to actually come to the realization later that Oh my gosh, somebody's actually receiving a piece of me, you know, and there's so few avenues to do that. And, and it is a way I think when people are like, oh, I don't know about the world. I don't know what's going on. You know, how can I show love and support for my fellow man? And donating blood is actually one way to do it. And so once you, you do that and you make that connection it really, I think can, can affect how you see yourself and really improve your own life. Although that's not why you're donating, you're donating to help others, you know. So it's, it's really a magical almost.

Dr. Sanjay Shewakramani (17:38):

Yeah. You actually, you just hit upon two of the other values and we talked about give, but my little, my little underscore next to give is give, but not to get. And, and that's what you just referred to with, you know, not, not to get something in return. Yeah. We're just putting that blood into the ether, but you can know that people are benefiting from it. And that's, it's a cool feeling. And it's different than, than the feeling I had before, which is very much transactional. If I'm putting something in, well, what, what am I gonna get? Well, I get a cool T-shirt. Yeah, right. I, I won't you know, minimize that importance in my life. So, and then heal heal is a word you mentioned, and that's one of the, the four tenants as well for me. Which I look at my job as an emergency physician and I get that opportunity. And I know, like you say, it sounds corny sometimes when you say this, but when you start living into it, it really makes it worth it. You know, I get a chance to meet 25 to 30 people every shift I work, and I have a chance to help them to heal them in the way they need to be healed. And that's something that's also taken time for me to realize. It's not, it's not about me. It's about being who I can be, what those people need at that moment. And that's the heal part. And then inspire is actually the fourth one, which actually comes from the first three or, or well serve and then inspire. So serving kind of goes with the healing part that we talked about then in Inspire was something that I tried to do. I, I, I used to try to do very ally, and now it just kind of comes out of doing that. I, you know, I, I try to have a, a decent brand on social media where I can get the word out but not overdo it. I try to live into things more than I, than I try to message 'em. And I just hope through my actions, you know, whether it be inspiration for others or, you know, just helping other people is, is kind of my mo.

Dr. Oh (19:31):

That's, that's awesome. I see a lot of similarities actually in, in your story with kind of my, my journey as well. You know, I think I was very fortunate to become a physician, you know, and I, I think that as a young person I, I, I didn't think about it as much, right. I wasn't in touch as intentional. Some of us are are kind of steered towards certain professions and and I, you know, I'm an Asian and I'll say, you know, I kind of got steered this way. And it really wasn't until later, you know, as I was finishing my training, where I really started thinking about what am I doing? You know, what, you know, what can I do with this? And, and actually for a little bit I shared this with folks. I was thinking about not doing medicine for a while, you know, and then I came back and I made the decision, oh my gosh, I've done all this training. I've, you know, I, I did my schooling in Madison. We talked about that earlier, medical school, and I did my residency at Cleveland Clinic. I did a, and so I was like, oh my gosh, I'm in a, this situation, an opportunity to really use this training and all the effort and, and time I put into it to really help other people and to live a, a, a life of service. And so I feel so fortunate today because I think that if I had been left to my druthers in high school, I probably wouldn't have have gone this path. I wouldn't have gone a different path. But I'm situated to be able to help folks in and, and through, you know, being medical director with Hoxworth and being help, helping out with that mission and really believing in that mission. I get to do cool things like this, you know, podcast and, and to talk to people like you. And, and hopefully I'm helping to inspire folks as well. But really it is getting into a mindset where you can use the skills and talents that you've built up over the years to really help others. And, and, and that is, is just a great gift.

Dr. Sanjay Shewakramani (21:15):

Yeah. And I think you know, you touch upon something too is when, when we become physicians, we, we think about just the patient in front of us, and that's how we can help. But, you know, when you wanna make a larger difference, it can get hard when you think about it that way. But it's kind of how I approach my leadership roles, which is mm-hmm. <Affirmative>, you know, I can't help everybody that comes to uc Health, but I can help the people that can help them by, you know you know, helping them do their jobs better, or removing obstacles for them to have that greater reach beyond just the one-on-one patient encounters, which is still the, the thing I cherish most in my job, which is having that one-on time, one time with patients. And without that, I, I don't think I would have that excitement and energy for healthcare in general, but it's all part of the pie and, you know, things we can keep working on.

Dr. Oh (22:02):

It's just fabulous. So, you know, we talked a little bit about the promotions as well. We've been joking about it, and we did a, a little bit of a podcast recently to talk about promotions. And I think you're ex saying exactly what, what I wanted to say in that podcast is, the promotions are nice and they're fun, but really what we are talking about today in terms of tenants of life and, you know, making a difference. I think that really does fuel the, the blood donors that are out there, that are, that are really dedicated to what they're doing. And I'm hoping through this podcast that we can encourage other folks who are looking for a way to contribute to society, to look at blood donation and see, hey, maybe this can make a difference and, and really change your outlook for your own life, really. But it's all through helping others. Right?

Dr. Sanjay Shewakramani (22:44):

Exactly. And you don't like, you know, my story, I, I was not born this way. I was not born to be a giver. But if you're looking to improve your life and the life of others, if you're looking for a more fulfilling life, blood donations, a a potential avenue. And it's okay if you're not quote a blood donor now. You're not, you're not one yet. But you know, things can change and you guys provide a great avenue for that.

Dr. Oh (23:08):

Oh my gosh. So, awesome. Okay, we're gonna take a little break here. And I'll probably close this podcast. We'll have Dr. Sanja join us and we'll talk a little bit more. But you've been listening to, in the Know with Dr. Oh.

Dr. Oh (00:12):

You're listening to In the Know with Dr. Oh. I'm here with Jackie Marschall, and we have our special guest, Dr. Sanjay. We're talking about kindness, I think, in general. And some of the messaging from our currents, surgeon General has been really inspiring to me personally. When I was out at Stanford I was able to see him speak as a visiting dignitary and just really moved me in terms of, of talking about mental health and all the pressures in society today. And it happens that you, you have met him before. Can you tell us a little bit about how you know him?

Dr. Sanjay (00:47):

Sure. So I started my residency training in 2003 at the Brigham Women's in Boston, as well as Mass General Hospital. And Vivek, Dr. Murthy was an intern. So he is a first year resident in my exact same year at the Brigham, doing internal medicine training. So I've known him since 2003. And we, we ran into each other a lot of times. In fact, he's a friend and, you know, I've, I've had the honor of, and we've all had the honor of seeing him kind of grow through his two stints as, as Surgeon General. And now with his focus on, you know, the, the loneliness epidemic and, you know, his, his emphasis on togetherness and how much that means and how it's, how it can really help. But also how, how the lack of community and togetherness can really hurt is especially true now, especially in the last three years. You know, it's been, it's been a rough ride for, for many of us and, you know, isolation. We've seen the results of it. And so it's been, it's been cool because I think he got in early on this stuff and now a lot more people are talking about it, but it, it's probably largely due to him too. I mean, you got a role like that and you can spread a message that's not, you know, we think without Surgeon General, we think about the messaging on, on tobacco products, right? We don't think about, hey, love each other, you know, make time for relationships. That's not, that's not one what physicians do in general, especially not physicians leaders. We don't talk about that. But I think we're all learning the importance of relationships in our lives above everything else. So it's, it's been great to watch him. And, you know, on a, on a personal level, he's still just the nicest human. It's just not the person you see at talks at Stanford. He's you know, I, I broke my leg last year in March, and he was, was one of the first messages I got, wishing me good luck when he saw that I had broken it. And so he's just a genuine human.

Dr. Oh (02:34):

Just a tremendous person. I just it's real. So, it's so interesting cause we asked you on, cause we were gonna talk about a lot of technical things. The way I see this podcast in a lot of ways is really for donors because there are other podcasts out there and, and sources for transfusion medicine information. And it's very important, and a lot of our donors wanna know where their products are going, but there's not a lot out there towards the donation side and learning more about, you know, know how to donate and where that blood goes and, and benefits of donation. So I never tout the health benefits of blood donation, right? But I do think that, you know, if you think of mental health, I do think that that is the core for blood donors, the, the folks who just donate and, and really identify themselves as blood donors. There is a benefit for them in terms of mental health and, and feeling a part of society and all these different things that that we don't talk about a lot. But I do think that, I love being able to put a spotlight on that with you today and to really talk about, yeah, if you're looking for something, you know, blood donation may really help to, to fill some needs that you have. And and it's a great thing for society. It's a great thing. I, I think in general, and so I really, when I went into refocusing, going back into medicine I love the blood center side of things and I was just very fortunate to, to stumble upon it and to realize that hey, you know, with with the blood supply, there is a public health element to this whole thing. And and that there is benefit I think in terms of for sure blood centers making sure that all the blood is available for donation. But I think that there's, there are other things that we're doing as well.

Dr. Sanjay (04:12):

Absolutely. You know, it's that access, right? So I used to think that blood like Hawksworth was just, you know, just the only way I could contribute as a human would be by donating. And that would be the only thing. And that's how I see it. And I think that's how many people see it, which is totally reasonable, you know, and, and people that are scared of needles, understandably, or you know, have have any other trepidation about it, I get why they'd be like, ah, Hoxworth not for me. Maybe other people. But there's just other, there's so many other avenues, and I've only been exposed to it even in the last couple years because of Jackie <laugh> and our involvement in Make-A-Wish and talking about stuff and becoming friends with her and, and learning about all the, the other options that we have to, to help that I've gotten more and more involved in the, the other ways to help, in addition to just giving my blood every eight weeks.

Dr. Oh (05:06):

So, Jackie, what are, what are some of those other ways that people can, can help without actually rolling up a sleeve? And, and and

Jackie Marschall (05:12):

So one of the things that Dr. Sanjay does is he hosts blood drives at Revive Strength and Wellness. So if you wanna talk a little bit about why you started doing that. I mean, that's one of the hugest things. Like you're not only leading by example, but you're like giving an avenue for people who may be nervous to donate, but do it in the comfort and a space that they're comfortable with, you know?

Dr. Sanjay (05:34):

Yeah. To rewind a little bit, so I'm a, I'm a fitness center owner for a place called Revive Strength and Wellness in Oakley here in Cincinnati. And that came out of the same kind of change in my life five years ago when I wanted to do more. And, and part of that I knew was taking care of myself. And so five years ago I got a, a personal trainer, a coach, and after about a year of that, when I, you know, I was, I never worked out, you know, just like I never donated, I never worked out. I was unhealthy, I ate poorly, I slept poorly. I, you know, didn't do anything for exercise. And realizing the benefits of having a non-judgmental coach who could help me through anything I was facing, not just fitness, but even kind of mental stuff and struggles and trying to grow. I wanted to give that a bigger stage. And so we created Revive Strength and Wellness. Well, we started four years ago. We opened up in 2020 as a personal coaching and lifestyle coaching place. And so in that we love, you know, we have seven pillars of wellness. And one of them is service and that's service to the community. And so we realize the importance of that in wellness in general. We're not just a gym. We realize the importance of the whole life wellness, that that can go into helping you feel better. And so those giving opportunities, you know, there, there are plenty and we take it upon ourselves to kind of organize those avenues like, like you folks do, to make it easy for people to give. Because I think people realize they want to give, but they just don't know how sometimes or where. And so having events like Blood Drives, so we've had a couple at Revive where the, the mobile bus has come over and, and parked in our lot and it's been successful and it's been cool cause you know, people get that chance to come together and help and, you know, they would stop by in the gym afterwards, you know, with their orange juice and, and Oreos and <laugh>. It would just be, it, it would be great cause it just builds community even further when you're able to give together.

Jackie Marschall (07:31):

Yeah, exactly. And then you do stuff with Make-A-Wish as well. I recently just saw an event there with Make-A-Wish. So you wanna talk about your involvement there too? How'd you get involved with Make-A-Wish? I know you've been involved for quite a bit.

Dr. Sanjay (07:44):

<Laugh>. So I've been involved for a couple years actually as a advisory board member for our local chapter for Make-A-Wish Ohio, Kentucky, and Indiana. And honestly, it was just someone I knew. It was Elena Martella who doesn't she worked she was with W L W T at the time, she's since moved to Boston. But she was like, Hey, I know you like to give a lot and be like to be involved in giving communities. Do you want to be a part of Make-a Wishes advisory board? And I was like, sure. And, and DJ Hodge, who works with iHeart Media too is advisory board member as well. And I got to meet some really cool people that way. But it's, you know, part of it is the networking, but most of it is, you know, what are we, what are we doing? What do we have the capability to do as, as leaders in our community and this board, and how do we get that reach out more? And so Elena and I actually were the liaisons for the Emerging Leaders Board which Jackie, you know, you're a part of <laugh> which is our young professionals organization for people that, that want to help as well. Just being involved, actually being involved with that energy has been really energizing for me just cause there's so many people and you see it like they, everyone wants to do more and it's just a really uplifting kind of group and, and it's been an honor to work with emerging leaders, especially with the recent drive with William's Wish watching that, oh my gosh, go forward has been just oh man, I just got tingles.

Jackie Marschall (09:05):

Absolutely insane. William's Wish will be going through the holidays. So people who are interested in donating blood can still do it in his honor. And then they're also doing monetary donations through the holidays as well to help other kids in their wishes as well. But just in the three weeks, in the first October 7th through 31st 1000 people donated in his honor, and I just think, I mean, I haven't been there as long as many people have, but a thousand in three weeks.

Dr. Sanjay (09:36):

This goes back to like, how, how can you help, you know, there's the, the donation part. I, I have helped arrange drives, but then there was that other part of, you know, even if you don't want to give blood or can't arrange something like just promoting cool stories like Williams, like, so, so this kid received a, a bunch of blood products while re while recovering from his his liquid tumor and, and wanted to give back. And his wish was to just organize a blood drive and just that story alone of like you know, kids and, and this is no fault to them and kids want toys or, or trips. And, and I would too. But then there's, there's remarkable human who just wants to give back and you know, I remember that day when, when I shared that story on Instagram and like nine people clicked the link to donate from my story and then now we're a thousand, you know, down the road, which is ah, again, tingles. I know, and you know, I I I, I think, and I hope there's a lot of people that normally wouldn't, but just saw that story and said, wow, I, I kind of want that level of, of giving back and I I want to be able to do the stuff that this incredible kid has has been able to do.

Jackie Marschall (10:43):

Yeah. It's been, it's been such a rewarding time cause you know, we see, we do a lot of blood drives and we, you know, serve a lot of people, but I've never really been this close to like a patient before. And I mean, Will was on FaceTime at his chemotherapy appointment talking on the phone with Mayor Aftab. Right. Like, and I'm just like, this kid is incredible.

Dr. Oh (11:07):

Yeah, it's great talking to his family, you know, after the pep rally right. At the high school. And they're like, gosh, if you've known that there'd be this much attention, I I don't think he'd have come, you know, and just

Jackie Marschall (11:16):

I know, I know.

Dr. Oh (11:17):

That's, that's just such a great, his motivations are so, so pure. It's so cool. Yeah. Yeah. Yeah. I think we're coming to, to near the end of our time. I, I wanna echo your, your statement that you just made about living life with intention. I think that as we go forward, I, I would encourage people as you make choices, as you go forward think about blood donation as a way, especially if you're looking for something to contribute to volunteer, to, to give back to society, to help your fellow man. I think it's a good step. And I think that what we love talking about is how it, it fits with the journey that you're on. Obviously. And and I, I wanna thank you for joining us today and, and truly for being an inspiration for us and, and for me personally, actually, I same. I feel like I'm walking outta here and I'm gonna try to refocus on my intention as we go out.

Dr. Sanjay (12:08):

Thank you, Dr. Oh, thank you, Jackie. It's been awesome talking with you.

Jackie Marschall (12:11):

Yeah. Thank you so much for being here.

Dr. Oh (12:12):

Yeah. So this has been In the Know of Dr. Oh.

Dr. Oh (00:05):

Hi. You're listening to In the Know with Dr. Oh where we talk about blood donation and issues related to blood collection. I'm really pleased today to have Dr. Stephanie Kinney with us. She is one of the physicians at Children's Hospital. I'm actually gonna ask Dr. Kinney to introduce herself. But first let me let you know that Lisa Cowden is here as well. She's from Hoxworth Blood Center and she's in charge of our customer or donor experience. And Dr. Kinney, I was hoping you could say a few words about yourself.

Dr. Kinney (00:37):

Hi. Yes, thanks David. So, I am Stephanie Kinney. I am the medical Director of Transfusion Services at Cincinnati Children's Hospital. I have been there going on a little bit over five years now, and came from my fellowship at University of Minnesota.

Dr. Oh (00:55):

That's fabulous. Where'd you go to medical school?

Dr. Kinney (00:57):

I went to medical school at Indiana University and grew up in Indiana and did my residency in AP Anatomic and clinical pathology at Indiana as well.

Dr. Oh (01:08):

That's fabulous. So I was fortunate when I came in 2017 that you were already here and leading children's hospital. There was a bit of a transition when you got here and Hoxworth was actually much more involved in the Children's Hospital transfusion service before. Maybe you could talk a little bit about coming and leading that transformation.

Dr. Kinney (01:31):

Yeah, so it was a really cool experience to get to come to Cincinnati Children's, kind of help transition their blood bank and transfusion services. So yes, Hoxworth, I think since the inception of the clinical lab and blood bank at Cincinnati Children's, Hoxworth has had actually been running the blood bank. Shortly before I came, Cincinnati Children's Hospital decided to insource their blood bank and that was kind of how my position came open. And they asked me, you know, to come in and be the, the director of the transfusion services and to kind of help be that onsite person that can help guide our hospital and our, our physicians. But we still have to maintain and had to maintain a really close relationship with Hoxworth because Hoxworth is as you know, our sole blood supplier for all of our blood products at the children's hospital. And so I think it was a really fortuitous transition in that you came shortly right after I came and we both brought kind of this outside knowledge of how things are done potentially in other places. And I think we worked together really well to help make that transition as smooth as possible. And at least feedback that I heard from the Children's Hospital was that they really didn't notice any kind of difference in services and blood supply or anything like that. And I know you and I, we've been working together the last five years to help make different changes and improvements in blood supply and availability for all the hospitals in town as well as ours in Cincinnati Children's.

Dr. Oh (03:13):

Yeah, I think it's, it was really interesting time, right? So I got here in, in, we're in the middle of all this change and I think that you brought with you a lot of training. So you did the fellowship and you're board certified in transfusion medicine, blood banking, and you came from from Minnesota, which is a great, great program. So Uncle Jed is your, is your fellowship director there? Who's legend in, in transfusion medicine, blood banking. And I think you came and you were really open to exploring different models. Right. So the way that we had always done things here in Cincinnati was not necessarily the way it was gonna continue and I got here just as you were, I think starting to make some changes and we were able to, instead of you changing everything, which I think you may have been on the route to doing and looking at different providers and, you know, all different types of things, I think we were able to come together and say, Hey, let's re-look at our relationship with Hoxworth and Children's Hospital and let's make sure we can make this work as, as well as we can. And so we did some things, we increased in inventory. We were very aggressive about making sure that we were meeting, you know, your expectations, which were very high <laugh>. And, and I think together we actually have created a fantastic relationship. And it's healthier than I think when I look at different hospitals and blood providers. It's different, you know, it's very integrated and we make sure that we're kind of in each other's business all the time. Right?

Dr. Kinney (04:40):

Yeah, absolutely. Absolutely.

Dr. Oh (04:41):

So absolutely every Monday we, we just this is Monday where we're taping. We have a meeting and we talk about interesting cases. We talk about blood supply, we talk about anything at a clinical level to make sure that we are still learning and we're still helping each other and making it really a team approach to make sure that we're meeting all of your needs. So I want to thank you personally for being such a great partner as we go forward. And I think that it's actually proof that when I look at the model that a single provider is sometimes better than multiple providers. Maybe you could talk about that a little bit.

Dr. Kinney (05:16):

Absolutely. So for, you know, listeners that don't really know or have much experience, at least being in on the hospital transfusion side, the norm and the majority of hospital transfusion services probably have at least two blood suppliers to supply their blood supply. Mostly because one sole supplier can't necessarily fulfill all the needs, you know, at, at other hospital transfusion services. And that had been my experience in all of my training sites and locations. And this was definitely when I came to Cincinnati, a really unique model in that rarely anyone has a sole blood supplier. And so obviously that was, was a, a learning curve for me coming here and I think was a strong stimulus for us to really work on our relationship together. Like how, how can we make this work? And I've been amazed, you know, and I, you know, having a different experience. This relationship between Cincinnati Children's and Hoxworth has been a really strong relationship. And I agree. I thank you very much for your ability to listen to us, listen to our concerns, work with us, make changes hopefully for the better, and to really help support our entire hospital needs, which are very high. Like you said, <laugh>. We have a lot,

Dr. Oh (06:38):

Very, very high <laugh>.

Dr. Kinney (06:40):

We have a lot of need and blood usage being a huge children's tertiary care center and level one trauma center. We do a lot of different things that require blood products. So we are very needy in that regard. But it's been a really, really cool relationship that we've gotten to grow over the last five years. So I think it's been been really good. And like you said, the having one sole provider sometimes can be more beneficial than multiple, and I think that speaks to the whole customer service aspect. So I think the local blood suppliers and having this close relationship with their hospitals and transfusion services, that provides and opens up the opportunity for amazing customer service and for them to really listen and help make changes to help support you as a transfusion service. And where other blood suppliers may not have the opportunity for good reasons, they may not have the ability to do that. And I think that that just not only helps your transfusion service, but your patients as well get the best care that they can to be able to get the best blood products that they can in the time that they need to get it. So I really do think everyone benefits from that close relationship and customer service.

Dr. Oh (07:54):

Yeah. For us, you know, the fact that Children's Hospital made the decision to hire a transfusion medicine, you know, board certified expert to tend to their needs really spoke to the demand for quality that they were wanting. And I think that from the central physician right of bloods up higher there are models and they're older models where the transfusion medicine director for the different hospitals is actually one of the medical directors from the blood center. And that's the, that's the fellowship model that I, that I trained in at Blood Center Wisconsin. And that is really similar to kind of what it is here. And I actually, we actually have that model at U C M C, where I'm the transfusion director at the hospital as well as at the blood center. So there's great opportunities there for synergies and for us to act well. But I think that at Children's it was, it was great. Cause I think that your needs are even more <laugh> than what we have at U C M C. And, and the fact is that even you alone just concentrated on Children's Hospital, have found that you need additional, additional physicians to help to oversee and to run that service. And so you've made some recent changes. Maybe you could talk about that.

Dr. Kinney (09:03):

We have two additional pathology faculty that assist with our call for our blood bank service. That's been a really nice transition and just allows for helping out with each other and giving a little bit of time and break off. It also is really nice because we've been able to incorporate those, that faculty into our Monday meeting. Yes. And I think it just benefits everyone to hear different experiences, especially from, you know, people that have been doing this for a while and are board certified and have maybe potentially an extra layer of knowledge. And I think that it's just a, a great experience for all of our, our faculty specifically at Children's Hospital who do more other things than just blood banking. But it's a nice way to provide continuity and kind of standardization of our knowledge across from the whole blood center to the hospital side.

Dr. Oh (09:57):

Yeah, I think it's it's actually great. I know we know a little bit about your most recent faculty addition to transfusion medicine. If you go back to a previous podcast, our former fellow Christina Perus who is board certified in pediatrics and pediatric hematology oncology did her fellowship with us after doing that training in transfusion medicine, blood banking worked for another blood center for a while and is now coming back as faculty for transfusion medicine to support you. Maybe you could talk a little bit about some of the special needs over at Children's Hospital that you helped to make sure in place as the medical director.

Dr. Kinney (10:36):

So we take care of all kinds of patients at Cincinnati Children's Hospital and we have some key kind of patient groups that require, you know, a lot of blood usage. Our patients that are getting bone marrow transplants, patients that are getting cardiac surgery. We have a pretty big congenital cardiac surgery program at Cincinnati Children's. And they usually require a lot of blood products of all different types of blood products during their cardiac surgeries. We are a level one trauma center, so any kind of pediatric trauma that may come in will come to us at Children's. And so we have to be able to supply blood on an emergent basis so quickly. We have to get them blood products as soon as the patient hits the door. We also have hematology oncology patients being treated. We have some you know, sickle cell patients or patients with hemoglobinopathies disorders in their hemoglobins or red cells that need frequent transfusions, frequent red cell transfusions. We also service a neonatal population. And so, you know, we are delivering more and more infants at our hospital system. So we have to be able to supply special blood, blood products, whether for a fetus that hasn't been born yet, while they're still in the uterus and or right after birth, we may have to supply some special blood products for them too.

Dr. Oh (11:56):

Wow. So children's Hospital of course in Cincinnati is one of the top two three hospitals Children's hospitals in the country and are always identified as such. And so we really have to work to supply the blood needs, which is one of the most common procedures that's actually performed in hospitals. And I'm sure it's the most common procedure performed at Children's Hospital as well. So let's talk a little bit about bone marrow transplant and transfusion medicine and supporting those special patients. So this is often very taxing for a blood center because of the special needs for patients who are undergoing bone marrow transplant. Maybe you could talk a little bit about supporting a, a patient on getting a bone marrow transplant or a stem cell transplant.

Dr. Kinney (12:39):

Yeah, so these patients, it kind of depends on what their underlying reason for requiring a a stem cell transplant or bone marrow transplant. And it could be multiple different reasons. Some of them, cause of their underlying clinical condition may require extensive blood products up front before they even get their bone marrow transplant. Some patients, before they get their, their stem cell transplant, they usually undergo some kind of chemotherapy treatment and that knocks out a lot of your blood cell lines. And so that makes patients really need blood transfusions during that time. And usually we'll have to help support these patients right after they get their transplant for several weeks, if not maybe a month or two in some of their blood products. So red cells and platelets are the top two blood products and probably platelets the most. They, you know, may not be fully making their new platelets yet from their stem cell transplant that they got. So they really rely on those platelet transfusions to help prevent bleeding. And those are some of the heaviest products that we, we have to utilize in these types of patients. Another challenging part to this is that sometimes they can give stem cell transplants that are different ABO type different blood type from their own. And so when they do that, then we have to go an extra step further in the transfusion service and make sure that we're providing blood pro, not just blood products period, but blood products that are compatible with both their own and the new blood type that they're gonna be getting in their stem cell transplant. So that limits the type of and number of blood products that you can give as far as there has to be a certain blood type and making it even more challenging for the blood center to provide blood products for us.

Dr. Oh (14:29):

And so, so if you have a stem cell transplant patient and their blood type A, let's say, and they receive marrow or stem cells from the donor, which are let's say type B, can you even do that?

Dr. Kinney (14:45):

Yes, you can do that <laugh>, but we're gonna have to give them you know, blood products that are compatible. So platelets, for example, I'm gonna have to give AB platelets, which is the most rare blood type. And the least numerous amount of donors are ab and that platelet product is our real liquid gold is how we refer to it. <Laugh>, <laugh>. And unfortunately, you know, it's gonna, it's the least numerous amount of donors that are

Dr. Oh (15:12):

It's about 4% of our donors, right.

Dr. Kinney (15:14):

4% that are blood type ab and we can be transfusing these patients, you know, one platelet a day, one platelet unit a day for several weeks up to a maybe a month at sometimes. That's a lot of platelets. And so it's amazing that you guys can find in bringing these donors and that the donors come in to donate is such an amazing feat. These patients couldn't literally survive without their blood products.

Dr. Oh (15:42):

Wow. Because they're not producing them anymore, right?

Dr. Kinney (15:44):

Correct. Yes. Yep. Yeah. So yeah, they kind of have to wait until their new marrow or stem cells that they get starts kicking in and making new platelets for them, which hopefully eventually they will. And then they won't need, you know, platelet transfusions anymore.

Dr. Oh (15:59):

What about red cells then?

Dr. Kinney (16:01):

Yeah, so we still have to provide compatible for both the patient and the recipient. And so we may have to provide o red cells in that case of the major ABO incompatible. And unfortunately, again, o red cells are our least numerous and least amount of donors are type O. So type O red cells are our universal donor red cells and type AB platelets are our universal platelet donors. And so yeah, these, these patients may utilize, you know, very rare blood to us, what we consider rare blood supply and rare donors. So yeah, it's it's pretty amazing.

Dr. Oh (16:38):

So when donors out there are getting calls and they're being asked to donate based on their blood type these are the reasons. So we, we wanna go for o donors when they come in. We want the red stuff and we want you know, op Paz or oeg, right? Are, are the more universal so they can be given to, to the most people. The RH positive and negative. I dunno if we'll get into that today cause it's another level of complexity, but know that the O'S are the most flexible in terms of the right cells that can go to, to almost everybody. And and for some of these patients they can, they should only get Os correct. The platelets on the other hand are AB right. Is where we want our platelet donors. And so we actually when you first started, you came and you started asking for AB platelets, I was like, yeah, you know, I want a Ferrari too, but you know, I don't know if I'm gonna be able to get one <laugh>. But our our team really was like took this on, you know, internally and was like, no, we're gonna get, we're gonna get these AB donors, you know. And so sometimes we collect ab donors for platelets with platelet counts that are not the greatest. And we usually, when we ask somebody to donate platelets, we usually ask them to donate, you know, two or three platelets at a time. And so that kind of depends on what the platelet count is of the, the donor. And so we had kind of groomed out a bunch of our ab platelet donors over the years cause we wanted to be more efficient, you know, with getting doubles every time we collected. And so we have more platelets for everybody for that time. It takes on the machine. But we changed our thought process for the ABs and we started recruiting more aggressively the AB donors, even if they could only donate one platelet, usually we could get a plasma as well. And both platelets and plasma are, are really beneficial, but had to kind of change our thought process on that. And I've been so impressed with our team to be able to maintain an unbelievable number of ab platelets for you guys because he's, you use a ton of them and there are times when other blood types can work for platelets. It's not as, it's not as rigid as it is for the red cells. There are certain manipulations we can do, but in general we prefer not to do those things. They can affect the potency of the products as we kind of give them. And so we've, we've been able to do a great job in terms of collecting on the large number of a platelets for, for our, for children's hospital and you are the largest user of our platelets actually.

Dr. Kinney (18:54):

Yes.

Dr. Oh (18:54):

In, in the Cincinnati area.

Lisa Cowden (18:56):

I was gonna ask Dr. Kinney really quick. So for platelet products, is that the most utilized product that you receive from Hoxworth Blood Center?

Dr. Kinney (19:06):

I would say it's up there in really close to our red cells. We do quite, quite a bit of red cell transfusions. It's probably still our most numerous product that we transfuse, but platelets are definitely up there in close second to the number of blood products. We transfuse.

Lisa Cowden (19:20):

Platelet donors ask that often. About where their products are most utilized when we're like everywhere, but I I thought Children's was probably one of the higher utilizers in hospitals here in the tri-state.

Dr. Kinney (19:34):

Yeah. We, you we do about all blood products combined. We do almost 20,000 transfusions a year. Wow.

Lisa Cowden (19:40):

Oh great. That's awesome. Thanks for throwing that out. I think donors like to hear kind of, they like to know Yeah. You know what happens. After I donate and I think that's important information.

Dr. Kinney (19:50):

For platelets. We utilize probably on average about 12 units a day in a 24 hour period.

Dr. Oh (19:55):

Wow. That's Fabulous.

Lisa Cowden (19:56):

That's why we keep calling you.

New Speaker (19:57):

Yes. <Laugh> and we thank you.

Lisa Cowden (19:59):

Our fabulous donors,

Dr. Kinney (20:01):

Our patients. Thank you. <Laugh>.

Dr. Oh (20:02):

You know, we've actually been able to do some innovation with the platelets as well. We are doing the R F I D process. I think we can talk a little bit about that. There's something I don't think that we can't share. What, what's your impression on that project and, and how that's been going?

Dr. Kinney (20:15):

Yeah, so this is a really exciting project that we've been working on the last couple years I think together. And so right now we're using the R F I D,

Dr. Oh (20:25):

So that's radio frequency identification I believe.

Dr. Kinney (20:28):

Yeah. So it's this little tag sticker that Hoxworth puts on while they're labeling the platelet. We're just doing platelets right now. The platelet product goes underneath the label and this little R F I D tag tracks just the blood product information. So unit number, expiration date, what type of product it is, things like that. And not only does it contain that information, but it also is like a location tracker. So on our, we have a platelet incubator in our blood bank. And so our platelets sit on different shelves in our platelet incubator until they're needed for a transfusion. And these shelves have and are set up connected to a sensor that can tell you the exact location of where each of these platelets are. And so what we're mainly utilizing it for now is keeping track of our inventory. So we have threshold levels for our platelets, how many we like to keep on stock at all times to have available for our patients, even down to the different blood types that we have on our shelf, knowing that AB is important in certain patient situations. So we keep track of those numbers too. And we actually created the stoplight system. So when we have three levels of our thresholds, when they reach a low point, the color changes yellow when it reaches a critical point, changes red. But we've taken this a step further with Hoxworth. So not only can we see, you know, our inventory and previously our, it would be our technologist in the blood bank seen when that changes colors, knowing that they'd have to place an order for more platelets to Hoxworth in their ordering system. And sometimes there would be a, you know, kind of a delay our technologist getting busy and, you know, we would have a temporary delay of getting restocking our platelets. And so we have now started with Hoxworth. They also can see the stoplight system in our dashboard. Yep. And they are now tracking when it changes, they go ahead and place an order for us to restock our platelets. So now it is more of a blood center driven restocking of our supply to help mitigate that temporary times of sh you know, temporary shortages. And it's worked really well so far. And I think at first some of our, our technologists weren't so sure about the system, but now I think they're starting to see the benefits. Like, oh my gosh, this is nice. I just have platelets when I need them on my shelf and don't really have to think about that extra stuff.

Dr. Oh (22:58):

Platelet fairy just comes and delivers a platelet. <Laugh>.

Dr. Kinney (23:00):

Platelet fairy. Yes. <Laugh>

Lisa Cowden (23:01):

And it's so much more efficient too.

Dr. Kinney (23:03):

It is.

Speaker 2 (23:03):

Right. It really is creates an efficiency in the process for everyone. That's amazing.

Dr. Oh (23:08):

Yeah. It's amazing. You know, you don't think about the nuts and bolts sometimes and you think Yeah, it actually takes somebody's time to count how many platelets are, especially if you wanna go by blood type. Right.

Dr. Kinney (23:17):

Right. Exactly.

Dr. Oh (23:18):

And, and then to send that over and then, you know, this is just like, oh yeah, this is a great idea.

Dr. Kinney (23:22):

Yeah. It's really you know, visualizing our inventory is really nice for, you know, everyone as a whole to be able to, you know, I can walk by and see where are we at, how healthy are we today? You know, are there any issues? Do I need to talk to you <laugh> about what's up with our platelets now? And it's been a really nice system that I'm, I'm really excited about. And maybe someday we can implement for red cells as well.

Dr. Oh (23:48):

Yes. I would love it. <Laugh>. So I'll give a shout out to Judith Gonzalez, who's our in charge of our laboratory. She really helps set this up and she's given numerous talks at our art group, AAB B kind of talking about this technology and, and how others can possibly adopt it. So we're really, when we did this, we were the only place that was doing it. There was some experimentation with it five, five years ago or so, but that all kind of dropped off. And I think that we've kind of reinvigorated some interest in this across the country. So let's go ahead and, and end this first half of our discussion with Dr. Kinney. You've been listening to In the Know with Dr. Oh.

 

Dr. Oh (00:10):

Hi, this is David Oh you're listening to In the Know with Dr. Oh. I'm really happy to have in the studio today, Lisa Cowden, who's our Manager of Customer Experience, and Dr. Stephanie Kinney, who is the medical director at Children's Hospital Cincinnati. We talked last time a little bit about some of the technical issues with being medical director over at Cincinnati Children's and the collaboration that we have with Hoxworth Blood Center. I happen to know that Dr. Kinney is also a blood donor and a very valuable one. What's your blood type?

Dr. Kinney (00:40):

I'm O negative.

Dr. Oh (00:41):

Oh my gosh. Your phone should be blowing up with our people, calling for you to donate <laugh>

Lisa Cowden (00:46):

That it is <laugh>

Dr. Kinney (00:48):

So, but it doesn't bother me because I know it's for a good cause and for a good reason that they're calling me.

Dr. Oh (00:54):

That's great. Can you tell us a little bit about like your history of donation and, and how you decide to go into transfusion medicine, I guess is a specialty?

Dr. Kinney (01:00):

Yeah. So I'll answer the donation question first and kind of why I donate. It's kind of a couple reasonings behind it. So I usually donate red cells when I donate.

Dr. Oh (01:12):

O negative. The o negative we, your red cells <laugh>.

Dr. Kinney (01:15):

And part of the reason I do that is one, I am a medical director of a transfusion service, so I'm using lots of red cells for our patients. And so I know how valuable it is to donate, and that's one way to help, that I can help give back as well. The second reason is that a more personal reason actually, my mother was is a cancer survivor and underwent cancer treatments and needed a lot of blood transfusions as well. Platelets and red cells, I think she got quite a bit. And so personally it's my way of helping to give back to other people that need it because they help keep my mom alive so she can undergo her treatments. And she's here with us today because of it. So yeah,

Dr. Oh (02:00):

Really pleased to hear that.

Dr. Kinney (02:02):

And then for how did I get into transfusion medicine? This was when I was going through medical school. You get to go through all kinds of different rotations to see what you would like. I always thought I'm, I would be a pediatrician. That was always my number one thing in the back of my head. I think I said it when I was in sixth grade. I job shadowed someone for a job fair. We had to put, put on a job fair and I job shadowed a pediatrician who was amazing in our hometown. So that kind of stuck with me throughout the rest of my life. But in medical school I got to look at all different kinds of specialties and while pediatrics was still a really neat specialty I didn't find myself really falling in love with it once you got to know like the nitty gritty pieces of it. And I had a pathology professor actually talk to me, or I talked to, to him about, you know, options and had never even heard of pathology being an option going in, you know, before you go into medical school. And he let me shadow him. And pathologists are pretty, I think, really well known for teaching. And I love, I love to teach. I also really liked that in pathology instead of for other medical fields, you're usually teaching patients and families maybe about their diagnosis or disease or how to take care of themselves. In pathology, you're actually helping to teach and educate the other physicians to help take care and better care of their patients. And so

Dr. Oh (03:33):

Pathologists often call ourselves the doctor, doctor, right? That's a little corn.

Dr. Kinney (03:38):

I've never heard that before, but yeah, I like that. And I absolutely love that. I found that very re rewarding being, you know, loving teaching. I found that the physicians that I communicated with or the, you know, a nurse practitioner that I'm communicating with, they really understand the terminology that I was using where, whereas when you're trying to educate a patient, sometimes it's a little bit more challenging. So I love that and ended up going into pathology. And then within pathology, there's a whole bunch of other specialties that you can get into.

Dr. Oh (04:09):

So when you went into pathology, you were not thinking transfusion, you were thinking I didn't Anatomic pathology, probably, probably, yes. Looking under the microscope.

Dr. Kinney (04:16):

Yes. Looking at slides and making diagnoses. And I didn't even know transfusion medicine existed at this point.

Dr. Oh (04:23):

It's very similar to me.

Dr. Kinney (04:24):

Yes. And then once you get into pathology, anatomic and clinical pathology you go through a bunch of rotations similarly, like medical school. And when I got to transfusion medicine, it was like, oh my goodness, this so different field. A lot of people actually shied away from it. Pathol, other pathologists shy away from it. And I really saw that there was a need, a lack of understanding. Again, my teacher's side of me, Hey, this is could be a great opportunity where I could help educate people and teach people. And found it really rewarding. I also found that out of all the pathology specialties, it was the one that I still communicated with clinicians the most. And I still to this day, you know, if I get a call and have to talk to a another clinician about a patient case, I usually am also real time educating on the phone while we're talking about whatever it is blood bank transfusion medicine related. And to me, that's just, I get to use my knowledge that I've learned over all these years daily. And I love that.

Dr. Oh (05:26):

So I think that's very common. The, the folks who go into pathology are not always the most people, people, people that are out there. But there's some that are very, very good. But many of them are attracted to transfusion medicine. I think because of that interaction, the ability to teach, be able to talk about cases. And that's one of the reasons I think that, you know, we, we like to, to get together. If you, if you're a transfusion medicine trained board certified person and you don't have anybody else to talk to on a regular basis, it it's a little isolating.

Dr. Kinney (05:56):

It's very isolating. Yeah. So I think exactly why I love our Monday get togethers that we get to talk about different cases. Not only is it nice to, you know, maintain the hospital to blood center relationship, but it's also getting to talk to someone who underwent additional specialty training. To see, you know, if we're the only ones in the city.

Dr. Oh (06:18):

Yeah. Yeah.

Dr. Kinney (06:19):

You know, in that room usually that underwent that training. And is this what you would do? Is this, am I thinking along the same lines? Because we all kind of had different education and input, and I think talking it out and thinking about options and oh, well this is what we used to do is very valuable in helping to ensure that you're keeping up with standards of care and helping to instruct your clinicians at your hospital in the best way that you can.

Dr. Oh (06:44):

Yeah. Our monday meetings are, are just just really enriching. I think we have now expanded we include Dr. Alquist who is a expert in HLA testing. And just, that's something I, I will never totally understand, but I try, I try, I try. And Dr. Cancelas who's our director, he, you know, has experience in in hematology ecology as a, as a practicing clinician. Another physician who's just joined us recently is very active did both a transfusion medicine fellowship as well as a hematology fellowship. And so it's just a great chance for us to just, Hey, what would you do? Or, you know, does this make sense? Am I crazy? And you know, I think it's interesting too cuz I I'm much more on the donor side, right. And, and you're much more on the transfusion service side. That's kind of a big divide in transfusion medicine, blood banking, it's actually transfusion medicine slash blood banking. Right. And so and so there's, there's a lot of overlap, but, but there is a lot of subspecialization that kind of occurs as well. I take a lot of pride with our program here in terms of fellowship training. We give them an excellent blood bank, you know, experience or they're actually centered at Hoxworth. But, you know, children's Hospital has been just a fantastic partner to be able to give them that transfusion service experience, especially in the pediatric setting, which is different. Yeah. It's different than the adult setting.

Dr. Kinney (08:01):

You know, when you go into your fellowship, you, again, you have multiple options as far as different areas or different asks or requests of you when you get out into the job world. And I think as a fellow, it's really nice to get a broad training in all the different areas that you potentially could be asked to oversee in a future job. And so being able to have access to that, all those different areas, and even pediatric transfusion medicine is, I think, like you said, very valuable for them and, and gives them really good, well-rounded education, which will only serve them better in the future for their jobs.

Dr. Oh (08:41):

There aren't a ton of transfusion medicine fellowship programs out there. I think that we have been working on ours to make sure that we, you know, provide the best possible experience that we can. And I think that every year since I've been here, we've really tried to, to grow that and to, to make it a better experience. And and I think it is a great experience now. So if there's anybody out there who's interested in transfusion in blood banking, it's crazy. The, the fellowship positions actually fill up like two years in advance, you know? That's when you have to kind of start applying. And so we already have,

Lisa Cowden (09:13):

It's hard to see the fellows go though when come in. It's, they get so, you know, invested. And we get invested in them and it's really hard when, you know, you see them transition out, but, you know, you wish 'em well and hope that they were given a great experience, but yeah, that's a, that's a hard transition sometimes for us.

Dr. Oh (09:32):

Yeah. I tell you, when Dr. Bruce left, i, i, it was the tough thing cuz she had to integrate herself into so much of the different things that we do. And she had done a couple special projects and, you know, really helped us with finding special donors to find for the tough platelet matches. So we, there's a, there's, that's probably another episode that we'll do, but it was a special program to find donors and recruit them specifically for specific patients. And it was very much kind of a scattered process that she really brought some thought formality to it. So we were able to do much better now today than we had in the past.

Lisa Cowden (10:06):

I have a question. So love your story on both sides of the experience of your practice and you as a blood donor, it's like a bonus having you at, you know, doing both in what we do. What can you say to people listening to current donors or maybe people that are not donors that, you know, think about, is this something I wanna do? Should I be doing it? What could you say to them that would maybe motivate them or inspire them of how important donating blood is to our community, to our patients? I mean, you're seeing it firsthand, so what could you share with our audience about that?

Dr. Kinney (10:45):

Yeah, that's like a great question. You know, how do you motivate someone to do something? I think Hoxworth has done a excellent job at sharing some stories of patients that have gone through different treatments or need of blood transfusions for one reason or another. And I think reading those stories are, you know, the best firsthand experience and really inspiring stories. I mean, these patients would not be alive today if they didn't get blood transfusions. And that really is a very moving thing. And it's honestly a really easy way to give back. It really, it, it, it's takes 15, 20 minutes of my time to donate A red cell whole blood product think gets turned into a red cell. And I don't even think you really fathom or think about it when you're donating or when you go to donate that. And it sounds it sounds like, oh, not, not cheesy, but it sounds like really this little thing that, that I'm donating is gonna save a life. And the answer is yes. Like, it is amazing. We, we've had patients at our, at Children's Hospital, we've had to transfuse lots of blood products too, and they literally wouldn't be alive without those blood products. We would not have been able to keep them alive. And to just even think about that, I mean, it's just, I, I can't even put it into words really. And

Lisa Cowden (12:20):

It is hard

Dr. Kinney (12:21):

It's hard to imagine that, and it's hard to think about that, but that's the truth that this little product and little amount of time that you donate really saves and can change someone's life.

Lisa Cowden (12:33):

No, I appreciate you stating that. And I think for, you know, our donors, especially that may be listening or the people that haven't donated in a while, but you know, you're receiving our calls, our texts, our emails. It's not because we wanna drive you crazy <laugh>, we wanna drive you into our donor centers, our mobile drives, and have you donate to save lives. I mean, this is really what it's all about. So, you know, for anyone that's listening, it's very familiar with the Hoxworth Blood Center, university of Cincinnati side of this, you know, we have the pleasure and the honor to have, you know, Dr. Kinney from Children's really speaking to what happens after that donation. And it really is about saving people's lives every day.

Dr. Oh (13:14):

You've also helped to organize some blood drives as well and promote them at Children's Hospital as we have really relied on our hospital partners to help us to reach possible donors to help share some of these stories and to make help to share awareness as well. One of the things with this podcast I think I've been trying to do recently is really talk about how it can affect donors as well. So I think that we really talk about the patients and them needing the products and, and I think that's, that really is the root of everything. But for donors to come and take action, I think that sometimes sharing those stories as well is very helpful. And the fact that when you donate you to help, help to connect yourself to the community and to help other people. So you don't know the name of the person that you're helping, you don't know really anything about them, age, religion, all these different things. But you know, when you donate your, you're reaching out to the community and that you are trying to do good and the world. And I think that when our donors leave our donor centers or mobile drives, I hope that they have that sense of connectivity and peace and positivity that, you know, so many of us are looking for today in this kind of contentious world. It's hard. I know, and especially during the holiday season, this is when we're kind of taping this right now, to find the time to be able to do that and to donate. But I think sometimes it's really a refresh for people and it reminds us kind of, of the fact that we're human beings <laugh> in a community and, and we all want to have a network and to, to connect.

Lisa Cowden (14:55):

I think everybody has a why. Yeah. And you have to discover what your why is for donating and as you shared, very personal connection your mother, which we're so happy to hear that she's well and, and here. But I think that's really important. We all know someone, if not ourselves, that may need a product will need a product, could need a product. And I've heard donors say this line frequently, which I love. It's, I always say, what, what do you say to your family, your friends, your community to inspire people to donate like you? And I'll never forget this one donor in our donor center, as he's in the chair, he says, I always tell my friends, you know, donate today, so if you need it, it's there one day. You know, and I love that. It's like, pay it forward, you know, even if it's not today one day, you know, that's what it's about. So I appreciate you sharing your personal story as well as professionally how important this is. I'm sure our donors will appreciate that too.

Speaker 1 (15:57):

Thank you.

Dr. Oh (15:58):

Thank you for, for that.

Lisa Cowden (15:59):

Absolutely.

Dr. Oh (16:01):

Yeah. So I think that Dr. Kinney, we we're just so glad to have you in the community here and to help all the, I'm glad the patients over at Children's Hospital, the little small patients that we care about. And it really helps me sleep better at night to know that you're here and, and and helping to make sure that the transfusion surfaces are, are a one over at, at your hospital.

Dr. Kinney (16:22):

Likewise, I get good sleep at night knowing that <laugh> Hoxworth is our blood supply knowing seriously, it's the truth.

Dr. Oh (16:27):

<Laugh> We are proud of the fact that we're able to, to supply blood for you guys. We talked a little bit about the, the model and that, gosh, how is one greater than two or three, you know, different blood providers? But when we work with our hospitals, which are the 30 hospitals in the 18 counties here in near the Cincinnati area, we take ownership of that. And so customer service, and a big part of that is supply Right. Is paramount to us. And if, if we don't do a job, then you guys should go and get multiple, you know, suppliers. I, I, I totally believe that. But what we find in many, many other models across the country is two suppliers is not better than one because no one then takes responsibility for you guys and you just end up getting a certain commodity of products. And, and what we provide is not only the products and we make sure that that's number one, but we also provide all the ancillary services, the i l the, the testing laboratory, the, you know, and the ability to talk to us as physicians. And it's actually that we can implement changes.

Lisa Cowden (17:26):

It's really more of a partnership. It's total partnership. You know, I think it's just not a service we deliver. It really has become, it sounds like a partnership over years and everyone's fully invested on all sides. And I think that's what makes it work, right?

Speaker 1 (17:42):

Yeah. And I think the world of transfusion, blood banking, we kind of alluded it to a little bit is, you know, there is this sense of working together and really wanting to collaborate in transfusion medicine, and not just internally, but externally with the clinicians that, that you hope to serve Dr. Kinney. And that's kind of just part of the calling. And so sometimes we'll talk about blood bankers, you know what, and there's a sense of what a blood banker is for us, right. As somebody who cares and is gonna go the extra mile.

Dr. Kinney (18:09):

I think we all have shared that, you know, we've all been through when there's blood shortages and that kind of shared experience on, it's a very scary time. When there's blood shortages, how am I going to get blood products for patients? And it's a different scariness on each side, right? That blood center and then the, the hospital side. And so having, I think we've all kind of as blood bankers have been through that type or similar experiences. And so that I feel like really helps us, how can we work together to help ensure that is at a minimum? And, you know, likewise, like having us share our experiences on the hospital side and why we do certain things the way that we do, but also knowing how important we are for donations and collections and appropriate utilization, efficient utilization of our blood supply. It, it really is a partnership. We're doing things all around to help make sure not only are we transfusing our patients, but we're doing it appropriately. So there's blood products available for other patients in the city that actually really do need it. You know, if there's, if we know we're not gonna use a product before it's expiration date, we, you know, try to be diligent about you know, can we use it on someone else that may need it in the city before it actually expires. So knowing that all of the hospitals in the city are sharing that same blood supplier, it really is a big community feel and community partnership really that I have not experienced anywhere else. So it's really neat, a really neat experience.

Dr. Oh (19:44):

Oh, I'm so glad that, that you said that. That's the model that I, I train edar in Milwaukee. That's, that's the model that I really love and, and there aren't that many places country anymore that, that have it. And so I'm, I'm privileged to, to, to work here in Cincinnati as well.

Lisa Cowden (19:58):

Yeah. I think it's important for our donors to hear too, that, you know, donating, you're in this community, you're from this community, and you're, it's going back to this community. I think that's a real sense of pride. And I think that's a real motivator for donors who is very much a part and extension of this partnership. Right. Right. As well as our team. So I, I love that about what we do together, is that we really, you know, what happens here stays here, <laugh>. We're not Vegas, but you know, it's

Dr. Oh (20:29):

Saving lives close to home.

Lisa Cowden (20:30):

We're saving lives close to home. Yeah. I mean, that's a, that's a great feeling for people to know that. And I think that's what gets people up and end the doors to donate because you're helping somebody in your neighborhood. Absolutely. Some, somewhere in the tri-state.

Dr. Oh (20:46):

Yeah. So, so Dr. Kinney, thank you again so much for your time. It's been just an honor to, to talk with you and it's just so much fun. I just love, I love working with you. So you've been listening to In the Kow with Dr. Oh. Thank you very much.

 

Dr. Oh (00:12):

Hi, thank you for joining us for another segment of In the Know with Dr. Oh. First in studio with me is Lisa Cowden. She's our, our donor experience guru here. And our special guest today is Paul Plotsker. He is a fantastic regular donor for us. I got to meet him after he did a special collection, so we'll talk a little bit about that later. But he's a donor who just has been really, really fantastic and, and just an interesting person too. So I thought that it would be interesting for everybody to get to know Paul a little bit more. So, Paul, please let us know who you are.

Paul Plotsker (00:53):

Thanks very much Dr. Oh, and thank you, Lisa. Thank you both very much. So beautiful honor. Appreciate it. I'm from New York City. I kind of wear my colors on my head and my, on my sleeve <laugh>. I am a New York Mets and Jets fan, and my father would joke around back in you know, when he was with us, he would say, I'm not going to hell because I've already had my hell here on Earth. That's kind of how I feel. <Laugh> as a Mets fan and the Jets fan, those of you who were into sports can certainly commiserate with me. I think. I'm from the lower East side of Manhattan. I was raised and still am a practicing Orthodox Jew. And that hopefully gives me some sort of moral compass. It kind of hopefully fills my life with meaning. We are of the belief that we were given in a set of rules and laws by the Almighty. And one of those rules and laws is to be considerate, kind, compassionate, and generous. And so back in the day, I do remember, I think my very, very first donation, my very first blood donation, may have very well been in Israel when I had already graduated college. I went to New York University and graduated from there. And then I went off to Jerusalem to study Rabbinics in the David Chappelle College of Jewish Studies. And I do remember giving a pint of blood over there for Mazak, which is like the Jewish Red Cross. It's the equivalent of the Red Cross, the red star of David. And I enjoyed that. It was very very gratifying. And then I came back to the United States. And

Dr. Oh (02:14):

So, so let me let me pause you here. Sure. Because you're a storyteller, right? So we're gonna have to make sure we get our questions in as we go along. So for that first donation, was that something that you just did yourself and you, you saw it listed and you went in? Or did you go with some friends or,

Paul Plotsker (02:29):

Well, it's been really, truly so long. It's hard to remember some of the details of that. But I, I, it could be that we heard that there was somebody who was ill and who needed a pint. And so I figured why not? Let me let me help out my fellow man. And and so I went into the local blood center over there, and I gave a pint and it felt good. It felt right. Then I came back to the United States and I began working in the, in the field of law. Ultimately, I was a paralegal. And then I, I went to law school and I became an attorney along the way. There are probably three things that I can look to for the impetus as to why I'm into the blood thing as much as I am, number one. I do remember sitting down in the chair in the synagogue and trying to cut a deal with God. He's not always amenable to this <laugh>, I think. But I had heard it before in Jewish circles that sometimes a person says, God, if you help me through this, I'll keep the Holy Sabbath to the nth degree. I had already been keeping the Sabbath to the Nth degree, kind of. I'm, I'm pretty I try to be you know punctilious if I can be, and I try my best. So Sabbath was you know, and I keep kosher, so what's left? So I thought, God, if I love being healthy, if you give me good health, I'm gonna share that with the world, with all your children on earth. I'm gonna do what I can to give them the gift of health. But in order for us to do that, you gotta bless me with good health and then I'll be happy to share it. So God has certainly kept his end of the bargain. And now I'm just trying to play catch up. I'm just trying to, to honor my my end of it. So there is that this deal that I kind of cut asking for good health. And I'm very grateful for all the good health that I've had over the, so many, so many years. Another reason why I'm into blood donation is because I almost drowned as a kid. I was about 10 or 11 years old in a Jewish bungalow colony in the Catskills in upstate New York. And we were at the pool and I decided that I was going to measure the deep end of the pool with my arm. Not a very bright move, <laugh>. I, I always tell my wife, you didn't marry the smartest guy. And they were all just the best looking. So I fell into the pool and thank God there was somebody there who who jumped in after me and caught my legs. I didn't really know how to swim. I just, I didn't. And there I am going to the deep end and falling in this madness. And thank God there was this man who got me to the surface and really, truly saved my life. I don't remember his name. We never really gave him a party, which is a Jewish thing. He do, you make a kiddish, a big reception, bring out all the best food and the best whiskey and the bourbon. I don't think we did that for this guy. So all I could do is pay it forward. I mean, I never really got all the details from him, but he certainly saved my life. And I'm gonna be eternally grateful for that.

Dr. Oh (05:15):

So, so that's really interesting that you don't even know the name of the person who, who really affected the, the arc of your life, I think as a blood donor for your, you know, you people don't know who you are, right, right. But they know somebody came and, and, and donated and was able to change the arc of hopefully a lot of our recipients lives. That's really, really interesting. So thank you. Okay, so that's two parts of your, of your deal.

Paul Plotsker (05:40):

Okay there's another one. My father, my late father back, probably in oh seven or oh eight on the Laurie s of Manhattan, got up to use the bathroom in the middle of the night and never really came back. Didn't go back to the, the bed. And my mom wanted to know, you know, where he was. And he couldn't respond. She went to check on him and there was a pool of blood on the floor of the bathroom. Naturally she freaked out and she called Sala, which is the Jewish Ambulance Corps in the five boroughs of New York. And throughout New Jersey and upstate New York, wherever there's a very strong concentration of Orthodox Jews and Cedic Jews, you will find a very robust group of guys who are totally committed to getting that bus, that ambulance right to the patient and packing him or her up and getting him or her to the hospital as soon as possible. In a city of New York size, it's often challenging to get an ambulance cuz you're up against 8 million other people. I mean, it's just, we should all of and be well, but it's reality. So the Jewish community decided to do something for itself. It always does respond to its own. It also responds to anybody else who's gonna call that particular number. It does not discriminate. And so the guys came, I know them all by name cuz I, I grew up with these guys. Some are younger, some are older, but I, I know them all we pray together, cited together. They're lower Eastsiders. It's a very small little very tight-knit community in Manhattan. And so they packed him up and they were commenting, I was told, oh, that's a lot of blood. Never saw that much blood. And I, I wasn't there so I really cannot speak to it. But they packed him up, took him to Beth Israel Hospital, which is not that terribly far away. That's on First Avenue and 16th Street. If you know New York geography, the lower East side is about a 20 minute drive away from there. It's not that far away. You make all the lights and you're there in about 20 minutes. And they got him to the emergency room. And I was informed, don't remember who, but I was told that he had to receive 11 units of whole blood and one fp one fresh frozen plasma in order to give him some volume. He had lost an enormous amount of blood. And I, I think he was, you know, who knows what could have been the result if the ambulance guys had taken their sweet time and if there wasn't any blood in the in the hospital. The difference between a hospital and my living room is that there are doctors in the hospital who can transfuse a patient who needs blood. It's one of the many good things about a hospital. And so I'm always telling my friends, we gotta help out because that's what a hospital's for. And one never knows if one's gonna actually need the product. Every two seconds someone needs some pints of blood or something. And that's a reality. It's true in my neighborhood here in Cincinnati, one young lady was going into labor, she hemorrhaged and she needed a pint. A Jewish lawyer, a partner at a major law firm, was caught in a gun battle on New Year's Eve about four years ago, roughly. And he got hit with some bullets and he needed to be taken down to the hospital and he needed some blood. And then there's a rabbi who needed a, needed some blood, I'm sure for a surgery that he had. So everybody needs blood. You never do know if it's gonna be you. But the reality is that most of us at one time or another will indeed needed. So that was another one. Just gratitude to the blood donors. At Beth Israel Hospital who had given blood to my dad. Well, they get back in return, maybe a tuna sandwich. I'm not kidding you at Beth Israel Hospital. What do they give you? They give you a kosher back in the day anyway, when they were more kosher than they are now, sorry, Beth Israel <laugh>. But

Dr. Oh (09:11):

Hashtag not as kosher as they used to be.

Paul Plotsker (09:14):

Right? I wish that they would return the more kosher ways and have more kosher. They used to have a nice kosher cafeteria. But anywhere people giving to the Ralph Gore Blood Bank of Beth Israel Hospital in Manhattan saved my father's life. And I'll never be able to thank them, obviously, cuz you never, ever know who they are. All you could do is just pay it forward. And so you get a t-shirt, you get a little umbrella, you get a Frisbee, you get a sandwich, and you think that was absolutely nothing. Yeah, you did everything and you saved my dad's life. Had him for another three years or so. So mo's gonna be grateful for him for that, to those donors rather for that. And then there's a cosmic thing in Jewish law, maybe in mystical text is lots to be said about the soul. What happens to the soul after death and goes up to heaven and it has to have a judgment day. And you know, there's a judgment day at the end of one's life and there's one at the end of maybe all recorded human history. There are reasons why. So my understanding is that there was somebody in my ancestry who who did some, who hurt himself in a very severe way. And so I personally feel like I'm obligated to help his soul every day of my life because his soul is up there almost like waiting on me every day saying New, new, which is Yiddish. Four. Well, well what are you gonna do today for my soul? And so I give blood because if he hurt himself, I wanna make sure that other people live. I want, I want that to be some sort of cosmic, if possible, some sort of exchange where somebody hurts himself prematurely, obviously, and should not have done that. His soul is gonna hopefully be bettered and improved and get closer to the the almighty's throne because a descendant of his is giving life to other people. So it's really kind of a kind of like some sort of cosmic or interstellar exchange machine. I realize it's a little bit funny to put it like that, but I just do what I can and haunts me every day, really. So I am just, what can I tell? You're never gonna get rid of me no matter what you say <laugh> on this program, or you can stick me in the wrong vein, it won't matter. I'm gonna just keep on coming back like the dog that has to come back to his house.

Dr. Oh (11:27):

So interesting. So, so there are a few things I wanna make sure I, I get back to, and Lisa, maybe it help me to remember, cuz I often forget, we'll talk a little bit about really dedicated donors who can no longer donate and we'll just, I just wanna address that because, you know, we, we are offering to connect people right? By donating with the community. And when people make that strong connection like you have made, it's really tough when at some point I, I have to say to you, Paul, hey, you know,

Paul Plotsker (11:56):

You're 99, it's time.

Dr. Oh (11:58):

Yeah like, you know, it's, you know, or for some other reason. So we'll talk about that a little bit because it, it's a major thing. It is because we're, we're creating these bonds and we're helping and we, so we do have a responsibility there, right? That's the roughest part of my job, Paul, is when you have people who, who want to donate for whatever reason. And we'll talk a little bit about donor motivations as well, and then I have to give them the messaging that, oh my gosh, the screening test. Unfortunately we know it's, we know it's nothing but unfortunately, you know, you have to take a little break from donating or, or you may never be able to donate again. And they're like, I didn't do anything wrong. You know, I've got this, I've got this agreement with God <Laugh>, You know, and now you're seeing away That's right. Or, or they found some value for it. So let's get back to that. Cuz, cuz that is a really rough thing.

Paul Plotsker (12:45):

It's gotta be painful for a dedicated donor to be told he's maxed out age wise or maybe health-wise. So obviously there are things that that individual can and really must do for these community number one, he or she can indeed volunteer at the blood centers and there are absolutely plenty of options to help out. You can bake the cookies, you can give me the juice when I get off the couch and I'm half drunk and <laugh> exhaustive for my nap.

Dr. Oh (13:13):

Yeah, do not, do no. Oh no, do not donate. Drunk <laugh>. He just put that out here for everybody.

Lisa Cowden (13:17):

He means drunk on feeling good. Yeah, please come. He's high on the feeling of giving and saving lives. Right Paul?

Paul Plotsker (13:27):

That's exactly right.

Lisa Cowden (13:28):

Thank you Paul. Thank you.

Paul Plotsker (13:29):

A drink, really. So it's a, so the violence hearing thing in the blood centers might be an idea for a person who's maxed out. Number two, I'd like to get those people in front of high school students, college students and professionals and people and factories. And it doesn't matter what you do for a living, your blood is precious and it's every bit as read as anybody else's. And you've gotta be reached. When we came here years ago in oh seven, my wife and I moved here. She's a physician at Children's Hospital. My wife is a child psychiatrist and so she's got a double appointment both at the uc Medical School and at Children's. She's an attending at Children's. Long story short, I took a little position at United Way and I was a loans executive. So for the whole summer we were working on the annual United Way campaign. Why do I mention that? Because I had the great privilege of speaking to attorneys in law firms. And then I got a chance to speak to everybody else the non, the non-attorney community in various companies. And it was always a pleasure going wherever, spreading the importance of the United Way. Cause it's such a critically important charity. Yeah, same thing over here. Hoxworth is critically important to Cincinnati and I think that people who have spent their whole lives donating are really great. They're just wonderful people and they should be out there mixing it up with young people, high school kids, college kids and beyond, and meeting and greeting everybody and telling about, about the importance of blood donations. So maybe that's an idea for those who can no longer give, but they can donate and, and be so generous and be so valuable and effective.

Dr. Oh (15:04):

Yeah, that's fantastic. You know, a lot of times we give that news and people are, need a little time to recover and, and are are heard and, and there's a little bit of a separation. But yeah, we always offer, you know, stay engaged with us, you know, the volunteers are so important.

Lisa Cowden (15:17):

Yeah. Our volunteers are amazing. That program is amazing and it, it's just as valuable as, you know, rolling up your sleeve and, and giving blood. Our volunteers are essential to this life-saving mission. And I'll also say, you know, we always tell people, you know, if you can't, I have sometimes people that are you know, for medical reasons that are temporarily deferred from donating for a period of time. And they're very devastated by that. And I always say, well if you, you can't volunteer your time, refer a friend. I mean, that's really powerful too. You know, grow this network of heroes. I mean, we're always looking to grow and bring more people from our community and to, to join our mission to save lives close to home here.

Paul Plotsker (16:03):

Beautiful. I was thinking maybe Hawksworth can approach uc and Xavier and instead of merely having a basketball, you know, intercity rivalry the inter-city shootout they call it. Yeah. Which is nice, you know, and if you're into basketball, not really, but if you, I'm into baseball and football, not that I'm out, but if you're into basketball, that is a, I think a really great platform for college students who are, you know, healthy and well and want to give back to be able to contribute to the community. So basketball's great. We're also gonna have an intercity shootout regarding blood donations and the winner of that could be an A or just could be a great honor. Yeah. And not just, you know, uc and Xavier, but bring in other schools maybe just like they had the bean pot. I spent a year in Boston University law school getting another element banking law. So spent a great year in Boston. They have a bean pot tournament on ice hockey. It's Harvard, Boston College, Boston University and Northeastern. Why don't we get N K U Mount St. Joseph uc, Xavier, I'm just thinking out loud over here. Yeah. St Thomas Moore. OSU I'm just about that in Columbus and maybe they got their own thing going on, but we get the idea that maybe we should have like a bean pot and have it all about the blood. And the winner wins the trophy for most donations. Now that is an honor.

Dr. Oh (17:23):

That's a great idea.

Lisa Cowden (17:24):

We could, well Paul you must be in our marketing meetings. <Laugh>, <laugh>. I think Paul does everything at Hawksworth. Actually they did something a few years ago related to that. And because we do have a re obviously Hawksworth Blood Center is a part of the University of Cincinnati hashtag bearcat proud. And, but we work with all the universities and colleges throughout the tri-state. We're actually this week I think, on, on site at a few campuses. But that's actually something we've talked about this year and moving forward, it's a great opportunity to take in a community event and really turn it into something very meaningful and that continues to support saving lives close to home. So I'll call you in our planning meeting and you can consult on that Paul, but great idea and we agree with you. And, and that is in the works, you know, our strategy

Paul Plotsker (18:17):

<Laugh>. And on top of that, what if you really get big and you convince Notre Dame and USC in Michigan and osu maybe that's the big 10, the Big 12, the s e c and tell 'em football's great. We all love football. I mean I do. And it's, the point is, what if in addition to playing football, Notre Dame goes up against Michigan or USC in a blood bowl. They used to have back way back in the day when I was young. They used to have on television, used to have like, you know, the some kind of like, you know, brain bowl, I forgot exactly what it's called, and representatives of the universities. This talented young men and women would represent the school and they would try to win for their school and and so on. How about if we try to win some blood product from all these major schools? I'm talking Harvard and Yale. They've got a great rivalry. Let's approach them. How about Army? Navy? Go Army. Cuz my father serves <laugh> Army and I, we live not too far from West Point. So go Army. The point is, what if Army Navy was able to, what if tho those two service academies decided to do a a blood drive competition? Now that's worthy. You know, it's not just football. That's great. It is. But also getting blood from these fine, young, really patriotic and dedicated young men and women in the service academies could be awesome.

Dr. Oh (19:29):

So I think listeners can, can tell why we asked Paul to join us today. You just have so much passion for blood donation and it's just, it's invigorating to talk to people like, yes. So let's take a little bit of a break. I think this is a good stopping point for the first portion of this conversation. And we'll be back for part two.

 

Dr. Oh (00:12):

Hi, thanks for joining us for In the Know with Dr. Oh. I'm here with Lisa Cowden, our experience guru, and Paul Plotsker. And we're gonna continue our conversation that we had just the other day. So, Paul, I wanna talk a little bit last time you mentioned that you made a, a bargain with God and it sounds like you set the terms up for this, but <laugh>,

Paul Plotsker (00:35):

Because I'm a lawyer and I know how to cut a deal.

New Speaker (00:36):

Exactly. I can figure associating with him. I feel a little sorry for God here cause I, I don't know if he knew what he was signing, but yeah,

Paul Plotsker (00:43):

He really stepped into it, <laugh>.

Dr. Oh (00:45):

But I think, you know, the part of what we've been wanting to explore with this podcast is donors and why our frequent, frequent donors donate. And I think that your story represents a very personal story, but that our donors, many of them have very significant reasons for donating, often very, very personal. And again I wanna explore our, you know, mission at Hoxworth and our ability to connect. And Lisa, I don't know if you have other stories of that donors have shared in terms of like just a real commitment to helping other people through blood donation?

Lisa Cowden (01:27):

No, I mean, it's every day. I mean, I think that's the best part of my job, honestly, is connecting with donors for different reasons. But when donors are challenged due to reasons that are out of their control of why they can't donate or, or they're deferred for just a little bit of time, or they're new into the donation experience, there is something that is driving them. It's something so personal that they just really are driven to make a difference. And every story is the, the characters change, but really the, the mission, the motive is really the same, to be very honest with you. Yes, it's just changing the characters. But I think this is what's really interesting about Paul. I think we, we have to mention this, I think one of the reasons Paul's sitting here today is Dr. Oh and I and, and Dr. Oh's our chief medical officer. And you know, he's not always in the day-to-day operations, but gets a very involved, I think you're very passionate about our donors. You're very passionate about our mission in saving lives. And I think you really do give more time to support that and so Dr. Oh and I, I think received a message, and I'll keep this short a message one day from Paul. Yes. via email. And Paul is also not just a blood donor, very dedicated blood donor, comes in, rolls up his sleeves and gives blood. But he's also a community organizer of a blood drive annually. And I, you've been doing this for years, but you know, we have been challenged over the last couple years with Covid and with staffing, and we are making our way out of this, but one of the things that we do outside of collecting in our neighborhood donor centers is collecting out in our community through mobile drives. So Paul was not able to do his annual event because we were restricted with staffing. So then Paul reaches out to Dr. Oh and I what became a conversation about why, you know, we're unable to meet the need of the blood drive that Paul wanted to host became something so much bigger and has kind of led us to today. And so I think that's, again, it speaks to your level of dedication. We found a way to make it happen. It's different than what Paul is traditionally has been accustomed to doing in a community blood drive, but was very flexible with us. I happened to be with Paul the Sunday he did the, the virtual drive at one of our neighborhood donor centers. And it was amazing to me that you were able to bring donors that you had an event that weekend, but you had donors come in that were from other parts of the country as well. And I think that just speaks to the power of your passion for serving our mission with us to save lives in our community. So I I think that's interesting to note with Paul.

Paul Plotsker (04:26):

Thank you so much. Thank you both. All credits to my wife who had done a singles Sabbath oriented meet and greet program for young men and women who are looking for their mate. And so a guy flew in from Los Angeles, they all had a very nice time. But that would explain why we had people from the New York area Brooklyn, New York, and maybe upstate, maybe from New Jersey, and Julian was from Los Angeles. Maybe we had somebody from Baltimore. These were people who were coming into Cincinnati to possibly meet somebody really nice to to potentially marry.

Lisa Cowden (05:01):

But I will note I was there for just a few hours and the donors that came in that Paul had, you know imparted his wisdom and his passion, they came in and they were so happy to save lives that day. They were so happy to take time out of their day. Every single person, I could not believe their level of enthusiasm for rolling up a sleeve and, and saving lives in the tri-state area. So I I thought that was amazing.

Paul Plotsker (05:30):

Thank you.

Lisa Cowden (05:30):

And it was, it was a neat experience to be a part of and to watch that. So I think again, that just speaks to your dedication, your passion for saving lives.

Paul Plotsker (05:39):

I think bagels, Lux and Cream, she's also probably had a hand in that <laugh>, we told people that they can get a full blown breakfast

Lisa Cowden (05:45):

And they did

Paul Plotsker (05:45):

And they did at Gulf Mat Synagogue, we don't just feed the donors. We also feed Hoxworth employees and technicians. And so, you know, in the past, the Gulf Mat Synagogue, social hall, we'd bring in all, all kinds of food and I'd tell 'em, no need to leave the building. You have a free lunch right here. That's awesome. And I remember one technician said, food's food, <laugh>, you know, and let's go. And what's, you know, Mark's bagels with some, with a Shamir cream cheese and some locks. It's a beautiful thing. <Laugh>. So maybe that was also,

Lisa Cowden (06:13):

I think it was a motivator for sure.

Dr. Oh (06:14):

I I think so too. <Laugh>

Paul Plotsker (06:17):

Gotta feed people.

Dr. Oh (06:17):

So Paul, tell us a little bit about how frequently you come in. Not, not, you don't have to get too, too specific, but, or the past few years.

Paul Plotsker (06:25):

Yep. It's it's become once a month hopefully I try to come in once a month and I try to give platelets and plasma because you're able to give those sub-components more frequently than whole blood. I figured I was, I would like graduate myself out of whole Blood, which is a, a once every eight week donation and decided to go platelet and plasma. And I figured if you can do a double platelet plus a once a month plasma, well that's three units of blood right there. And if you get really religious about it, <laugh> and there are 12 months in the year, then you're hopefully, hopefully coming in once a month. And I, I make sure my children who are athletes from Mathnasium, how much is 12 times three <laugh>. So they can do that now. And that's 36 units and that adds up very quickly. And it enables me to be very effective in in giving. And even though I'm o positive, and I think that hu may prefer that we give whole blood. And so maybe platelets and plasma, but they're very kind technicians don't really quibble about it. They take the platelets and the plasma and and I've been doing that for, for years now, and it adds up. It's been, th it's 43 gallons.

Dr. Oh (07:37):

Oh my gosh.

Paul Plotsker (07:38):

That's so really very happy.

Lisa Cowden (07:39):

I see Paul has his gallon pin on his lapel of his suit jacket today. <Laugh> here. It's, I love seeing that our donors are very proud, you know, a blood donor. Cause they usually have a, a gallon pin somewhere. Right.

Dr. Oh (07:53):

Let's talk a little bit about the technical stuff. Cause I can't help myself when we're talking about blood type and donation. And so you're absolutely right. Donor comes in, donor walks into a donor center, <laugh>,

Lisa Cowden (08:04):

This is not going on. Yeah, we're stop you there

Dr. Oh (08:09):

Behind that. So so donor comes into a donor center and, and they maybe have donated once before. So we know that they're a blood type, let's say o right Opos or Oneg, we want to collect your red stuff, right? Because that red stuff is, is compatible with with everybody, right? Or not everybody, but many. Yeah. <laugh>, I don't wanna get too tech. I always like, oh, there's one exception. So, but oh, you know, o is the universal blood type, right? For red cells. And so, so we really preference sh want to get them. So typical donor will come in once, twice, maybe three, four times a year. Three or four is, is is good. So once or twice a year. So if they come in and they're, we know their type O, we're gonna want the red stuff. And so we can actually ask them to collect on a double red if they qualify. And that's great because if, if you come in once a year, let's say you're just gonna come in once a year, we can get twice as many red cells from you, right? And let's say you come in twice a year, we can get four units of red cells instead of the two units if we collect the whole blood, right? And the plasma is useful, but it's not as useful as the red blood cells if you're a typo. So that's where we're gonna go. A donor like you who has been here for a long time, right? And it's like, I want to increase my ability to help people. And I know you guys want the red stuff from me cuz I'm an O but dang it, I'm gonna come in every freaking month and I'm gonna donate for you. Can I, can I donate platelets? Yeah. You're the perfect person then to say, Hey, let's go ahead, let's clock play this from you because the o platelets, it's not like they're useless, right? I mean, they are totally needed and 40% of the population is o and so they're gonna want those o platelets from you. So that's, that's a lot, right? So if we can get our dedicated donors to come in and then we'll, we'll probably say to you in the future, don't do the the red stuff because then there's a longer interval between the time you can come back again. And really, if you donate red cells with platelets and you're a regular platelet donor, that's really tough on your iron as well. So, and even just doing the platelets as you're doing, I recommend taking iron supplementation as well. So that's kind of the story find o's where it's like, well, you do collect some platelets. Why do you collect some platelets from these donors and others? If you're gonna come in just once a year, we really want the red stuff from you. But if you're gonna have a a frequent donation with process with us, then you know, then, then the platelets are good on the other side. If you're an AB donor and you come in, we really don't want the red stuff from you because you're only gonna be compatible with 4%. So when you do a dating thing, if people are asking what their type is and they say, oh, you, oh, okay, you're gonna be compatible <laugh>, but if they're AB you're gonna be like oh, I'm the next person. But so it's a tough life for ABS out there unless you're doing 80 platelets and then we're like, oh my gosh, you're a superstar. So if you come in once and you're an ab you know, once a year an ab we want to collect the platelets, you, we can. And it's a longer collection. So, so to have that dedication to come in once a month, right? It's like, oh, this could take a couple hours, right? Typically we'll take a couple hours, we've, we've upgraded our devices so it's a little bit quicker, but it's still, you should expect to be there for a couple hours, right? When you're doing platelets, when you're doing the re or the whole blood. It's a, it's on hour from, from beginning to be an end. So, so that's kind of the, in a nutshell, the story between blood types and kind of how we're steering folks towards one versus another.

Paul Plotsker (11:23):

I'm very grateful that you allowed me to No, donate what I, what I like donating and hopefully it's useful.

Dr. Oh (11:29):

Yeah. And so yeah, if you, if you were donate frequently like that 10 times or more, you know, for 10 times one or a year, that's where Yeah. Platelets, plasma, that's where we want it. And the plasma is once every four weeks. I know all these crazy rules, so, right. And so yeah, if we're collecting plasma specifically, then it's once every four weeks. If we just do platelets, it's once every two weeks, a maximum, 24 times a year. And we, we have had a few 24 timers, right, Lisa,

Lisa Cowden (11:55):

We had in 2022, we had 11 platelet donors donate 24 times, which is yeah, major shout out, golf clap everyone <laugh>, that is amazing. And I had the privilege of meeting two of those platelet donors right before Christmas because we went into the NDC and to recognize them. And I tell you, they were, they're amazing. They're amazing.

Paul Plotsker (12:21):

So Paul said, and then we had, so we have our regular donors who are are like you now. So we're like, oh gosh, they're, you're, you're, you're a part of the family.

Paul Plotsker (12:29):

Like, cheers. I walk into a right name.

Dr. Oh (12:33):

So I try to use that. I try to use that example with our, our employees sometimes. And the ones that are younger are just looking at me like, I've got, you know, five eyes are like, norm. What?

Lisa Cowden (12:43):

Yeah. They don't know the cheers reference doctor. You have to know your demographic for that. You're safe in this room though.

Paul Plotsker (12:49):

They usually don't know the reference in these sweatshirts where it's just says college, the red sweatshirts. Yes. I love that. And so people, one lady in thinking Kroger said to me, you, you left out the name of the school. I said, you didn't see the movie, did you?

Dr. Oh (13:01):

<Laugh> I love those college college shirts. So sometimes when we have our frequent donors, we have patients in the hospitals, oftentimes children's, typically children's hospital, they are needy. If you go hashtag go look at our previous podcast with Dr. Kenny and so they sometimes will request a product called called Grain of Cytes. And so there's, or white blood cells. So usually we, we have red cells which are, you know, we get from the whole blood and we have plasma and platelets, whitewash. They're the yellow stuff. And the white cells are the white stuff, right? <Laugh> between, and kinda like the Oreo cookie filling, I guess <laugh>. And so it's rare where we'll give those, because cuz that's a, that's a hardcore treatment. Those white cells are the ones that have cytokines in them and they fight to fight infections. And typically we remove those white cells from our donations so that they don't cause fever in recipients. And needed for most, most patients, folks who have just had a bone marrow transplant and are very immunocompromised, sometimes can't fight off infection on their own. Even with the great antibiotics we have, there's more resistance that's kind of coming up. And then fungal infections are really resistant. And so so we'll we will get a request for granial sites. And so we ask some of our frequent donors who are very reliable, you get a call from our office and usually you're like, okay, just tell me where and when and I'll be there. It's just amazing.

Paul Plotsker (14:27):

Thank you. Yeah, I've done this Beth, I think three times, maybe four. It doesn't get any easier because the procedure is one needle in one arm and then the second needle on the top of the hand. And so I'm not really accustomed to that anymore. Back in the day when I would give in New York a Sloan Kettering or at the New York Blood Center, they eventually phased out double arm machines and they just became what they called, you know, one arm bandit machines, <laugh>. And so you just, you know, had one needle in one arm and you could use your other hand to stretch your nose if you needed to. Now over here, you know, give platelets of plasma. Of course it's how it is one arm, but the granulocytes, those white cells that second needle goes into the top of the, of the hand. And I noticed I don't have too many fat cells in the top of my hand. I'm always asking myself, why can't Dr. Oh help me? Trends for some fat cells from my belly or went to the top of my hand? Apparently he refuses to do that <laugh>, but okay, we're gonna just go forward anyway. And man, I gotta say, I've, I've done a lot of blood donations, but a needle at the top of the hand, there's not much there to, to kind of, to cushion it, I guess. So if that's the word. And so it goes in and it does hurt like the dickens, but oh gosh, it's an hour and a quarter, hour and a half, whatever it is, and you're saving, you're saving a life. Way back in the day, I was the one in a million bone marrow match for somebody out there, 28 year old individual, doctors don't tell you ethnicity, gender, religion if nobody's concerned. And I got approval to go forward and I was gonna do the procedure with Dr. Joseph Michael, Dr. Michael Schuster of Cornell University Medical Center in the upper, upper east side. And I remember every time I met him he'd said, hi, hi Paul. How are you? Oly, were gonna take some blood. After a while, they rendered me anemic because they were taking a lot of blood to test it. And I was like, occasionally giving blood. And I said, well, you know, I have to be respectful. I said, but doctor, I mean, you're taking blood every time you meet me. It's probably no surprise that I've got anemic. He says, you gotta start taking iron pills. Yeah, yeah. And so I did. And liver and onions maybe we tried that as well. Some iron pills. And we did the, you know, the pills and got the numbers back up. And then the individual patient had to also go through, you know, it was like a dance. I mean, you gotta make sure the person goes through radiation or chemo, whatever it is in order to wipe out the bad in order to be able to transfuse the good marrow. And, and I was all getting very, very excited about it, very psyched. And sadly, we got the news. Months had gone by. I had to wait to get my numbers up. He had to do his, he or she had to do his or her thing. And we could not proceed because the patient passed away. It was devastating. Cause I, I was let's understand, I was like, the one in a million, when you're the one in a million, it's not like you're giving a pint of blood, you know, which is great. But when you're the one in the million, you are the six H l a type person who's going to match that individual and hopefully save that person's life. That blew me away. And then to not be able to go forward with it after all that preparation all the time it was it was devastating. But you gotta just jump back on the on the horse and, and keep on doing what you gotta do. If you're a cowboy, you gotta just keep on doing what you gotta do. So hopefully we're, we're trying to do that.

Dr. Oh (17:41):

So those collections, the, the group, it used to be called N mdp, but they're called now Be the Match. And they do this, they're the largest organization. They're, there are others, but we are a collection center for them as well. So this is something we do pretty frequently. Dr. Alquist is our medical director over that area, and we've got a fantastic crew. So we're, we're the area where you did the OSE site collections is the exact same area where we do these special collections. And these donors come from all over the,

Lisa Cowden (18:07):

They do all over the country.

Dr. Oh (18:08):

We we're one of the premier, I'm gonna pat this on the back a little bit. Dr. Alquist has a fantastic group over there. And, and we're one of the premier

Lisa Cowden (18:15):

Amazing

Dr. Oh (18:16):

Collection centers in the country. So we see, we see donors from all over the place come and and our nurses are fabulous there to, to do

Paul Plotsker (18:23):

A lot of love and generosity out there in the world. And we gotta just fan those flames and keep it going, get the word out. They're important and they're saving lives every single day. This is so important. And people just tend to forget about it. They don't give it much thought blood donations, ah, they just poo poo it. You can't poo poo saving a life that is outrageous to me. You gotta just jump into these pool and, and help out. And I want to thank some Hoxworth with people who have enabled me just to speak to at least was saying earlier, we had, you know, we were hoping to be able to host the blood drive as we have normally done in our beautiful, spacious social hall. But for whatever reason sure. You know, staffing we decided to roll the dice and show a little bit of faith in God and say, we're going to do this blood drive at the Blue Ash Blood Center, and we can only give platelets or double reds. I forgot exactly what the parameters were, but we're going to travel really far. We're gonna go all the way to Blue ash, okay. And we're going to roll up our sleeves and we're gonna have some really great food at a really great time. And thank God we had a we had a response. I mean, people went up, went Along with you did. I wanted to thank Bobby Becher, who I work with currently in the past I was working with Jade Brown, Eric Langen, and Alison Yates, and of course a shout out to Elizabeth Davis and Michael Whiting. Yes. Were always good friends and help me out whenever I have a question or, or a concern. It's a really great staff at Hoxworth and I'm very grateful to be working with such great people.

Paul Plotsker (19:53):

Paul, I thank you so much for that shout out. I think, you know, there's two sides to this mission in saving lives close to home. It's our donors, actually three our patients. The end goal for all of us, but our donors are that come in and volunteer their time and their blood, and then our staff. It, it really is just an amazing group throughout that blood center. Hoxworth at uc. But the real question is, Paul, who are your two favorite Hoxworth employees?

Dr. Oh (20:23):

I think one of them might be sitting in the

Paul Plotsker (20:26):

<Laugh>. Well, you, you guys are good. <Laugh>. That's the start. I've got to know Dan Cunningham.

Dr. Oh (20:32):

Dan is, oh, Dan's fantastic.

Lisa Cowden (20:34):

He got a promotion. I understand. Yes. So he's, I think somewhere maybe in central.

Dr. Oh (20:38):

Yes. He wanted a little change up, I think from the stuff he was doing. So he's part of our, so

Lisa Cowden (20:44):

He's still very valuable.

Dr. Oh (20:44):

Quality is job number one for us. And he's in our quality department now. Okay. He's a fabulous guy.

Paul Plotsker (20:48):

And then there was a Nicki, Nicki Sweet

Dr. Oh (20:52):

Nicky, sweet

Paul Plotsker (20:53):

Nikki is, I remember, I think she was a tri-state. It's hard for me to remember exactly where she's you know, based. But years ago, not that long ago, my children said, how about we do a special Sabbath oriented Harry Potter thing? Oh gosh. And I thought, well, that person not really into it, but if children are and that'll bring the children in and their parents, let's do this. So we had a special Saturday night party and Nikki sweet's daughters are into the thing in a big way, and they kind of dolled up our social hall and made it look like that dining hall, if you want me to the attend Japan in in the movies. And they kind of really did a beautiful job. They did a lovely, lovely job. And then the next day we went off to see the movie at Music Hall, Harry Potter film with a live performance of the music by Cincinnati Orchestra. And so the symphony was there. They were doing the music of the movie live and watching the film. Kids were absolutely loving it. I think I did the usual fall asleep kinda thing. I said, I'm just added to that genre, but I'll, I'll do a program. I mean, if that's gonna bring in the, you know, the bodies, I'll do almost anything. I often wonder, it would've been so much fun to be like a producer on Broadway or a producer in Hollywood, get those people in the seats and I don't care what they believe, I don't care about their politics. Get donors to come in, get children to come into the synagogue, make it exciting for them, that kind of thing.

Dr. Oh (22:17):

So, so, so let me, let me end on that because I I I love that. And we're kind of coming first full circle.

Paul Plotsker (22:23):

We can keep going if you like,

Dr. Oh (22:24):

<Laugh>, we can talk afterwards for sure. So, you know, you're Jewish, that's a very important part of, of your life. You have organized this blood drive and have your own community of, of people who you, who are like, like, like you to donate blood. And we at Hoxworth try to be open to everybody that we can. And that's the beauty of it. I really, that's just, I just love that mission. So, you know, whatever religious you know, affiliation you have, you know, we are gonna try to work with you and have, you know, your group or your organization or you know, the people who are eligible blood donors come on in and donate and then that blood doesn't stay within your group. Right. It goes and it helps everybody. And That's right. It's just, I just, I get, you know, excuse me.

Lisa Cowden (23:10):

I know you look at you, you're so overwhelmed, Doctor Oh. I love it.

Paul Plotsker (23:15):

It's an Abrahamic thing. If I could just jump in and, and, and jump on that. Gulf Van Synagogue has over the years raised 574 units of blood Wow. Over the course of all the blood donations and that people do throughout the year and of course on our annual blood drive. And lately we're doing a pre Thanksgiving pre-holiday season kickoff to the holiday season blood drive when people really feel grateful to the country, grateful to their neighbors, grateful to God for all the good stuff that they've got. And, and so many people have so much good and they really have to you know, really learn to appreciate it. And many of our donors do. And they say, you know what, how can I, how can I show something in my appreciation? How can it be a tangible thing? Let me donate some blood to my neighbor. And so we've decided have various dates throughout the year, and I think that we finally have found our home on the calendar. That's gonna be the Sunday right before Thanksgiving, four days before, when people are truly thinking, I am not traveling just yet. That's gonna be Tuesday or Wednesday, but I have little time in my hands on Sunday and I wanna kick off my holiday season and be grateful and show some gratitude to God and to country and to my community. And they come to our blood drive. And I cannot tell you how, how gratifying it is that they come to us and they make our our drive successful. And we wanna really, hopefully everything will be figured out by November. I'd like to have a catered affair with maybe a, some important dignitaries and maybe some movies for the children and maybe a juggler or a comedian or something, and entertain kids and make the golf and a synagogue blood drive a truly circus-like environment and really give you a lot of product. That's my hope for this coming November.

Dr. Oh (25:00):

Well thanks so much. You're so passionate about this and I know you're always pushing us. So hope you had a good time talking to us today. And we'll, we can be maybe a microphone or microphone for your, for your she's, he's driving the microphone to take.

Lisa Cowden (25:17):

No, but I'll take a picture of you and Dr. Oh to memorialize your podcast experience today.

Dr. Oh (25:22):

So I wanna thank, Lisa, any last thoughts for you?

Lisa Cowden (25:25):

No, just, I just reiterate thank you so much Paul for joining us. Love hearing your stories, your passion, your motivation. I think it's hard for somebody to listen to you and not wanna get up and make an appointment to come save lives. So thank you for being that person and doing that with us and saving lives close to home. Thank you.

Paul Plotsker (25:46):

It's a real pleasure, truly an honor and I'm really very, very happy to be able to be associated with Hoxworth and be a donor and donate for many, many healthy years.

Dr. Oh (25:54):

Thank you so much.

 

Dr. Oh (00:08):

Hi, thank you for coming back for another episode of In the Know of Dr. Oh. We've got Lisa Cowden in studio, and we've got two great, great donors who are actually, gosh, they donate the most you can donate for platelets over the past year. So they donate 24 times each. Lisa, would you mind introducing our guest?

Lis Cowden (00:26):

Oh, it's my pleasure. Thank you Dr. Oh. So with us this morning, joining us for In the Know with Dr. Oh, we have Karlie Winnett. She's one of our 24 club members in platelets for 2022. I'm certain she'll hit it again in 2023. And Dave Shardelow, thank you both for being here. Dave is also a 24 what I call 24 club member, donating to platelets 24 times in a year. He hit that in 2022, maybe previous years too. We can talk about that in a minute, but we're very happy to have you both. So thanks for taking time out to come talk with Dr. Oh and myself today.

Karlie Winnett (01:01):

Thanks for having us.

Dave Shardelow (01:02):

Happy to be here.

Dr. Oh (01:03):

So what I usually do is I actually have you introduce yourselves to the, to the listeners who are here. So Karlie, why don't you start?

Karlie Winnett (01:09):

Yeah. My name's Karlie Winnett, as Lisa said, and I have been here in Cincinnati since I came to go to Xavier for my undergrad back in 2003. So before that I was donating with the Red Cross. When I started, when I was in high school, picked up with Hoxworth doing Whole Blood when I came to Cincinnati, and it was just a couple years ago that I switched over to platelets. So one day I asked at the donor center, Hey, based on my blood type and, and everything you guys know about me now, where would I be most valuable? And that's when the site manager there, he was like, we would love to have you in platelets if you're willing to do it. So I started doing platelets. I think it was probably 2019 ish into 2020. And it's kind of kicked off from there.

Dr. Oh (01:53):

That is just fabulous. Dave, why don't you introduce yourself?

Dave Shardelow (01:57):

Sure. I'm Dave Shardelow and proud Cincinnati and been in and out of town a few times. Grew up in Glendale and a proud Princeton High School, Viking, and oh gosh had had great times there at Princeton and, but I came back to work for a Cincinnati company, Cincinnati Milacron, and now Milacron and started giving there on a mobile unit. And that was quite a while ago, boy back could have been 30 plus years ago. And was giving whole blood units at that point. And then I'll, I'm sure we'll get into it a little bit later, more about my journey as far as getting to platelets because I think that's an important part for your listeners to know about of blood type and reasons why to get matched. Karlie mentioned that also, but I'm fortunate to have been in Cincinnati now a Montgomery resident and I love the Cincinnati area and, and have known Hoxworth for almost my whole life.

Dr. Oh (02:57):

That's so awesome. So one of the things we always talk about is that when you donate with Hoxworth, you're saving lives close to home, right? So it's folks here and all the blood in the local hospitals, every single hospital in the area is getting the blood from Hoxworth Blood Center. So, you know, it's staying, staying in town and it's actually saving, you know, all those folks who are relatives, friends, neighbors via medical services in the Cincinnati and Surrounding area. So Lisa, how did you meet these two?

Lisa Cowden (03:24):

Well I think it was the week of Christmas. We were coming to the end of 2022. And so we were doing this month January as I think Karlie and Dave, and I know for those who may not know it's blood donor month. So nationally this is a, you know, a recognition celebrated around the world and celebrating blood donors. And so I knew that Karlie and Dave were tagged by our marketing team to do a donor spotlight because we were looking at donors who had really had a high level of donation throughout the year and really wanted to talk to them about what motivated them to come in 24 times in, although that may not seem like much to somebody that doesn't donate or donate very often, that's really a large investment for a person to make. Again, you're volunteering your time, your your blood it's a couple hours hanging out with our team when you come in. And so we were going to go in and recognize them. So I, I showed up with the team we had certificates. We wanted to recognize Karlie and Dave along with a few other donors throughout our Hoxworth system to just say thank you, thank you for your commitment, thank you for the lives you saved, and thank you for your support and our mission in saving lives close to home. So when I went in, you know, you never know what you're gonna get, right?

Dr. Oh (04:54):

They never know.

Lisa Cowden (04:55):

And it ended up being a party. I mean, like Dave walks in the door, Karlie's already in the chair, she's got her sleeve rolled up, she's hanging out watching Netflix or doing work. I don't really even know what, reading a book, I think.

Karlie Winnett (05:08):

Yep. Yeah, it's my perfect time. I'm part of a book club. And so that's when I get through my book club book <laugh>.

Lisa Cowden (05:12):

Perfect. Yeah. So she was relaxed, she's got her blanket on. Everybody's swirling around or like they, you know, she's a, a part of the crew. And so we recognized her, took pictures, she was great about it. Then Dave walks in and he's like, Hey, ready to go. And so he said, Hey, I heard there's another one of me in here, <laugh>, meaning another 24 platelet donor. I said, there is, I said, she's donating right now. So then we introduced them and took pictures and, you know, became fast friends that day. So as I was thinking, as I walked away the day I had a, a great time talking to both of them and just getting to know a little bit about them. I thought, wow, these are gonna be great guests for in the know with Dr. Oh on the podcast.

Dr. Oh (05:57):

Yeah. You got back from that blue ash visit, right? And you were like, oh my gosh, I just met two of the coolest stoners and they're gonna be great guests and they seem to really connect. And I love the fact that, that you guys actually met each other, right? And just connect. Yeah, I thought I say so cool. You, you're in so often, but I think, you know, you probably have your own time slots that we usually come in and so you don't intermix, but this is, this is awesome. And it actually shows kind of and I kind of, I kinda wanna do that with this podcast, I guess is to connect the listeners here. If you're frequent donors, listen and, and maybe you can connect with other blood donors who are out there as well. So you mentioned Dave, that you were AB right? And so I did want to touch on that a little bit. So when you were donating whole Blood, we wanted you to come, right? We all, every type is welcome as you come through, but when you donate, donate a unit of whole blood, the red cells typically, often, unfortunately don't get transfused. And yeah, I hate to tell folks that, but that's where when you come and, and, and donate with us after we get your blood type, that first time you come through, we really then try to, if you're, especially if you're an AB steer, you towards either you can do platelet only

Dave Shardelow (07:01):

Does it make a difference whether you're AB positive or AB negative.

Dr. Oh (07:05):

It really doesn't matter. Yeah. Yeah. It went with the abs and then and then or platelets, right? So either plasma or platelets and those are the, just the beautiful things. And then you can come in 24 times a year. So 24 for you guys is the absolute maximum. Like FDA says, no, no, no, no more than 24 times a year. So I wish they would say 26. Cause you just make it a rolling, you know, every two weeks. But we have to actually tell folks who come in 24 times. You're like, okay, take, take it easy for a week, you know, a couple weeks and, and make your appointment later. Cause we're, that's a rolling 24. Yeah.

Speaker 2 (07:38):

Can I give a quick set? Hopefully this is okay. If not, raise your eyebrows or say <laugh> Lisa, we're gonna cut that. But I think this is really interesting for both of you to hear too, Karlie and Dave and for our listeners. So approximately what, 11,000 platelet donors probably last year, roughly around that out of, let's just even go round up to 11,000 donors. 11 donors hit 24. Wow. You are two of the elevens.

Dave Shardelow (08:05):

And we, I just gave a fist bump to Karlie

Dr. Oh (08:07):

<Laugh>. No, we're <laugh>. That's crazy.

Lisa Cowden (08:09):

He did. So I really want, wanted to highlight that. Cause I, I think you really need to know like how special you really are that it just, again, I think it takes a lot to carve out that kind of time, but you're two of the 11 out of 11,000.

Dave Shardelow (08:24):

Well, and I can tell you at, to the people listening to the, to the podcast that one of the things that Hoxworth has done is upgrade their systems.

Dr. Oh (08:33):

Yes.

Dave Shardelow (08:33):

And it's, it's very, very good to be able to at I'll, I'll go at home and I'll schedule out probably six weeks ahead, go online, sign in to my account on, on the Hoxworth website. You can pick your time, your date, and, and when you're going 24 times a year, you really need to do, do that. Or it, it's because you have to get 'em in just about every two weeks schedule around vacations and do all that to get 24 in. So, but I, my compliments to the Hoxworth people for the upgrades to the systems and you know, they'll send you email reminders and if you want you can have phone call reminders. There's a lot of things that they've done with their systems to make it easy to make the donations.

Speaker 3 (09:21):

The other big thing that I've loved is now we have the ability to fill out a ton of your paperwork at home before you come. So

Dr. Oh (09:27):

Quick pass, right

Karlie Winnett (09:28):

Quick pass. So everyone is tight on time. I don't know, come across anyone in life today that isn't tight on time. So I'll find myself, you know Mondays and Fridays I work from home. So I always do my donations now at the end of the day on a Monday. So I'm finishing up, you know, maybe one of my last meetings of the day, multitasking a little bit, going ahead and filling out my quick pass. So as soon as I walk in the door, you know, I can get going and getting processed through the screening and quickly get into the chair and get donating. So yeah, 24 times, you know, you do have to plan intentionally and, you know, it is somewhat of a time commitment, but by doing the quick pass ahead of time and other things like that, you know, it helps get in and out as efficiently as possible there too.

Dave Shardelow (10:09):

Yeah. And, and, and that's, I I echo what Karlie said there, that now, since I know the people I give it blue Ash, I know the people there, so, so well. Terry is one of the, the receptionists there. She goes, Dave, did you fill out your quick pass? And with a big smile on her face when she does that because you can do it the day of, you can go ahead and fill that quick pass out and they have the, the pads that you can fill out there when you arrive at the donation center if you want and you just didn't have time or whatever. But it does save you anywhere from probably 10 to 20 minutes to in making a donation by using the quick pass.

Dr. Oh (10:50):

I'm so glad to hear that. So a couple things with the quick pass you do have to do with the day of the donation. So one of the crazy questions we asked, right? We asked all these questions is how are you feeling today? Or are you feeling well unhealthy today? Right? That's the question. And so you can't answer that yesterday, right? So it, it really is meant to be filled out the day of, but I'm so glad. So there are a couple different things. So we updated our computer systems last year in October, September, October. And so that allowed us to do a lot of these things that we're doing. So quick pass is one of them. I'm glad that the registration process is working well for you. And then we actually updated our devices that we collect the platelets on last week of November, early December. And so your collections now, if you could, platelets before should be actually quicker. They've streamlined the process and there should be fewer of these crazy beeps and alerts that go on. So I don't know if you guys noticed that at all.

Lisa Cowden (11:39):

Is that true?

Karlie Winnett (11:39):

I am a high maintenance donor <laugh>. So I get really cold in life. I run hot, but for whatever reason, when I start donating, I get really cold really fast. So I'm always in some sort of warming, which causes lots of beeping. And so, you know, the, the techs are constantly having to make adjustments and with these new machines, they're able to take care of lots more people than just me at any given time. And the machines kind of adapt to what my body needs that time. But the other thing is, is I'm still able to give, you know, the donations, but I get out of there sometimes 20 minutes faster than I used to because you're not waiting on like a person to kind of figure out, you know, the right speeds and everything for you. The machine is figuring it out and then the person's doing the oversight behind it. So between that and Quick pass, you know, I went from before and, and I was happy to do it, but I would be, there be two and a half, sometimes three hours on an in an evening. And now, you know, maybe because I chat a little bit and stuff, it, it could be an hour and a half to, to two hours, you know, coming in and out

Lisa Cowden (12:40):

That's great. There's your time study Doctor Oh. Time study, yeah, I just gave it to you.

Karlie Winnett (12:44):

<Laugh>. Now, personally, I don't mind the time because like I said, it's, it's my time. There's nobody else to bother me or ask for anything else. And so I can just sit there and, and read my book or I can chat or whatever. So it's kind of a nice excuse cause I know a lot of people get concerned about the time, but when else can you be doing something good and saving lives and getting like some self-care time to yourself to just lay back and relax? I love nice heated chair.

Dr. Oh (13:09):

So Netflix, we were talking Netflix and Chill, right?

Lisa Cowden (13:11):

Because we're gonna give it a new meeting. At Hoxworth <laugh>, forget the meaning that's out there now. It's Netflix and Chills another thing at Hoxworth Blood Center. But it, we hear people often referring to it as their me time. And there's one thing I do wanna note about Karlie and Dave both when I went in there, first of all the staff is like, well let me ask Karlie first. Like they were surrounding her protecting her. I'm like, oh my gosh, okay. <Laugh>. You know? And so it's like they take great pride in the relationships they build with the donors and, with Karlie and Dave both being 24 times in a year in there you know, the staff, it was great with the staff at Blue Ash cause they were very proud to like be your representative to me. <Laugh>, you know, it was like Dave's on his way, just so you know, we'll know when he's in the in the parking lot. I'm like, okay <laugh>. And so it was just great. And I think with Dave, one of the things that was fun when they presented him with his certificate,

Dave Shardelow (14:11):

Can I, can I tell the, I think I know where you're going. Can I tell the story?

Lisa Cowden (14:13):

Yes. Oh, please.

Dave Shardelow (14:14):

So I, I really have gotten to know the people at Blue Ash very well. And I am gonna mention a couple of names just cuz I, I really, really like these people. And Dan Cunningham was a former manager out there. He's, he's gotten a promo and he is moved downtown or down to Clifton. Erica Lovett and Lori Pearson are the people that are doing the sticks on me. And which they do a a tremendous job. And I'm, I'm fortunate I've got good veins on either right or left arm. But then Jill Mel is down there and I mentioned Terry Peasley before. So those, but Erica is my person, so <laugh>, she's the one doing the stick and awesome. So, and I used to give Dan so much grief earlier in 22 because they ran outta Oreos one, one time.

Dr. Oh (14:57):

Oh no.

Dave Shardelow (14:58):

And, and, and I got out of the chair and I went over to the Oreo and I said, Dan, my man, how the heck do you not have the Oreos? That's how my self-care is the Oreos. And I take one home to my wife because I'm gone for two plus hours, <laugh>. And so one time I came in and Erica came to me and she goes, here, these are for you. And she had bought on her way in, she knew they were outta Oreos. She bought a 10 pack of Oreo cookies out of her own pocket. And she goes, these are for you. Cause I knew we were at Oreos. And so then when I made my 24th Don donation, which was the last week of December, she bought a whole pack of, you know, big pack, family pack of Oreos. So it was just very nice. And, and I, I can't tell you enough how friendly the people are at Hoxworth. I mean, I, I can truly say that you may go in and be motivated by lots of different reasons and I'm sure we'll talk about that. But the fact that the people are so friendly and welcoming make it very easy to come back on a regular basis.

Lisa Cowden (16:07):

You could just see it though on both sides. Like yeah, I think they feel the same way about you guys as you do them. Like, and it was cute when I was introducing Dave and Karlie and we all, the staff was kind of surrounding, you know, them and we were having a great time, our own little party there. It was funny. I said, do you know a blow donor? When they asked the questions to what's your blood type?

Dr. Oh (16:30):

<Laugh> Exactly.

Lisa Cowden (16:32):

I'm like, you know, you're a blood donor when that's the first question you ask somebody when you meet them. So what's your blood type? And that's what those two did. How many gallons have you donated was the next question. I'm like, oh my God, they're gonna compete now.

Dr. Oh (16:42):

Exactly. <Laugh>, ab, ab wins. Ab wins <laugh>.

Karlie Winnett (16:47):

Dang it just an a positive over here.

Dr. Oh (16:50):

Yeah. So it is interesting cause you talked about motivations for donors to come in and that's kind of, i I the scenario that I, I've been asking a lot of questions about and I think that, you know, traditionally blood centers have, have had like a, the same type of messaging that you see with Sarah McLaughlin singing and like, you know, these pets that are homeless or children that are dying and stuff. And that's, that is, you know, totally important. But I think that what we need to do is have our donors come in and, and not like have it be somber as they're donating and you know, cuz you're doing a great thing, you know, you're doing a great thing when you come in. Just know that you're having a great thing and then have fun while you're donating and, you know, and make it an enjoyable event for you. You know, I I I don't want it to be all melodramatic as everybody's, you know, donating, but oftentimes that's kind of the origin story for donors is that they'll have an incident that happened to them where they were like, okay, I'm gonna go and donate blood because I have a loved one in need. But that doesn't have to be the reason you come and donate every single time afterwards. I think one of the things that we can do again is, is provide an outlet for people to do good while they have a little bit of me time and while they are helping other people. So that, that's just my 2 cents. Do you guys have origin stories in terms of why you ended up donating it the first time?

Karlie Winnett (18:09):

Yeah, I can talk about mine a little bit. First and so I kind of got it honestly and learned from my dad. He started much like Dave did where a mobile unit came to his workplace. And so just on whatever routine they were coming there, he did that. So kind of after having that kind of role model behavior and seeing it when, you know, as soon as I was old enough the mobile unit would come to our high school. So some of the kids ran there cuz it was an excuse to get outta class or things like that for a while. But I kind of started doing there and then the same thing as I came to Xavier. But you know, I do get the question a lot, like, why do you do that? Like man, that's a lot of time or it must hurt or this or that or the other. And my answer's always just been why not? So I don't have, you know, a big dramatic story. You know, everybody's obviously got people that they know that have benefited from, from blood, but, you know, lucky for me it's not been anybody super close in that regard. It's just been like a why not? I've got something that I'm not using or I can replenish. So why not give it to somebody else who could use it? And then especially as I learned, you know, about kind of between my counts and, you know, all different kinds of things like that, you know, that it is something that is really valuable when you start to hear the stories of, of how your, your platelets are being used. It just becomes further motivation and things over time. So, so my answer and my origin story is always just why not? You know, even if you can't make it in 24 times a year or whatever it is you know, even if you're doing a whole blood that maybe you can be in and out in in 20 minutes or so, you know, everybody can kind of find that little sliver of their time and, and why not just do something for somebody else when it's not gonna hurt you that much anyway.

Dr. Oh (19:48):

I love that. I I absolutely love that. You know, never, no, not everybody has to have this crazy story, you know, of, of need. But Exceptable origin story is for high schoolers who just wanna get outta class for an hour. <Laugh>, I think that's okay. And then you learn what you're doing. Yeah.

Lisa Cowden (20:04):

You're still helping, right? It's okay.

Dr. Oh (20:05):

For sure, for sure.

Dave Shardelow (20:07):

Well, and, and even on at different employers on the mobile units was where I started is that my employer Milacron was very, very service oriented. And, and I know that a lot of the employers right now, they're talking about how they're helping the world and building culture and, and that type of thing. So when you know, the mobile units do come out to your place, please, please just figure out a way to get an hour outta your time. Or if it's through a community organization you're with, you are bettering the world. But I started there in, quite honestly in some of the mobile units and at work at my second employer that there are people looking to just get outta work, quite honestly. <Laugh>, I mean I it and, but still it's a donation and the company agrees and thinks that it's an important thing. So I started giving there and I, I do have a couple of instances where I've had people I'm close with have different illnesses. My father-in-law survived four different cancers along the way and had the best attitude. He was a great, great guy. And the fifth cancer he had was a, a leukemia. So I just got started donating more frequently around that time and that when I was doing mobile units, they said to me why are you donating whole blood? Cause you're AB yeah, we want your platelet. So that's when I started giving platelets even before my father-in-law became ill. But I started giving more regularly then. And then more recently, probably about five years ago, I had a coworker, a peer that was moving from England and he moved to Memphis in, unfortunately, his six-year-old son came down with an illness that needed platelets and he, and he has done very, very well, fortunately, moved to Memphis. He's got St. Jude right there. And so I, I gave an honor of him and in fact gave platelets one time when I was down there in Memphis at St. Jude. so I've, I've got a number of different reasons to give, but when I found out that ab positive or ab blood was a universal donor for platelets, that's really what made me drive home, give back regularly. The other thing, I like my wife on my way out every day I'm retired now, she says, thanks for saving life every time I go out the door for the couple hours.

Lisa Cowden (22:24):

Your wife?

New Speaker (22:25):

My wife does too.

Lisa Cowden (22:26):

Oh, now that, that's gonna make me tear up old <laugh>. Okay. That's so kind.

Dave Shardelow (22:33):

I, I like that too.

Dr. Oh (22:35):

So I think what we're finding is that that's just a, just a great story. As I get older I'm still young, but as I get older,

Lisa Cowden (22:42):

We're almost the same age. So watch it.

Dr. Oh (22:45):

Thank you very much. So but I'm, I'm finding I want to connect more with the community, you know, and I, and I'm finding, you know, maybe this, maybe we'll be able to encourage a whole bunch of people who, the world we live in where there's so much strife and there's so much disagreement and stuff, we're looking for an outlet that can just help everybody. And that's what I, I really like about blood donation is you don't know the specific person the blood is going to most of the time. And just knowing that it helps somebody in the community, in this community that I'm a part of, i, I, I think really helps me to connect with with where I am, who I'm living, where I'm living, and, and all the folks that I interact with every day.

Dave Shardelow (23:23):

Another time that I had an instance which drove home giving platelets and connecting with a, an individual, again, I didn't know the name of the person, but I knew I got a call from Clifton ah, to say, come down, we want you to give, and maybe you can help me, Dr. Oh where they, they yes. Get you in both arms at the same time.

Dr. Oh (23:43):

In both arms. Both.

Dave Shardelow (23:44):

But there was was a young child that was being operated on that day and they needed the donation that day. Cause one of the things again, for listeners is the shelf life for platelets is five days?

Dr. Oh (23:57):

You know, it's extended now to seven days. Okay. But, but we have to release it eight or it's, it's, it's on the shelf for about five days. So yeah, that's, that's still about right.

Dave Shardelow (24:05):

So, which, which is a, a short amount of time, so they have to keep it going all the time. Another reason why it's important to make the donation, but I, I knew it was absolutely helping that day Yep. To that young child. And so I was happy to make the drive down to Clifton to be able to make the donation.

Dr. Oh (24:24):

Yeah. So the, you're a super, super donor then. Yeah. So those are, those are granite collections. We do them very rarely. Usually it's a children's hospital and it's usually somebody who's in, in pretty rough shape. And and it's kind of a last ditch type of treatment for those folks, to be honest. In, in, in olden days, we would never do it unless we really felt like there is no chance of survival unless you've got these cells. And then, and sometimes, you know, we don't help everybody, but we at least are there to, to give it a chance. Right. So let's end this portion of the of this episode of the podcast and we'll be back with Dave and Karlie for the second half for our next podcast. You're listening to In the Know with Dr. Oh.