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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!
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):
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):
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):
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 firstname.lastname@example.org. 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):
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):
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):
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):
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):
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):
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 (00:40):
You are listening to In the Know with Dr. Oh, presented by Hoxworth Blood Center. Our guest today is Dr. Carolyn Lutzko from Hoxworth Blood Center and Cincinnati Children's Medical Center, right here in the tri-state. We've been talking a lot about the work that she does. We've been talking about CAR T therapies, but one of the things that we were talking about off-air was women in STEM education. So I guess, to kind of transition, at what point did you decide that you wanted to go into the medical field and get into that STEM education?
Dr. Carolyn Lutzko (01:13):
I loved science in high school and decided that I wanted to be a physician. And so went through my undergraduate focused on biology, and genetics was my love. And then I'd lucked into getting a job, a summer job in a lab, and I just felt so at home in the lab and just thought, "Oh, this is what I want to do." You know, I can contribute to the health of people and the, the field, but in a different way than I had originally thought. Cause I just, I was interested in that. So that's how I ended up following the path I did, of going through a lab in graduate school and, um, you know, leading, leading that group. But what the best part is that I work with teams of physicians, I impact the health of our patients and am part of that team that's built from whether it's, you know, uh, the clinical sites or Hoxworth Blood Center, whoever is part of that team. So that's how I got where I am.
Alecia Lipton (02:15):
There might be some people listening that have daughters or maybe young girls themselves that are thinking, yes, I love science and I want to do something in there, but I don't know what, I don't know what type of a doctor I want to be. Did you struggle with that at all?
Dr. Carolyn Lutzko (02:32):
Well, you know...no, I think not more than most. Young people do struggle with that balance of what I'm interested in and how do I make a career out of it. I think that that's a hard challenge for all young people of transitioning from what you like, but I knew it was biology. It just made sense to me. I just wanted to know more and I had more and more questions. Some of the other maths and sciences, you have to understand them, but they weren't my love, they weren't what I was just, I wanted to know more and the books didn't always have the answers and I just kept asking the questions and I think that's what worked for me in moving through that laboratory more.
Alecia Lipton (03:16):
Did you have any mentors along the way?
Dr. Carolyn Lutzko (03:19):
I had some fantastic mentors and I think, people successful in any career, I think will say that there are lots of people along the way. Um, but I was definitely fortunate. A high school science teacher was, was one of the first ones: Anne Lovitt. She was a woman who really encouraged me to move through that path. But through that time, I've had a lot of female and male mentors of different, that have, have taught me a lot of different things along the way. You don't have to have one sex or the other. I've really been supported through a lot of people....but I will say one of my biggest mentors has been Jose Cancelas, who is the director of our Hoxworth Blood Center, as a cheerleader and really teaching me along the way to keep moving, keep learning and moving what I like to do.
Alecia Lipton (04:17):
And I'm quite sure what the work that you're doing now, you are kind of paying back and that you're serving as a mentor for other young researchers.
Dr. Carolyn Lutzko (04:24):
One of the best parts of my job and career has been to teach and support young people in, in their own, either quest to, to identify what they want to do and get along there along the way and going to take a side out. My younger brother thought that what I, when I talked about my work as a graduate student, it sounded so exciting and so interesting. And so he is five or six years younger. He signed up for biochemistry for undergraduate and came to work in the lab with me one summer. And at the end of the summer, he said, thank you very much. I now know what I do not want to do the rest of my life. And he switched to computer science and was extremely happy. And I, and I think that, you know, that you, sometimes you don't know until you get there, what you want to do. And I think that's really hard. And so, yes, I've had the privilege to teach, but also learn from a lot of students from graduate students, undergraduate students, clinical fellows along the way,
Dr. Oh (05:27):
You currently do a lot of mentoring, I think, yourself, in your role as director of the laboratories, do you have any recommendations for young women who may be interested in terms of how they can get more exposure or how they can develop their resume so that they can have real solid careers in a STEM field?
Dr. Carolyn Lutzko (05:49):
Reaching out to people I think is the best way. Don't try and do it all your own. None of us can do, do it all. Reach out and hopefully take advantage. If somebody offers, don't feel, "Oh, they're too busy. I don't want to bother them." If you know, uh, ask, most people are happy to share their experience and help you along the way. I do think that that all young people, I think probably more females, but they're a little more hesitant. They're a little less, I don't want to bother people. Why would they want to talk to me? But I think in any field, not just science and medicine, I think reach out. People are usually very happy to teach or connect you as best they can with others that can have, if it's not in your area. I think that that building asking those questions and reaching out to people is really important. And whether it's your teachers, your neighbors, or just, you know, somebody who's done something of interest to you, I think. It's the best way to start.
Dr. Oh (06:54):
Do you feel like there are a lot of differences from when you were first starting out to today? When you look at young people at your similar ages in terms of opportunities available, or is it really, you know, primarily self-motivated accomplishments because you obviously were able to do it yourself?
Dr. Carolyn Lutzko (07:10):
I think one of the things that I've always seen, a lot of women in the biological sciences and often the medical sciences at a technical level and in labs. But what I think is different, when in my physics and my chemistry and math, there was definitely fewer female students than there are, I think, these days. So I was a minority in many of those classes. One of the things that's really exciting to me, so I have daughters who are seniors in high school. And what's really exciting to me is if, you know, we go to math competitions or robotics or other things, there's actually usually an over-representation or more than half of the participants are females. And so I think that's a big change from 20, 30 years ago when I was at that age. I think it's a, there's a cultural shift or an awareness that you can do anything. So I think it's better. I don't know that that translates all the way through in the engineering and math, but I'm hopeful when I see younger people not restricting themselves or being have constraints put on them to restrict them to one path or another, that, that, that will change with time, not fast enough. Um, cause I think the creativity of our society and our communities are by having different input from people of all different voices, backgrounds, outlooks, from sex, diversity, socioeconomic differences. So we need to keep that because that creativity will come through. So I'm very hopeful as I see these changes from a younger level.
Dr. Oh (08:53):
Yeah. I see, just from my standpoint, I think you're right. There are many more women who are active in biology and some of the other like math and, uh, may have fewer women. My daughter is also at Loveland High School and she's a junior and she's a programming lead for the Bionic Tigers. So I'm going to give a shout out to the robotics team. She and Claire are the two female members of the team and, and they greet each other sometimes jokingly and they say, women in STEM. So I always get a kick out of that. But I wish there were more, cause it's still is a small percentage of the team, but at least there is presence there and there is growth. So it is encouraging I think. And I think we just have to continue to encourage these opportunities. One of the things I like for Hoxworth, is we just went through a little bit of a review of our organization. And I think we have now 70% of our employees are females. So that's a fabulous thing. And, and I think often medicine and biology, there are more women, I think going into it.
Dr. Carolyn Lutzko (09:57):
Now, one of the other things at Hoxworth is this at the leadership level, that there is really strong representation from women as well. That's a change since I started at Hoxworth, a big change. So I think that the direction we're moving is, is acknowledging that and, and acknowledging, you know, leaders in our, within our groups.
Dr. Oh (10:21):
Well, Carolyn, you're a big part of that. So it's a pleasure to be working with you, Alecia, you as well.
Alecia Lipton (10:26):
Thank you. No, I'm looking back and even my own family, my mother, and I've talked about when she went to college in 1965, they didn't ask her, "Susan, what do you want to do?" They said, Oh, you can be a teacher or you can study nursing. And neither of those were an area she wanted to go into. So needless to say, college was not a fun experience for her. I think she was taking every class she could find and electives that had nothing to do with either of those areas. So then when I came to go to college in the eighties, she was a huge supporter and you can do whatever you want. I really, really appreciated, but still in the eighties, you didn't see a whole lot of women going into the STEM. You still had a lot of that, "Oh, you can be a teacher." So now when I look at these young girls and especially the high schools now that are really promoting, you know, that STEM education, it's exciting.
Dr. Carolyn Lutzko (11:19):
One of the things with, I think STEM education is, is having those role models. I think my first thought when I was growing up was I liked biology. And the only things I could think of to do were science teacher or medicine. And so I think the awareness of other careers or, or areas of study that weren't one of those two and that's where I think my original was medicine. And then, but once I got in a lab that was like, yeah, this is what I want to do. So I think it's important to have those broader views. I know that, for example, again, I know Loveland High School, there is the women in science group there that has guest speakers coming in with women who will just talk a little bit about their career paths. And, you know, some of them take an unexpected turn. Some of them get shortened, you know, just, they realize that they don't want to be in school for forever, just different opening up ideas. So I think that those types of groups are really important for high schoolers to say, Oh, that's engineering. I think they've done, GE usually has some people who come in or P&G or, you know, just some female scientists around so that I think that those types of networks, again, another opportunity to use a network of a speaker would come in doing something of interest, make that connection, um, ask them, Hey, where can I learn more about this? Or do you know of opportunities for summer jobs in this area?
Alecia Lipton (12:46):
I think that's a great point, um, of having that summer job or that co-op, which the University of Cincinnati is known for their co-op, having that mentor that's already in the field, because as you said, you knew you wanted to go into medicine, but you didn't know you had that love for the lab until you had that summer job there. So getting in there and finding out what you like while you're still in school can help you get your degree headed in the right area.
Dr. Carolyn Lutzko (13:12):
That's right. And you know, there are through both, uh, University of Cincinnati and Children's Hospital, I think GE and some of the other areas do have summer programs, and sort of internship or other things. Yes, they can be challenging, but if you're interested in it, reach out, see what resources are available through, you know, they reached to the human, maybe the human resources. I'm not really sure I'm sort of making that up, but I think reach out and look for those. I think that there are good programs out there that will give you as a summer job.
Dr. Oh (13:44):
One of the nice things for Hoxworth is again, we're fairly unique is that we're owned and operated by the University of Cincinnati. So we have student workers all the time that come through different parts of, of Hoxworth and, and other opportunities for shadowing. My wife was a college student counselor, and helped to arrange those types of internships and really felt like for individuals who don't know what a field is, like, the best thing you can do is do a short-term externship or, or co-op here at UC. We are great at that. So I think those are great opportunities and recommendations for women out there who are interested in the sciences.
Alecia Lipton (14:24):
That's great. Dr. Lutzko, In closing. Is there anything that you would like to put out there to those young women that are maybe thinking about STEM?
Dr. Carolyn Lutzko (14:32):
The most important thing is to follow something that's of interest to you. Don't be constrained by other people's ideas. If it's something of interest, follow it. If you're passionate about something, you will find a way and there's nothing better than to get up in the morning and want to keep going, right? Going, I love this. I can't wait to get in and keep working on it. So find that path. You might take you a few tries, but if it's science, math, engineering, just follow it.
Dr. Oh (15:02):
I would add, try to be resilient if at all possible. It's hard, but sometimes you will meet a mentor. And perhaps it's a male mentor who is not supportive of you, find a new mentor. There are many people out there, male and female, who can help you to develop and want to help young people develop, and, and have great careers and lives.
Alecia Lipton (15:21):
And I think it's also important to, to ask. You don't know if there'll be a mentor or work with you until you ask. And most people I think are very flattered when they're asked to help you develop your career. So follow your passion and then ask for that assistance.
Dr. Carolyn Lutzko (15:39):
And even if they themselves can not, they may be able to find you and set you up with those resources.
Alecia Lipton (15:45):
Well, Dr. Lutzko, Thank you so much for being our guest today on the podcast. Hopefully you'll come back and join us again.
Dr. Oh (15:51):
Yes. Thank you very much.
Dr. Carolyn Lutzko (15:54):
Pleasure to be here.
Alecia Lipton (15:55):
You have been listening to In the Know with Dr. Oh, brought to you by Hoxworth Blood Center.