>> WELCOME BACK, EVERYONE TODAY
TO THE SECOND DAY OF THE STATE
OF SCIENCE AND TRANSFUSION
MEDICINE SYMPOSIUM. I'M HAPPY TO
SEE YOU JOIN AGAIN, AS OTHERS
ARE JOINING NOW. YESTERDAY WE
HEARD AND DISCUSSED RESEARCH
PRIORITIES FROM THREE WORKS
GROUPS FOCUSED ON BLOOD DONORS
AND SUPPLY, OPTIMIZING
TRANSFUSION OUTCOMES AND
RECIPIENTS AND EMERGING
INFECTIONS. TODAY YOU WILL HEAR
PRESENTATION RESEARCH PRIORITIES
FROM THREE MORE STATE OF THE
SCIENCE WORKING GROUPS FOCUSED
ON MECHANISTIC ASPECT OF
COMPONENTS IN TRANSFUSION, NEW
METHODS IN TRANSFUSION SCIENCE,
AND DONOR AND RECIPIENT HEALTH
DISPARITIES. AS REMINDER FOR
THOSE WHO ARE NOT WITH US
YESTERDAY WE ASK DURING THE
PRESENTATIONS YOUR MICROPHONES
REMAIN MUTED AND YOU UTILIZE THE
ZOOM CHAT BOX TO ASK QUESTIONS.
OR MAKE COMMENTS. MANY OF YOU
SHOULD HAVE RECEIVED BIOSKETCHES
ON OUR SPEAKERS. YESTERDAY AND
IN PARALLEL WITH YESTERDAY'S
AGENDA FOLLOWING THE THREE
PRESENTATIONS BY THE WORKING
GROUP CO-CHAIRS, WHETHER HE HAVE
A LUNCH BREAK THEN RETURN TO
PARTICIPATE IN ONE OF THREE
SIMULTANEOUSLY OCCURRING BREAK
OUT SESSIONS. LUNCH BREAK WE'LL
PROVIDE INSTRUCTIONS THOUSAND
ENTER THE BREAK OUT ROOMS AND
DURING THE THE BREAK OUT
SESSIONS YOU WILL HAVE THE
OPPORTUNITY TO ASK QUESTIONS OR
MAKE COMMENTS VIA THE CHAT BOX
OR RAISE YOUR HAND THROUGH THE
ZOOM PORTAL TO BE CALLED ON TO
SPEAK. IN PARALLEL WITH
YESTERDAY'S PRESENTATION, AFTER
THE BREAK OUT SESSIONS EACH
WORKING GROUP WILL PRESENT A
SUMMARY OF THE DISCUSSION. WE
ALSO HOPE TO HAVE SOME TIME FOR
OPEN DISCOURSE AND PRESENT SOME
FINAL THOUGHTS PRIOR TO CLOSING
THE MEETING THIS AFTERNOON. WE
ARE PLEASED TO HAVE TWO KEYNOTE
SPEAKERS TO SHARE PERSPECTIVES
ON STATE OF THE SCIENCE IN
TRANSFUSION MEDICINE AND I WILL
TURN IT OVER TO BRIAN TO
INTRODUCE OUR FIRST KEYNOTE
SPEAKER FOR TODAY.
>> THANK YOU SO MUCH, NAREG.
APPRECIATE HANDING OVER TO ME
AND THANKS TO EVERYBODY FOR
JOINING US AGAIN TODAY, VERY
EXCITED FOR THE SECOND DAY OF
THE WORKSHOP AND ALSO THE
OPPORTUNITY TO BE ABLE TO
INTRODUCE OUR FIRST KEYNOTE
SPEAKER OF THE DAY. FIRST
KEYNOTE SPEAKER IS DR. DANA
DEVINE, DIRECTOR OF THE
UNIVERSITY OF BRITISH COLUMBIA
CENTER FOR BLOOD RESEARCH AND
SHE IS THE CHIEF SCIENTIST AT
CANADIAN BLOOD SERVICES. SHE WAS
FORMALLY VICE PRESIDENT MEDICAL
AND SCIENTIFIC SERVICES AT
COMMUNITY BLOOD SERVICES,
POSITION SHE HELD FOR 11 YEARS.
BEFORE THAT SHE WAS DIRECTOR OF
THE CANADIAN BLOOD SERVICES
CENTER FOR INNOVATION. AS MANY
OF YOU KNOW, SHE IS CURRENTLY
THE PRESIDENT OF THE ASSOCIATION
FOR THE ADVANCEMENT OF BLOOD AND
BIOTHERAPIES. WE ARE THRILLED
THAT DANA WILL BE HERE TODAY.
SHE IS GOING TO PRESENT
PRE-RECORDED REMARKS. HOWEVER
SHE IS ONLINE AND WILL BE ABLE
TO FOLLOW UP WITH ANY QUESTIONS
ON -- AND ANSWER THOSE. WITHOUT
ANY MORE WAITING LET'S PLEASE
TURN IT OVER TO HEAR DR. DEVINE
KEYNOTE ADDRESS. THANK YOU.
>> GOOD MORNING OR GOOD
AFTERNOON, WHEREVER YOU HAPPEN
TO BE. THIS IS DANA DEVINE
SPEAKING. I AM CURRENTLY THE
DIRECTOR OF THE UNIVERSITY
BRITISH COLUMBIA CENTER FOR
BLOOD RESEARCH AND CHIEF
SCIENTIST FOR CANADIAN BLOOD
SERVICES. I WANT TO TALK TO YOU
TODAY ABOUT THE IMPACT OF BLOOD
DONOR VARIATION ON TRANSFUSION
PRODUCT QUALITY. I THINK THIS IS
AN AREA THAT IS HAS BECOME
GREATER INTEREST IN RECENT
YEARS. SO I HAVE A FEW
DISCLOSURES. I AM A HALF TIME
EMPLOYEE OF CANADIAN BLOOD
SERVICES, I CHAIR THE BOARD OF
MACRO PHARMA, CHAIR MEDICAL
ADVISORY COMMITTEE OF RED CROSS
AND MEMBER OF THE BOARD OF
DIRECTORS OF STORM BIO, A BOSTON
BASED STARTUP IN THE GENE
THERAPY AREA WHICH WAS FOUNDED
BY ONE OF MY FORMER GRADUATE
STUDENTS. SO I GUESS THE
QUESTION THAT WE ARE TRYING TO
ANSWER FOR TODAY IS WHAT HAPPENS
TO BLOOD CELLS IN STORAGE? I
THINK THAT WE ALL ARE ALL WELL
AWARE THAT CELLULAR BLOOD
PRODUCTS DEVELOP STORAGE LESIONS
OVER TIME AND THESE HAVE A
NEGATIVE IMPACT ON BLOOD PRODUCT
QUALITY. THIS CAN BE
DEMONSTRATED BY A COLLECTION OF
DATA THAT WAS PUT TOGETHER BY
THE BEST COLLABORATIVE AND
PUBLISHED IN 2008 IN
TRANSFUSION. WHAT YOU CAN SEE IN
THIS SLIDE IS SIMPLY THAT THE
MINIMUM STANDARD FOR 24 HOUR
RECOVERY FOR THE FDA IS 75%. YOU
CAN SEE THAT THERE ARE NUMBER OF
INDIVIDUALS WHO DON'T REACH THAT
75%. THIS IS A REFLECTION OF
THE FACT THAT THERE'S A LOT OF
VARIABILITY AMONG BLOOD DONORS
AND THIS IS REFLECTED IN THE
SURVIVAL RECOVERY OF THE RED
CELLS. YOU CAN ALSO SEE IF YOU
LOOK AT IMAGES OF RED CELLS IN
STORAGE, THIS IS ADOPTED FROM
ANOTHER TRANSFUSION PAPER. WHEN
WE ARE TALKING BLOOD COMPONENT
QUALITY WE ARE TALKING ABOUT THE
IMAGES DAY ONE. BY THE THE TIME
YOU HAVE GOTTEN TO DAY 21 YOU
SEE A LOT OF RED CELL FORMS,
THESE RED CELL FORMS ARE
BLEVVING OFF FROM TIPS AND
CREATING MICROPARTICLES IN THE
UNIT. IF BY DAY 35 YOU HAVE RED
CELLS THAT ARE SPE SPHERICAL AND
COMPLETED THIS BLOOD BLEVVING
PROCESS AND ON THE WAY TO LYSIS.
SO THESE ARE NOT THE GREATEST
RED CELLS TO TRANSPHUTS TO
PATIENTS. WE CAN SEE THESE
STORAGE INDUCED
MICROERYTHROCYTES AND HERE YOU
HAVE -- THESE ARE DAY ONE, AND
HERE YOU GO ON THROUGH VARIOUS
WEEKS AND YOU CAN SEE THAT WE
GET THESE VERY ROUND SPHERICAL
CELLS BY 42 DAYS STORAGE, THESE
CELLS ARE VERY DIFFICULT TO GET
THROUGH SPLENIC SINUSES BECAUSE
THEY ARE ROUND SO THEY DON'T
HAVE THE DEFORMABILITY
CAPABILITIES THAT FRESH RED
CELLS DO. WE HAVE EXAMPLES IN
THIS GRAPH OF HIGH STORAGE
INDUCED MICROERYTHROCYTE FORMERS
AND YOU CAN SEE SOMETIMES THIS
IS VERY HIGH INDEED. WE HAVE LOW
STORAGE INDUCED MICROERYTHROCYTE
PERFORMERS WHICH ARE THE BETTER
DONORS. THERE IS ALSO AN IMPACT
OF -- THIS IS DATA FROM KANIAS.
THIS IS AN EXAMPLE OF STORAGE
REMOLLSIS BY AGE. YOU CAN SEE
THAT FEMALES ARE GENERALLY DOING
BETTER IN STORAGE THAN GUYS ARE.
SO THIS IS A GRAPH OF THE
VARIABILITY YOU SEE IN BETWEEN
THE GENDERS. OVER HERE ON THIS
OTHER SIDE ARE SOME DATA THAT
LOOK AT OSMOTIC FRAGILITY. YOU
CAN SEE THE OSMOTIC FRAGILITY IN
MEN IS IS MARKEDLY DIFFERENT
THAN IN WOMEN, AS IS THE PLASMA
TAC WHICH IS TOTAL -- FORGOT
WHAT THE ABBREVIATION STANDS
FOR. SORRY. SO THIS IS JUST WHAT
WE ARE LOOKING AT THE DIFFERENCE
BETWEEN GENDERS. WE ALSO SEE
THIS IS WORK OUT OF MY OWN
LABORATORY. WE ALSO SEE THAT YOU
CAN SEE SIGNIFICANT DIFFERENCE
IN BODY MASS INDEX WHICH HAS
SIGNIFICANT LEVEL OF STORAGE
HEMOLYSIS SO HIGHER BMI THE MORE
LIKELY YOUR RED CELLS ARE TO
LYSE IN STORAGE. WE ALSO SEE
THESE TRIGLYCERIDE LEVELS IN
DIFFERENCE BETWEEN MALES AND
FEMALES, IS PARTLY ACCOUNTS FOR
SOME OF THE DIFFERENCE. WHAT
ABOUT PLATELET?
THIS IS AN INTERESTING DATA SET
PUT TOGETHER BY THE BEST
COLLABORATIVE. THESE ARE DONORS
DOWN HERE IN THIS RED BOX WHOSE
PLATELETS FAIL PH ON ONE
DONATION AND THEY ARE MORE
LIKELY TO FAIL ON A SECOND
DONATION. SO THESE ARE DONORS
THAT WE PROBABLY DON'T WANT IN
OUR SYSTEM. THEY ARE FAILING PH
ON MULTIPLE OCCASIONS THROUGH
SEVEN DAY QUALITY CONTROL OR
FIVE DAY QUALITY CONTROL
DEPENDING WHERE YOU ARE. THIS IS
A SET OF POOL DATA ACROSS THE
TWO CANADIAN BLOOD SERVICES, THE
BRITT S OSSIES, DUTCH AND COUPLE
OF AMERICAN OUTFITS. SO BLOOD
SYSTEMS KNOWN AS VITALANT AS
WELL AS EFS. SO THIS IS A VERY
INFORMATIVE QUALITY CONTROL SET
OF DATA THAT TELLS US THAT WE
REALLY NEED TO GET THESE
PLATELET DONORS, WHOSE PLATELETS
ARE FAILING PH ON MULTIPLE
DONATIONS OUT OF THE SYSTEM. SO
ONE OF THE THINGS THAT MY GROUP
HAS DONE IS STARTED TO CHASE
AROUND BIOMARKERS TO TRY TO
IDENTIFY POOR STORING DONORS.
WE HAVE TAKEN A COUPLE OF
APPROACHES TO THIS, WE LOOKED BY
PROTEOMIC METHODOLOGIES AND SOME
OF THIS IS DONE IN COLLABORATION
WITH D'ALESSANDRO. WE HAVE SEEN
A STRONG CORRELATION BETWEEN RAP
1 AND RHOGDI FOR THE ABILITY OF
THESE PLATELETS TO GIVE
REASONABLE NUMBERS ON SURVIVAL
AND RECOVERY. THE OTHER QUESTION
THAT BECOMES MORE RELEVANT IS DO
THESE BIOMARKERS PREDICT
TRANSFUSION OUTCOME IN PATIENTS
SO WHAT WE DID IS A PROJECT WITH
CHERYL BEFORE SHE RETIRED, THIS
WAS LOOKING AT DONORS WHO
CURRENTLY MET SUCCESSFULLY MET
SCREENING CRITERIA. THEN WE
LOOKED AT THEIR OWN SURVIVAL
RECOVERY. WE RADIO LABELED THE
PLATELETS OF DONORS AND RETURNED
THEM TO THE DONOR. WE LOOKED
WITH WHETHER OR NOT THEY HAD A
GOOD OR POOR OUTCOME. WE FOUND
DONORS THAT DID NOT HAVE A GOOD
OUTCOME. AND WOULD NOT HAVE
PASSED THE FDA MINIMUM
STANDARDS. PROTEOMICS IS A VERY
POWERFUL TECHNOLOGY AND OFFERS
AN APPROACH TO IDENTIFY DONOR
BIOMARKERS THAT ARE RELATED TO
SUCCESSFUL STORAGE. WE USE
PROTEOMICS TO IDENTIFY PUNITIVE
BIOMARKERS AND WE NEED TO TEST
THESE IN LARGE CLINICAL TRIALS.
THE QUESTION IS HOW DO WE
OPTIMIZE QUALITY OF DONORS GIFT.
WE NEED TO ENSURE THAT COMPONENT
PRODUCTION STORAGE ARE OPTIMAL,
WE CAN BE FOCUSED ON IMPROVING
STORAGE CONTAINERS WHICH I HAVE
A GRADUATE STUDENT IN MY GROUP
WHO IS WORKING ON THAT
PARTICULAR PROBLEM. THEN WE HAVE
A SERIES OF STORAGE SOLUTIONS WE
CAN ADD TO PLATELET CONCENTRATES
OR RED CELL CONCENTRATES AND TRY
TO UNDERSTAND WHETHER THEY ARE
GOING TO CONTRIBUTE TO
IMPROVEMENT OF QUALITY OF
PRODUCT. WE NEED TO UNDERSTAND
DONOR APPRECIATION TO PRODUCT
QUALITY AND THAT WILL ALLOW
STORAGE LESION DEVELOPMENT WELL
ENOUGH TO HAVE BIOMARKERS THAT
GUIDE DONOR MANAGEMENT. SO WHAT
WE WANT TO BE ABLE TO DO IS LOOK
AT OTHER APPROACHES TO QUALITY
IMPROVEMENT, WORKING ON NOVEL
ADDITIVE SOLUTIONS AND WORKING
TO IDENTIFY BIOMARKERS THAT
IDENTIFY POOR STORING DONORS.
THERE IS A NICE PAPER THAT
(INDISCERNIBLE) PUB -- NAREG
ROUBINIAN PUBLISHED IN JCI
INSIGHTS THAT LOOKED WHETHER YOU
GOT -- WHAT WERE CONTRIBUTORS TO
POOR-STORING DONORS. THEY FOUND
THAT THE SEX, THE RH STATUS, THE
FINGER STICK HEMOGLOBIN, WHETHER
OR NOT THE DONOR SMOKED, THEN
STORAGE DONATION WHETHER OR NOT
YOU GAMMA IRRADIATED THE
COMPONENT, WHETHER OR NOT IT WAS
LEUKOREDUCED, WHETHER OR NOT IT
WAS AN APHERESIS COLLECTION AND
THE KIND OF STORAGE SOLUTION
THAT WAS INVOLVED, WERE ALSO
CONTRIBUTING FACTORS. FOR THE
RECIPIENT, THE SEX, THE BODY
MASS INDEX, THE RACE AND
ETHNICITY AND THE AGE, WERE ALL
CHARACTERISTICS ASSOCIATED WITH
HEMOGLOBIN. AND BILIRUBIN. SO
THESE ARE THINGS WE NEED TO BE
THINKING ABOUT. SO IN
CONCLUSION, THE QUALITY OF BLOOD
PRODUCTS IS REALLY VERY
IMPORTANT FOR OUR PATIENTS, AND
WE NEED TO WORK TO IMPROVE OUR
APPROACH TO QUALITY ASSURANCE
FOR BLOOD COMPONENTS. THIS
EFFORT HAS TO INCLUDE THE
DEVELOPMENT OF BETTER STANDARDS
FOR COMPONENT QUALITY CONTROL
AND THE IDENTIFICATION OF DONORS
WHO HAVE CHARACTERISTICS THAT
CAUSE REDUCED QUALITY. THOUGH I
WOULD SAY THAT RIGHT NOW IN THE
MIDDLE OF THE PANDEMIC WHEN WE
ARE A LITTLE BIT SHORT OF DONORS
MAYBE WE DON'T WANT TO IMPLEMENT
THAT AT THIS PARTICULAR POINT IN
TIME. SO THANK YOU FOR YOUR
ATTENTION AND I AM MORE THAN
HAPPY TO TAKE ANY QUESTIONS. WE
DO HAVE TIME, THIS IS AN
ADDITIONAL CHANCE TO HAVE
DIALOGUE. I SEE WE HAVE A HAND
RAISED. PLEASE GO AHEAD.
>> THANK YOU FOR THAT EXCELLENT
PRESENTATION. I WAS CURIOUS,
ABOUT THE DONORS THE PLATELET
DONORS THAT ARE FAILING PH
MULTIPLE TIMES, DO WE HAVE ANY
KIND OF UNDERSTANDING OR
SPECULATION EVEN AS TO WHY? THAT
MIGHT BE? IS IT SOMETHING THAT
HAS TO DO WITH FACTORS THAT ARE
EXPRESSED ON THEIR PLATELETS OR
IN THEIR PLASMA? I THINK MOST
PLATELETS DONORS WHO ARE FAILING
MULTIPLE TIMES ARE ACTIVATED.
THAT CAUSES THE PLATELETS TO
HAVE A MUCH SHORTER ADULT LIFE
THAN WHAT NORMALLY SEE.
>> HAVE WE LOOKED AT ACTIVATION
MARKERS ON THESE PLATELETS?
>> YES WE HAVE.
>> THIS IS THE OPPORTUNITY TO
RAISE COMMENTS AT THIS POINT
MORE BROADLY. THANK YOU. I SEE A
HAND RAISED. I APOLOGIZE. ALL I
CAN SAY IS PLEASE GO AHEAD. I
DON'T KNOW YOUR FULL NAME.
>>
>> I HAVE A QUESTION FOR YOU.
COULD YOU FOR SEE DIFFERENT
DONORS YOU COULD HAVE DIFFERENT
STORAGE TIMES THAT WOULD BE
MANAGED BY IT?
>> THAT IS WHERE WE ARE GOING TO
END UP GOING. I THINK THAT FOR
SOME OF THESE DONORS, WHOSE
PALATALLIES DON'T STORE WELL FOR
INSTANCE WERE GOING TO HAVE
SHORTER STORAGE PERIODS THAN SAY
FIVE OR SEVEN DAYS. AND THAT
CREATES A SET OF CHALLENGES FOR
THE HOSPITALS.
>> THANK YOU. LOOKS LIKE WE HAVE
MERLIN WHO RAISE THEIR HAND,
THEN A CHAT THEN FOLLOW WITH YOU
CASSANDRA.
>> MANY THANKS. HOW DO YOU
RECONCILE THE VALUE OF
IDENTIFYING STORAGE LESIONS WHEN
WE KNOW THAT SOME OF THEM ARE
REPAIRED DURING CIRCULATION LIKE
THE SODIUM POTASSIUM,
CONCENTRATION OF D 3 PDG.
>> I DO THINK THAT I'M A
PLATELET BIOLOGIST PRIMARILY. SO
I'M MORE FOCUSED ON WHAT IS
GOING ON WITH THE PLATELET
DONORS. I DO THINK THAT WHAT WE
SEE IS A LARGE NUMBER OF
ACTIVATED PLATELETS IN THESE
DONORS THESE PLATELETS ARE
ACTIVATED AND CLEARED QUICKLY IN
CIRCULATION, SO I THIS I THEY
ARE NOT A REALLY GOOD PRODUCT.
SOME OF THESE STORAGE LESIONS
GET REPAIRED IN CIRCULATION.
PARTICULARLY FOR RED CELLS.
>> I'M GOING TO READ THE CHAT
QUESTIONS AND FOLLOW IN ORDER OF
HANDS. MONICA, I DON'T KNOW YOUR
LAST NAME. INTERESTING
CHALLENGE, ARE POOR PLATELET
DONORS ALSO POOR RED CELL
DONORS?
>> NOT NECESSARILY. IF YOU ARE
COLLECTING PLATELETS BY
APHERESIS TECHNOLOGY YOU WILL
SEE THIS PHENOMENON FOR PLATELET
DONORS. IT DOESN'T NECESSARILY
ALSO MEAN THEY ARE POOR RED CELL
DONORS.
>> THANK YOU. DR. JOSEPHSON
PLEASE.
>> GREAT TALK. CURIOUS WHETHER,
I DIDN'T SEE IT PRESENTED BUT
YOU MIGHT HAVE LOOKED AT IT, BY
DONORS AND PLATE LET'S, OPPOSED
TO RED CELLS. WHETHER YOU FOUND
OR INVESTIGATING THERE IS A
SIMILAR DIFFERENCE OR NO
DIFFERENCE AT ALL BETWEEN THE --
AND THE AGE OF THE PLATELET,
DOES THAT MATTER.
>> WE HAVEN'T LOOKED AT THAT
THOUGH WE COULD. I HAVEN'T --
THE WORK WE HAVE BEEN DOING
ISN'T REALLY FOCUSED IN THAT
DIRECTION. I COULD EASILY GO
BACK AND COUNT UP THE NUMBER OF
MALE AND FEMALE DONORS AND SEE
THE SAME KIND OF DIFFERENCE WE
DO FOR RED CELLS.
>> NEXT UP IS DR. BUSCH.
>> THE CONCEPT WHAT IS IN THE
BAG, WHICH IS ONE OF THE POINTS
RAISED (INDISCERNIBLE) WE
ACTUALLY DON'T MEASURE AT THE
TIME OF ISSUE OR CERTAINLY TIME
OF TRANSFUSION WHAT THE CONTENT
OF RED CELLS OR PERHAPS
PLATELETS ARE IN THE PRODUCTS
THAT WE ISSUE. WE PACK IN A RED
CELL AND NEVER QUANTIFY THE
HEMOGLOBIN OR RED CELL CONTENT.
SO BOTH IN TERMS OF DOSE OF RED
CELLS AND PLATELETS AT THE TIME
ISSUE FROM TRANSFUSION SERVICE
OR QUALITY MEASURES. WHAT IS THE
FUTURE DIRECTION IN THAT REGARD?
>> I THINK AS PROBABLY MOST
PEOPLE KNOW, THE NUMBER OF UNITS
IS HIGHLY VARIABLE AND WE ARE
NOT GIVING STANDARD DOSE TO
PATIENTS SO THAT IS A CONCERN
THAT WE DON'T HAVE A STANDARD
DELIVERY SYSTEM. WE ARE GO GOING
TO END UP WITH QUALITY CROW
FEATURES THAT WE HAVE GOT NOW. I
THINK WE ARE -- WE JUST HAVE TO
GO DOWN THAT PATH OF DEVELOPING
NEW QUALITY CONTROL PARAMETERS.
>> THANK YOU. DR. KOR.
>> FANTASTIC PRESENTATION. THANK
YOU. A QUICK QUESTION OF THE
CLINICAL RELEVANCE OF THE
STORAGE LESION. RED CELLS
CLEARLY A LOT OF INTEREST OVER
TEN PLUS YEARS, 20 YEARS AT THIS
POINT BUT COULDN'T FIND IT MADE
A BIG CLINICAL DIFFERENCE IN
PATIENTS WHO RECEIVE EXTENDED
STORE RED CELLS VERSUS SHORTER
STORE RED CELLS. I'M WONDERING
FROM A PLATELET PERSPECTIVE,
CLEARLY YOU HAVE SHOWN NICELY
THAT THERE ARE SUBOPTIMAL
PLATELET COMPONENTS BUT ANY
SENSE WHAT THE IMPACT OF
TRANSFUSED THOSE COMPONENTS TO
RECIPIENTS IS ON RECIPIENT
OUTCOMES? ?
>> NOSE PLATELETS ARE ACTIVATED
SO THEY GET CLEARED IMMEDIATELY
THEY HAVE ALL ACTIVATION
RECEPTORS ARE TURNED ON AND THEY
GET CLEARED OUT IN THE RECEPTORS
IN THE LIVER AND ALSO BY
MACROPHAGES IN THE SPLEEN. THE
OTHER ISSUE ABOUT THE RED CELLS
IS THAT HONESTLY, NOT SURE WE
REALLY KNOW. I'M VERY INTERESTED
IN GETTING INVOLVED IN SOME
CLINICAL STUDIES THAT WOULD TELL
US WHAT IS HAPPENING. BECAUSE IF
YOU LOOK PARTICULARLY IN
PATIENTS WHO ARE RECEIVING
CHRONIC TRANSFUSION SUPPORT LIKE
THALASSEMIA PATIENTS AND SICKLE
CELL DISEASE PATIENTS, I THINK
IF YOU GIVE THEM A BAD UNIT OF
RED CELLS, THEY ARE COMING BACK
FOR ANOTHER TRANSFUSION MUCH
QUICKER THAN THEY WOULD BE IF WE
GAVE THEM A GOOD UNIT.
>> MOSTLY THINKING INCREMENTS
DANA, OPPOSED TO POTENTIAL
INJURIOUS EFFECT TO AN ORGAN?
>> YES, I'M THINKING THINKING T
IS THE INCREMENT. I DON'T THINK
WE HAVE ANY EVIDENCE THAT THESE
CELLS ARE CAUSING DAMAGE TO END
ORGANS
>> THANK YOU.
>> GREAT. WE DO SEE ADDITIONAL
HANDHANDHANDS. PLEASE GO AHEAD,E
YOUR NAME SO WE CAN CATCH YOUR
NAME PLEASE.
>> THIS IS LARRY HORASCH, CAN
YOU HEAR ME?
>> HI.
>> HI, DANA, THANK YOU FOR THAT
SUMMARY. TWO QUESTIONS FOR YOU.
YOU PUT YOUR FINGER AND MIKE
ALSO POINTED TO SOMETHING
IMPORTANT IN A CLINICAL TRIAL WE
DID SEVERAL YEARS AGO. WE HAD TO
MEASURE HEMOGLOBIN IN THE BAG
BECAUSE WE WERE INTERESTED IN
CONSUMPTION IN THALASSEMIA
PATIENTS. HEMOGLOBIN VARIED FROM
38 TO 75 GRAMS, HUGE FROM
ACCEPTED DONORS. SO I THINK YOU
ARE RIGHT ABOUT THAT. WE NEED TO
BE MEASURING THE AMOUNT OF
HEMOGLOBIN IN BAG. BUT WHAT
ABOUT COLD STORED PLATELETS? WE
KNOW THEY DON'T CIRCULATE WELL.
WHAT ABOUT THE QUALITY CONTROL
OF THOSE?
>> I THINK COLD STORED PLATELETS
HAVE BEEN SHOWN TO BE USEFUL FOR
BLEEDING PATIENTS. YOU
SHOULDN'T BE USING A
PROPHYLACTIC PLATELET
TRANSFUSION. THEY HAVE A ROLE
BUT IT IS MORE FOR BLEEDING
PATIENTS AND CARDIAC SURGERY,
THAT SORT OF THING.
>> I AGREE WITH THAT. TO THE
MARKERS YOU LOOK AT IN COLD
STORED PLATELETS TELL YOU
ANYTHING ABOUT THE QUALITY OF
ROOM TEMPERATURE STORED
PLATELETS?
>> I HAD A GRADUATE STUDENT WORK
IN COLD STORED PLATELETS. HE'S
FOUND VERY INTERESTING THINGS
THEY WORK REALLY WELL IN -- HE'S
BEEN DOING A LOT OF IN VITRO
WORK AND THEY WORK WELL IN ROTEM
(PHONETIC) ASSAYS BUT THEY DON'T
WORK THAT WELL IN PLATELET
AGGREGATION STUDIES AND THAT
SORT OF THING.
>> THANK YOU.
>> DOCTOR, WE WILL COME BACK TO
YOU IN A SECOND. THE REASON I
WANT TO MAYBE JUST TURN TO THE
CHAT BOX IS THIS QUESTION THAT'S
BEEN RAISED BY DR. SUNNY ZEKE IS
VERY MUCH CONNECTED TO WHAT WE
HAVE BEEN DISCUSSING WHICH IS
ACTIVATED PLATELETS ARE
PRESENTED AS AN ARGUMENT IN
FAVOR OF COLD STORED PLATELETS.
MIGHT THE FUTURE HAVE TWO KINDS
OF PLATELET LABELS BLEEDING
VERSUS PROPHYLAXIS? WONDERING
WHAT YOU THINK ABOUT THAT, DR.
DEVINE?
>> YEAH, I'M PRETTY SURE THAT
MOST OF OUR HOSPITALS WILL END
UP WITH DUAL INVENTORIES WHERE
WE HAVE ONE SET OF COLD
PLATELETS, WE ARE GOING BACK TO
SOMETHING THAT ALL PLATELETS
WERE STORED IN THE COLD
INITIALLY WHEN FIRST DEVELOPED
COMPONENT THERAPY. I THINK THAT
THESE -- WE ARE GOING TO END UP
GOING BACK THERE BECAUSE THESE
PLATELETS ARE REALLY VERY GOOD
AT PREVENTING -- HELPING
PATIENTS STOP BLEEDING. I THINK
THAT WE WILL HAVE TWO DOUBLE
INVENTORIES IN MANY THE
HOSPITALS. ONE SET OF PLATELETS
THAT STORED ROOM TEMPERATURE,
PLATELET SHAKER AND THE OTHER
SET THAT IS STORED IN THE
REFRIGERATOR.
>> THANK YOU. SO DR. EICHBAUM
PLEASE GO AHEAD.
>> SIMILAR TO THE COLD STORAGE
PLATELETS, JUST A GENERAL
FOLLOW-UP QUESTION ABOUT WHAT IS
THIS TELL US ABOUT WHAT WE
SHOULD BE TELLING CLINICIANS
ABOUT THE RESULTS OF MANY
MULTI-MILLION DOLLAR,
MULTI-CENTER TRIALS THAT THOUGH
THEY ARE PROBLEMS WITH THESE
STUDIES MOST OF THE END POINTS
WERE ABOUT MORTALITY MORBIDITY
ABOUT THE RED CELL STORAGE
LESION THAT THERE MAY NOT BE
THAT BIG IMPACT. DO WE HAVE TO
RE-EVALUATE ALL THESE STUDIES?
HOW DO WE LOOK AT THESE -- ALL
THESE STORAGE LESIONS STUDIES?
>> I THINK WE NEED TO GO BACK
AND RE-EVALUATE THEM. I THINK
THAT THEY ARE -- WE PUT A
CERTAIN LEVEL OF INTERPRETATION
ON THEM INITIALLY AND I THINK WE
REALLY NEED TO GO BACK AND LOOK
AT THEM AGAIN.
>> THANKS.
>> THANK YOU. WE HAVE ADDITIONAL
QUESTION FROM -- NEED TO SCROLL
BACK UP. QUESTIONS ARE STARTING
TO COME IN, WHICH IS GREAT,
APPRECIATE THAT. RELATED
QUESTION IS THE POSSIBLE IMPACT
ON STORAGE NOT ONLY ON 24 HOUR
RECOVERY BUT ALSO LONG TERM RED
CELL SURVIVAL. ESPECIALLY
CONSIDERING TRANSFUSION NEEDS OF
PATIENTS WHO REQUIRE LONG TERM
TRANSFUSION SUPPORT. MORE A
COMMENT BUT WONDERING IF WILL IS
ASOR IN I ASPECTS
>> THIS IS AN IMPORTANT ASPECT
AND I THINK THAT IF WE LOOK AT
WHAT IS GOING ON THERE WE SEE A
SHORTENING OF SURVIVAL WITH RED
BLOOD CELLS IN THESE PATIENTS
WHO REQUIRE LONG TERM
TRANSFUSION SUPPORT. IT IS
RELATED TO DONORS. IT IS
RELATED TO THE CHARACTERISTICS
OF THE DONOR.
>> THANK YOU ALSO SEEING QUITE A
FEW QUESTIONS AROUND COLD STORE
VERSUS NOT AND POTENTIALLY
DIFFERENT ASPECT OF PLATELETS
THEMSELVES. THAT IDEA OF
POTENTIAL DUAL INVENTORY BOTH
WHETHER THAT MIGHT BE PRIORITY
IDENTIFIED COMING OUT OF THE
STATE OF SCIENCE AND ADDITIONAL
LITERATURE COMPARING PERFORMANCE
IN DIFFERENT SETTINGS. SO FOR
THOSE WHO ASKED THOSE QUESTIONS
IF YOU DO WANT TO COME OFF AND
FURTHER EXPLORE THAT, VERY HAPPY
FOR YOU TO DO SO.
>> I NOTICE THAT DR. SPINELLA
(PHONETIC) HAS A PROMOTIONAL
THING FOR HIS
>> TRIAL.
>> HIS TRIAL IN THE CHAT BOX AND
I ENCOURAGE ALL OF YOU WHO ARE
BASED IN THE STATES TO REALLY
PILE IN AND TRY TO HELP THEM GET
THAT TRIAL DONE. I THINK THAT IS
GOING TO SHOW US SOME REALLY
IMPORTANT INFORMATION. .
>> THANK YOU, DR. DZIK. PLEASE
GO AHEAD.
>> FOLLOW UP, IT IS A GREAT
TOPIC AND VERY INTERESTING AND
YOU KNOW, THE POTENTIAL FOR DUAL
INVENTORIES AND PROBL PROBLEMS T
THAT WOULD PRESENT IN TERMS OF
LOGISTICS AND CROSSING LINES AND
THAT SORT OF THING MAKES IT --
AND CONSEQUENCES FOR PATIENTS
MAKES IT REALLY IMPORTANT WE
DEMONSTRATE COLD STORED
PLATELETS STOP BLEEDING IN
PATIENTS. DANA WHO I ADMIRE
VERY MUCH TOSS THAT OFF. THE
QUALITY OF THE EVIDENCE LOOKING
AT CLINICAL BLEEDING OUTCOMES,
WITH ONE PLATELET VERSUS ANOTHER
IS NOT THAT ROBUST. THIS IS
SUCH AN IMPORTANT BIG ISSUE THAT
I THINK IT COULD BE SOMETHING
NHLBI MIGHT WANT TO GET BEHIND.
THAT IS NOT TO SAY THE CHIPS ARE
NOT INFORMATIVE, LOOKING FORWARD
TO IT AS WELL AS ANYONE. BUT
MAY NOT BE THE FINAL ANSWER. WE
MAY NEED MORE STUDIES IN
SETTINGS OTHER THAN CARDIAC
SURGERY TO DEMONSTRATE THE
EFFECT IN VIVO, LEST WE FALL
INTO A TRAP WE HAVE FALLEN INTO
A HUNDRED THOUSAND TIMES IN THE
PAST WHICH IS TO USE LABORATORY
MEASURES AS SOME SORT OF TRUTH
SERUM REGARDING IN VIVO
EFFECTIVENESS. WHICH --
>> I COMPLETELY AGREE WITH YOU,
SUNNY.
>> I DO THINK BY THE WAY ADD ONE
MORE THOUGHT THEN BE QUIET,
WHICH EVERYONE WILL BE HAPPY
ABOUT. DR. LARRY WHO IS LIKE
MR. PLATELET FROM DECADES AGO,
AND A GENIUS WHEN YOU LOOK BAT
AT EARLIER WORK, THE GUY WAS WAY
AHEAD OF HIS TIME. NOTICE WHEN
YOU PUT PLATELETS IN THE COLD
THEY UNDERGO FORM OF ACTIVATION
THAT CAUSES THEM TO RELEASE
INTERIOR THINGS SUCH AS VWF. AND
FIBRINOGEN. SO WHEN YOU THEN
TAKE A COLD PLATELET WITH ITS
PLASMA NOW ENRICHED WITH VWF AND
STICK IT IN THE ROTA MACHINE, IT
IS POSSIBLE THE EFFECT YOU
OBSERVE HAS NOTHING TO DO WITH
PLATELETS THEMSELVES BUT THE
FACT YOU CHANGED THE PLASMA
ENVIRONMENT OF THOSE PLACE LETS
BY HAVING THEM ENRICH THAT
PLASMA FOR VON WILLEBRANDE AND
ALL, AN EFFECT WHICH IS
SUBSTANTIAL AND A CLOSED TEST
TUBE, BUT NOT NECESSARILY BE
TRUE IN VIVO WHERE THAT FLUID
GETS WASHED AWAY, IF YOU FOLLOW
WHAT I'M TRYING TO SAY.
>> YOU ARE EXACTLY RIGHT, SUNNY
>> ALL RIGHT.
>> PERFECT TIMING. I DO
APOLOGIZE BUT IT IS A VALUABLE
DISCUSSION AND THERE'S
ADDITIONAL CHAT REMARKS COMING
IN. WE ARE GOING TO RECORD ALL
THOSE AND MAKE SURE THEY ARE
AVAILABLE FOR THE SAKE OF TIME,
WE WANT TO TRY TO STAY ON
SCHEDULE SO WE WILL MOVE ON. I
THINK WE WILL BE INTRODUCING THE
NEXT GROUP WHICH WILL BE ONE OF
THE ACTUAL WORKING GROUPS.
>> THANK YOU SO MUCH, DR. DEVINE
FOR YOUR TALK AND ALSO
ENGAGEMENT WITH THE MEMBERS WHO
ARE PARTICIPATING TODAY.
>> THANK YOU VERY MUCH FOR THE
INHAVE IATION.
>> THANK YOU, AGAIN, DANA. AS
WELL. AND WE DO HOPE TO COME
BACK TO THESE QUESTIONS WE NOW
BEGIN GENERAL SESSION WITH THE
PRESENTATION OF DRAFT RESEARCH
PRIORITIES BY WORKING GROUP
CO-CHAIRS, IT IS MY PLEASURE TO
INTRODUCE OUR FIRST GROUP OF
CO-CHAIRS, FOCUSED ON
MECHANISTIC ASPECT OF COMPONENTS
AND TRANSFUSIONS, OMICS
EFFECTIVENESS QUALITY AND
SAFETY. DR. ELDAD HOD,
DEPARTMENT OF PATHOLOGY CELL
BIOLOGY CLEMSON UNIVERSITY.
LEADER IN TRANSLATIONAL RESEARCH
FOCUSED ON RED CELL BIOLOGY AND
RECIPIENT OF SEVERAL GRANTS FROM
THE NIH INCLUDING PRINCIPLE
INVESTIGATOR FOR THE NEW YORK
HUB PROGRAM. DR. ANGELA
D'ALESSANDRO, PROFESSOR
DEPARTMENT OF CHEMISTRY
MOLECULAR GENETICS UNIVERSITY OF
COLORADO, AMONG MANY OTHER ROLES
HE FILLS HE IS DIRECTOR OF
MEDICAL OMICS CORE AS WELL AS
MASS SPECTROMETRY SHARED
RESOURCE, UNIVERSITY OF
COLORADO. WELCOME TO YOU BOTH.
>> THANK YOU, THANKS TO THE
ORGANIZERS, NHLBI, BRIAN AND ART
FOR GIVING US THE OPPORTUNITY TO
CO-CHAIR THIS COMMITTEE. I
APPRECIATE THE DISCUSSION WE
JUST HAD BECAUSE IT GIVES US A
GOOD INTRODUCTION TO THE WORK WE
DID ON THIS COMMITTEE. SO JUST
TO INTRODUCE YOU TO THE PROCESS
WE UNDERTOOK WHEN DRAFTING
PRIORITIES FOR THIS COMMITTEE.
WE FORMED A COMMITTEE WITH -- IN
ADDITION TO ANGLO AND MYSELF WE
ASKED THE PEOPLE YOU SEE LISTED
HERE TO JOIN US AND WE TRY TO
GIVE PRESENTATION FROM BOTH
PEOPLE WHO DO CLINICAL RESEARCH
AND BASIC RESEARCH IMMUNOLOGY
ALSO REPRESENTED AS WELL AS
PEOPLE WITH FOCUS ON PEDIATRIC
TRANSFUSION MEDICINE AS WELL AS
ADULT AND PEOPLE WITH REGULATORY
EXPERIENCE. WE MET SEVERAL TIMES
BY ZOOM TO BRAINSTORM IDEAS AND
IT BECAME APPARENT TO ANGLO AND
I THAT FIVE BROAD THEMES EMERGED
SO WE BROKE OUT FIVE SUBGROUPS
TO DEVELOP THEMES INTO SEPARATE
PRIORITY AND THEN MET BACK AGAIN
LARGER GROUP TO REVIEW WHAT THE
SUBGROUPS HAVE COME UP WITH AND
WILL PRESENT FIVE THEMES OR
DRAFT PRIORITIES TO YOU TODAY.
NEXT PLEASE. SO JUST TO OUTLINE
THE BROAD FIVE THEMES BEFORE WE
GO INTO THEM ONE BY ONE. THE
FIRST THING I WANT TO MENTION IS
THAT WHEN WE DID THIS WE WANTED
EACH OF THE PRIORITIES -- WE
DIDN'T WANT PRIORITY TO BE
REFLECTIVE OF ONE BLOOD PRODUCT
LIKE RED CELL OR PLATELET, WE
WANTED THEM TO BE RELEVANT TO
ALL BLOOD PRODUCTS SO THAT WAS
ONE OF THE THINGS WE WENT IN
THINKING ABOUT WHEN WE DID THIS
AND WE ALSO DIDN'T WANT THEM TO
JUST BE DEDICATED TO PARTICULAR
POPULATION. SO IT WASN'T LIKE
ONE PRIORITY FOR NEONATAL
TRANSFUSION MEDICINE. WE WANTED
THAT TO ENTERCOLLATE AND BE PART
OF EACH OF THE PRIORITIES WE
CAME UP WITH. SO AT THE END OF
THE DAY FIVE PRIORITIES, FIRST
HOW TO BETTER DEFINE BLOOD
PRODUCT QUALITY AND WE HAD AN
EXCELLENT DISCUSSION ABOUT THAT
IN THE PRIOR FOLLOWING THE
KEYNOTE SPEECH. THE NEXT IS ARE
THERE BETTER WAYS TO EVALUATE
TRANSFUSION NEEDS AND
EFFECTIVENESS. THE THIRD HAS
SOME OVERLAP WITH THE SIX
PRIORITY FROM YESTERDAY SECOND
COMMITTEE CHAIRED BY CASSANDRA
AND DARRELL, NON-INFECTIOUS
SAFETY OF BLOOD PRODUCTS BE
IMPROVED. THE FOURTH IS MORE
IMMUNOLOGY BASED PRIORITY, WHAT
STRATEGIES CAN BE EMPLOYED TO
REDUCE RESPONSES TO RED BLOOD
CELL OR OTHER ANTIGENS IN
CONSEQUENCES OF ANTIBODIES IN
TRANSFUSION AND PREGNANCY. AND
THEN THE FIFTH IS HOW TO DESIGN
AND TEST NEXT GENERATION OF
BLOOD PRODUCTS, BLOOD DERIVED
THERAPEUTICS AND HOW WE ENSURE
SAFETY OF BLOOD PRODUCTS
REPURPOSED FOR NON-TRANSFUSION
INDICATIONS. ALSO MENTION THESE
ARE IN NO PARTICULAR ORDER WE
WILL PRESENT THEM IN THE ORDER
THEY ARE HERE BUT THAT DOESN'T
MEAN WE ARE PRIORITIZING ONE
OVER THE OTHER. IN THE
DISCUSSION WE WOULD LOVE TO HEAR
FROM YOU, IF YOU THINK SOME ARE
MORE IMPORTANT THAN OTHERS IF
YOU DON'T AGREE WITH PRIORITIES
NEXT PLEASE. I WILL PRESENT THE
FIRST ONE, HOW TO BETTER DEFINE
BLOOD PRODUCT QUALITY. WHAT THIS
ENCOMPASSES IS THREE THINGS, THE
FIRST IS INNOVATIVE METHODS TO
ASSESS BLOOD PRODUCT QUALITY
INCLUDING DEVELOPING
ALTERNATIVES TO CURRENT MEASURES
USED FOR QUALITY CONTROL AND
REGULATORY PURPOSES. A LOT OF
WHAT WE WERE TALKING ABOUT IN
THE PRIOR DISCUSSION SESSION.
UNDERSTANDING MECHANISMS FOR HOW
QUALITY MARKERS AFFECT DIFFERENT
OUTCOMES AT THE MOLECULAR AND
FUNCTIONAL LEVEL AND USING NOVEL
STRATEGIES TO IMPROVE QUALITY
USING PERCHIZE TRANSFUSION
MEDICINE APPROACHES SO THIS WILL
ENCOMPASS THESE THREE IDEAS. SO
WHY IS THIS AN ISSUE AND I
DIDN'T PLAN THIS WITH DANA, SHE
SHOWED THE SAME FIGURE FROM THE
SAME PAPER SHOWING EFFECTIVELY
WHAT HAPPENS WITH THE RED CELL
STORAGE LESION IS AS YOU PUT RED
CELLS IN A BAG, THEY START TO
DETERIORATE AND WE CAN NOW
MEASURE MICROERYTHROCYTES IN A
RELATIVELY AUTOMATED WAY, USING
FLOW CYTOMETRY. THAT IS WHERE
THEY ARE SO FAR DAMAGED THEY
DON'T CIRCULATE WELL. WE CAN ME
MEASURE THESE THINGS, SINCE LAST
DAY OF THE SCIENCE WE DEVELOPED
NOVEL METHODS FOR MEASURE THESE
THINGS. WE HAVE OMICS TOOLS, ME
TAB ONLYIC, PROTEOMICS. THINGS
MY CO-CHAIR IS EXPERT ON THAT
CAN REALLY -- WE CAN DEFINE
STORAGE LESION. THE GAP IN
KNOWLEDGE WE STILL FACE IS WHICH
OF THESE MEASURES AFFECT OR
PREDICT TRANSFUSION
EFFECTIVENESS. THAT IS THE ONE
OF THE GOALS OF THIS PRIORITY.
NEXT PLEASE.
SO WHY IS THIS AN ISSUE? THE
POST TRANSFUSION RECOVERY STUDY,
THE CURRENT FDA GOLD STANDARD
FOR RED CELLS AND PLATELETS AS
WELL, THERE ARE LOT OF METHOD
LOGICAL ISSUES WHETHER YOU USE
CHROMIUM OR BIOTIN, THERE ARE
ISSUES WITH IT THAT ARE
PUBLISHED FROM HAVING DONE MANY
OF THESE STUDIES THE WAY YOU
EXTRAPOLATE TO T 0 AND DETERMINE
WHAT STARTING POPULATION IS, IS
A MATHEMATICAL CALCULATION AND
SOMETIMES FLAWED ESPECIALLY WHEN
YOU TAKE INTO ACCOUNT WHAT IS
SPLEEN MIGHT DO AS THEY FIRST
PASS THROUGH THE CIRCULATION.
BUT IT IS THE GOLD STANDARD BUT
IT DOESN'T NECESSARILY TELL US
ANYTHING ABOUT OXYGEN DELIVERY,
IMPORTANT FOR RED CELLS AND
HEMOSTASIS WHICH SOMETIMES IS
IMPORTANT FOR RED CELLS AND
PLATELETS. OR PLASMA FOR THAT
MATTER. SO IT IS THE GOLD
STANDARD BUT DOESN'T TELL US
WHAT IS IMPORTANT IN OUR
PATIENTS. THE OTHER LAYER TO
THIS, THERE'S DIFFERENT MEASURES
OF QUALITY THAT MIGHT BE
IMPORTANT FOR DIFFERENT
POPULATIONS TO GETS AT THE
CONVERSATION ABOUT COLD STORED
PLATELETS, POTENTIALLY IN
TRAUMA, YOU DON'T CARE ABOUT
WHETHER THE PLATELETS CIRCULATE
FOR 24 HOURS BUT WHAT YOU CARE
ABOUT IS DO THEY GO TO SITE OF
BLEEDING AND STOP IT SO THE
QUALITY MEASURE FOR PLATELETS
MIGHT BE -- CURRENT GOLD
STANDARD QUALITY MEASURES MIGHT
BE IRRELEVANT FOR COLD STORED
PLATELETS. DEFINING THOSE
MEASURES IN MORE OPTIMAL WAY IS
PART OF THIS PRIORITY. SIMILARLY
FOR CHRONIC RED CELL
TRANSFUSIONS OR SICKLE CELL, YOU
NEED BETTER LIFE SPAN FOR THOSE
RED CELLS. POTENTIALLY AS
QUESTIONED IN THE PRIOR SESSION
ALLUDED TO, MAYBE OUR MEASURES
ARE NOT OPTIMAL FOR THEM EITHER.
NEXT SLIDE. WE ALSO NEED
QUALITY MEASURES AND BETTER
DEFINING THEM BECAUSE WE THINK
IT WILL HELP US TO DEVELOP NOVEL
PRODUCTS SO WITHOUT USEFUL
QUALITY MEASURES THAT ARE
REPRODUCIBLE AND EASIER TO
PERFORM THAN POST TRANSFUSION
RECOVERY THAT HINDERS OUR
ABILITY TO DEVELOP NOVEL
PRODUCTS AND ALLOW US TO BETTER
QC CURRENT PRODUCTS. NEXT
SLIDE. IN TERMS OF PROPOSED
APPROACH, IN ALL PRIORITIES IT
GOES BACK TO WHAT STEVE
MENTIONED YESTERDAY, WE NEED
GOOD STUDIES AND DOESN'T MATTER
-- WE NEED EVERYTHING ALL
TOGETHER CLINICAL STUDIES BASIC
STUDIES, PRE-CLINICAL STUDIES,
AND SO CLEARLY NEED MORE OF
THAT. WHAT THE GROUP DID WANT TO
HIGHLIGHT IS THAT THERE IS SOME
COMPARATIVE EFFECTIVENESS
RESEARCH AND THERE ARE DIFFERENT
POPULATIONS THAT WE THINK THE
QUALITY MEASURES MIGHT FUNCTION
DIFFERENTLY IN THEM. SO LOOK AT
THIS LIST AND IF YOU HAVE ANY
COMMENTS ON THEM OR ANOTHER
POPULATION IMPORTANT TO
HIGHLIGHT PLEASE LET US KNOW IN
THE DISCUSSION SECTION BUT WE
THINK THE FOCUS SHOULD BE ON THE
QUALITY -- LINKING QUALITY
MARKERS WITH TRANSFUSION FOR
DIFFERENT POPULATIONS AND
DIFFERENT TRANSFUSION INDICA
INDICATIONS. WE ALREADY HAVE
STUDIES UNDERWAY THAT ARE TRYING
TO LINK GENETIC AND OMICS
MARKERS TO PREDICT BLOOD PRODUCT
QUALITY. THERE ARE STUDIES SHOWN
OBSERVATIONALLY THAT YOU CAN USE
HEMOGLOBIN PLATELET, BILIRUBIN
INCREMENTS TO ASSESS CERTAIN
PARTS OF THE STORAGE LESION SO
THEY CAN DIFFERENTIATE ON A
POPULATION LEVEL YOU CAN USE THE
INCREMENTS IN AN OBSERVATIONAL
DATA SET TO OBSERVE THAT OLDER
STORED UNITS RAISE THESE MARKERS
GREATER. THERE IS A MOUSE MODEL
OF RED CELL TRANSFUSION BUT WE
CERTAINLY NEED MORE WORK
DEVELOPING MODELS FOR THE OTHER
BLOOD COMPONENTS. AND MORE WORK
NEEDS TO BE DONE DEVELOPING IN
IN VITRO OR EXVIVO IN SILICO
MODELS TO ADDRESS THE QUESTIONS
FOR ALL BLOOD PRODUCTS. I WILL
HAND IT OFF TO ANGLO FOR THE
NEXT PRIORITY.
>> THANK YOU, ELDAD. SO THE
SECOND PRIORITY IS PRETTY MUCH
ALIGNED WITH THE FIRST ONE, WITH
THE MINOR DIFFERENCE THAT
SOMEWHAT FIRST PRIORITY NEEDS TO
THE BLOOD IN CERTAIN PRIORITY,
IDENTIFY THE FOCUS MORE ON
EFFECTIVENESS OF RECEIVED
PRODUCTS. SO SPECIFICALLY AMONG
THE PRIORITIES IN THE WORKING
GROUP CONSENSUS WAS REACHED ON
THE NEED TO IDENTIFY BETTER WAYS
TO TRANSFUSION EFFECTIVENESS. WE
BELIEVE THAT NOVEL METHODS
STRATEGIES NEED TO ASSESS BLOOD
PRODUCT EFFICACY INCLUDING
DEVELOPING ALTERNATIVE MEASURES
US.WE ALSO THINK IT IS IMPORTANO
UNDERSTAND MECHANISMS THAT
UNDERLIE THE (INAUDIBLE) ALL
BLOOD COMPONENTS. WHILE WE HAVE
A CHANCE TO GO INTO DETAILS THE
NEXT FEW SLIDES, OUTCOMES
IDENTIFY, WE (INAUDIBLE) BLOOD
CELLS POPULATION WITH INCREASE
FOR PLASMA AND OTHER COMPONENTS
THOUGH IT IS BEING INCLUSIVE
(INAUDIBLE) PLAY A ROLE ON
FORMATION, AT THAT POINT WORKING
GROUPS IN PARTICULAR THE ONE LED
BY DR. JOSEPHSON HAVE DISCUSSED
EXTENSIVELY THE IMPACT OF
ASPECTS OF -- THAT FORM THE
CONTEXT OF QUALITY CONTROL OF
BLOOD PRODUCTS AND EFFICACY. FOR
EXAMPLE YESTERDAY IT HAS BEEN
DISCUSSED THAT THE BREAK OUT
SESSION FOR THE WORKING GROUP
DISCUSS SIX MINUTE WALKING TEST
HEART RATE IMMUNE FUNCTION,
WORKING GROUP OPTIMIZING
OUTCOMES FOR RECIPIENTS. AS SUCH
THIS STUDY PRESENTATION FOCUS ON
POTENTIAL BLOOD MARKERS FOR
EFFECTIVENESS. SO THE NEED FOR
NOVEL STRATEGIES TO MEASURE
TRANSFUSION EFFICACY OF BLOOD
PRODUCTS IS IDENTIFIED BY
STRATEGIES LARGELY BASED ON FOR
EXAMPLE CELLS, -- FUNCTIONAL
MEASUREMENTS OF THE SUFFICIENCY
OF DELIVERY OR PHYSICAL
INTOLERANCE OR ANEMIA. THE GROUP
-- INDUCES BLOOD PRODUCTS AND WE
ARE TRYING TO MEASURE MODEL
CONTENT OR ALTERNATIVE MEASURES
OF POTENCY TIED TO EFFECTIVENESS
OF THE PRODUCT. THE SAME
CONSIDERATION APPLIES TO ACCOUNT
FOR THE HETEROGENEITY OF THE
BLOOD PRODUCTS. AS POINTED OUT
IN THE KEYNOTE ADDRESS P. AND
THE SESSION THAT FOLLOWED. AS
SUCH WORKING GROUP ON THE
URGENCY TO FIND NEW QUALIFIED
BIOMARKERS TO IMPROVE
PRECISIONS, IDENTIFY PATIENTS
WHO MOST LIKELY BENEFIT FROM
TRANSFUSION EITHER IN THE ACUTE
OR CHRONIC CARE SETTING.
PATIENTS (INAUDIBLE) SURGERY OR
PATIENTS WITH ACQUIRED GENETIC
ANEMIA OR THROMBOCYTOPENIA. AS I
PERSONALLY ADDRESS THESE
QUESTIONS, WE NOTED THAT NOVEL
BIOMARKERS EFFECTIVENESS CAN BE
IDENTIFIED BY TECHNOLOGY,
TARGETED BLOOD DEVICE TO ASSESS
FOR EXAMPLE MEASUREMENTS OF ALL
LEVELS FOR SPECIFICALLY
METABOLIC MARKERS OF HYPOXIA
MANY IN CONTEXT OF RED CELL
TRANSFUSION. ANTICIPATED FOR
NEED O FOR DEVELOPMENT OF LAB --
DEVICES, FOR EXAMPLE SENSORS FOR
METABOLITE TESTS, GAS
METABOLITES OR OTHER FUNCTION
BIOMARKERS OF EFFECTIVENESS WHO
PROVIDE MECHANISTIC INSIGHT TO
FUNCTIONAL IMPROVEM IMPROVEMENTS
(INDISCERNIBLE). MARKERS ALSO
GUIDE TRANSFUSION OF BLOOD
PRODUCTS AND RED BLOOD CELLS,
FOR EXAMPLE PLATELETS
TEMPERATURE COLD STORED
PLATELETS OR FREEZE-DRIED. WE
DISCUSS A LITTLE BIT OF THIS
THIS MORNING, PLASMA CAN BE --
FOR WHOLE BLOOD. NOVEL MARKERS
TRANSFUSION EFFICACY FOR THIS
PRODUCT, COULD COMPLIMENT
MEASUREMENTS. FOR EXAMPLE
DONATION THAT ACCOUNTS,
MENTIONED THAT, CLASSIC
(INDISCERNIBLE) POSITIVE
GENERATION OR POINT OF CARE
QUANTITATIVE MEASUREMENTS OF
CLOTTING FACTORS FOR FIBRINOGEN
LEVELS. ONE THING THE GROUP --
IS SUCH MARKERS NOVEL MARKERS
SHOULD MEET CLIA CERTIFIED
STANDARDS AND WHAT HAS BEEN
DEFINED BEST BIOMARKERS END
POINTS AND OTHER TOOLS, FOR
DEVICES AND BIOMARKERS. WE
BELIEVE THAT PROGRESS IN
ADDRESSING THESE ISSUES
EFFECTIVENESS AS OUTLINED WILL
BE FEASIBLE AT LEAST BEGIN TO BE
IN THE NEXT TEN YEAR YEARS. FOR
EXAMPLE, CONCEPTS SUCH AS ANEMIA
TOLERANCE AND IMPACT ON
TRANSFUSION REQUIREMENT ARE
BEING STUDIED AND DISCUSSED TO
OPTIMIZE TRANSFUSION TRIGGERS.
WE NEED TO BETTER DEFINE THE
QUALITY FOR EXAMPLE RED BLOOD
CELLS AS REPRODUCIBLY EFFECTIVE
OXYGEN THERAPEUTICS BEYOND
HEMOGLOBIN INCREMENTS. DEFINING
EFFECTIVE HOMEOSTASIS IN
CONJUNCTION WITH PLATELET,
CRYOPRECIPITATE WHOLE BLOOD
TRANSFUSION REQUIRE ADDITIONAL
REFINEMENT. SUGGESTING P BY
OTHER GROUPS THE IDENTIFICATION
OF MAGIC BULLET, THERE WAS A
NICE -- IN ONE OF THE BREAK OUT
SESSION. MAGIC BULLET MARKERS
NEEDED EFFECTIVENESS MAYBE BY
THE -- TRANSFUSED PRODUCT IN
SUCK COMPONENTS LIKE RED BLOOD
CELLS AND BEYOND HEMOSTASIS AND
GAS TRANSPORT. MEASUREMENTS MAY
NOT JUST BE RELATED TO ONE
PARAMETER, BUT A COMBINATION OF
MEASUREMENTS PERHAPS INFORMED BY
TRADITIONAL OMICS APPROACHES AND
CLINICAL MEASUREMENTS IDENTIFY
BY ACTIVATION INTELLIGENCE OR
MACHINE LEARNING OPERATIONS OF
AVAILABLE DATA AND WORKING GROUP
RELATED TO THAT. NEXT SLIDE
PLEASE. FINALLY TRANSFUSION
BLOOD COMPONENTS MRI FOCUSING ON
DIFFERENT POPULATION AS RED
BLOOD CELL, FOR EXAMPLE FOCUSING
ON NEONATES, CONSIDERATION CAN
BE MADE FOR PATIENTS TRANSFUSION
MANY THE SETTING OF TRAUMA
PATIENTS OR UNDERGOING ELECTIVE
SURGERY, AS POINTED OUT IN THE
CHAT, CHRONIC TRANSFUSION, FOR
EXAMPLE PATIENT SUFFERING FROM
CRYOGENIC ANEMIA OR
THROMBOCYTOPENIA. ONE I HOLD
NEAR AND DEAR TO MY HEART IS
CONCEPT OF PRECISE TRANSFUSION
MEDICINE HAS BEEN PERSONALIZED
SINCE (INAUDIBLE) TRANSFUSION
EFFORTS BUT PRECISE MEDICINE
APPROACHES WILL BE CLINICAL
DEFINE AND VALIDATE NOVEL
BIOMARKERS. THE SAME
EFFECTIVENESS PARAMETERS IS
TRANSFUSION OF BLOOD PRODUCTS,
AGAIN IN OTHER WORDS GROUP NOTED
THAT THERE (INDISCERNIBLE)
TRANSDUCED PATIENTS IS BY LACK
OF MARKERS THAN EFFECTIVENESS.
IT IS NOTED THAT TRANSFUSION
(INDISCERNIBLE) RED CELL
PRODUCTS, THERE IS LIMITED BASIC
CLINICAL SCIENCE IN THIS SPACE
THE EXTENT TO TRY INDICATIONS
UNDERWENT TO STOP TRANSFUSION.
NEXT SLIDE. WITH THAT, ELDAD.
>> SO THIS IS OUR NONINFECTIOUS
SAFETY TRANSFUSIONED BLOOD
PRODUCT PRIORITY. SO THIS ONE
ENCOMPASSES IDENTIFYING
COMPOUNDS AND TRANSFUSED BLOOD
PRODUCTS THAT LEAD TO ADVERSE
EFFECTS AND SUSCEPTIBLE
RECIPIENTS, NOT NECESSARILY ALL
RECIPIENTS. UNDERSTANDING THE
MECHANISMS FOR HOW BLOOD
PRODUCTS AND COMPOUNDS FOUND
THERE IN INTERACT WITH CELLS AND
ORGAN SYSTEMS AND NOVEL
STRATEGIES TO IMPROVE SAFETY BY
PREVENTING THE OCCURRENCE OF THE
WRONG PRODUCT GETTING INTO THE
RIGHT RECIPIENT OR THE RIGHT
PRODUCT GETTING TO THE WRONG
RECIPIENT. NEXT SLIDE. SO WHY IS
THIS AN ISSUE? THERE ARE
COMPOUNDS FOUND IN THE PRODUCT
THAT WE CAN THEORETICALLY
MEASURE AND THEY POTENTIALLY CAN
LEAD TO ADVERSE OUTCOMES IN
VULNERABLE PATIENTS AND THE
GROUP FEELS THERE SHOULD BE MORE
WORK DONE ON ESTABLISHING THIS,
SO AGAIN YOU WOULD LOOK AT THE
LIST WE PUT HERE AND IF THERE
ARE ANYTHING YOU THINK WE ARE
MISSING PLEASE LET US KNOW THESE
COMPOUNDS FOUND IN THE PRODUCT
COME FROM DONOR SUCH AS
ANTIBODIES, THIS IS WHERE WE
INCORPORATE THE ABO ANTIBODIES
OR HLA ANTIBODIES OR OTHER
ANTIBODIES THAT MIGHT BE IN THE
PRODUCT. THERE CUB PRESCRIPTION
AND NON-PRESCRIPTION DRUGS THAT
ARE FOUND IN THE PRODUCT,
HORMONES, HEAVY METALS, AND
GENETIC VARIANTS OF CELLULAR
ELEMENTS OR PROTEIN ELEMENTS
THAT COULD BE IN THE PRODUCT
FROM THE DONOR THAT MAY LEAD TO
ADVERSE OUTCOMES IN CERTAIN
RECIPIENTS. IN TERMS OF
MANUFACTURING, THERE'S THE
STORAGE SOLUTIONS WE USE,
THERE'SPLASTISIZERS AND OTHER
COMPOUNDS THAT MIGHT BE USED FOR
PATHOGEN INACTIVATION THAT MAY
OR MAY NOT LEAD TO ADVERSE
OUTCOMES. FINALLY, THE PROCESS
OF STORAGE INCREASES OR CHANGES
WHAT IS IN THE BAG AND RELEASES
POTASSIUM TO THE SUPERNATANT,
THERE'S INCREASES IN
MICROVESICALS, EXOSOMES,
HEMOGLOBIN NOT IN THE RED CELL
BUT FOUND OUTSIDE THE RED CELL
AND OTHER RESPONSE MEDIATORS
LIKEOXILIPINS TO CAUSE OUTCOMES
-- ADVERSE OUTCOMES IN CERTAIN
MODEL SYSTEMS. THEN THERE IS A
CONCEPT OF TRIM, TRANSFUSION
RELATED IMMUNOMODULATION. WE
DON'T UNDERSTAND IT, WE STILL
DON'T UNDERSTAND WHAT EXTENT IT
HAPPENS AND WHAT CAUSES IT. BUT
WE THINK THERE MIGHT BE
COMPOUNDS IN THE TRANSFUSED
PRODUCT THAT MAY INTERACT WITH
THE RECIPIENT, RECIPIENT CELLS
OR ORGAN SYSTEMS, AND THAT
STUDYING THE MECHANISMS AND THE
BIOLOGICAL CROSS TALK BETWEEN
THE DONOR PRODUCT AND RECIPIENT
SHOULD BE PRIORITY. NEXT SLIDE
PLEASE. IN TERMS OF PROPOSED
APPROACH. THE GROUP ALSO FELT
THERE ARE -- WE DON'T
NECESSARILY DO A GREAT JOB
MONITORING FOR ALL THE
TRANSFUSION -- HARMFUL EFFECTS
AND TRANSFUSION REACTS OCCUR
WITHOUT KNOWING SO NOVEL METHODS
TO MONITOR FOR HARMFUL EFFECTS
ARE NEEDED. WE NEED TO
DETERMINE WHICH PATIENT
POPULATIONS ARE MOST VULNERABLE
TO THESE EFFECTS SO FOR SOME
LIKE HEAVY METALS, NEONATES
MIGHT BE MORE VULNERABLE. ALSO
INCORPORATING SEX, RACE,
ETHNICITY, GENETIC BACK GROWN OF
RECIPIENT AND DONOR MAY ALSO
IMPACT THIS. FROM THE REGULATORY
SIDE, WE THINK THERE MIGHT BE
NEED TO BE EXPOSURE LIMITS
ESTABLISHED AND STANDARDS FOR
CONCENTRATION OF POTENTIALLY
HARMFUL COMPOUNDS DEPENDSING
WHAT THE STUDIES SHOW. THEN
ADDITIONAL METHODS ARE NEEDED TO
IMPROVE BLOOD SAFETY TO REDUCE
ERRORS IN ALL STEPS OF TRANS
FUSION PRODUCT. WE SEE WRONG
BLOOD IN TUBE WAY TOO OFTEN THAN
IS -- MAKES ME FEEL COMFORTABLE.
NEXT SLIDE. SO IN TERMS OF
BARRIERS, ONE OF THE MAIN
BARRIERS FOR ANY STUDIES IN
PARTICULARLY AS A RESULT
FORRABLE NEONATES AND CHILDREN
IS MIGHT REQUIRE LONG STANDING
SUPPORT FOR LONG RANGE STUDIES
TO LOOK AT THE LONG TERM
CONSEQUENCES. SO THAT IS A
BARRIER TO DOING THOSE KINDS OF
STUDIES BUT WE FEEL THAT THAT IS
-- MORE SUPPORT IS NEEDED FOR
THOSE TYPES OF STUDIES. MORE
ANIMAL AND PRE-CLINICAL MODELS
FOR BLOOD PRODUCTS NEED TO BE
DEVELOPED AS IN THE OTHER
PRIORITIES WE HAVE, ADDITIONAL
OMICS APPROACHES, NEEDED TO PUT
ALL THIS TOGETHER AND
IMPLEMENTATION SCIENCE
APPROACHES FOR IMPROVING SAFETY
WE MOVE ON TO DRAFT PRIORITY
FOUR WHICH IS WHAT STRATEGIES
CAN BE EMPLOYED TO INDUCE
RESPONSES TO RED BLOOD CELL OR
OTHER ANTIGENS AND CONSEQUENCES
OF ANTIBODIES IN TRANSFUSION AND
PREGNANCY. SO THIS ENCOMPASSES
THREE THINGS. FIRST IS
PREVENTION STRATEGIES AND THE
GROUP FELT STRONGLY THAT AN
OUNCE OF PREVENTION IS WORTH
POUND OF CURE AND WE SHOULD TRY
WHERE POSSIBLE TO AVOID ANTIBODY
FORMATION AND SO THAT WAS THE
FIRST PART, SECOND ONE WAS
UNDERSTANDING MECHANISMS, SO IT
IS STILL MORE WORK ON -- INTO
WHY SOME MAKE ANTIBODIES AND
SOME DON'T. FOR RED CELLS
PLATELETS AND ALSO SELF ANTIGENS
VERSUS ALLO ANTIGENS, AND
INCLUDING THE ROLE THAT DONOR
COMPONENT CHARACTERISTICS MAY
PLAY. NOVEL STRATEGIES AND
THERAPEUTICS TO MINIMIZE
COMPLICATIONS SO WHEN SOMEONE
HAS ANTIBODY TO SOMETHING HOW
CAN WE MINIMIZE THE
COMPLICATIONS OR HARM THEY DO.
THIS INCLUDES HYPERHEMOLYSIS
WHICH IS STILL POORLY
UNDERSTAND. AUTOANTIBODIES THE
TO RED CELL ANTIGENS AND
ANTI-BODY THES TO OTHER THINGS
LIKE PLASMA LIKE IGA OR
HAPTOGLOBIN TO BE INCLUSIVE OF
ALL BLOOD PRODUCTS. SO WHY AN
ISSUE? ALLO ANTIBODIES CAN
RESULT IN HEMOLYTIC TRANSFUSION
REACTIONS, DELAY OR PREVENT
FUTURE TRANSFUSION SUPPORT, IT
CAN POSE BARRIERS TO
TRANSPLANTATION AND CAUSE OTHER
SERIOUS ADVERSE EFFECTS, ONE OF
THE THINGS WE DIDN'T PUTS HERE
IS IT ALSO ADDS SIGNIFICANT COST
IF THERE WERE NO ALLO ANTIBODIES
WE WOULDN'T SPEND EFFORT AND
MONEY PERFORMING TIGHTENED
SCREENS, THINGS LIKE THAT. THERE
IS ALSO THIS CONCEPT OF
RESPONDER VERSUS NON-RESPONDSER
POPULATIONS WHERE SOME PEOPLE
TEND TO RESPOND AND MAKE
ANTIBODIES WHEN EXPOSED TO ALLO
ANTIGENS AND SOME DON'T. WE
STILL DON'T UNDERSTAND THAT.
THERE NEEDS TO BE MORE RESEARCH
INTO DEFINING WHO IS AND ISN'T A
RESPONDER. ALSO THE CONCEPT OF
ANTIBODIES OF INESSENCE, MANY
ANTIBODIES APPEAR AND THEN
DISAPPEAR NOT DETECTABLE BY
AGGLUTINATION METHODS SO WE
DON'T DETECT THEM IN BLOOD VEIN
AND AS PATIENTS GO FROM BLOOD
VAIN TO BLOOD VAIN IF WE DON'T
HAVE A METHOD FOR TRACKING
E. CXFC ANTIBODIES SOMETIMES
EXPOSE PEOPLE TO ANTIGENS THAT
HAD WE HAD THEIR HISTORY WE
COULD HAVE AVOIDED SO
UNDERSTANDING THE PROCESS OF
EVANESCENCE AND WHEN CLINICALLY
SIGNIFICANT IS IMPORTANT. WHEN
YOU CHALLENGE SOMEONE WHO HAS
ALLO ANTIBODIES, OR
AUTOANTIBODIES FOR THAT MATTER,
WHY SOME PEOPLE HAVE CLINICAL
SYMPTOMS WITH IT AND SOME DON'T,
WE STILL DON'T KNOW. SO
UNDERSTANDING THAT MECHANISTIC
IS ALSO THE GROUP FELT WAS
IMPORTANT. NEXT SLIDE. SO THE
GROUP FELT AGAIN THAT PREVENTION
STRATEGIES ARE OUT MOST
IMPORTANCE. WE NEED MORE WORK
DONE ON BETTER MATCHING BASED ON
MOLECULAR PHENOTYPES AND MORE
WORK DONE ON MOLECULAR
GENOTYPING. ADDITIONAL BASIC
TRANSLATIONAL AND CLINICAL
STUDIES TO STUDY MECHANISMS
UNDERLYING IMMUNIZATION.
SEVERITY OF TRANSFUSION
REACTIONS AND THERAPEUTICS TO
MINIMIZE COMPLICATIONS. T NEXT
SLIDE. TERMS OF BARRIERS, ONE
OF THE MAJOR BARRIERS IS THAT
ALLO IMMUNIZATION IS A
RELATIVELY RARE EVENT, HARD TO
PREDICT WHEN SOMEONE WILL HAVE
OCCURRENCE OF ALLO ANTIBODY. WE
NEED TO DO A BETTER JOB BUILDING
BIOBANKS WITH FLOW ANNOTATED
BIOSPECIMENS, SPECIMENS THAT ARE
AVAILABLE BEFORE SOMEONE MAKES
AN ANTIBODY. WE NEED BETTER
INFORMATION SYSTEMS AND DATA
SHARING TO DOCUMENT ANTIBODIES
ACROSS THE STATES. THINGS THAT
ARE MAYBE ROUTINE A IN OTHER
COUNTRIES. WE NEED ADDITIONAL
HEMOTOLOGY GENOMICS TOOLS TO BE
ABLE TO DEAL WITH THIS
INFORMATION. FINALLY, AGAIN AS A
MAIN BARRIERS THAT WE NEED
COLLABORATIVE NETWORKS AND
POTENTIALLY REGISTRIES TO REALLY
MAKE A DIFFERENCE IN -- FOR THIS
PRIORITY. NEXT SLIDE. SWITCH
BACK TO ANGLO.
>> SO LAST BUT TESTING AND
DESIGN AND THE TEST THE NEXT
GENERATION OF BLOOD PRODUCTS
BLOOD DERIVED THERAPEUTIC. AND
IMMEDIATE TO ENSURE SAFETY OF
NOVEL BLOOD PRODUCTS OR EVEN
BLOOD PRODUCTS REPURPOSED FOR
NON-TRANSFUSION INHIBITIONS. --
INDICATIONS. AS NOTESSED BY
YESTERDAY, MULTIPLE WORKS GROUPS
PRIOR SESSIONS THE GLOBAL
PANDEMIC, COVID-19 PANDEMIC HAS
EXACERBATED ISSUES IN THE BLOOD
SUPPLY CHAIN. HURDLES IN DONOR
RECRUITMENT AND SUBSEQUENT
SCARCE BLOOD RESERVES HAVE
PERSISTED IN EARLY 2022 DESPITE
EASING OF THE PANDEMIC. EFFORT
TO DEVELOP NOVEL BLOOD PRODUCTS
EXTEND SHELF LIFE, QUOTHMENT OR
EVEN REPLACE CURRENT PRODUCTS
ARE OF INCREASED IMPORTANCE.
MULTIPLE APPROACH WERE
IDENTIFIED TO TRANSFER THE
BLOOD, DEVELOPMENT OF EXVIVO
GENERATED BLOOD CELLS FROM STEM
OR PROGENITOR CELLS OR INDUCED
PLURIPOTENT STEM CELLS OR ADULT
UMBILICAL CORD BLOOD ORIGIN,
SYNTHESIS OF ARTIFICIAL BLOOD
CELLS, ERYTHROCYTES OR
PLATELETS, THE USE OF BLOOD
CELLS AS TRANSFUSION WERE
NOTICED. SUCH AS THE USE OF
BLOOD CELLS, SPECIAL EMPHASIS ON
BLOOD CELLS AS DELIVERY SYSTEMS.
FOR EXAMPLE ENZYME LOADED RED
BLOOD CELLS FOR METABOLIC
INTERVENTIONS IN CANCER. NEXT
SLIDE PLEASE. THE DEVELOPMENT
OF BLOOD PRODUCTS ENCOMPASS
SIGNIFICANT GOALS, FORWARD TO
QUALITY SAFETY AND EFFICACY AND
PERHAPS SHELF LIFE OF FROM DR.
DEVINE BLOOD GIFT. AS PART OF
THE APPROACHES THE GROUP
INCLUDED HIGH THROUGH PUT OMICS
THAT ARE DEVELOPMENT OF NOVEL
STRATEGIES OR ADJUVANTS FOR RED
BLOOD CELLS PLATELETS WHOLE
BLOOD PRODUCTS. IN ADDITION THE
RESEARCH TEMPERATURE MENTIONED
IN MISPRESENTATION BEFORE, FOR
-- THROMBOSOMES, THE
OPTIMIZATION OF MANAGEMENT
APPROACHES FOR EXAMPLE HYPOXY
STORAGE RED BLOOD CELLS WHOLE
BLOOD. WHILE THE SARS COV-2
TRANSFUSION IS NOT REPRESENT
CRITICAL ISSUE IN THE LATEST
PANDEMIC, WE MAY NOT BE SO LUCKY
THE NEXT PANDEMIC. PROVIDED
IMPLEMENTATION OF PATHOGEN
RELEASED PRODUCTS WILL BE BY
DEVELOPMENT OF SPECIFIC --
POTENTIAL EMPHASIS OF PATHOGEN
REACTION PROCESS. AS PART OF THE
DISCUSSION WE ALSO BOTH CONTROL
-- BRIEFLY DISCUSS DEVELOPMENT
OF UNIVERSAL BLOOD PRODUCTS, FOR
EXAMPLE ENZYMATIC TREATMENTS IN
BLOOD GROUP ANTIGEN OR MORE
BRIEFLY, WE DISCUSS PERCENT
BLOOD GIVEN RECENT BREAK THROUGH
IN CONDITION TO HUMANS. IN
PARALLEL TO DEVELOPMENT OF NOVEL
BLOOD PRODUCTS, NOVEL USE OF
CORED BLOOD PRODU PRODUCTS ARE
EMERGING. FOR EXAMPLE POOR
PLASMA OR PLATELET GELS IN
COSMETIC, RHEUMATOLOGY, SPORTS
MEDICINE, EMERGENCY MEDICINE. IN
BURN PATIENTS AND TRAUMA
PATIENTS. STUDIES BY RODENT
MODELS FOLLOWED BY MORE RECENT
STUDIES ON TRANSFUSION OF PLASMA
FROM YOUNG DAUGHTERS AND
RECIPIENTS PROVIDE TRANSFUSIONAL
BLOOD PRODUCTS FOR ANTI-AGING
PURPOSES. FINALLY, COVID-19
PANDEMIC REVIVED INTEREST IN USE
OF CONVALESCENT PLASMA FOR
PROPHYLACTIC OR ACUTE DISEASE,
OPENING KEYNOTE LECTURE NOTESSED
HOW (INAUDIBLE) IF NOT FOR THE
NEXT EPIDEMIC. NEXT SLIDE
PLEASE. SO FOCUS THERE DESCRIBE
BEGINNING TO DESCRIBE WOULD BE
POSSIBLE WITHIN THE NEXT THREE
TO TEN YEARS, STUDIES WOULD NEED
TO (INAUDIBLE) AT THE TIME, AS
PART OF THE STUDIES EXISTING
ANIMAL MODELS ANIMAL MODELS
WOULD BE NECESSARY. CAN BE
UTILIZE THE DEVELOPMENT OF
PRODUCTS WHICH CAN BE TESTED IN
TRIALS. WITH RESPECT TO
DEVELOPMENT OF EXVIVO GENETIC
BLOOD PRODUCTS ONE ISSUE
IDENTIFIED RELATED TO FOR
EXAMPLE, HOW THOSE CELLS
FUNCTION INCLUDING COST
EFFECTIVENESS AND SAFETY,
DIFFERENTIATION AMONG -- FOR
EXAMPLE IN MANIPULATION --
ENUCLEATION OF ERYTHROID
PRECURSORS. DEVELOPING
STANDARDS AND QUALITY CONTROL
METHODS FOR THESE NOVEL PRODUCTS
IS CRUCIAL. SO THIS FINAL SLIDE
SUMMARIZES THE PRIORITY OF
WORKING GROUP OF COURSE AS DR.
HOD MENTIONED, SEE THERE'S BEEN
ACTIVITY IN THE CHAT, AND WE
WILL BE HAPPY TO DISCUSS THIS IN
THE BREAK OUT SESSION. THAT
SHOULD BE AROUND 12:35 TO 1:35
P.M. AND THANK YOU ALL FOR YOUR
ATTENTION. THANKS FOR THE
OPPORTUNITY TO PRESENT TODAY AND
SPECIAL THANKS TO THE WORK TO
PUT ALL THIS TOGETHER AND OF
COURSE ADD TO THE PRIORITIES
ADDITIONAL PRIORITIES THAT WERE
IN THESE WELL IDENTIFIED AS
PARTS OF THE DISCUSSION AND PATH
FORWARD. THANK YOU.
>> THANK YOU SO MUCH DR. HOD AND
D'ALESSANDRO, LOTS OF
OPPORTUNITY TO COME BACK AND
DISCUSSION DURING THE BREAK OUT
SESSION AND LATER ON. I WILL
MOVE TO THE NEXT WORKING GROUP.
THAT IS AN INTERESTING WORKING
GROUP, WE ASK THEM TO TACKLE A
LOT OF DIFFERENT THINGS. THIS
WORKING GROUP IS BEING CHAIRED
BY DR. RUCHIKA GOEL AND DR.
JANSEN SEHEULT, NEW METHODS
TRANSFUSION SCIENCE, DATA
SCIENCE MULTI-FACTORIAL
ANALYSES, USE OF ARTIFICIAL
INTELLIGENCE AND MACHINE
LEARNING. SO AGAIN, THOSE ARE
THE CHAIRS, THE CO-CHAIRS, DR.
GOEL IS ASSOCIATE PROFESSOR IN
PEDIATRICS HEMATOLOGY ONCOLOGY
AT SIMMONS CANCER INSTITUTE AT
SIU AS WELL AS ADDITIONAL ROLES
AT JOHNS HOPKINS UNIVERSITY AND
IMPACT LIFE AND DR. SEHEULT IS
SENIOR CONSULTANT PROFESSOR IN
DIVISION OF PATHOLOGY,
COMPUTATIONAL PATHOLOGY AND
ARTIFICIAL INTELLIGENCE,
DEPARTMENT OF LABORATORY
MEDICINE AT THE MAYO WHICH I IN
THIS CASE IN ROCHESTER. SO THANK
YOU. PLEASE GO AHEAD.
>>
THANK YOU SO MUCH, DR. CUSTER
FOR THE INTRODUCTION. WE ARE
GRATEFUL TO NHLBI FOR GETTING A
CHANCE TO CO-CHAIR A SUBGROUP.
AND ALSO WE ARE THANKFUL FOR
NOVEL EMERGING DATA SCIENCES AND
COMPUTATIONAL METHODS IN BLOOD
BANKING TRANSFUSION MEDICINE TO
BE RECOGNIZED AS AN INDEPENDENT
SUBGROUP. NEXT SLIDE PLEASE.
SO AS WE THINK ABOUT THE
RESEARCH PRIORITIES THE NEXT
FIVE TO TEN YEARS, WHY IS DATA
SCIENCE IMPORTANT? DOES IT
DESERVE A SEPARATE ROLE IN
IDENTIFICATION? SO JUST LOOKING
AT THE BACKGROUND, APPLICATIONS
OF THE VARIOUS NEW DATA SCIENCE
TECHNIQUES SUCH AS ANALYTICS,
ARTIFICIAL INTELLIGENCE AND MANY
SHEEN LEARNING AND MULTI-OMICS
TO BANKING TRANSFUSION MEDICINE
IS STILL IN THE RELATIVE
INFANCY, DATA ANALYTICS CAN BE
KEY TO PROPOSED ASSOCIATIONS FOR
BETTER MECHANIC DECISIONS AND
HELP IDENTIFY PREDICT PATTERNS
AND TRENDS THAT WERE PREVIOUSLY
UNKNOWN AND THOSE INFORM FUTURE
STUDIES AS WELL AS
INTERVENTIONS. HOWEVER, DESPITE
A LOT OF BUZZ, LOTS OF NEWER
COMPUTATIONAL METHODS ARE
RELATIVELY UNDERUTILIZED ANDs
SEW TEARIC CONCEPT BUT ONLY IN
TRANSFUSION MEDICINE BLOOD
BANKING BUT IN GENERAL ADOPTION
IN HEALTHCARE IS SLOW AS
COMPARED TO COMPANIES WHICH ARE
TECH AND HIGHLY DATA DRIVEN
BUSINESS SECTORS WE HAVE ADAPTED
THEM MUCH FASTER. SO I THINK
TIME IS RIGHT TO IDENTIFY AND AS
WELL AS APPLY SOME OF THESE NEW
NOVEL TECHNOLOGIES AND DRIVE
INNOVATION IN THE FELTED. --
FEEL. OUR SUBGROUP -- FIELD. OUR
SUBGROUP AS SOME ATTENDEES WILL
NOTICE BRINGS TOGETHER A LOT OF
PROPOSED APPROACHES FROM MANY
STATE OF THE SCIENCE WORKING
GROUPS AND EXCELLENT
PROPROPOSALS PUT FORTH. AS DR.
CUSTER MENTIONED ONE CHALLENGE
WE FACE AS WE TRY TO COME UP
WITH DRAFTING RESEARCH
PRIORITIES WAS THAT DO WE USE
EACH DATA SCIENCE TECHNIQUE AND
PROPOSED THAT AT ITS OWN
RESEARCH PRIORITY OR IDENTIFY
RESEARCH GAPS WHERE THE DATA
SCIENCE TECHNIQUES COULD BE
APPLIED. WE HAVE COME WITH A
HYBRID MODEL, WE HAVE ONE
RESEARCH GAP THAT COULD BE SOLVE
BY PROPOSING VARIOUS DATA
SCIENCE TECHNIQUES OR ONE DATA
SCIENCE TECHNIQUE THAT COULD BE
APPLICABLE TO MORE THAN ONE
RESEARCH GAP COMING UP WITH
PROPOSED DELIVERABLES. HERE IS
OUR WORKING GROUP AND WE HAVE
BEEN FORT MAT THE UNIQUE
STRENGTH OF THE GROUP IS HALF
THE TEAM MEMBERS ARE PRIMARILY
BASED IN CLINICAL TRANSFUSION
MEDICINE, OTHER IS COMPOSED OF
TECHNICAL DATA SCIENCE EXPERTS
RANGING FROM GENOMICS
INFORMATICS, BIOSTATISTICS AND
DATA SCIENCES, ARTIFICIAL
INTELLIGENCE AND MACHINE
LEARNING AND THESE ARE EXPERTS
FROM U.S. AND CANADA. SO THANK
YOU SO MUCH FOR ALL THEIR TIME.
NEXT SLIDE. FOR OUR METHODOLOGY
SIMILAR TO GROUP AS ELDAD
PRESENTED WE HAD A LOT OF
CONVERSATIONS FIVE THEMES THAT
BROADLY EMERGED. BASED ON
COMBINATION OF APPLICATION AS
WELL AS ANALYTIC TECHNIQUES. WE
IDENTIFIED SUBGROUP LEADS AND
RESPONSIBILITIES, AND LEADING
TEAMS WERE ARTIFICIAL
INTELLIGENCE AND MACHINE
LEARNING. INFORMATICS, DATABASE
CURATION, DATA VISUALIZATION AND
BIG DATA RESEARCH. DEMAND
FORECASTING AND BLOOD SUPPLY
CHAIN MANAGEMENT. PERSONALIZED
TRANSFUSION MEDICINE AND COST
EFFECTIVENESS. OMICS AND SYSTEMS
BIOLOGY IN BLOOD BANKING. SO
WHAT WE CAN SEE HERE IS WE TRY
TO -- DATA SCIENCE CATEGORIES TO
VARIOUS SUB MEMBERS NEXT SLIDE.
BUT THIS LOT OF EXPERTISE AND
IDEAS ARE FLUID AND OVERLAPPING
BUT YOU WILL SEE AS WE PRESENT
RESEARCH PRIORITIES. NEXT
SLIDE. SO THIS IS THE SUMMARY
OF FOUR PRIORITIES. RIGHT NOW
NO SPECIFIC ORDER. JANSEN WILL
GO OVER RANKING STRATEGY BUT
LOVE TO HEAR INPUT DURING THE
BREAK OUT SESSIONS AND BEYOND
AND THE RANKING SHOULD BE
FLEXIBLE. SO SUMMARIES ARE USE
OF INFORMATION COMMUNICATION
TECHNOLOGIES, ICT AND SOCIAL
MEDIA TO BETTER UNDERSTAND BLOOD
DONOR BEHAVIOR. DEVELOPMENT AND
USE OF MULTI-DIMENSIONAL RANGE
OF DATABASES AND VISUALIZATION
TECHNIQUES AND BLOOD BANKING IN
TRANSFUSION MEDICINE. DATA
DRIVEN ECONOMIC EVALUATIONS IN
BLOOD BANKING TRANSFUSION
MEDICINE. DEPLOYING ROBUST
SCALABLE ARTIFICIAL INTELLIGENCE
MACHINE LEARNING WORK FLOWS.
INTEGRATING GENOMICS INTO
CLINICAL TRANSFUSION WORK FLOWS
USE OF IN SILICO CLINICAL
TRIALS, AS WELL AS MULTI-MODAL
AI AND MACHINE LEARNING WITH
PHENOMMIC DATA. SO MOVING ON TO
FIRST PRIORITY. THIS USING
INFORMATION COMMUNICATION
TECHNOLOGIES OR ICT AND SOCIAL
MEDIA TO BETTER UNDERSTAND BLOOD
DONOR BEHAVIOR. ALTHOUGH ICT
SOCIAL MEDIA ARE CONCEPTUALLY
DIFFERENT THEY ARE INTERTWINED
AND INEXTRICABLY CONNECTED SO
OUR QUESTION IS, HOW CAN SOCIAL
MEDIA, AND OTHER ICT
TECHNOLOGIES BE USED TO BETTER
UNDERSTAND DONOR MOTIVATION,
VARIOUS DONATION AND HELPING
INCORPORATE THOSE TO FACILITATE
DONOR RECRUITMENT. WHY AN ISSUE?
COMMUNICATION TECHNOLOGY SUCH AS
MAIL, TELEPHONE TEXT MESSAGING
AND EMAIL USED IN RECRUITING
BLOOD DONORS FOR DECADES AND
THESE REMAIN PRIMARY CHANNELS OF
COMMUNICATION FOR BLOOD CENTERS
AND DONORS. ACADEMIC AND
MARKETING AND SOCIOLOGY
DEVELOPED TECHNIQUES FOR
ADVANCING UNDERSTANDING HUMAN
BEHAVIOR THROUGH THE LENS OF
SOCIAL MEDIA. THESE TECHNOLOGIES
PROVIDE A NOVEL YET UNTAP
POTENTIAL TO UNDERSTAND DONOR
BEHAVIOR AS WELL AS ENGAGE IN
DONOR RECRUITMENT AND
COORDINATION. WHAT IS PROPOSED
APPROACH? WE LIKE TO PRESENT A
RECENT EXAMPLE AS WELL. WE CAN
USE THE ICT AND SOCIAL MEDIA
PLATFORMS, TO REPLACE, SAY
COMPLIMENT AND/OR REPLACE OLDER
COMMUNICATION TECHNOLOGIES AND
ESPECIALLY TARGET CERTAIN
GRAPHICS, THE YOUNGER DONORS AS
THESE PLATFORMS OFFER DEEPER
MORE INTEGRATED CONNECTIONS AND
AUTOMATION AND ADAPTED LEARNING
BETTER THAN THE OLDER
TECHNOLOGIES. THERE ARE RECENT
SUCCESSFUL EXAMPLES THE BLOOD
DONATION TOOL USED TO CONDUCT
THE FIRST LARGE SCALE
ALGORITHMIC MATCHING OF BLOOD
DONORS. I WILL SHOW THE NEXT
COUPLE OF SLIDES AND THIS SHOWS
THE FIRST MODEL OF DEPLOYMENT IN
BLOOD BANKING LARGE SCALE. THE
GOEL WILL BE TO USE THIS
PLATFORM AS OPPORTUNITIES FOR
THE BLOOD CENTERS TO RECRUIT
DONORS AND ALSO FOR THE DONORS
TO IDENTIFY COMMUNITY AMONG
THEMSELVES. THERE ARE ALSO NEWER
NOVEL TECHNOLOGIES SUCH AS
VIRTUAL OR AUGMENTED REALITIES
WE HAVE BRILLIANT EXAMPLES AND
NEWER TRIALS COMING UP FOR DONOR
ENGAGEMENT AND ENHANCED
EXPERIENCES. NEXT SLIDE. THIS
SLIDE IS ADAPTED FROM -- WHO LED
THIS WORK UNIVERSITY OF MARYLAND
AND FACEBOOK FOR DEVELOPING
LARGE SCALE ALGORITHMIC MATCHING
FOR BLOOD DONATION, WHERE THE
BLOOD DONORS AS THE NEED AROSE
RECEIVE NOTIFICATION ABOUT THE
DONATION OPPORTUNITIES AND HOW
AND WHERE TO DO SO. THIS DID
HAVE A GO LIVE IN 2017, STARTING
WITH INDIA AND TO DATE BY
EXAMPLE MORE THAN 35 MILLION
PEOPLE WHO DID SIGN UP TO BE
BLOOD DONORS ACROSS THE
COUNTRIES AS LISTED. FOLLOW-UP
IN PERSON SURVEYS IN SOME OF
THESE COUNTRIES HAVE SHOWN THAT
IN ONE TO FIVE DONOR SET THAT
THE BLOOD DONATION TOOL DID
INFLUENCE POSITION TO GIVE
BLOOD. LOOK AT EXAMPLES
FEASIBILITY AS WELL AS BARRIERS,
YES, THERE IS FEESIBILITY
BECAUSE TECHNOLOGIES ALLOW
PERSON REAL TIME COMMUNICATION,
WITH ENORMOUS AUDIENCES TO
VARIETY OF MEDIA INCLUDING TEXT,
RADIO IMAGES AN OPPORTUNITY FOR
REACTION AND INDIVIDUAL IMPROVED
MESSAGES. ON SOME OF THESE
MODERN PLATFORMS USERS TEND TO
ENGAGE WITH GROUPS RATHER THAN
INDIVIDUALS WHICH ALSO WAS
MENTIONED BY OUR BLOOD DONORS
AND SUPPLY SUBGROUP BY DR.
BRIGHT, THIS YOURS TRULY FOR
COLLECTIVE CONSCIOUSNESS FOR
NOVEL SOCIAL DYNAMICS. THERE ARE
BARRIERS, TO BE TAKEN CARE OF,
SO AS THESE TECHNOLOGIES ARE
CONSTANTLY EVOLVING, ONGOING
RESEARCH WILL BE NEEDED TO
UNDERSTAND THE CHANGING ONLINE
SOCIAL DYNAMICS. ONLINE PRIVACY
BREACH OF INFORMATION FOR THESE
MODALITIES ALWAYS REMAINS
IMPORTANT ESPECIALLY SOME OF
THEM THERE IS CONCERN FOR DEEPLY
SHARING PERSONAL INFORMATION.
THERE IS ALSO A NEED TO ACCOUNT
FOR DONOR CONCERNS, PARTICULARLY
RELATES TO NOTIFICATION FATIGUE,
IN ADDITION SOME OF THESE
COLLECTIVE CONSCIOUSNESS
TECHNIQUES CAN HAVE POSITIVE AND
NEGATIVE EFFECTS ON INDIVIDUALS
AS WELL AS COMMUNITY SO LARGELY
REMAINS TO BE STUDIED WHY THESE
REMAIN INCORPORATED. OUR SECOND
PRIORITY IS USING
MULTI-DIMENSIONAL DATABASES AND
DATA VISUALIZATION TOOLS AND
BLOOD BANKING. THE QUESTIONS
ARE, HOW CAN SOME OF THE
MULTI-DIMENSIONAL DATABASES
FIRST BE CURATED AND UTILIZED TO
ANSWER RESEARCH QUESTIONS IN
SOME OF THE SPECIFIC
POPULATIONS, DR. -- MENTIONED
SEVERAL TIMES THE POPULATIONS OF
INTEREST AND THE SAME APPLIES,
ABILITY OF HAVING SOME BIG DATA
MULTI-DIMENSIONAL DATABASES DOES
ALLOW THAT TO BE STUDIED. WE CAN
ALSO STUDY RARE OUTCOMES AN
EXPOSURES. HOW CAN YOU BEST
UTILIZE DATA VISUALIZATION TOOLS
TO EVALUATE AS WELL AS IMPROVE
QUALITY IN DATA MANAGEMENT. SO
WHY IS THIS IMPORTANT? TO DATE
THERE IS LIMITED AVAILABILITY OF
COMPREHENSIVE VEIN TO VEIN
DATABASES WHICH CONTAIN
INFORMATION ON DONORS, BLOOD
COMPONENTS, AS WELL AS
TRANSFUSION RECIPIENTS. THESE
DATABASES PROVIDE KEY
INFORMATION FROM MANY
OBSERVATIONAL STUDIES AND ENABLE
INVESTIGATORS TO ADDRESS
EMERGING RESEARCH QUESTIONS. AS
FAR AS DATA VISUALIZATION GOES
MANY CURRENT EXTEND DATA
VISUALIZATION TECHNIQUES HAVE
BEEN STATIC AND TEND TO FOCUS ON
SINGLE CENTER. WHILE THESE
PROVIDE USEFUL FOCUS SUMMARIES
ON PERFORMANCE DATA, THEY MAY
NOT ALLOW FOR ENHANCE CONTEXT OR
FLEXIBILITY AT HIERARCHICAL
LEVELS FOR A DEEPER
UNDERSTANDING.
WHAT IS THE PROPOSED APPROACH?
IT WOULD BE DEVELOPMENT OF
COMPREHENSIVE VEIN TO VEIN
DATABASES WHICH CONTAIN THIS
INFORMATION. INCLUSION OF
NON-TRANSFUSED CONTROLS IN
PATIENT DATABASE COMPARATIVE
EFFECTIVENESS STUDIES AREN PRO.
UTILIZING MODELS I WILL TALK IN
THE NEXT SLIDE INCLUDING
OBSERVATIONAL MEDICAL OUTCOMES
PARTNERSHIP OR OMOP COMMON DATA
MODEL TO ALLOW'S OF COMBINING
MULTIPLE VEIN TO VEIN DATABASES,
SO WELL DESIGNED DATABASES AND
THE DATA ANALYTICS PIPELINE CAN
REALLY ENABLE THE DEPLOYMENT OF
DATA VISUALIZATION TOOLS ACROSS
MULTIPLE CENTERS. AND THIS CAN
ALLOW INTRAAND INSTITUTIONAL
BENCHMARKING OF PERFORMANCES
USING A FEDERATED MODEL,
SOMETHING JANSEN WILL ELABORATE
ON. IN ADDITION, THE ADVANCE
DATA VISUALIZATION APPLICATIONS
FOR PATIENTS LIKE MINE, IT CAN
ALLOW VISUALIZE PERFORMANCE IN
OUTCOMES OF PAST PATIENTS, THAT
IS SIMILAR TO UPCOMING PATIENT
AND SERVE AS PERSONALIZE RISK
ASSESSMENT TOOL. I WANT TO GIVE
THIS EXAMPLE, FROM THE ODYSSEY
WEBSITE SHOWING VERY SIMPLISTIC
VIEW OF THE OMOP COMMON DATA
MODEL WHICH ALLOWS SYSTEMATIC
ANALYSIS OF VARIOUS DISPARATE
OBSERVATIONAL DATABASES AND
TRANSFORMS THE DATA WITHIN THESE
DATABASES INTO A COMMON FORMAT
OR A DATA MODEL. AS WELL AS
COMMON REPRESENTATION USING THE
TERMINOLOGIES, VOCABULARIES AND
CODING SCHEMES. THEN NEXT STEP
PERFORMS SYSTEMATIC ANALYSIS,
USING A LIBRARY OF STANDARD
ANALYTIC ROUTINES. THAT HAVE
BEEN BASED ON THIS COMMON
FORMATS. ALSO WANT TO GIVE AN
EXAMPLE OF NON-STATIC PATIENT
LED MANAGEMENT DATA VISUALIZING
TOOL DEVELOPED BY (INAUDIBLE)
DR. (INAUDIBLE) TEAM WHICH
ALLOWS REAL TIME TRACKING AS
WELL AS TRANSFUSIONAL BENCH
MARKING. SO FEASIBILITY AND
BARRIERS, DATABASES HAVE BEEN
SUCCESSFULLY CREATED, THE RED
THREE STUDIES INCORPORATED IT
WELL, SO THERE ARE EXAMPLES.
THE BENEFITS OF USING
INCORPORATING SOME OF THE NEWER
DESIGNS FOR EXAMPLE THE OMOP
COMMON DATA MODEL CURRENTLY
DOING, REALLY ALLOWS COMBINING
THE DATA FROM VARIOUS DATE
OPERADISPARATE SOURCES ONCE
INCORPORATED THE MODEL CAN BE
INTERROGATED BY IDENTIFYING NEW
DATA MAPPINGS SUCH AS LABORATORY
METHODS BEYOND CLINICAL
APPLICATIONS. FURTHER DEPLOYING
THE DATA VISUALIZATION TOOLS, IS
BECOMING INCREASINGLY FEASIBLE
WITH USE OF OPEN SOURCE AND/OR
CHILD BASE SOLUTIONS. THIS CAN
BE FACILITATED BY STANDARDIZE
DATABASE STRUCTURE. THERE ARE
BARRIERS INCLUDING NEED FOR DATA
USE, SIGNIFICANT BARRIERS IN
HARMONIZING THE DATA SETS,
CURRENTLY USED NOVEL SYSTEMS
SUCH AS THE LOGIC OBSERVATIONAL
IDENTIFY FOR AGGREGATING THE
LABORATORY DATA AND ALSO
DEPLOYING REAL TIME DATA
AGGREGATION PIPELINES. IN
ADDITION ONCE THIS IS DONE
DEFINING VALIDATED METRICS TO I
ALLOW MEANINGFUL COMPARISON IS A
KEY CHALLENGE. OUR NEXT
PRIORITY IS USE OF DATA DRIVEN
ECONOMIC EVALUATIONS AND BLOOD
BANKING AND TRANSFUSION
MEDICINE, AND HOW TO USE
APPROACHES TO IMPROVE ACCURACY
AS WELL AS APPLICABILITY
ECONOMIC EVALUATIONS TO OUR
COMMUNITY. WHY IS THIS AN ISSUE?
COST EFFECTIVE ANALYSES, PERFORM
FORMAL ASSESSMENT OF TRADE OFFS
WHICH INFORM BENEFITS, HARMS AND
COSTS INHERENT AS KEY IN ANY
ALTERNATIVE OPTIONS. IT IS NOT
COMPLETELY NEW TO TRANSCRIPTION
MEDICINE BUT IN OTHER SCENARIOS
AS WELL IT IS USED TO INFORM
PUBLIC AND PRIVATE
ORGANIZATIONS, INCLUDING
DECISIONS BENEFIT DESIGNS AND
PRICE NEGOTIATIONS. MODEL BASE
ECONOMIC EVALUATION, SYNTHESIZE
EVIDENCE AND REVEAL TRADE OFFS
BETWEEN POLICY ALTERNATIVES WHEN
FORM -- AND USE ALLOW EFFECTIVE
AS WELL AS PATIENT USER HELD
RESOURCES AND ALLOCATIONS.
THERE HAVE BEEN SEVERAL ECONOMIC
EVALUATIONS WHICH FOCUS
PRIMARILY TRANSFUSION INFECTIONS
ALL NOTABLY NON-INFECTIOUS
TRANSFUSION CAN ACCOUNTS FOR
MOST TRANSFUSION ASSOCIATED
MORBIDITY AND MORTALI MORTALITYS
AN EXAMPLE FROM PARTICIPANT,
THIS SLIDE ADAPTED FROM SOME OF
THE WORK ON (INAUDIBLE) ALSO AN
AWARDEE WORKING AT STUDYING THIS
ISSUE WHERE YOU SEE THAT THERE
ARE STUDIES DATING MORE THAN 20
YEARS PLUS WHICH ASSURE DATA
DRIVEN ECONOMIC EVALUATION FROM
COST ANALYSES CAN
REPRODUCIBILITY COMPARATIVE
EFFECTIVENESS STUDY, COST
CONSEQUENCE AND UTILITY
ANALYSIS. SO WHAT WOULD BE THE
PROPOSED APPROACH? WOULD BE FOR
IN OUR TRANSFUSION MEDS SIN
BLOOD BANKING, DERIVE BETTER
MODEL BASE ECONOMIC EVALUATION,
TO SYNTHESIZE EVIDENCE AND TRADE
OFFS BETWEEN POLICY
ALTERNATIVES, USE DECISION TREES
AND MODELS WHICH MODEL DIFFUSION
RECIPIENTS AS A HOMOGENOUS
POPULATION AND MODELS AGAIN
RESOURCES FOR EXAMPLE
PUBLICATION AND LITERATURE. THE
DECISION MODELING CAN BE USED TO
INFORM DONOR ELIGIBILITY AND
DEFERRALS, MODELS CAN BE USED TO
CONTINUALLY REASSESS THE BLOOD
SAFETY PORTFOLIO. IN ADDITION
THE DATA APPROACHES DIRECTLY
ANALYZE PATIENT LEVEL DATA AS
PART OF THE DECISION ANALYTIC
MODEL. THESE APPROACHES CAN BE
REDUCE BIAS IN POPULATION LEVEL
ESTIMATES AND ENABLE ANALYSIS OF
POLICY IMPLICATIONS AS WELL AS
FACILITATE MODEL BASE ECONOMIC
EVALUATIONS OF INTERVENTIONS,
NON-INFECTIOUS TRANSFUSION
REACTIONS. FEASIBILITY IS AS WE
MENTION SOME OF THESE STUDIES
HAVE BEEN ATTEMPTED IN VARIOUS
SCENARIOS PREVIOUSLY AND THERE
IS INCREASE AVAILABILITY OF HIGH
PERFORMANCE COMPUTERS AS WELL AS
CLINICAL AND ADMINISTRATIVE
BILLING DATA SYNCED ON
TRANSFUSIONED PATIENTS ENABLE
MORE DATA DRIVEN EVALUATIONS.
RISK MODELS AND DECISION
ANALYSIS INFORM EFFECTIVE BLOOD
SAFETY POLICIES. SOME OF THE
BARRIERS ARE ACCESS WE NEED TO
LARGER DATA SETS, COMPONENT
EXPOSURE AND OUTCOMES. DATA
DIRECTLY ESTIMATE ADVERSE EVENT
IN DONOR DATA AS WE THINK OF THE
LONG TERM IMPLICATIONS AND
ECONOMIC EVALUATION INTO
ACCOUNT, SOME DATA TAKES YEARS
TO ACCUMULATE ESPECIALLY --
THOSE ARE TOUGH ONES TO ACCOUNT
FOR BY COST EFFECTIVENESS
ANALYSIS. ALSO IN THE U.S.
MULTI-CARE SYSTEM MULTI-SOURCES
MAYBE NEEDED TO AGGREGATE TO
ENSURE REPRESENTATIVENESS. NOW
PASS TO JANSEN TO DISCUSS
QUALITY.
>> WE HAD NUMBER OF AI AND
MACHINE LEARNING EXPERTS IN OUR
GRUEL IN CLINICAL DOMAIN AND
TECHNICAL EXPERTISE AN DATA
SCIENCE AN ENGINEERING. WE
STRUGGLED WITH THE AI PRIORITY
AND FOCUS OF SCOPE BECAUSE AI IS
A LARGE FIELD RIGHT NOW. SO ONE
OF THE THINGS WE STRUGGLED WITH
IS AI IS NOT NOVEL OR NEW THOUGH
WE THINK OF IT AS A NEW CONCEPT,
NEW THING THAT IS HAPPENING IN
THE LAST DECADE, THE (INAUDIBLE)
WAS DEVELOPED IN THE 50s, BACK
PROPAGATION SINCE 1960s AND
MODIFIED IN 1980s. SO THE
CONCEPTS OF DEEP LEARNING AND
MACHINE LEARNING ARE NOT NEW,
THEY HAVE BEEN AROUND FOR
DECADES BUT WHAT WE DO HAVE ARE
IMPROVEMENT IN COMPUTATIONAL
POWER, AND ALSO ACCESS TO DATA
ON SCALE AND SHAPE NEVER SEEN
BEFORE. SO YOU CAN THINK OF AI
AS A PIPELINE, AI MODEL IS
INTEGRATED IN THIS PIPELINE THAT
INCLUDES PREANALYTICAL FACTORS
OR PRE-MODEL FACTORS. AND ALSO
POST MODEL FACTORS. WE WANT TO
TRY TO TAKE THIS FROM A BIRD'S
EYE VIEW HOLISTIC VIEW OF AI AND
BLOOD BANKING TRANSFUSION
MEDICINE AND COME UP WITH AN
OVERARCHING PRIORITY. SO THE
QUESTION WE CAME UP WITH
CLINICAL SERVICES AND BLOOD
BANKS EVALUATE ADOPT AI TOOLS
PREDICTING PATIENT TRANSFUSION
REQUIREMENT, BLOOD UTILIZATION
AN DEMAND FORECASTING. HOW WE
CAN ENSURE THOSE TOOLS ARE
GENERALIZABLE ROBUST AN
SCALABLE. THIS HAS BEEN
FACILITATED BY THE IMPROVEMENT
IN COMPUTATIONAL POWER AND
CONNECTED INTEROPERABLE HEALTH
DATA PIPELINES. WE ARE SEEING A
NUMBER OF RESEARCH AND
TRANSLATIONAL APPLICATION OF A
AI ML TRANSFUSION ANALYTICS AND
BLOOD DEMAND FORECASTING. TWO
MORE COLLISION.
THESE ARE -- CLICKS. THESE ARE
DATA RESEARCH APPLICATIONS
PUBLISHED IN TRANSFUSION
MEDICINE DOMAIN, ARTIFICIAL
INTELLIGENCE BASE PREDICTION OF
TRANSFUSION IN ICU, APPLICATION
DECISION TREE ALGORITHMS,
PREDICTION MASSIVE TRANSFUSION
TRAUMA. THEN MORE TRANSLATIONAL,
SOMETHING THAT IS GOING FOR FDA
APPROVAL IS AI ENABLED ADVANCE
DEPLOYMENT, LOOKING AT
COMPENSATORY RESERVE MACHINE
LEARNING ALGORITHMS. THERE ARE
ALSO FEW APPLICATIONS IN THE
BLOOD BANKING DOMAIN, THIS ONE
STUDY REDUCTION OF PLATELET
OUTDATING AND SHORTAGE BY
FORECASTING DEMAND WITH THE
COMBINATION OF STATISTICAL
LEARNING AND DEEP NEURAL
NETWORKS. ONE OF OUR WORKING
GROUP MEMBERS PUBLISHED THIS
QUITE FANTASTIC PAPER ON DEMAND
FORECASTING WHICH INCORPORATED
BOTH STATISTICAL MODELING AND
MACHINE LEARNING FOR INVENTORY
OPTIMIZATION. THEN RUCHIKA
MENTIONED THE FACEBOOK AI BLOOD
DONATION TOOL. THIS WAS A QUICK
OVERVIEW OF SOME OF THE RESEARCH
APPLICATIONS POPPING UP IN THE
LITERATURE. SO FOR THIS
OVERARCHING GOEL DEPLOYING
ROBUST SCALE GENERALIZABLE
RISK-BASED APPROACH IS IDEAL
WHICH BALANCES THE DISEASE
STATES SEVERITY AND DECISION
CONSEQUENCE. GOING ON TO FOCUS
PRIORITY ON IMPLEMENT -- PLEA
AGREEMENT TAKES RESEARCH ON DATA
AVAILABILITY SOURCING FOR
ALGORITHM EVALUATION. A
STATISTICAL FRAMEWORK FOR MODEL
VALIDATION VERIFICATION.
PERFORMANCE MONITORING FOR
DRIFTS OR SHIFTS OVER TIME.
HUMAN COMPUTER INTERACTION AND
MODEL CHANGE CONTROL. WE ALSO
WANT TO FOCUS ON TWO TECHNIQUES
WHICH ARE RELATIVELY NOVEL.
FIRST ONE AROUND ENSEMBLE
LEARNING BUT UTILIZED MORE IN
BLOOD BANKING AND TRANSFUSION
MEDICINE RECENTLY. SO USING
MULTIPLE MODELS WHICH ALL HAVE
THEIR OWN PROS AND CONS. TO
ARRIVE AT A BETTER PREDICTION.
WE ALSO WANT TO FOCUS ON
FEDERATED LEARNING SO THE
PRINCIPLES OF FEDERATED LEARNING
ARE DECENTRALIZATION,
DISTRIBUTION, SECURE
AGGREGATION, AND ALL THOSE
FACTORS CAN REDUCE CLIENT
LATENCY, IMPROVE THE HUMAN
COMPUTER INTERACTION, PROVIDES
TOOL FOR DOING VERIFICATION.
PROTECTS PRIVACY, HOUSING DATA
LOCALLY. MUSCLE ROBUSTNESS AND
GENERALIZABILITY, THE AIM WAS TO
FOCUS ON USE OF ENSEMBLE
LEARNING FEDERATED LEARNING
TECHNIQUES ACHIEVING THE
OVERASH.ING AIM OF ROBUST
SCALABLE AI. SO THE FEASIBILITY
ISSUES OF ROBUSTNESS SCALABILITY
RELIABILITY, WE THINK CAN BE
ADDRESSED WITHIN 3 TO 10 YEARS
BECAUSE DATA INFRASTRUCTURE
WIDELY AVAILABLE. EACH OUR
VENDORS -- EPISICK SEPSIS MODEL
WE AREN'T AWARE OF KNOWN
IMPLEMENTATIONS IN BLOOD BANKING
AND TRANSFUSION MEDICINE.
ENSEMBLE AND FEDERATED METHODS
ARE RELATIVELY NEW BUT THEY HAVE
BEEN APPLIED QUITE A LOOT
MEDICAL IMAGING AND OTHER
CLINICAL USE CASES, THEY DO HOLD
SIGNIFICANT PROMISE FOR
TRANSFUSION MEDICINE BLOOD
BANKING. THERE ARE PROBLEMS WITH
INTEROPERABILITY AND
AGGREGATION, SOME ALLEVIATED BY
HAVING BETTER DATABASE DESIGN.
SOME WILL ALSO BE ALLEVIATED AS
SOFTWARE VENDORS GRAPPLE WITH
COMPLIANCE WITH THE FIREMAN
DATE. THE REACH OF THE MANDATE
MAY NOT EXTEND BEYOND PATIENTS
TO BLOOD DONOR AND REIMBURSEMENT
IS ONGOING CONCERN AND PATHOLOGY
AND RADIOLOGY RIGHT NOW. MOSTLY
IM ALGORITHMS RECEIVE CATEGORY 3
CPT INITIALLY AND GETTING PAIRS
TO REBUST FOR THESE MODELS IS
CHALLENGING. FOR THE FIFTH
PRIORITY WE LEVERAGE EXPERTISE
OF OUR TWO GENOMICS EXPERTS,
SELENA AND BILL, I DON'T HAVE
EXPERTISE BUT I WILL PRESENT
THEIR PRIORITY THEY DRAFTED FOR
US. SO THE QUESTION HOW CAN WE
BETTER INTEGRATE GENOMICS
CLINICAL TRANSFUSION WORKFORCE
WITH OBJECTIVE PROVIDING THE
BEST DONOR FOR RECIPIENT, IN
CLINICAL TRANSFUSION? GENOMICS
HAS POTENTIAL TO ENHANCE
NATIONAL RARE BLOOD INVENTORY
IMPROVE ALLEGATION OF BLOOD
DECREASE UTILIZATION, OPTIMIZE
CLINICAL RESPONSE AN SAFETY.
>> TWO MINUTE WARNING.
>> GROWING EVIDENCE BASED
DEMONSTRATED ADVANTAGES OF
GENOMIC TESTING, CRITICAL
FACTORS FOR BROAD UPTAKE OPTIMAL
BIOINFORMATICS PIPELINE CREATION
OF VALIDATION DATA SETS WITH
RARE DIVERSE SAMPLES, ISSUES OF
EQUITY AND RACIAL DIVERSITY,
INCORPORATION OF LONG RANGE
SEQUENCING GLOBAL CURATED ALLELE
FREQUENCY DATABASES AND
INTEROPERABILITY. APPLICABILITY
OF THE PIPELINES TOOLS AN
APPROACHES NEED TO BE
SYSTEMATICALLY TESTED, THERE ARE
POTENTIALLY UNTAPPED GENOMICS
APPLICATIONS SUCH AS ALLO
ORGANIZATION, AUTO-IMMUNITY,
HYPERHEMOLYSIS, PERMIZED BLOOD
DONATION SCHEDULES, DISCOVERY
DATA SCIENCE CAN BE CROWD
SOURCED USING GRAND CHALLENGES
THOUGH WE HAVE TO GET AROUND
PRIVACY. THERE IS A ROLE FOR
MULTI-CENTER CLINICAL TRIAL.
FEASIBILITIES, TOOLS ARE
AVAILABLE IN OTHER DOMAINS AND
INCREASELY AVAILABLE IN BLOOD
BANGING TRANSFUSION BUT AT SLOW
PACE. THERE ARE PLATFORMS
AVAILABLE FOR CROWD SOURCE GRAND
CHALLENGES, THERE ARE CONCERNS
ABOUT PRIVACY, INTEROPERABILITY
AND AGGREGATION. QUICKLY GLANCE
OVER TWO ADDITIONAL PRIORITIES.
FIRST WAS IN SILICO CLINICAL
TRIALS, THE FADS PLACED A LARGE
EMPHASIS ON -- FDA PLACED LARGE
MODELING AND SIMULATION IN
DEVICE APPROVAL PROCESS AN
CLINICAL TRIALS. THIS ONE IN
SILICO TRIALS OFFER INNOVATIVE
APPROACH TO EVALUATING
COMPARATIVE EFFICACY AND SAFETY,
MODELING AND SIMULATION USE TO
PREDICT PERFORMANCE, EXPLORE
ALTERNATIVE STUDY DESIGNS, NOVEL
EFFECTIVE THERAPEUTICS, SO THE
QUESTION HERE WAS CAN IN SILICO
CLINICAL TRIALS BE US YEW TO
IDENTIFY PATIENT SUB GROUPS MOST
LIKELY TO BENEFIT FROM RECESS
STATION STRATEGIES, GUIDE
INCLUSION AND EXCLUSION CRITERIA
FOR CLINICAL TRIALS AND IMPROVE
STATISTICAL POWER. THE OTHER
PRIORITY WAS CHANGING THE
PARADIGM OF AI ML, WE HAVE A TOP
DOWN APPROACH, WE FRAGMENT THE
PROBLEM TO SMALLER PROBLEMS,
REFORMULATING THAT BOTTOM OR
CONNECTIONIST APPROACH,
COMBINING SINGLE MODEL AND
SYSTEMS THAT BUILD UP TO FORM
MORE COMPLEX MODELS. SO JAMES
WORKED ON THIS PRIORITY FOR US,
A SYSTEMS BY BIOLOGY EXPERT, HOW
TO CREATE MULTI-MODAL AI THAT
LEVERAGES DATA USING SYSTEMS
BIOLOGY. TO INTEGRATE KNOWN
MECHANISTIC DATA AND MOLECULAR
DATA. HOW CAN THIS BE USED TO
INTEGRATE DOMAIN KNOWLEDGE OF
BIOCHEMICAL PATHWAYS AND IMPROVE
PREDICTIVE ANALYTICS. WHAT WE
USED WAS THE RICE SCORING
METHOD, USED IN
TELECOMMUNICATION, WE ADAPTED IT
SLIGHTLY BUT USES FOUR FACTORS
THE REACH, NUMBER OF INDIVIDUALS
PRIORITIES LIKELY TO EFFECT THE
IMPACT CONFIDENCE OF FEASIBILITY
ACCOMPLISHED AND EFFORT
NECESSARY TO IMPLEMENT PRIORITY.
WE MADE A SLIGHT MODIFICATION BY
SWEARING THE EFFORT TO GET
VALUES TO BE CLOSER TO VALUE OF
1. THIS ADDRESSES STRIP PLOT HOW
OUR WORKING GROUP MEMBERS RANKED
ALL THESE SEVEN PRIORITIES IN
ORDER THEY WERE PRESENTED TODAY
SO THE FIRST FIVE PRESENTED WERE
RANKED HIGHEST. LAST TWO ARE
CONSIDERING ADDITIONAL
PRIORITIES. SOME VARIABILITY,
TECHNICAL EXPERTS RANKED IN
SILICO CLINICAL TRIALS HIGHER
THAN OTHER PRIORITIES BUT IN THE
END WE CAME UP WITH A GOOD
OVERALL RANKING FOR THE SERVE
PRIORITIES. SO THIS HERE IS
ANOTHER SUMMARY, THESE ARE
OBVIOUSLY OPEN FOR
REPRIORITIZATION BASED ON
DISCUSSION MANY THE BREAK OUT
SESSION. WE WANT THE THANK OUR
11 WORKING GROUP MEMBERS, THEY
CRIBBED TO DISCUSSION AND
HELPING DRAFT PRIORITIES. WE
WELCOME DISCUSSION AND QUESTIONS
IN THE BREAK OUT SESSION. THANK
YOU.
>>
>> THANK YOU CLEAR RESEARCH
PRIORITIES WHICH ENCOMPASS THE
EXPERTISE OF YOUR WORKING GROUP
I NOW ARE HAVE THE PRIVILEGE OF
INTRODUCING DR. YVETTE MILLER
AND MEGHAN DELANEY, DONORS IN
TRANSFUSION MEDICINE. DR. -- IN
CHARLOTTE, NICK NICK SHE SERVED
IN MULTIPLE LEADER SHIP ROLES
FOR THE AMERICAN RED CROSS AND
AABB AND RECOGNIZED FOR HER LONG
STANDING COMMITMENT TO
ADDRESSING HEALTH DISPARITIES
AND STRUCTURAL RACISM AND BIAS
IN HEALTHCARE. DR. MEGHAN
DELANEY IS CHIEF DIVISION OF
PATHOLOGY, DIRECTOR OF
CHILDREN'S NATIONAL HOSPITAL AND
PEDIATRICS GEORGE WASHINGTON
UNIVERSITY. WELCOME TO BOTH.
>> GREAT. THANK YOU. SO MUCH.
AGAIN WE WANT TO -- WE WANT TO
THANK NHLBI FOR TAPPING US TO
TALK ABOUT THIS IMPORTANT TOPIC
ON DONOR BLOOD RECIPIENT HEALTH
DISPARITIES. THIS IS A SPECIAL
TIME AND SPECIAL PLACE TO BE TO
HAVE THIS DISCUSSION IN GENERAL
IN THE SCIENTIFIC LITERATURE,
AND SPECIFICALLY IN TRANSFUSION
MEDICINE, THERE HAS NOT BEEN
MUCH DISCUSSION AROUND HEALTH
DISPARITIES AND INHE CAN IS SO
WE UNDERSTAND THAT THIS IS AN
INCREDIBLE OPPORTUNITY TO BE
INNOVATED TO HAVE THIS
DISCUSSION. WE WANT TO THANK
NHLBI AND BRIAN FOR TAPPING US
AND INVITING US TO THIS SPACE.
NONE OF THIS COULD HAVE BEEN
DONE. WITHOUT THIS FANTASTIC
GROUP OF INDIVIDUALS THAT HELP
US THAT WORKED WITH US TO PUT
THIS INFORMATION TOGETHER.
MEGHAN AND I WERE DELIBERATE AN
INTENTIONAL AND FOCUSED ON
PUTTING A CROSS CULTURAL TEAM OF
VICTIMS THAT HE WANT ARED
DIFFERENT AREAS OF CERTAIN
DIVERSITY IN TERMS OF ETHNICITY
AND BACKGROUND BUT ALSO
EDUCATION AND EXPERIEN EXPERIENL
THESE INDIVIDUALS REPRESENT
EXCELLENCE IN THEIR FIELDS.
SO FIRST PRIORITY WAS REGARDING
INCLUSION AND RESEARCH. HOW CAN
DIVERSITY OF RESEARCH
PARTICIPANTS FOR EXAMPLE RACE
SOCIOECONOMIC STATUS AN
LANGUAGE, BE INCREASED FOR BOTH
BLOOD DONOR STUDIES AND STUDIES
OF PATIENTS. WHAT IS THE PROBLEM
WE ARE DESCRIBING? RACIALIZED
ECONOMICALLY DEPRIVED
COMMUNITIES HAVE POOR HEALTH
OUTCOMES. THIS IS SOMETHING WE
KNOW FROM THE LITERATURE, THE
PUBLIC HEALTH LITERATURE AS WELL
AS ASPECT FROM THE SCIENTIFIC
LITERATURE. DONORS DIVERSITY OF
THE DONOR POOL IS IMPORTANT FOR
SUFFICIENCY BUT ALSO RARE BLOODS
TYPES. STUDIES IN WHICH SUCH
COMMUNITIES ARE
UNDER-REPRESENTED, MAY IDENTIFY
EFFICACY OF RESEARCH IN MORE
ADVANCE MORE ADVANTAGED
COMMUNITIES BUT MISIDENTIFYING
EFFECTS IN COMMUNITIES MOST IN
NEED. STUDIES DIVERSE DONORS OR
POTENTIAL DONORS ARE
UNDER-REPRESENTED RESULT IN
RECRUITMENT STRATEGIES AND DONOR
CRITERIA THAT DON'T ADDRESS
RECOGNIZE IN THOSE SPECIFIC
COMMUNITIES. SO WHY AN ISSUE?
EXCLUSION OF MINORITIES RESULTS
IN UNEQUAL RESOURCE ALLOCATION
FOR TREATMENT OR DONOR
RECRUITMENT APPROACHES THAT
BENEFIT SOME MORE THAN OTHERS
AND LESS EFFORT BEING PUT INTO
THE ALLOCATION OF TREATMENT THAT
BENEFIT MORE DIVERSE GROUPS. ONE
OF THE ISSUES, FEW WORDS
ABOUTIUS OF TERM MINORITIES. IN
CONVERSATION WITH COMMUNITY
DIVERSE COMMUNITIES AND SOME
SPECIFIC INTERACTIONS HAVE BEEN
WITH THE SICKLE CELL DISEASE
COMMUNITY, AND COMMUNITIES THAT
ARE GREATER RISK FOR HAVING
SICKLE CELL DISEASE, THEY ARE
MOVING AWAY FROM SELF
IDENTIFYING AS MINORITY BECAUSE
WE KNOW THAT IN THE TERMS OF
POPULATION, IN THIS COUNTRY ARE
THE COUNTRY IS BECOMING MORE
DIVERSE AND WHEN THE NEXT 10 TO
15 YEARS THE WHITE POPULATION IN
THIS COUNTRY WILL NOT BE THE
DOMINANT CULTURE. SO WE ARE
ABSOLUTELY MOVING AWAY FROM
IDENTIFYING GROUPS, COMMUNITIES
OF COLOR, UNDER-REPRESENTED
COMMUNITIES, AS MINORITIES BUT
WE ARE GOING TO CONTINUE TO USE
THAT LANGUAGE IN THIS
PRESENTATION BECAUSE THAT IS THE
LANGUAGE MOST PEOPLE ARE USING
NONOW. BUT TRAJECTORY IS MOVE ON
FROM IDENTIFYING
UNDERREPRESENTED POPULATIONS AS
MINORITY. IN TERMS OF
FEASIBILITY AND BARRIERSK
SPECIFIC STUDIES ON DIVERSE
COMMUNITIES SHOULD BE FUNDED AND
SPECIFIC FUNDING ANNOUNCEMENTS
TO DEVELOP PROJECTS BY DIVERSE
RESEARCHERS. IF YOU DON'T KNOW
THESE RESEARCH PROJECTS AND
FUNDING IS AVAILABLING IT IS NOT
WIDELY PUNILY SIZED YOU DONE
KNOW -- PUBLICIZED YOU DON'T
KNOW IT IS AVAILABLE. MEMBERSHIP
OFTY VERSE RESEARCHERS INCLUDES
MENTORING FROM START TO FINISH
OF A PROJECTED, AND OPENNESS TO
DIFFERENT WAYS OF EXPRESSING
RESEARCH PLANS. SO WE
UNDERSTAND LOOKING AT THE
SCIENTIFIC LITERATURE IS
MONOLITHIC IN TERMS HOW ARTICLES
ARE WRITTEN SO SO BRINGING
DIVERSE COMMUNITIES IN, THERE'S
DIVERSITY OF THOUGHT AND
PRESENTATION SO WE NEED TO
RESPECT THAT. QUALITATIVE
APPROACHES AND INTERDISCIPLINARY
COLLABORATION SUPPORTED BECAUSE
THESE WILL ENHANCE INCLUSIVITY.
SODS ONE OF THE THINGS WE DO
WITH PRIORITIES IS THAT WE LIST
DISCUSSION QUESTIONS. WHILE WE
KNOW YOU WILL ABSOLUTELY BE
DROPPING THOUGHTS AND QUESTIONS
IN THE CHAT WE WANTED
CONVERSATIONS STARTERS. SO WHAT
PART DOES MISTRUST PLAY IN THE
INABILITY TO RECRUIT RESEARCH
PARTICIPANTS FOR
UNDER-REPRESENTED COMMUNITIES.
WHAT TRUST BUILDING TECHNIQUES
EMPLOYED AND DOES TRUTH
RECONCILIATION MODEL HAVE A
PLACE? USING CRISPER TECHNOLOGY
AS AN EXAMPLE, SCIENTISTS
EMPLOYING THESE TECHNIQUES MAY
HAVE CONTACT WITH INDIVIDUALS
THAT MAYBE RESEARCH SUBJECTS AND
ULTIMATELY THE PATIENTS THAT
WILL BE TREAT WITH THIS
TECHNIQUE. IS THIS EXERTING
UNDUE INFLUENCE ON PATIENT?
AND HOW CAN THE CONFLICT OF
INTEREST BE ADDRESSED? PRIORITY
2, ACCESS TO CARE. ACCESS TO
APPROPRIATE TRANSFUSION CARE CAN
BE LIMITED BY CHURL NORMS,
FINANCIAL AND GEOGRAPHICAL
BARRIERS. HOW CAN THESE
BARRIERS BE OVERCOME? WHAT IS
THE PROBLEM GEOGRAPHY PLAYS A
NEGATIVE ROLE IN ACCESS TO CARE
FOR PEOPLE WITH SICKLE CELL
DISEASE AND OTHERS WHO NEED
TRANSFUSION IN EMERGENCY SESSION
SITUATIONS. IN 2010, 55% OF
BLACK AMERICANS LIVED IN SOUTH
AND 105 SOUTHERN COUNTIES HAD A
BLACK POPULATION OF 50% OR
GREATER. WHILE IN GENERAL,
COMMUNITIES WITH HIGHER
PERCENTAGES OF INDIVIDUALS FROM
UNDER-REPRESENTED UNDERRESOURCED
COMMUNITIES WHAT WE DO KNOW IS
THEY HAVE DECREASE ACCESS TO
CARE. AND RURAL HEALTHCARE HAS
TRADITIONALLY LAGGED BEHIND THAT
IN URBAN AREAS. SO THE PICTURE
CHANGED DRAMATICALLY OVER THE
PAST DECADE, DUE TO
TRANSFORMATION OF FINANCING,
INTRODUCTION OF TECHNOLOGIES AND
CLUSTERING OF HEALTHCARE
SERVICES AND RESOURCES TO
SYSTEMS AND NETWORKS OFTEN
PRIMARILY SITUATED IN URBAN
CENTERS. DESPITE CHANGES, RURAL
RESOURCES FOR RURAL HEALTH
SYSTEMS REMAIN RELATIVELY
INSUFFICIENT. AND UNCHANGED.
RURAL COMMUNITIES CONTINUE TO
EXPERIENCE SHORTAGES OF
PHYSICIANS AND HEALTHCARE
PROVIDERS IN GENERAL. AND
PROPORTION OF RURAL HOSPITALS
UNDER FINANCIAL STRESS AND
STRAIN IS MUCH GREATER THAN THAT
URBAN HOSPITALS. FOR PEOPLE
WITH SICKLE CELL DISEASE LIVING
IN RURAL AREAS, THERE ARE
CHALLENGES, GREATLY AMPLIFIED
UTILIZATION OF RESOURCES AND
SERVICES IS DIRECTLY RELATED TO
SOCIAL ECONOMIC CONDITIONS, THAT
PATIENTS FACE IN TERMS OF
DISTANCE TO CLINICAL SUPPORT. SO
WHY IS THIS AN ISSUE? HEALTH
OUTCOMES AS WE KNOW ARE DIRECTLY
IMPACTED BY ACCESS TO CARE
INCLUDING INDIVIDUALS WITH
SICKLE CELL DISEASE. WHEN
CONSIDERING ACCESS THE CARE AND
TRANSFUSION MEDICINE,
INDIVIDUALS WHO LIVE IN RURAL OR
REMOTE OR LIMITED HOSPITAL
LOCATIONS, HAVE DECREASE ACCESS
TO PATIENT AND EMERGENCY
TRANSFUSIONS SUCH AS
OBSTETRICAL, EMERGENCY
TRANSFUSIONS AND TRANSFUSIONS TO
SUPPORT CHRONIC ILLNESS. IT IS
IMPORTANT TO LOWER THESE ACCESS
BARRIERS FOR TRANSFUSION THERAPY
AS THIS COULD BE THE DIFFERENCE
BETWEEN LIFE AND DEATH FOR
POPULATIONS. PATIENTS MUST
RECEIVE APPROPRIATE CARE WHEN
NECESSARY, FOR EXAMPLE, ADEQUATE
TRANSFUSION PHENOTYPICALLY RED
BLOOD CELLS AN OUTPATIENT RED
CELL EXCHANGESES END IT DAD AND
AS NEEDED. -- EXCHANGES AS
NEEDED. WHAT IS THE PROPOSED
APPROACH? RESEARCH FOCUSED ON
COMPARISON OF U.S. STATE LEVEL
PROGRAMS TO TREAT FOR TREATMENT
OF SICKLE CELL DISEASE AND OTHER
HEMOGLOBINOPATHIES AND COSTS
REIMBURSEMENT, MORBIDITY AND
MORAL. WHAT ARE THE --
MORTALITY. WHAT ARE THE BARRIERS
IN? PROPOSED STUDIES IDEAS WOULD
BE FEASIBLE THOUGH DEFINITELY
REQUIRE USING PUBLIC DATABASES
IN CONJUNCTION WITH COST OF
COLLECTION NEEDED TO FILL THE
GAPS. NEXT SLIDE. DISCUSSION
QUESTIONS, MEDICAID EXPANSION
MAYBE PART OF THE EQUATION
INCREASING ACCESS TO HEALTHCARE
IN URBAN AREAS AND RURAL AREAS.
WHAT ARE THE PROS AN CONS TO
THIS EXPANSION? OVER THE LAST
SEVEN OR EIGHT YEARS, BECAME
PART OF THE LARGER CONVERSATION
WHEN THE AFFORDSABLE CARE ACT
EUPHEMISTICALLY KNOWN AS THE
OBAMA CARE I GUESS, MEDICAID
EXPANSION BECAME A HUGE ISSUE WE
ARE STILL TALKING NOW BECAUSE
SOME STATES HAVE NOT EXPANDED
MEDICARE. THEN THE NEXT
DISCUSSION QUESTION IS, CAN
NON-PHYSICIAN HEALTHCARE
PROVIDERS FILL THE PHYSICIAN
GAP. PRIORITY 3 IS ACCESS TO
DONATE. WHAT ARE EFFECTIVE
STRATEGIES FOR OVERCOMING
BARRIERS TO BLOOD DONATION
EXPERIENCED BY MINORITY
POPULATIONS? DESCRIPTION OF THE
PROBLEM IS THAT A DECLINING
BLOOD DONOR POPULATION
EXACERBATES THE DISPARITIES
OBSERVED IN THE
UNDERREPRESENTATION OF MINORITY
DOE NO, SIR. SO WHILE STUDIES
HAVE SOUGHT TO UNDERSTAND THE
MOTIVATIONS BEHIND NON-DONOR
BEHAVIOR, FEWER STUDIES FOCUS ON
THE BARRIERS TO DONATION. ONE OF
THE THINGS THAT IS COMMONLY SEEN
IN THE LITERATURE AROUND LACK OF
INVOLVEMENT OF COMMUNITIES OF
COLOR AND DIVERSE COMMUNITIES
BLOOD DONATION, THE BLAME IS
USUALLY PUT ON THE COMMUNITY. SO
THAT IS PART OF THE LITERATURE,
PART OF WHY PEOPLE DON'T DONATE
BLOOD IS THEY HAVE NEVER BEEN
ASKED IN WAY CONSISTENT WITH
THEIR CULTURE OR WITH THE WAY
THEY FEEL LIKE THEY NEED TO BE
ASKED SO WE NEED TO REALLY TAKE
A LOOK AT THAT. MINORITIES ARE
UNDER-REPRESENTED, IN THE DONOR
POPULATION, DUE IN PART O TO
EDUCATIONAL BARRIERS, LACK OF
ACCESS TO BLOOD DRIVES
PHYSIOLOGIC BARRIERS AN LACK OF
ENGAGEMENT DUE TO PERCEPTIONS OF
CULTURAL RELEVANCE. SO WHY AN
ISSUE IN THE DONOR CRITERIA
CREATE A BARRIER DUE TO
PHYSIOLOGICAL CHARACTERISTICS
INCLUDING LOWER HEMOGLOBIN
LEVELS AND HYPERTENSION. IN
TERMS OF COMMUNITIES OF COLOR,
HYPERTENSION CERTAINLY IS AT
GREATER HIGH RISK OF
HYPERTENSION AN SPECIFICALLY IN
TERMS OF AFRICAN AMERICANS, OUR
HEMOGLOBIN LEVELS AREN'T ON THE
NORMAL LOWER END OF THE
HEMOGLOBIN FRAMEWORK. ONE OF THE
OTHER ISSUES THAT CERTAINLY HAS
TO BE ADDRESSED IS THAT LOOK ACT
THE REFERENCE RANGES, IN GENERAL
REFERENCE RANGES WE HAVE FOR I
WOULD SAY MOST TESTS, PARAMETERS
IS BASED ON A MONOLITHIC WHITE
POPULATION, SO TO BE ABLE TO
RECTIFY THAT WE NEED TO REDO
THOSE RANKS TO INCLUDE ALL
POPULATIONS AND NORMALIZE THE
PHYSIOLOGIC -- PHYSIOLOGY OF ALL
POPULATIONS. SO INDIVIDUALS
WITHIN THIS COMMUNITY ARE MORE
LIKELY TO HAVE RARE BLOOD TYPES
OR BE -- HAVE RARE BLOOD GROUPS
AS WELL, IN RARE BLOOD GROUPS AS
WELL WHICH ARE DESIRED AND
HELPFUL TO CLINICAL SUPPORT OF
COMMUNITY MEMBERS AS PATIENTS
WHO NEEDS BLOOD TRANSFUSION. SO
WHAT ARE THE PROPOSED
APPROACHES? A SYSTEMIC APPROACH
TO UNDERSTANDING AND MITIGATING
EDUCATIONAL, CULTURAL,
PHYSIOLOGICAL AND ACCESS RELATED
BARRIERS TO DONATION CAN BE
ADDRESSED IN SINGLE OR MORE --
MULTI-CENTER FORMAT. IN
PARTNERSHIP WITH BLOOD CENTERS
ALSO IN PARTNERSHIP WITH
ORGANIZATIONS, FOCUS ON
COMMUNITY OF INDIVIDUALS, THE
BROAD COMMUNITY, MULTI-ETHNIC
COMMUNITY OF INDIVIDUALS WITH
HIGHER RATES OF SICKLE CELL
DISEASE AS WELL AS OTHER
HEMOGLOBINOPATHIES WE LOOK AT TO
THE CDC, SICKLE CELL DISEASE
ASSOCIATION OF AMERICA SO WITH
OUR COMBINED EFFORTS AND
ACTIVITIES, CAN BE DESIGNED TO
IMPROVE EDUCATION,
COMMUNICATION, PERCEIVED
CULTURAL RELEVANCE AND ACCESS
ISSUES COULD BE DEVELOPED TO
DEEPEN ENGAGEMENT WITHIN THESE
COMMUNITIES AS WELL AS HAVE A
CONSISTENT LITERATURE THAT CAN
BE USED BY ANYONE TO INTERFACE
AND INTERACT WITH THESE DIVERSE
COMMUNITIES. PRE AND POST
INTERVENTION METRICS INCLUDES
THE NUMBER OF PRESENTING NEW OR
FIRST TIME DONORS, THE RETURN
RATE WITHIN ONE YEAR OF
SUCCESSFUL DONORS, THE NUMBER OF
SPONSORS WITHIN THE COMMUNITY,
AND LOOKING AT THE RETURN RATE
OF DEFERRED DONORS. IN TERMS OF
NEW SPONSORS, BECAUSE BLOOD
COLLECTION ORGANIZATIONS RARELY
HAVE INTERNALLY WE ARE ALL
CERTAINLY GETTING BETTER. HAVE
STAFF THAT REFLECT COMMUNITIES
THAT WE ARE TRYING TO INTERFACE
WITH, OUR PARTNERS BECOME
IMPORTANT BECAUSE OUR PARTNERS
ARE THE ONES THAT BRING US ALONG
WITH THEM INTO THE COMMUNITY.
PHYSIOLOGICAL BARRIERS APPLY
MOST STRONGLY AGAIN TO AFRICAN
AMERICAN DONORS ADDRESSING
WHETHER THE MINIMUM HEMOGLOBIN
CUTS OFFS ARE APPROPRIATE, FOR
POPULATION WHOSE AVERAGE LEVELS
AND DISTRIBUTIONS ARE CLEARLY
DISTINCT FROM AND LOWER THAN
POPULATIONS NOT OF AFRICAN
ANCESTRY. OPERATIONAL METRICS
INCLUDE DEFERRAL RATES AND
RECOVERY OF HEMOGLOBIN AND
FERRITIN BETWEEN DONATION
VISITS. SO WHAT IS THE
FEASIBILITY BARRIERS? STUDIES TO
ADDRESS THE FOREGOING BARRIERS
TO DONATION CAN BE CONDUCTED
CERTAINLY WITHIN THE NEXT THREE
TO TEN YEAR TIME FRAME, THOUGH
STUDY OF PHYSIOLOGIC BARRIERS TO
DONATION WOULD BE OPTIMALLY
STUDIED FROM THE OTHER IDENTIFY
BARRIERS. THESE STUDIES INFORM
WHETHER DONOR CRITERIA BENEFIT
FOR MODIFICATIONS. ONE GREAT
THING THAT HAPPENED THIS YEAR IN
MAY OF 2022, DRAFT GUIDANCE WAS
ISSUED BY THE FDA TO THE
INDUSTRY, TO LOOK AT BLOOD
PRESSURE AND PULSE ELIGIBILITY
REQUIREMENTS AND GIVE BLOOD
COLLECTION RELATED TO ASSESSMENT
OF THESE PARAMETERS. DISCUSSION
QUESTIONS WILL RISK-BASED
ELIGIBILITY QUESTIONS UP CREASE
ACCESS TO DONATION. AND THE
OPERATING MARGINS FOR BLOOD
CENTERS, IS SMALL. HOW DOES
INDUSTRY FUND NECESSARY
RESEARCH. SO PRIORITY 4, ADVERSE
EVANS. WHAT ARE EFFECTIVE
MEASURES TO LOWER THE RATE OF
ADVERSE EVENTS FROM PRODUCT
TRANSFUSION, BLOOD PRODUCT
TRANSFUSION AS WELL AS PREVENT
FURTHER DEVELOPMENT OF ADVERSE
EVANS IN PATIENTS OF MINORITY
DIVERSE BACKGROUNDS. ONE OF THE
THINGS WE HAVE SEEN WITH THE
2020 CENSUS IS THAT OUR
POPULATIONS BECOMING MORE
DIVERSE THAN EVER. THE
POPULATION, SEGMENT OF
POPULATION THAT HAD HIGHEST
PERCENTAGE GROWTH WERE THOSE
INDIVIDUALS THAT SELF-IDENTIFIED
AS MIXED RACE. SO WE CERTAINLY
KNOW THAT WE HAVE TO PAY
ATTENTION TO THIS. IN TERMS OF
DIVERSE BACKGROUNDS. THE
DESCRIPTION OF PROBLEM IS
PATIENTS FROM DIVERSE
BACKGROUNDS EXPERIENCE HIGHER
RATE OF TRANSFUSION RELATED
ADVERSE EVENTS, IN PART TO
GENETIC DIFFERENCES AND RED
CELLS PLATELET AND HLA ANTIGENS
ADVERSE EVENTS INCLUDES ALLO
IMMUNIZATION, DTHTR, AND CELL
ENGRAPHMENT WHICH LED TO
SIGNIFICANT MORTALITY AND
MORBIDITY AND MAY PRECLUDE LIFE
SAVING INTERVENTIONS. SEW WHY IS
THIS AN ISSUE? PATIENTS OF
AFRICAN DESCENT LIVING MANY THE
UNITED STATES HAVE HIGHER RATE
OF RED CELL ALLO
SENTENCETYIZATION TRANSFUSED
FROM A DONOR POPULATION
PRIMARILY CAUCASIAN DESCENT.
PATIENTS WITH SICKLE CELL
DISEASE ARE DISPROPORTIONATELY
AFFECTED BY ALLO IMMUNIZATION
AND DHCRs, THOUGH LESS WELL
DOCUMENTED THIS SIMILARLY
AFFECTS HISPANIC POPULATIONS.
ALLO IMMUNIZATION AND DTHRs
ARE FUTURE SAFE BLOOD
TRANSFUSIONS PROPHYLACTIC RED
CELL ANTIGEN IS RECOMMENDED TO
REDUCE RISK BUT GENETIC MATCHING
MAYBE REQUIRED TO MITIGATE THE
RISK SUBSTANTIALLY. ALLO
SENSITIZATION MAYBE PREVENTED
WHEN HIGHER LEVELS OF MATCH
BLOOD REQUIRES FURTHER STUDY. WE
KNOW THAT THERE ARE LOTS OF
APPROACHES TO THIS ALLO
SENSITIZATION ISSUE, SOME
CLINICIANS, PHENOTYPE THE
PATIENT RIGHT UP FRONT BEFORE
FIRST TRANSFUSION IF POSSIBLE.
THEN THE OTHER APPROACHES, WAIT
AND SEE IF THIS PATIENT BECOMES
ALLO IMMUNIZED AND WE WILL DEAL
WITH IT AFTER THE FACT. SO
STRATEGIES TO MANAGE PATIENTS
ARE NOT WELL STUDIED. SO WHAT
IS THE PROPOSED APPROACH? FIRST
PREVENTION. STUDY PROSPECTIVE
MATCHING FOR PATIENTS RECEIVING
CHRONIC TRANSFUSION USING
ADVANCE TECHNOLOGY AN MATCHING
ALGORITHMS. DIVERSE ADD MIXED
BACKGROUNDS, THAT POPULATION
GROWING, MORE PRECISE MATCHING
FURTHER REDUCE RISK OF ALLO
ANTIBODY FORMATI FORMATION. USEF
GENOMICS IN MEDICINE EXPANDS AND
EVER EXPANDING AREA, FOR TRANTAS
FUSION MEDICINE RED CELL
PLATELETS AND HLA GENOTYPING
PROVIDES AN AL TERM TEAR GNAT OR
HL -- ALTERNATE OR HL ASSAY TO
IMPROVE MATCHING OF DONORS AND
RECIPIENTS. IN TERMS OF
OUTCOMES, MEASURE ALLO
IMMUNIZATION AND DHTR RATES,
TRANSFUSION DELAYS DUE TO
DIFFICULTY IDENTIFYING
COMPATIBLE BLOOD AND WHETHER HLA
IMMUNIZATION IMPACTS THE
ELIGIBILITY FOR CURATIVE STEM
CELL TRANSPLANT AND GENE
THERAPY. FURTHER PREVENTION, FOR
THOSE ALLO IMMUNIZED HIGH RISK
OF FURTHER ALLO IMMUNIZATION
FEASIBLE STUDIES MANAGEMENT MAY
INCLUDE INTENSIFIED MATCHING,
PROPHYLACTIC SUPPRESSION FROM
FUTURE TRANSFUSION AND USE OF
ANTI-COMPLIMENT OR OTHER AGENT
TO HALT HEMOLYSIS DURING DHTR.
SO IN TERMS OF FEASIBILITY AND
BARRIERS, SYSTEMIC APPROACH TO
STUDY PROPHYLACTIC RH AN
EXTENDED RED CELL ANTIGEN
MATCHING BY GENOTYPE SICKLE CELL
DISEASE WOULD BE FEASIBLE IN THE
NEXT TEN YEARS. WITH SINGLE OR
MULTI-INSTITUTIONAL STUDY DESIGN
TO DEMONSTRATE CLINICAL IMPACT,
AS PERFORM PREVIOUSLY IN OTHER
PATIENT POPULATION. THIS
REQUIRES COLLABORATION BETWEEN
TRANSFUSION SERVICES AND BLOOD
DONOR CENTERS. NEW SEQUENCING
TOOLS ARE CONSTANTLY EMERGING AS
STUDIES AT NOVEL METHODS OF RED
BLOOD CELL ANTIGEN GENOTYPING
ARE FEASIBLE. SO DISCUSSION
QUESTIONS. HOW CAN ADDRESSING
HEALTH DISPARITIES AND HEALTH
INEQUITIES IN UNDER-REPRESENTED
RECIPIENT POPULATIONS DECREASE
RECIPIENT ADVERSE REACTIONS? AND
HOW CAN THE CHANGE IN ADVERSE
REACTION RATES BE QUANTIFIED?
SO THE FIFTH PRIORITY STRUCTURAL
BARRIERS. WHAT ARE THE
STRUCTURAL SOCIETAL ELEMENTS
THAT IMPACT ACCESS TO
TRANSFUSION ME SIN THERAPIES?
AND HOW CAN THESE BARRIERS BE
OVERCOME TO ACHIEVE EQUITABLE
HEALTHCARE? SO IN TERMS OF
DESCRIPTION OF THE PROBLEM,
ACCESS TO HEALTH INSURANCE,
CONSTRAINTS OF HEALTH INSURANCE
POLICIES CAN PREVENT ACCESS TO
TRANSFUSION MEDICINE CARE
THERAPY, THERAPY AND
DIAGNOSTICS. FOR INSTANCE THERE
IS A HIGHER MATERNAL MORTALITY
AMONG AFRICAN AMERICAN WOMEN,
HOWEVER, THE ROLE TRANSFUSION
MEDICINE PLAYS IS NOT WELL
UNDERSTOOD. IN ADDITION, THE
IMPACT OF RACIAL CULTURAL
LINGUISTIC INCONGRUENCE WEAN
PATIENTS AND DONORS AND THE
TRANSFUSION MEDICINE WORK FORCE
REQUIRES EXAMINATION ALONG WITH
THE STUDY OF STRUCTURAL FACTORS
THAT SUSTAIN IT. SO WHY IS THIS
AN ISSUE? THE LINK BETWEEN
HEALTHCARE DISPARITIES, AND
STRUCTURAL FACTORS WITHIN
INSTITUTIONS, ORGANIZATIONS,
PROCESSES IN OUR SOCIETY, IS
ESTABLISHED THROUGHOUT THE
LITERATURE. MOSTLY IN THE PUBLIC
HEALTH LITERATURE BECAUSE THE
SCIENTIFIC LITERATURE UNTIL THE
LAST TWO OR THREE YEARS SINCE WE
HAVE BEEN IN THIS COUNTRY WE
HAVE BEEN IN THIS CONVERSATION
ABOUT SOCIAL CHANGES AND SOCIAL
INJUSTICE AND HEALTH DISPARITIES
AND HEALTH INEQUITIES THERE'S A
DERTH OF LITERATURE IN THIS
SPACE BUT LOOK AT THE LAST TWO
YEARS TREMENDOUS AMOUNT OF
CONVERSATION AROUND HEALTH
DISPARITIES. HEALTH DISPARITIES
AMONG RACIALIZED GROUPS HAVE
BEEN DOCUMENTED CONSISTENTLY
MANY THE U.S. FOR MANY DECADES.
REGRETTABLY THERE IS SCARCITY OF
LITERATURE ADDRESSING STRUCTURAL
BARRIERS INCLUDING STRUCTURAL
RACISM WITHIN TRANSFUSION
MEDICINE FIELD. DEFINE QUANTIFY
THESE STRUCTURAL BARRIERS
FOLLOWED BY THE DESIGN AND
IMPLEMENTATION OF INTERVENTION
STRATEGIES IS IMPERATIVE TO
ACHIEVE TRUE HEALTH EQUITY.
SO WHAT IS THE PROPOSED
APPROACH? MULTI-CENTER AND
MULTI-DISCIPLINARY COLLABORATION
AS WELL AS PUBLIC PRIVATE
PARTNERSHIPS, INCLUDING HEALTH
INSURANCE COMPANIES AN
GOVERNMENT INSURANCE
STAKEHOLDERS WITH COMMUNITY AS
VISERY BOARDS ARE ABSOLUTELY IN
COVERAGE. OBJECTIVE
IDENTIFICATION OF STRUCTURAL
BARRIERS, SHOULD BE FOLLOWED
CLOSELY BY IMPLEMENTATION OF
RESEARCH TO EVALUATE POSSIBLE
INTERVENTIONS AND CORRECTED
ACTIONS SHOULD BE IMPLEMENTED
WITHOUT DELAY. FACTORS THAT
MERIT INVESTIGATION INCLUDE
CHARACTERIZATION, CHARACTERIZING
THE VARIATION AND ACCESS AND
QUALITY IN TERMS OF TRANSFUSION
CARE BY RACE, ETHNICITY, GENDER
IDENTITY, GEOGRAPHIC RESIDENCE,
SOCIOECONOMIC STRATA AS WELL AS
OTHER DEMOGRAPHIC ATTRIBUTES. IN
TERMS OF FEASIBILITY AND
BARRIERS, RESEARCH PRIORITIES
REPRESENT IMPORTANT WORK THAT
BUILDS UPON ITSELF AND CONTINUE
TO STRONG CORRECT TESTIFY
MEASURES DEMONSTRATED OR ARE
FIRMLY IN PLACE. IT CANNOT BE
UNDERESTIMATED HOW IMPORTANT
COMMUNITY BASED PARTICIPATORY
RESEARCH IS, IN TERMS OF USEFUL
TOOL, THAT IS BEING USED TO
IDENTIFY SOCIAL, STRUCTURAL AND
ENVIRONMENTAL BARRIERS AND
IDENTIFY SOLUTIONS. CHANGES TO
HEALTH POLICY REIMBURSEMENT TO
ENSURE HEALTH EQUITY AND
TRANSFUSION MEDICINE WILL BE
NECESSARY. SO THE DISCUSSION
QUESTIONS ARE ACKNOWLEDGING
STRUCTURAL NATURE OF RACISM AND
BIAS IN HEALTHCARE IS THE
INITIAL STEP IN DETERMINING
SOLUTIONS. HOW IS THIS
ACCOMPLISHED ON NATIONAL BASIS?
WHERE WOULD ACCOUNTABILITY FOR
EXECUTION REST? HEALTHCARE IS A
FACET OF SOCIAL DETERMINANTS OF
HEALTH WHICH AFFECT HOW
INDIVIDUALS AN COMMUNITIES
ACHIEVE FULL HEALTH AND WELL
BEING. ARE COMMUNITY BASED
MODELS THAT CAN BE SCALED TO BE
USED IN VARIOUS COMMUNITIES.
FINAL SLIDE RESTATING OUR
PRIORITIES. AND AGAIN NOT ANY
PARTICULAR ORDER, HOW CAN
DIVERSITY RESEARCH PARTICIPANTS
BE INCREASED FOR BOTH BLOOD
DONOR STUDIES AND CLINICAL
STUDIES. ACCESS TO APPROPRIATE
TRANSFUSION CAN BE LIMITED BY
CULTURAL NORMS, FINANCIAL AND
GEOGRAPHICAL BARRIERS HOW CAN
BARRIERS BE OVERCOME.
WHAT ARE THE EFFECTIVE
STRATEGIES FOR OVERCOMING
BARRIERS TO BLOOD DONATION
EXPERIENCED BY MINORITY
POPULATIONS. WHAT ARE EFFECTIVE
MEASURES TO LOWER THE RATE OF
ADVERSE EVENTS FROM BLOOD
PRODUCT TRANSFUSION, AS WELL AS
PREVENTS FURTHER DEVELOPMENT OF
ADVERSE EVENTS IN PATIENTS WITH
MINORITY DIVERSE BACKGROUNDS AND
WHAT ARE THE STRUCTURAL SOCIETAL
ELEMENTS THAT IMPACT ACCESS TO
TRANSFUSION MEDICINE THERAPY AND
HOW BARRIERS OVERCOME TO ACHIEVE
EQUITABLE HEALTHCARE. SO THANK
YOU SO MUCH FOR YOUR ATTENTION.
CONTINUE TO DROP YOUR THOUGHTS
AND QUESTIONS IN TO THE CHAT.
AGAIN, THANK YOU FOR OUR ENTIRE
GROUP AND CO-CHAIR DR. MEGHAN
DELANEY.
>> THANK YOU VERY MUCH, YVETTE.
WONDERFUL PRESENTATION. WE
COMPLETED THE PRESENTATIONS OF
THE WORKING GROUP CO-CHAIRS FOR
THE GENERAL SESSION AND WE ARE
IN OUR LUNCH BREAK NOW. PLEASE
RETURN, HALF AN HOUR LUNCH
BREAK. WE WILL RETURN, HEAR SAYS
12:30, BUT A LITTLE EARLIER IF
YOU LIKE DIRECTION IN FINDING
THE BREAK OUT SESSION LINK ON
THE ZOOM CHAT BAR. THANK YOU.
>>I WANT TO WELCOME EVERYBODY
BACK FROM THE BREAK. THE NEXT
PAR OF OUR AGENDA IS RECAP OF
THE BREAK OUT SESSIONS THAT THE
CO-CHAIRS HAVE THE UNENVIABLE --
>> IF I MAY INTERRUPT. I THINK
WE ARE STILL WAITING FOR SOME
PEOPLE AT THE BREAK OUTS. JUST
20 SECONDS.
>> WELCOME BACK, EVERYONE. LOOKS
LIKE MAJORITY OF HAD A CHANCE TO
REJOIN THE SESSION. NEXT PART OF
OUR AGENDA IS FOR EACH OF THE
WORKING GROUP CO-CHAIRS TO
SUMMARIZE IN RAPID FASHION
DISCUSSION OF THE BREAK OUT
SESSION OVER THE LAST HOUR.
FIRST TO DO SO IS ELDAD AND
ANGELO.
>> WE HAVE A LOT OF TIME TO
PREPARE FOR THIS BUT WE WILL DO
THE BEST WE CAN AS WE HAD LIVELY
DISCUSSION FOR AN HOUR WITH A
WONDERFUL GROUP OF PEOPLE WHO
SHARED THEIR THOUGHTS REGARDING
PRIORITIES. SO I FEEL LIKE WE
SPENT A LOT OF TIME DISCUSSING
THE STORAGE LESION AND THE
CLINICAL TRIALS SURROUNDING THE
CLINICAL IMPACT OF THE STORAGE
LESION. WHAT I GOT FROM THE --
WHAT WE THINK WE GOT FROM THE
DISCUSSION IS THAT CLEARLY MORE
RESEARCH IS NEEDED AND THAT MORE
SYSTEMATIC APPROACH GOING FROM
THE BENCH BACK O THE -- FROM THE
BENCH TO BEDSIDE AND BACK AGAIN
IS STILL NEEDED. WE ARE PROBABLY
NOT GOING TO REPEAT THE CLINICAL
TRIALS THAT HAVE ALREADY DONE
SURROUNDING THE AGE OF BLOOD BUT
WE STILL NEED TO FIND, LOOK FOR
ADDITIONAL RECIPIENT POPULATIONS
OR ADDITIONAL BIOMARKERS
CAPTURED METABOLIC AGE OF THE
OPPOSED TO THE CHRONOLOGICAL AGE
USED TO RANDOMIZE ON AND SO
THERE'S STILL ADDITIONAL WORK
FROM PRE-CLINICAL STAGE THAT
NEEDS TO GET DONE TO THEN FUTURE
TAKE IT TO THE THE CLINICAL
TRIALS. THERE WAS SOME MENTION
MORE RIGOROUS VALIDATION OF
BIOMARKERS NEEDS TO BE DONE AND
WE HEARD THERE ARE SOME
AVAILABLE BIOMARKERS AND TOOLS
THAT EXIST THAT WE MIGHT BE
UNDERUTILIZING AND THOSE COULD
BE UTILIZED MORE SUCH AS NEERS
AND OTHER PUBLIC THINGS. WHAT
ELSE? THERE WAS ALSO SOME TALK
ABOUT AND THIS MAYBE OVERLAPS
WITH ONE OF THE SESSIONS FROM
YESTERDAY BUT DIFFERENT CLINICAL
TRIAL DESIGNS THAT MAY ALLOW US
TO LOOK AT BIOMARKERS AND IMPACT
SUCH AS ADAPTIVE TRIAL DESIGNS
AND THINGS LIKE THAT. ANOTHER
AREA IS ADDITIONAL RECIPIENT
FACTORS THAT WE SHOULD TAKE INTO
ACCOUNT SUCH AS RECIPIENT ANEMIA
OR RECIPIENT INFLAMMATION THAT
MAY IMPACT OUTCOMES OF PLATELET
OR RED CELL TRANSFUGS AND THOSE
SHOULD BE INCORPORATED TO
PRIORITIES SO WE ADHERE THAT.
CERTAINLY THE INTERACTION WITH
VARIOUS THINGS WE DO IN BLOOD
BANK OR CENTER LIKE IRRADIATION
AND THINGS LIKE THAT AND IMPACT
OF THOSE MODIFICATIONS AND HOW
THEY IMPACT RECIPIENT. WE ALSO
HAD A LITTLE DISCUSSION AROUND
ARE THERE -- NOW -- AT LEAST FOR
COLD STORED PLATELETS, WE KNOW
MECHANISM OF CLEARANCE AND THERE
ARE DRUGS AVAILABLE THAT CAN
BLOCK THOSE SHOULD WE DO MORE
STUDIES TO LOOK AT THERAPEUTIC
INTERVENTIONS THAT COULD PREVENT
CLEARANCE OF PLATELETS OR IF WE
UNDERSTOOD THE MECHANISM OF RED
CELL CLEARANCE BETTER CAN WE
DESIGN DRUGS THAT WOULD PREVENT
THAT AS WELL. SO WE HEARD THAT
AS WELL. AND TRY TO INCORPORATE
THAT INTO PRIORITIES. FINAL
THING I HAD IN MY NOTES WAS
RELATING TO LONGER TERM
STUDIESs ESPECIALLY NEONATES
AND TRANSFUSIONS, INTERUTERINE
TRANSFUGS DURING PREGNANCY AND
WE DON'T KNOW WHAT THE LONGER
TERM IMMUNOLOGIC OR OTHER
CLINICAL OUTCOMES ARE OF THESE
TRANSFUSIONS ESPECIALLY IN YOUNG
AND CLEARLY YOU NEED LONGER --
AS WE HAD IN PRIORITY WE NEED
LONGER TERM STUDIES TO FOLLOW-UP
ADVERSE CONSEQUENCES ESPECIALLY
IN THE YOUNGER POPULATIONS SO
THERE WAS GOOD DISCUSSION AROUND
THAT. I KNOW WE WERE SUPPOSED TO
-- WE HAD UP TO 20 MINUTES BUT
TOLD WE DIDN'T HAVE TO USE THE
FULL 20 MINUTES BUT ANGELO IF
YOU HAD ADDITIONAL THINGS TO
ADD.
>> TWO ADDITIONAL POINTS, AS
SOMEBODY WITH NO TIME PRETTY
MUCMUCH. THE ONLY TWO OTHER THIS
I HAVE ARE COMMENTS THAT CAME
DURING THE PRESENTATION THAT
PERTAIN TO OPPORTUNITY TO SELECT
DONORS BASED ON FOR EXAMPLE
KNOWING WHETHER CASE DONORS
PARTICULARLY IF (INAUDIBLE)
WHETHER WE KNOW THEY ARE GOING
TO STORE POORLY, WHETHER WE CAN
IDENTIFY PERSONALIZE THE
APPROACH AND DONORS BE COLD
STORE, ROOM TEMPERATURE AND USE
PLATELETS DEPENDING ON
ACTIVATION PROFILES FOR SPECIFIC
INDICATIONS. THIS COMMENT
WITHIN THE FRAMEWORK OF
POTENTIAL APPLICATION OF MORE
LIKE PERMIZED APPROACHES --
PERSONALIZED APPROACHES THAT
TOOK INTO ACCOUNT THE PHENOTYPES
AND THE NEEDS. THAT'S THE AMOUNT
I HAVE IN TERMS OF NOTES, AND I
SEE THERE IS A HAN HAND RAISED
>> STEVE I DON'T KNOW IF YOU
MEANT TO HAVE YOUR HAND RAISED.
>> I WANT TO ASK A QUESTION TO
ELDAD. IS YOUR GROUP ADVOCATING
NEW CLINICAL TRIALS ON RED CELL
TRANTAS FUSION THRESHOLDS NOW?
OR ARE YOU SAYING WE NEED BETTER
TOOLS TO DETERMINE THE METABOLIC
AGE OF RED CELLS AND ONCE WE DO
THAT THEN MAYBE CLINICAL TRIALS
COULD FOLLOW. I WASN'T SURE WHAT
THE CONCLUSION WAS.
>> SO I'M NOT SURE WE ARE
ADVOCATING EITHER. WE ARE
ADVOCATING FOR MORE RESEARCH
RELATING TO BIOMARKERS THAT
MIGHT LEAD TO FUTURE CLINICAL
TRIALS. YOU ARE ASKING REGARDING
THRESHOLDS OR AGE OF BLOOD? OUR
DISCUSSION WAS RELATING TO THE
AGE OF BLOOD NOT SO MUCH THE
THRESHOLD: TO THE EXTENT THERE
IS A RECIPIENT POPULATION THAT
HAS NOT BEEN STUDIED, THERE IS
ENOUGH PRELIMINARY DATA TO
SUPPORT A CLINICAL TRIAL THEN WE
WOULD ADVOCATE FOR THERE TO BE
FUNDING OR FOR THERE NOT FUNDING
BUT THERE TO BE A CLINICAL TRIAL
PROPOSED.
>> THIS IS WHERE I'M COR ARE I
FOR PERSEVERATING. THIS IS WHERE
I'M CONFUSED. IN THE ABSENCE OF
BETTER BIOMARKERS WHERE THE NOT
BOLLIC AGE OF RED CELLS YOU ARE
STILL ADVOCATING FOR CLINICAL
STUDY IN SUBGROUP OF PATIENTS
WHO HAVE NOT YET BEEN STUDIED?
WHO MAY ACTUALLY -- IF YOU DID
THAT WITHOUT THE METABOLIC
MARKER THEN YOU WOULD JUST BE
EVALUATING STORAGE AGE VERSUS
OUTCOME IN A GROUP THAT WAS IN A
SUBSET OF PATIENTS THAT YOU
THOUGHT HAD NOT BEEN STUDIED
ADEQUATELY?
>> I THINK WE NEED TO THINK
ABOUT DIFFERENT TYPE OF CLINICAL
DESIGNS THAN I HAVE DONE IN THE
PAST. I THINK THAT -- THERE ARE
CERTAINLY CERTAIN PATIENT
POPULATIONS THAT HAVE NOT BEEN
STUDIED, AGAIN ONE EXAMPLE WE
KEEP COMING BACK TO ARE
CHRONICALLY TRANSFUSED PATIENTS
WHERE CLEARLY THE SURVIVAL OF
THE RED CELLS HAS GREATER IMPACT
BUT OUTCOME THERE IS NOT
MORTALITY, THEY ARE CHRONICALLY
TRANSFUSED SO DIFFERENT OUTCOMES
YOU CAN LOOK AT. AND I MOW WE
ARE STUDYING THAT THROUGH
OBSERVATION, THERE MAYBE OTHER
CLINICAL TRIAL DESIGNS THAT ONE
COULD APPROACH TO DO
INTERVENTIONS TO LOOK IN
DIFFERENT POPULATIONS WHETHER
THAT MIGHT IMPROVE DIFFERENT
OUTCOMES THAN THOSE THAT HAVE
BEEN LOOKED AT SO NOT
NECESSARILY PROPOSING THAT WE
NEED BIOMARKERS, IT WOULD BE
GREAT IF -- IF THERE WERE
BIOMARKERS IF SOMEONE HAD ONE
THAT THERE WAS SUFFICIENT
PRE-CLINICAL DATA TO SUPPORT A
CLINICAL TRIAL THEN SURE LET US
PROPOSE ONE BUT THERE MAYBE
OTHER CLINICAL TRIAL DESIGNS
SOMEONE MIGHT PROPOSE.
>> THANKS FOR THE CLARIFICATION
>> OTHER QUESTIONS OR COMMENTS?
>> I HAVE ONE QUICK COMMENT
WHICH WAS I THINK IT WAS A VERY
HELPFUL DISCUSSION IN THAT LAST
SESSION ABILITY STUFF THAT WAS
SUMMARIZED BUT WHAT WE DIDN'T
GET TO WAS I HOPE WILL BE
INCLUDED IN SUMMARY STATEMENT, I
THINK SUMMARIZED BY THE WORKING
GROUP, ISSUES SURROUNDING
ALLOIZATION, THE NEED TO STUDY
UNDERSTANDING, EVIDENCE
NECESSARY SENSE, ALL THOSE
DIDN'T COME UP BECAUSE OF ROBUST
DISCUSSION AROUND OTHER SUBJECTS
BUT I WOULD ENCOURAGE ELDAD AND
ANGELO TO INCLUDE THOSE IN YOUR
GENERAL DISCUSSION AS THIS GOES
FORWARD TO THE NIH.
>> OF COURSE.
>> THESE ARE DRAFT PRIORITIES
AND STILL TIME BEFORE
FINALIZATION AND THERE COULD BE
OPPORTUNITIES TO SHARE INPUT AND
THEY WILL TALK ABOUT THAT LATER
>> OTHER QUESTIONS OR COMMENTS?
THANK YOU ELDAD AND ANGELA. I
CERTAINLY CHALLENGE TRYING TO
DIGEST WHAT COMMENTS AND
CONVERSATION OF THE BREAK OUT
AND BEING FIRST STEP. THANK YOU
FOR THAT. NEXT RUCHIKA AND
JANSENISM
>> I LIKE TO SHARE MY SCREEN. IF
THAT'S OKAY. SO WE HAD A LIVELY
DISCUSSION, OUR RECORD SUBGROUP,
JAN SON AND I WERE TRYING TO
COMPILE ON OUR INFORMATION
FEEDBACK INTO SLIDES AN
COMMENTS, SO HERE WHAT WE HAVE
IS FEEDBACK RECEIVED BY
PARTICIPANTS. SO GOING BY THE
PRIORITY, FOR THE INFORMATION
COMMUNICATION TECHNOLOGY AND
SOCIAL MEDIA TO UNDERSTAND THE
BEHAVIOR OUR KNOWLEDGE POWER OF
CLUCK AND ACCESSIBILITY DIVERSE
CONCERNS RAISED FOR EXAMPLE IN
UNITED STATES WITH DIFFERENT
ORGANIZATIONS, AS THE COLLECTORS
HOW WOULD LIKE NOTIFICATION
SYSTEM BE ABLE TO FAIRLY DIRECT
DONOR WITH COMPUTATION AMONG
COLLECTORS, THAT'S MISWRITTEN
THERE. IS THERE A WAY TO MAKE
THE PLATFORM NEUTRAL FOR AN
INTERVENTION LIKE THAT. WE ALSO
DISCUSS IN RELEVANCE TO ANOTHER
QUESTION THAT SOMETHING LIKE
THIS IN CANADA, THERE IS ONLY
TWO COLLECTORS PRIMARILY, MAY
NOT BE A PROBLEM SO BEFORE A
TOOL LIKE THIS IS IMPLEMENTED,
APPLICATION IN THE UNITED
STATES, SOMETHING THAT NEEDS TO
BE LOOKED INTO WE DISCUSSED THE
ROLE OF EVENTS FOR THE MASS
CASUALTY EVENTS, AND BUT THERE
ARE CURRENTLY THE INFORMATION
LACKS AUTOMATION. FOLLOW-UP ON
DOCUMENTING THE EFFECTIVENESS OF
INTERVENTION LIKE THIS. CAN BE
HARD BECAUSE SOMETIMES THE BLOOD
ESTABLISHMENTS DON'T USE IN REAL
NAME ON LINE AND THEY MAY BE USE
NON-SPECIFIC NAMES SO THAT COULD
LEAD TO DOCUMENTING
EFFECTIVENESS, NOT AN EASY TASK
THERE WAS CONCERN RAIDED FOR
SOME OUTCOME LIKE THIS WITH
NON-DONORS NOT RESPOND THAT MUCH
SO INVERTED RISK OF SYSTEMIC
BIAS AS WE ASSESS THESE
INTERVENTIONS, WHILE WILL CAN BE
BENEFIT OF CAUSATIVE DONATION
EXPERIENCE, THE NEGATIVE IMPACT
OF -- IT CAN BE MORE NEGATIVE,
SOMEONE HAD NEGATIVE DONATION,
IN THE BLOOD CENTER REALLY HARD.
CAN IT ADVERSELY AFFECT
COLLECTIONS LIKE NEGATIVE REVIEW
POSTED. IF WE CAN USE THIS IN
THE FUTURE TO INCORPORATE MORE
SYSTEMATIC FEEDBACK WITH BLOOD
CENTER OPERATIONS AND SOME BLOOD
DONORS AND COLLECTION CENTERS
COMMENTED THEY ARE ALREADY
TRACKING THE SOCIAL MEDIA
COMMENTARY FAIRLY CLOSELY. SOFT
THAT IS FIRST, PRIORITY. FOR OUR
SECOND PRIORITY ABOUT
MULTI-DIMENSIONAL DATABASES AND
DATA VISUALIZATION, WE HAD VERY
HEATED INTENSE DISCUSSION. SO
SOME IMPORTANT CONCERNS ABOUT
THE DATA COLLECTION MODEL IS IT
SUFFICIENT FOR RELATED RESEARCH
AND GIVE SUFFICIENT DETAIL. SO
CERTAINLY WE ACKNOWLEDGE AS WE
ARE DOING MAPPING FROM EHR TO
OMOP STANDARDS THERE'S LOSS OF
SPECIFICITY AND NOT EXACT
MATCHES ARE FOUND SO ONE DOES
HAVE TO SELECT THE BEST
AVAILABLE SO THERE ARE TRADE
OFFS. HOWEVER, JUST WE GOT SOME
RECENT EXPERIENCES HERE FROM
ADAPTIVE RED 4P AND OMOP IS
EVOLVING AND OVER THE YEARS THE
REACH HAS GROWN. SO AT LEAST
FROM CURRENT UNDERSTANDING FOR
APPLICATION TO MEDICINE THE
PRODUCT AND POSSIBLE SIDE OF
RECIPIENT COVERAGE IT LOOKS
BETTERMENT THE QUALITY OF DATA
IMPROVED BUT THE DONOR SIDE OF
THE DATABASE MODEL IS REALLY
LEARNING AND THE LEARNING IS
GOING WITH ADOPTING DONOR AS
PATIENT AND USING THE SAME
MODEL. WE HAVE DISCUSSIONS ABOUT
INCLUDING DONORS AND COULD WE
HAVE BETTER DONOR DATA
INCORPORATED. THIS WAS SHARED
THAT FDA BEST DEVELOP OMOP --
WHICH ACTS AS THE ISPP CORDS TO
IDENTIFY TRANTAS FUSED
COMPONENT. SO IT IS STILL
REQUIRES SOME REGIONAL LEVEL
WORK, SIMILAR BUT IT IS A
POSSIBILITY. ONE IMPORTANT
CONCERN AND FEEDBACK THAT CAME
WAS FOR THE -- ANY WAY TO
MAINTAIN DATA AND ITS
APPLICABILITY WAS THE REAL TIME
DATA AGGREGATION BECAUSE DATA
TENDS TO LAG BY YEARS AND
MONTHS. SO WE HAVE SOME -- THAT
SOMETHING AS WE WORK ON SEVERAL
DATABASES CURRENTLY, WE DISCUSS
NOVEL STRATEGIES LIKE NLP
NATURAL LANGUAGE PROCESSING FOR
POPULATING ELEMENTS FROM THE HIV
DATA. A LOT OF THIS IS
EXPERIMENTAL BUT THERE IS SOME
RESEARCH UPCOMING THAT SHOULD BE
PRESENT IN THE NEAR FUTURE
LOOKING HOW THIS IS IMPLEMENTED
FOR ANY DATA FIDELITY OF DATA,
IT REALLY DOES ALWAYS COME DOWN
TO HOW TRUE THE DATA, ANYTHING
DERIVED INDEPENDENT OF DATA, SO
WE DISCUSS TIME STAMPS WHEN
TRANSFUSION HAPPEN WHEN WAS
PRODUCT ISSUED WAS IT ISSUED OR
ISSUED FROM THE BLOOD BANK, NOT
VALIDATION AND ARE WE PAYING
ATTENTION TO THOSE DETAILS AS WE
DO DATABASE LEVEL RESEARCH. WE
ALSO SPOKE ABOUT COLLABORATION
WITH THE HHS OFFICE OF NATIONAL
COORDINATOR TO GET BIOLOGICALLY
DERIVED PRODUCTS INTO THE U.S.
CORE DATA FOR INTEROPERABILITY.
THAT CAN BE REALLY A LOT OF
COMMUNICATION BETWEEN BLOOD BANK
SOFTWARE AND EHR. SO SOME USEFUL
DISCUSSIONS HERE BETWEEN WOULD
LIKE TO TAKE BACK TO OUR WORKING
GROUP. FOR THE DATA DRIVEN
APPROACHES ABOUT THE ECONOMIC
EVALUATIONS, THIS POINT CAME UP
THAT RECENTLY FOCUS IS ON
INFECTIOUS DISEASE SCREENING AND
EFFICIENCY AND THE EFFICACY AND
THAT IS VERY IMPORTANT. HOWEVER
DATA FROM THE HOSPITALS
RECIPIENTS AND DOWNSTREAM
CLINICAL IMPACT IS LIMITED. SO
WE DID DISCUSS IT EARLIER IN
PRESENTATION HOWEVER
NON-INFECTIOUS OUTCOMES AND
ADVERSE EVENTS NEED TO BE
FOCUSED ON AND THIS IS A
CHALLENGE. WE DISCUSS SCENARIOS
WHERE ECONOMIC EVALUATIONS WOULD
BE HELPFUL FOR EXAMPLE USE OF
MACHINE COMPATIBLE PLATELETS AND
DEVELOPMENT OF UNIFIED DATABASE
TO UNDERSTAND SOME RESOURCE
INTENSE PRACTICES LIKE SIMPLY
DONOR MATCH COMPATIBLE DATA HOW
WE DO THAT FOR A SELECT
POPULATION. MOVING ON FOR OUR
MACHINE LEARNING AND ARTIFICIAL
INTELLIGENCE SEVERAL FEEDBACK
AND COMMENTS, BASICALLY WE HAVE
SOME SEVERAL STUDIES COMING BUT
HOW CLINICAL TOOLS APPLICABLE.
WE NEED ONGOING DEMONSTRATION OF
GENERALIZABILITY SCALABILITY AND
ROBUSTNESS SO THESE STUDIES ARE
NOT REACHING CLINICAL GRADE
APPLICATION LEVEL. WE HAVE TO BE
MORE SPECIFIC ABOUT THE USE
CASES. WHERE ARE TECHNIQUES
APPROPRIATE, HOW ARE WE
ADDRESSING THE IMPLEMENTATION
GAP. I THINK ONE CONCERN WAS
THAT THE PREDICTIVE MODEL BEYOND
MODELING STAGE, IMPLEMENTATION
STAGES NASCENT STAGE HOW ARE WE
MONITORING THAT IS IMPORTANT,
KEY METRICS FOR THAT. THE
QUESTION OF EQUITY VERSUS
EQUALITY, A MODEL THAT IS
DERIVED FROM ANOTHER TRAINING
DATA SET, IS IT GENERALIZABLE
AND DEPLOYABLE IN PATIENT
POPULATION WHICH WAS INDEPENDENT
OF THAT, THE INTENDED USE
POPULATION IS IT THE SAME SO
COULD BE MAKING ERRORS IN THE
APPLICATION VERY TRAINING
DEPLOYMENT, THE APPLICATION CAN
BE DEPENDENT ON TRAINING DATA SO
MAKING SURE THAT FOR TRAINING
DATABASE SETS MULTI-CENTER DATA
DIVERSITY IS INCLUDED AS
IMPORTANT. THAT TAKES INTO
ACCOUNT CURRENT IMPLEMENTATIONS
ARE NOT ACCURATE, COULD WE BE
CONCERNED ABOUT POTENTIAL HARM
ESPECIALLY FOR UNDER-REPRESENTED
GROUPS OR WHERE IT RESULTS
APPLIED NOT ENOUGH DIVERSITY IN
OUR DEVELOPMENT IN THE TRAINING
DATABASES. FOR GENOMICS WORKING
GROUP INTEGRATING GENOMICS TO
CLINICAL TRANSFUSION WORK FLOWS,
WE DISCUSSED REGULATORY VALUES
INHIBITED ADOPTION OR USING THE
GENOTYPING AND INTERESTING
PERSPECTIVE FROM SELENA SERVICES
FOR EXAMPLE THE DIFFERENCE
BETWEEN U.S. AND CANADA IS THAT
BECAUSE THERE ARE FOR THE ENTIRE
COUNTRY BASICALLY TWO BLOOD
COLLECTORS WITHIN THAT ONE BEING
MORE PRIMARY IT IS EASIER TO
ESTABLISH WORK FLOWS THE
INTEROPERABILITY IS EASIER,
SHARING INFORMATION
STANDARDIZATION WHICH IS GOING
TO BE A CHALLENGE FOR REALLY
WIDE SCALE GENOMICS
IMPLEMENTATION IN US. WE DO
NEED TO TAP INTO THE BLOOD DONOR
DIVERSITY AS WE TRY TO MAKE
GENOMICS WORK SUCCESSFUL AND SO
THE PROGRAM HAS ESTABLISHED
PROGRAM GENOTYPE FOR DONORS AND
PATIENTS IS USED TO PROVIDE
COMPATIBLE PRODUCTS FOR PATIENTS
WITH ALLO ANTIBODIES. SO THERE'S
SOME BACKGROUND ON WHAT PROGRAMS
ARE IN PLACE AND HOW CAN WE MAKE
IT WIDER MORE ACCESSIBLE
DISCUSSED. VERY LIVELY
DISCUSSION WE GOT THROUGH PRETTY
MUCH ALL OUR PRIORITIES. I
WOULD LIKE TO STOP HERE.
>> FEW COMMENTS IN THE CHAT FROM
AMANDA HESS. AARP LAUNCHING A
WEBSITE TO HELP SUPPORT WORK OF
PRIORITY NUMBER ONE. THEN FROM
DARRELL CORE, THE PROMISE OF AI
ML IS EXCITING IN THIS SPACE.
AND ECHOING COMMENTS WE RAISED
DURING THE BREAK OUT SESSION.
>> I REACHED OUT TO AMANDA,
PROBABLY AS WE TRY TO FINE TUNE
THAT PRIORITY 1, TO DARRELL'S
POINT THAT WAS THE OBJECTIVE OF
HAVING PRIORITY FOCUS ON
IMPLEMENTATION. RATHER THAN JUST
RESEARCH INTO USE CASES FOR AI
ML. THE REAL CHALLENGE IS
IMPLEMENTING A MODEL AFTER IT'S
BUILT. THEN CREATING BETTER
DATABASES FACILITATES THE FRONT
END WHICH IS CLEANING DATA
MANIPULATING DATA, DATA
ENGINEERING IN GENERAL. SO WE
TRIED TO HAVE PRIORITIES THAT
FOCUS ON THE FRONT AND BACK END
AND NOT JUST AI ML USE CASES.
>> AS WE DO OUR FINAL WRITE UP
THESE ARE IMPORTANT FEEDBACK TO
INCORPORATE. THANK YOU.
>> I HAVEN'T ABLE TO JOIN THIS
BREAK OUT BUT WONDER IF OFTEN
TIMES ONE OF THE CHALLENGES IS
WE LIKE TO CREATE MODELS USING
STATIC RELATIONAL DATA THAT
MIGHT EXIST IN OMOP DATA MODEL
BUT REALITY USING THE MODEL
UTILIZES IN WORK FLOWS NEEDS TO
BE BUILT ON TRANSACTIONAL DATA
MODEL THAT LOOKS DIFFERENT FROM
OMOP DATA MODEL. HOW DO YOU
ADDRESS THE GAP OF CREATING
MODELS USING A STATIC RELATIONAL
DATA ENVIRONMENT WHEN MODELS
HAVE TO BE IMPLEMENTED ON A VERY
DIFFERENT ENVIRONMENT AND
CHALLENGES ARE AROUND THAT
IMPLEMENTATION.
>> WE DISCUSSED THAT WHEN IT
CAME TO DATABASES. HOW DO WE
MOVE FROM THIS STATIC DATABASE
AGGREGATION TO REAL TIME DATA
AGGREGATION. WHAT YOU ARE
TALKING ABOUT AS WELL IS THE
FIELDS WE USE THE TRAIN THE
MODEL MAY NOT BE ACCESSIBLE FOR
REAL TIME. THAT DID NOT COME UP
AND WE WILL ADD TO LIST OF
COMMENTS AS WELL.
>> OTHER QUESTIONS OR COMMENTS
FROM WORKING GROUP CHAIRS? THANK
YOU VERY MUCH, RUCHIKA AND
JANSEN, WONDERFUL JOB.
>> THANK YOU.
>> GO NOW INTRODUCE YVETTE
MEGHAN TO PRESENT SUMMARY OF
THEIR BREAK OUT SESSION.
>> THANK YOU SO MUCH, NAREG.
SHOW YOU COUPLE OF SLIDES THEN
WE WILL CONTINUE TO TALK WITH
THOSE SLIDES. I WILL START BY
SHOWING -- FIRST I -- BEFORE I
SAY ANYTHING ELSE I WILL SAY
THIS GROUP AND OUR DISCUSSION
THAT WE JUST HAD AS WELL AS THE
WHOLE PAST YEAR WORKING TOGETHER
HAS BEEN A LEARNING EXPERIENCE.
EYE OPENING AND ALSO VERY
ENGAGING, JUST SO INSPIRING TO
HAVE SO MANY WANTING TO COME
FORWARD AND TALK ABOUT THESE
ISSUES THAT ARE UNFORTUNATELY
PART OF THE FABRIC OF OUR
SOCIETY THAT WE HAVE TO CALL OUT
AND WORK TOGETHER TO IMPROVE
HEALTHCARE FOR ALL PEOPLE. SO
THE FIVE PRIORITIES THAT WE HAVE
HERE, WE FEEL -- I WANT TO
CLARIFY, THEY ARE NOT IN ORDER
THEY ARE ALL IMPORTANT AND WE
HAVE THEM NUMBERED ONE TO FIVE
AND WE DON'T THINK -- THEY ARE
QUITE BROAD IN GENERAL AND WE
LIKE THEM THAT WAY. THOUGH WE
HAVE MORE TO ADD ABOUT THEM AS
WELL THAT CAME UP ESPECIALLY
DURING THE BREAK OUT SESSION. SO
SHOW THIS ONE SLIDE TO EMPHASIZE
SOME MAJOR THEMES AND THEN I
WILL TALK MORE ABOUT SOME OF THE
REALLY INTERESTING COMMENTS THAT
WERE BROUGHT UP. SO THINKING
ABOUT WHY WE WERE CALLED
TOGETHER BY THE NIH, SO OUR
RESPONSE BACK IS WE FEEL THE
FUNDING FROM NIH SPECIFICALLY
ALLOCATED TO STRENGTHEN
HEALTHCARE SYSTEMS DELIVERY AND
UNDERSTANUNDERSTANDING THE NEEDF
COMMUNITIES AND WE HAVE TO FACE
RACISM AND WORK TOGETHER TO CALL
IT OUT AND MOVE FORWARD
TRANSPARENTLY AND
COLLABORATIVELY. ONE THING THAT
CAME OUT FOR REALLY ALL OF THE
PRIORITIES THAT WE JUST PUT ON
THE SCREEN IS FIRST STEP FOR
MANY OR ALL OF THEM, IT'S
COMMUNITY BASED RESEARCH AND
WHAT WE MEAN BY THAT, IS TO TALK
TO THE COMMUNITIES THEMSELVES,
AND TO LET THEM TELL US WHAT
THEY NEED, WHAT THEY WANT, WITH
RESPECT TO PARTICIPATION IN
RESEARCH, ACCESS AND NEEDS FROM
THE HEALTHCARE SYSTEM. WANTING
TO DONATE BLOOD AND WHAT THEY
MIGHT WANT FROM A BLOOD DONOR
CENTER. SO THERE ARE ALREADY
MULTIPLE DIFFERENT GROUPS
BECAUSE SOCIAL DETERMINANTS OF
HEALTH IS NOT JUST THE
HEALTHCARE SYSTEM, IT IS ACCESS
TO HEALTHY FOOD AND THE
ENVIRONMENT PEOPLE LIVE IN. AS
WELL AS EMPLOYMENT
OPPORTUNITIES, MANY, MANY THINGS
THAT IMPACT SOCIAL DETERMINANTS
OF HEALTH. SO WE THINK THAT OUR
FIELD NEEDS TO PARTNER WITH
GROUPS AND LEARN FROM GROUPS
ALREADY WORKING IN THE
COMMUNITY. TO HAVE AN ENTRE INTO
THE COMMUNITY TO TRY TO LEARN
WHAT THEY NEED, WHAT THEY WANT.
WE NEED TO BE PREPARED FOR LACK
OF TRUST AND HEARING THINGS THE
HEALTHCARE SYSTEM OUR FIELD, OUR
APPROACH TO DONOR RECRUITMENT
AND TOUGH THINGS ABOUT HOW THOSE
THINGS MAY HAVE OR HAD EXCLUDED
MEMBERS OF DIFFERENT
COMMUNITIES. BECAUSE THERE IS
DESIRE AND KNOWN INTEREST TO
INCREASING BLOOD DONOR RECRU
RECRUITMENT, OF ALL TYPES OF
PEOPLE, ETHNIC GROUPS, DIFFERENT
GROUPS DIFFERENT GEOGRAPHIES
ANCESTRAL BACKGROUND WE THINK
HAVING BLOOD DONOR CENTERS AND
REPRESENTATIVE THE BLOOD DONOR
CENTERS IS PARTICIPANTS IN THIS
TYPE OF LISTENING AND LEARNING
WOULD BE ADVANTAGEOUS. WHEN WE
TALKED ABOUT PATIENT OUTCOMES,
THERE IS A LOT OF INTEREST IN
PRIORITY FOUR AS WELL, WHICH IS
TO REALLY BETTER CLASSIFY, KEEP
TRACK OF AND LEARN HOW TO
PREVENT AND TREAT ADVERSE EVENTS
RELATED TO TRANSFUSION
EXPERIENCED IN HIGHER PROPORTION
OF PATIENTS OF MINORITY GROUPS.
HOWEVER, THAT LOW -- THE LAST
BULLET THERE, WE THINK RIGHT NOW
WE KIND OF CONSIDER THOSE THINGS
RARE. BUT MANY DON'T THINK THEY
ARE RARE BECAUSE THEY ARE
UNDERSTUDIED, UNDERCLASSIFIED,
THERE'S NOT A LARGE FUNDING
MECHANISM TO STUDY AD VERSION
EVENTS SUCH AS TRANSFUSION
REACTIONS SO THIS IS
MULTI-CENTER AND QUITE LONG TERM
STUDY, NOT JUST SHORT TERM STUDY
SO FUNDING MECHANISMS HAVE TO
SUPPORT THAT. COOPERATION WITH
BLOOD DONOR CENTERS, COMMUNITY
ORGANIZERS, POLITICIAN, CHURCH,
THIS GOES BACK TO RESEARCH, WE
IN OUR OFFICES AND -- ARE NOT
ABLE TO SAY WHAT COMMUNITY
NEEDS, WE NEED TO HAVE THEM AND
ANYONE THAT WANTS TO TALK AND
HELP US BETTER UNDERSTAND
PATIENT OUTCOMES. THE PATIENT
OUTCOMES COULD BE LACK OF
TRANSFUSION WE CALLED OUT ON THE
GROUP, WHERE A PATIENT LIVES,
ACCESS TO TERTIARY AND
QUARTERNARY CARE, GENE THERAPIES
AND OTHER NEW TREATMENTS IS NOT
AVAILABLE EVERYWHERE. SO THAT
NEEDS TO BE RECOGNIZED STUDIED
AND THOUGHT HOW IT COULD BE
DELIVERED IN -- EVERYWHERE IN A
MORE EQUITABLE WAY. THE LACK OF
TRANSFUSION CAN BE FOR
EMERGENCIES. SO FOR TRAUMA BASED
CARE AS WELL AS BLEEDING, BOTH
OF THOSE NEED TRANSFUSION CARE
QUICKLY AND NOT ALL HOSPITALS OR
HEALTHCARE FACILITIES ARE
EQUIPPED FOR THAT. THERE IS RECK
NICHE, WHAT CARE PATIENTS
EXPERIENCE FOR THOSE EMERGENCIES
DOES DEPEND WHERE THEY ARE AND
WHO THEY ARE. SO THAT NEEDS TO
BE ADDRESSED BOTH WITH
HEALTHCARE SYSTEMS STRENGTHENING
AND RESEARCH TO SUPPORT
HEALTHCARE SYSTEM STRENGTHENING
SO THOSE ARE BROAD THEMES THAT
CAME OUT FROM OUR SESSION. I
WANT TO THANK SO MANY PEOPLE WHO
ALSO SPOKE UP AND GAVE REALLY
SPECIFIC EXAMPLES. ONE THING
THAT WAS DISCUSSED IN DETAIL WAS
THE INFORMED CONSENT PROCESS.
HOW THE LENGTH OF IT, THE DETAIL
OF THE WRITTEN WORD AND HOW THAT
DISUADES PEOPLE FROM
PARTICIPATING IN RESEARCH. OTHER
POINTS SPOKEN ABOUT IN TERMS OF
SOCIAL DETERMINANTS OF HEALTH
AND BLOOD CENTERS, THERE WAS A
NICE CONNECTION MADE BY SEVERAL
FOLKS ABOUT HOW NIH STARTING TO
VIEW BLOOD CENTERS AS A PLACE
WHERE CHRONIC DISEASES THAT
IMPACT MANY PEOPLE, CAN BE TOUCH
POINT FOR THE FIRST POINT OF
CARE. AS WELL AS FOR YOUNG
DONORS WHICH ARE OFTEN A TARGET
OF DONATION RECRUITMENT IN TERMS
OF ADOLESCENT BASED HEALTH. SO
INCLUDING IN TERMS OF THE WHOLE
COMMUNITY OF CARE FOR ALL
DIFFERENT REPRESENTATIONS OF
COMMUNITIES AND MINORITY GROUPS
TO INCLUDE THOSE BLOOD CENTERS
AND STUDY THAT TO BE ABLE TO
BOTH LEARN AND TEACH AND
POTENTIALLY RETAIN BLOOD DONORS
BUT ALSO PROVIDE ACCESS TO
HEALTHCARE OR AT LEAST THE ENTRE
POINT OF HEALTHCARE. THERE ARE
MANY OTHER POINTS, TRYING TO
THINK OF WHAT OTHERS TO CALL
OUT. THE -- BACK TO MY FIRST
POINT, THEN I WILL SEND IT TO
YVETTE. ABOUT COMMUNITY BASED
RESEARCH AND COMMUNITY BASED
LISTENING AND LEARNING, THERE
WAS AN INTERESTING ANECDOTE
SHARED ABOUT HOW ADVANCE STUDY
BEGAN IN FLORIDA AND HOW GOING
TO COMMUNITY AT LGBTQ COMMUNITY
CENTER TO DESCRIBE STUDY AND
LISTEN, WAS A REAL TURNING POINT
FOR UNDERSTANDING HOW THE
COMMUNITY WOULD RECEIVE STUDY
AND ALSO THE POINT THE INITIAL
DESCRIPTION OF THE STUDY WAS MET
WITH A GREAT DEAL OF NOT
TRUSTING SCIENTIFIC COMMUNITY.
SO THOSE HAVE TO BE WORKED
THROUGH TO MOVE FORWARD TO THIS
IDEAL OF BROAD DIVERSITY
INCLUDED IN OUR STUDY AS WELL AS
INCLUDED IN OUR RESEARCHERS
THEMSELVES. MY LAST POINT WILL
BE THE RESEARCH PIPELINE BRING
OF EDUCATING OUR YOUNG FOLKS IN
ALL COMMUNITIES ABOUT SCIENCE,
COMMUNITY BASED HEALTHCARE AND
ADVOCACY AND ALL THESE TOPICS
START YOUNG AND THERE ARE
ALREADY PROGRAMS THAT MANY OF
YOU ALSO LEAD AND PARTICIPATE IN
AND SOME THAT OUR PROFESSIONAL
SOCIETIES DO AND THOSE ARE
INCREDIBLY IMPORTANT AND
CONTINUE TO BE FUNDED IF NOT
STUDIED TO SHOW THE IMPORTANCE
OF FILLING THE PIPELINE WITH A
VERY DIVERSE GROUP OF
INDIVIDUALS THAT WILL ALSO MAKE
THE FUTURE RESEARCH ON MORE
INCLUSIVE. SO YVETTE, ANYTHING
ELSE? I TRIED TO SUMMARIZE A LOT
OF STUFF STUFF. IN A FEW MOMENT.
>> MEGHAN, YOU DID AN EXCELLENT
JOB. AGAIN, I WANT TO DO SOME OF
THE SAME THINGS, THANK OUR
CERTAINLY THE GROUP OF
INDIVIDUALS THAT ATTENDED THE
BREAK OUT SESSION BUT JUST
HARDLY WORDS TO DESCRIBE REALLY
HOW MUCH FUN IT WAS. TO WORK
WITH OUR WORK GROUP TEAM.
PERSONALITIES THAT MELD IT
TOGETHER AND IT BECAME VERY
COMFORTABLE FOR US TO WORK WITH
EACH OTHER AND SHARE INFORMATION
AND PARTNERSHIP. ALL OF US HAVE
CERTAINLY NOW HAVE A NEW GROUP
OF COLLEAGUES THAT WE CAN CALL
ON. FOR YEARS AND YEARS TO COME
AND GET THEIR OPINIONS AND
THOUGHTS BECAUSE OF THE GREAT
RESPECT WE HAVE FOR EACH OTHER.
THE LAST THING I WANT TO ADD IS
THAT BEING IN THIS SPECIFIC WORK
GROUP, WE BEGAN TO ADDRESS AREAS
IN RELATIONSHIP TO HEALTH
DISPARITIES AND HEALTH
INEQUITIES IN TRANSFUSION
MEDICINE WHICH MANY NEVER
DISCUSSED AT THIS LEVEL BEFORE.
SO FOR MANY OF US, THIS IS NEW
PLACE AND NEW SPACE AND NEW
PLACE TO START THINKING SO NOW
THAT THIS OPPORTUNITY HAS OPENED
UP FOR US TO THINK DIFFERENTLY
ABOUT WORK THAT WE DO, THE
POPULATIONS WE WORK WITH AS WELL
AS HAVE A COMPLETELY DIFFERENT
VIEW OF OURSELVES, AND OUR
ABILITY TO STEP UP AND STAND OUT
AND ADVOCATE ON BEHALF OF OUR
PATIENTS, THIS IS A NEW SPACE
THAT MANY OF US HAVE NEVER BEEN
IN BEFORE TO THIS EXTENT. WE ALL
KNOW OUR RESPONSIBILITY TO WANT
TO DO BEST FOR OUR PATIENTS BUT
WE ARE THINKING ABOUT
COMMUNITIES NOW. SO THE WORK
THAT WE HAVE TO DO IN FRONT OF
US IS VERY BROAD. BUT WE KNOW WE
CAN DO IT. THIS IS OUR SPACE TO
INHABIT. SO THAT IS THE ONLY
THING I WANT TO ADD AND AGAIN,
JUST THANK MY TEAM AND WORKING
WITH MEGHAN HAS BEEN PURE JOY.
WE WOULD JUST ENCOURAGE AND
SUPPORT EVERYONE IN THIS WORK
AND AGAIN THIS IS JUST THE FIRST
SCENE OF THIS PLAY. SO WE HAVE A
LOT OF WORK LEFT TO DO. THANK
YOU.
>> THANK YOU, YVETTE. BRIAN AND
NAREG BACK OVER TO YOU OR ANY
COMMENTS OF COURSE. I SEE SOME
PEOPLE COMING OFF -- PUTTING
THEIR CAMERAS ON.
>> THANK YOU VERY MUCH. YOU TAKE
A POSITIVE WAY TO END THE RECAP,
ECHOING IN THE SPIRIT OF
COLLABORATION AND THIS NEW
UNIQUE FACET TO THE PART OF THE
STATE OF THE SCIENCE, I CAN FOR
SEE THAT CONTINUING TO THE
FUTURE AS WELL. SO I WILL STOP
AND SEE IF ANYONE HAS COMMENTS
OR QUESTIONS.
>> BEFORE YOU DO JUMP IN WITH
ANY COMMENT FEEL FREE TO RAISE
YOUR HAND OR USE THE CHAT BOX.
THIS IS TIME FOR US NOT ONLY FOR
COMMENTS FOR MEGHAN AND YVETTE
BUT THE TWO OTHER WORKING GROUPS
THAT PRESENTED TODAY. PLEASE
FEEL FREE WE RECOGNIZE EACH OF
YOU ONLY ABLE TO JOIN A SINGLE
BRAINING OUT SESSION. WE
PROBABLY WANTED TO ATTEND MANY
MORE THAN JUST TWO OVER THE LAST
TWO DAYS. WE DO HAVE A LITTLE
BIT OF TIME. UPWARDS OF 20
MINUTES, WE WANT TO HAVE SOME
FURTHER DISCUSSION. AND WE WANT
TO TALK ACROSS GROUPS, FEEL FREE
TO DO SO. THIS IS AN OPPORTUNITY
FOR ALL OF TO HEAR EACH OTHER'S
THOUGHTS TOGETHER.
>> I WOULD SAY IF WE CAN FOCUS
INITIALLY ON THE SIX WORKING
GROUPS, IF THERE IS DESIRE TO
PROCEED TO THE BROADER OPENNESS
COURSE WE CAN DO SO PRIOR TO MY
PUSH THIS PRESENTATION IN 20
MINUTES. -- MIKE BUSCH'S
PRESENTATION IN 20 MINUTES.
OPERATOR: QUENTIN.
>> I WANT TO MAKE A BRIEF
COMMENT, MEGHAN KNOWS THIS
BECAUSE SHE WORKS WITH THE
GLOBAL TRANSFUSION FORUM, THERE
IS A LOT OF OVERLAP BETWEEN YOUR
WORKING GROUP AND WHAT IS GOING
ON IN LOW AND MIDDLE INCOME
COUNTRIES. I THINK WE SHOULD
EXPLORE OVERLAPS AND WHAT WE CAN
LEARN FROM EACH OTHER BY
DIRECTIONALLY, BIDIRECTIONALLY
PARTICULARLY WITH DONOR PROGRAMS
IN THESE SETTINGS MANY WHICH
WERE INNOVATIVE IN AFRICA AND
SURE YOU ARE AWARE BUT WE SHOULD
LOOK INTO THAT, IT IS NOT JUST
AS A WORD WE USE NOW IN GLOBAL
HEALTH I'M IMMERSED IN, GLOBAL,
LOCAL, GLOCAL STANDS FOR GLOBAL
AND LOCAL. AND THIS IS CERTAINLY
AN INCIDENCE OF SO TO SPEAK
GLOCAL. THERE IS A LOT TO BE
LEARNED FROM THE LOW AND MIDDLE
INCOME COUNTRY SETTINGS AND PUT
THE GROUPS IN TOUCH WITH EACH
OTHER.
>> BRIAN, OKAY IF I RESPOND?
>> PLEASE.
>> QUENTIN THANK YOU. WE WORK
TOGETHER ON -- TWO COMMENTS I
WANT TO BRING UP. ON OUR BREAK
OUT SESSION BERNARDO PYATT
BROUGHT UP USE OF WHAT'S APP AND
THINKING FROM THE COMMUNITY
BASED PERSPECTIVE, HOW DO
COMMUNITIES TALK TO EACH OTHER?
AND IS IT THESE DIFFERENT
MODALITIES AND SHOULD THEY BE
STUDIED. I PUT IN A PLUG THE
BLOOD BASE PROGRAM IS INCREASING
ACCESS TO SAVE TRANSFUSION IN
LOW AND MIDDLE INCOME COUNTRIES
SPECIFICALLY FOCUSED AT
SUB-SAHARAN AFRIC AFRICA. ONE OE
STUDIES LOOKS AT THE
INTERVENTION FOR BLOOD DONATION
RECRUITMENT AND GETTING PEOPLE
IN IMMUNITY TO DONATE. ON A
MORE GENERAL EXAMPLE, SORT OF
EMPHASIZING WHAT QUINTON IS
SAYING, THAT PROGRAM IN
PARTICULAR IS A WAY THE NIH BY
DOING IMPLEMENTATION SCIENCE
RESEARCH IS STRENGTHENING THE
HEALTHCARE SYSTEM WHERE THOSE
ARE OCCURRING AND TRYING TO SHOW
RESEARCH LEVEL METHODOLOGY THAT
OPTION A OR B ARE TWO STUDY ARM,
WHAT IS THE BETTER WAY TO
INCREASE ACCESS TO BLOOD
TRANSFUSION WHICH IS THE GOEL OF
THOSE PROJECTS. SO THERE IS A
PATHWAY THAT RESEARCH
ORGANIZATION AND FUNDING CAN
VERY CLEARLY PROVIDE HEALTHCARE
SYSTEM STRENGTHENING, WHICH IS
STILL NOT EVERYTHING THAT WE
TALKED ABOUT IN OUR SUBGROUP BUT
PART OF IT. SUPPORT, KNOWLEDGE,
GENERALIZABLE INCREASE IN
HEALTHCARE RECRUITMENT. THANKS.
>> CASSANDRA.
>> I WAS THINKING ABOUT
COMMUNITY AND I WAS THINKING
ABOUT HOW TO GET INTO THE
COMMUNITY AND I WAS THINKING
ABOUT PEDIATRICS AND FAMILIES.
AND SO MANY CHILDREN IN
DIFFERENT WAYS NEED BLOOD AND IT
IS VERY HARD TO FIGURE HOW TO
CONNECT TO THE COMMUNITIES AND
THEY ARE ALL DIFFERENT TYPES OF
COMMUNITIES OF PATIENTS THAT
NEED BLOOD IN EITHER CHILDREN'S
HOSPITAL OR IN -- WITH CHILDREN
IN AN ADULT HOSPITAL. I WAS
THINKING THAT ONE UNIQUE WAY
MIGHT BE TO GET INTO THE
COMMUNITIES BY HAVING -- LOOKING
AT FAMILIES AND SOCIOECONOMIC
DETERMINANTS OF HEALTH AND
LOOKING AT IT BECAUSE SO MANY
CHILDREN ARE ON MEDICAID AND
THERE IS JUST -- SEEMS LIKE THAT
WOULD BE AN INROAD TO TALK WITH
FAMILIES AND TALK WITH VERY HARD
TORR PARENTS TO GET PLACES, AND
VERY HARD FOR THEM TO UNDERSTAND
ABOUT BLOOD TRANSFUG. WE SPEAK
TO LOTS OF FAMILIES HOW BLOOD
GETS TO HOSPITALS. SOME
CHILDREN HOSPITALS HAVE A BLOOD
CENTER BUT MOST DONE. AND THEN I
WAS JUST THINKING SOMEHOW
SETTING UP WITH COMMUNITY, WHERE
THERE ARE CHILDREN HOSPITALS
MIGHT BE A WAY TO BRING BRING
COMMUNITY CLOSER AND EDUCATE
THEM ABOUT WHAT BLOOD
TRANSFUSION IS ABOUT AND THEN
FIND OUT WHAT THE BARRIERS ARE
TO PEOPLE IN THE COMMUNITY BEING
ABLE TO DONATE BLOOD. SO I WAS
THINKING THAT WAS ONE AVENUE
THAT MIGHT NOT HAVE BEEN
HIGHLIGHTED THAT IS I THINK AN
OPPORTUNITY.
>> THANK YOU, CASSANDRA. GO
AHEAD MIKE.
>> OBVIOUSLY I WILL PRESENT
LATER AND LAYING THE FOUNDATION
FOR WHAT -- WHY I BELIEVE LARGE
IMPORTANTLY SUSTAINABLE LINK
DONOR RECIPIENT AND DISEASE
REGISTRY DAY BASES ARE SO
IMPORTANT OPTIMALLY LINKED TO
REPOSITORIES. BUT PLEASED TO SEE
PARTICIPATION IN THE MEETING OF
SOME LEADERSHIP FROM SENIOR
PEOPLE FROM RED CROSS AND LARGE
TESTING LABS. I THINK IN MY
DISCUSSION HISTORICALLY WITH
NHLBI AND LEADERSHIP, NIH IS
REALLY NOT THERE TO SUPPORT
ESTABLISHING THE LARGE SCALE
INFRASTRUCTURE NEEDED TO
MAINTAIN AND ESTABLISH AND
MAINTAIN THESE LARGE LINK BLOOD
ORGANIZATIONS AND THE U.S. WE
ARE SEEING OTHER COUNTRIES ARE
LEAP FROGGING THOUGH SOME CASES
YOU CAN ARGUE WE DEVELOP THE
ORIGINAL PROGRAMS TO EARLY
REGISTER PROGRAMS BECAUSE OF THE
FRAGMENTATION OF THE U.S. BLOOD
COLLECTION PROGRAMS, WE DON'T
HAVE THE SYSTEMS LIKE THEY HAVE
FOR EXAMPLE MILLION CANADA OR
AUSTRALIA OR DENMARK THAT ALLOW
A NATIONAL LONG TERM DEVELOPMENT
OF SUCH DATABASES AND
REPOSITORIES SO JUST TO PLANT
THE IDEA THE BLOOD COLLECTION
ORGANIZATIONS THEMSELVES AND THE
LARGE TESTING LABS THEY OWN AND
OPERATE, THEY HAVE A CERTAIN
OBLIGATION. SOME OF THEM -- THEY
JUST ESTABLISHED VETALIN
INNOVATION CENTER, FOR
ACTIVITIES TO MOVE RESEARCH
FINDINGS TO REAL WORLD. I WOULD
LIKE TO LAY THE GROUND WORK FOR
ORGANIZATIONAL FUNDING THAT THEN
IS COMPLIMENTED BY NIH AND OTHER
EXTERNAL FUNDING.
>> I WANT THE THEY CAN THE
ORGANIZERS FOR THIS MEETING. ONE
THING IMPRESS WITH MY MIND WITH
THIS MEETING AND GENERAL
TRANSFUSION DESPITE THE FACT
TRANSFUSION IS A SMALL FIELD THE
TALKS ARE INCREDIBLY DIVERSE YOU
GO DOWN THE RABBIT HOLE AND
REALIZE SO MANY AREAS FROM DONOR
ASPECT OF GETTING THE
ANTHROPOLOGY BEHIND IT TO
ACTUALLY CHARACTERIZING IT TO
WHAT HAPPENS IN DIFFERENT
RECIPIENTS AND PATIENT
POPULATIONS.S. ONE THOUGHT I HD
TALKING ABOUT THIS, BASED ON A
COMMENTS STEVE MADE AT THE
BEGINNING OF THE MEETING IS THE
TRAINING, TRANSFUSION IS UNIQUE
ONE YEAR CLINICAL FELLOWSHIP
WITH LITTLE RESEARCH EMBEDDED
UNLIKE CARDIOLOGY OR OTHER
SPECIALTIES IN MEDICINE WHERE
THEY HAVE SIGNIFICANT RESEARCH
TRAINING THAT YOU CAN ARGUE IS
INSUFFICIENT TO BE ABLE TO PLAY
FOR GRANTS. WONDER IF WILL IS
OVERARCHING ASPECT THAT MAYBE
BENEFIT BY HAVING -- NOT
SPECIFICS IN TERMS OF HOW NIH
SHOULD TO THIS BUT WHETHER THERE
IS A BENEFIT FROM A PROGRAM. I
TRAIN IN GLYCO BIOLOGY WHICH IS
VERY ORGANIC CHEMISTRY AND
INTENSE FIELD, WEIRDLY, AND
NHLBI JUST FUNDED A K 12 PROGRAM
FOR GLYCO BIOLOGY, WE HAVE A
FOLLOW IN OUR LAB DOING THAT AND
THERE'S BUNCH OF GREAT
SCIENTISTS HERE AND NOT ON THIS
CALL BUT POINTED OUT IF THAT
WOULD BE USEFUL OVER ARCHING AND
JUST ANOTHER COMMENT IN GENERAL
FOR APHERESIS, NOT REALLY
DISCUSSING NOT A SPECIFIC
RESEARCH INTEREST OF MINE PER SE
BUT SOMETHING WE ALL DEAL WITH
CLINICALLY AND YOU CAN SEE
PATIENTS ARE JUST NO DATA FOR
MOST OF WHAT WE DO
MECHANISTICALLY OR OTHERWISE SO
JUST ANOTHER EXAMPLE OF
SOMETHING I DON'T SUGGEST ANY
WAY NEEDS TO PRIORITIZE ABOUT
THINGS WE TALK ABOUT TODAY BUT
SO MANY OPPORTUNITIES RESEARCH
ONE LIMITATION IS JUST DON'T
HAVE RESEARCH EMBEDDED IN
TRAINING, SO I THINK THAT DOES
LIMIT SOME OF THESE DIFFERENT
ASPECTS OF DONOR SCIENCE, OTHER
THINGS THAT MAY BE LEFT TO SITES
BECAUSE THERE IS A STRUCTURE IN
PLACE TO TRAIN PEOPLE. COULD BE
WRONG BUT JUST A THOUGHT ON THAT
IN GENERAL.
>> RUCHIKA.
>> HI. I STRONGLY -- EVERY TIME
YOU GO THROUGH THE PROCESS THE
QUESTION OF HOW CAN WE INTEGRATE
THIS INTO TEACHING OUR --
WHETHER NEXT GENERATION OR
FELLOWSHIP GRADUATES, TRAINEES,
SOME WAY TO HAVE A MORE
SYNCHRONIZE WAY OF MENTORSHIP,
SOMETHING THAT THEY COULD DO
START DURING THE TRANS--
INDEPENDENT, (INAUDIBLE) PEOPLE
COMING FROM HEMATOLOGY,
PULMONARY, ANESTHESIA,
TRANSFUSION MEDICINE RESEARCH.
BUT HAVING SOME PATHWAY THERE
COULD BE UNDER ONE UMBRELLA. IF
YOU HAVE AN INTEREST SOME WAY TO
CONNECT TO MENTOR, STUFF CAN BE
DONE REMOTELY, NOT EVERYTHING
BUT (INAUDIBLE) HAS MENTORING
PROGRAM, WE HAD DISCUSSION WITH
CLAUDIA RECENTLY, WE WERE ON A
CALL USING THE DEEP DIVE ABB
DATA GROUP PROJECTS AND WE
THOUGHT WE COULD USE IT TO
ANNOUNCE AND SEE IF THERE ARE
OTHER TRAINEES LOOKING FOR
MENTORSHIP OR JUNIOR FACULTY OR
SENIOR LOOKING FOR MENTORING, I
THINK HAVING SOME INFRASTRUCTURE
WOULD BE AMAZINGS. SOMETHING
SIMILAR COULD BE DONE FOR SOME
OF THE DATA SCIENCE AT LEAST
SOME BASIC EDUCATION AS WELL
WHICH WILL MAKE FOLKS MUCH MORE
COMFORTABLE THAT EVEN
UNDERSTANDING WHEN THE NEW
PAPERS COME OUT SO YES, I THINK
THAT IS A GREAT IDEA, SOME POINT
BUILDING INTO TRANSFUSION
MEDICINE EDUCATION IS HELPFUL.
>> THANK YOU, RUCHIKA. YVETTE.
>>S IN A GREAT CONVERSATION
AROUND HOW DO WE EMBED RESEARCH
IN TRAINING BUT THE I GUESS THE
BROAD THINKING AROUND APHERESIS
MEDICINE, WHEN YOU COME TO
APHERESIS MEDICINE TOLUENE FROG
OR PATHOLOGY OR HEMATOLOGY. SO
USING APHERESIS MEDICINE HOW
THOSE MULTIPLE MEDICAL
SPECIALTIES CAN GET, SPECIFIC
RESEARCH P P INFORMATION IN
RELATIONSHIP TO THOSE
POPULATIONS, PAINT DIVERSE
POPULATIONS OF PATIENTS WHO NEED
THIS ONE PROCEDURE APHERESIS.
SO JUST RECENTLY THIS WAS LAST
WEEK WE HAD A JOURNAL CLUB
TALKING ABOUT DIFFERENT
OBJECTIVE MEASURES OF TRAINING
PHYSICIANS IN APHERESIS MEDICINE
COMING FROM ALL THE MEDICAL
SPECIALTIES AND HOW TO HAVE
STANDARDIZED OBJECTIVES IN TERMS
OF TRAINING. USING APHERESIS
MEDICINE AS AN OPPORTUNITY TO
BRING FORTH INTO ONE PARTICULAR
PIECE OF DEALING WITH OR ONE
PARTICULAR PROCEDURE OR ASPECT
OF TREATMENT APHERESIS MEDICINE,
AND THEN HAVE ALL OF THOSE
MEDICAL SPECIALTIES THAT USE
THIS PROCEDURE TALK ABOUT HOW
THEY COULD COME TOGETHER IN
RELATIONSHIP TO FUNDING, AND
TRAINING AND RESEARCH AROUND
APHERESIS MEDICINE WHICH IS IN
MANY CASES TRANSFUSION, FALSE
TRANSFUSION AS WELL. WE STARTED
TA TALK TOWARD THEND OF THE
MEETING AND THERE'S GOOD
COMMENTS IN THE CHAT BOX AROUND
DIFFERENT INITIATIVES. BECAUSE
WE HAVEN'T HAD A CHANCE TO TALK
ABOUT THIS AND THINK THROUGH
WHAT SHOULD WE ASK FOR NIH AND
NHLBI TO DO TO HELP SUPPORT NEXT
GENERATION. AGAIN RECOGNIZING
EVERYBODY'S EFFORT AND INTEREST
IN THIS AREA, THANK YOU, FOR
SURFACING IT AND GIVING A CHANCE
TO RECORD IT AS A PARTS OF THE
PROCEEDINGS FOR THE STATE OF THE
SCIENCE TRANSFUSION MEDICINE.
THOSE CHAT MESSAGES WILL BE
CAPTURED. I WILL TRANSITION TO
GIVE INTRODUCTION FOR MIKE
BUSCH, AT LEAST MORE ME IT IS
CERTAINLY A VERY STRANGE TO SEE
HIM CLASSIFIED AS DIRECTOR
EMERITUS OF THE RESEARCH
INSTITUTE BUT WE ARE VERY
HONORED TO HAVE HIM AS WELL AS
WE HAVE DR. DEVINE SPEAKING ON
HIS PERSPECTIVE FOR A RESEARCH
CAREER IN BLOOD SAFETY AND
TRANSFUSION MEDICINE. WHAT HE
THINKS THE FUTURE BRINGS. SO HE
HAS AN ESTEEMED CAREER WITH OVER
600 PEER REVIEWED PUBLICATIONS
AS WELL AS 150 COMMENTARIES OR
EDITORIAL PIECES ON THAT. SO HE
DOESN'T NEED ANY MORE
INTRODUCTION FROM ME, I WILL
TURN IT TO MIKE. THANK YOU VERY
MUCH FOR CLOSING OUT THE MEETING
WITH YOUR KEYNOTE ADDRESS.
>> THANK YOU. IT'S BEEN A
TERRIFIC MEETING AND I WANT TO
COMPLIMENT THE EXCELLENT
PRESENTATIONS AND I'M HONORED TO
GIVE THIS TALK. I ENJOYED ALL
THE WORKING GROUP PRESENTATIONS.
I THINK THIS IS EXTRAORDINARILY
SUCCESSFUL, APPRECIATE STEVE'S
COMMENTS AT THE BEGINNING
LOOKING BACK AT THE LAST STATE
OF THE SCIENCE MEETING AND I
BELIEVE AS HE NOTED THAT WE HAVE
MADE ENORMOUS PROGRESS ON THE
IDEAS AND PROJECTS THAT WERE
DELINEATED. SO SURE WE WILL DO
THE SAME. IN MY TALK I WANT TO
STEP BACK AND SHARE PERSPECTIVE
OF STUDIES, DID BASIC RESEARCH,
LAB RESEARCH, Ph.D. IN
RESIDENCY BUT THEN I WAS
FORTUNATE TO GET INVOLVED VERY
EARLY IN MY CAREER IN THE EARLY
'80s WITH AIDS AND SOME BIG
STUDIES AND I WILL SHARE COUPLE
OF THOSE BUT THEN TALK ABOUT THE
EVOLUTION OF STUDIES AND IMPACT
OF BIG DATA ON THE FIELD. NEXT
SLIDE, I WANT TO RECOGNIZE TWO
MENTORS AND TED KATE FOUNDING
SCIENTIST SCIENTIFIC DIRECTOR
RESEARCH PROGRAM AT THE IRWIN
MEMORIAL BLOOD BANK WHICH I
JOINED AND PASSED AWAY ABOUT
NINE YEARS AGO A AND GEORGE NIMO
WHO RECENTLY PASSED AWAY. I MET
BOTH HERB AND GEORGE ALMOST
EXACTLY THE IMSAME TIME IN 1983
AT THE BLOOD BANK IN SAN
FRANCISCO AND TRANSFUSION AIDS
CRISIS WAS JUST BEGINNING TO BE
APAREN. AND GEORGE AT THE TIME
HAD JUST TAKEN OVER THE
TRANSFUSION MEDICINE BRANCH AT
NHLBI AND LEADING THE FUNDING
PROCESS FOR THE BIG STUDIES THAT
I WILL TALK ABOUT. SO MANY OF US
INCLUDING SIMONE AND RECRUITED
HER TO NHLBI AND NEXT SLIDE IS A
PHOTO WITH THE CONCLUDING
CEREMONY AROUND THE RED TREE
PROGRAM WHICH CHOSE GEORGE AND
SIMONE AND ALSO STEVE KLINEMAN
WHO HAS BEEN A LIFE LONG
COLLEAGUE, I MET HIM AT THE SAME
TIME BACK IN 1984 AND WE HAVE
BEEN CLOSE FRIENDS AND
COLLEAGUES COLLABORATORS
THROUGHOUT THE DECADES. SO THE
NEXT SLIDE IS THE FINAL
RECOGNITION WHICH IS TO BRIAN
AND NAREG, VERY PROUD OBVIOUSLY
THAT BRIAN IS SUCCEEDING ME AS
DIRECTOR. AND PROUD THAT BOTH
BRIAN AND NAREG ARE THE
CO-CHAIRS OF THIS SYMPOSIUM
BECAUSE THEY BOTH HAVE BEEN
COLLABORATORS AT MY -- OUR
INSTITUTE FOR LAST 10 TO 20
YEARS, WONDERFUL TO SEE YOUNG
PEOPLE SUCCEED WITHIN OUR
INSTITUTE STAY BUT ALSO TO MOVE
ELSEWHERE AND BE SUCCESSFUL SO
THAT RECENT DISCUSSION, IF THAT
WAS APPROPRIATE,S THE CRITICAL
VALUE OF TRAINING AND THE NEXT
GENERATION OF SCIENTISTS TO
ADVANCE THE FIELD. MOVING TO
THE NEXT SLIDE, COUPLE OF EARLY
STUDIES, I STARTED BACK IN 1984
AND I GOT INVOLVED WITH SAFETY
STUDY TSS WHICH MEASURED RATE OF
HIV INFECTION IN DONATION
COLLECTED PRIOR TO HIV ANN BODY
TESTING SO NHLBI HAD FORE SITE
AND JIM MOSLEY AND STEVE AND
GEORGE AND HERB PER KENS
ESTABLISH AD REPOSITORY OF
COUPLE OF HUNDRED THOUSAND
DONATIONS COLLECTED PRIOR TO
AVAILABILITY OF SCREENING IN
1985. WHEN WESTERED WITH EARLY
GENERATION ANTIBODY TESTS ABOUT
.8% DONATIONS IN SAN FRANCISCO
AT THE TIME WERE ANTIBODY
POSITIVE. AND THAT GAVE US
INSIGHT TO THE RATE OF INFECTION
PRIOR TO SCREENING BUT WE ARE
REQUIRED THE REAL UNDERSTANDING
OF THE PRE-SCREENING RISK WAS
INTEGRATION OF THAT DATA WITH
DATA ON RATE OF DONATION BY
PRIOR HIGH RISK INDIVIDUALS
IDENTIFIED AS AIDS CASES AND
TRACK TO LOOK BACK AND THEN
RATES OF INFECTION OVER TIME IN
SAN FRANCISCO BASED ON HEPATITIS
VACCINE TRIALS CONDUCTED, BY
INTEGRATING ALL THOSE DATA WE
WERE ABLE TO GENERATE THE CURVE
AT THE BOTTOM, WHICH IS THE RISK
OVER TIME AND DEMONSTRATE THE
EARLY IMPLEMENTATION OF DONOR
DEFERRAL CRITERIA WITH THE
REALIZATION OF TRANSFUSION AIDS
FIRST CASE REPORTED FROM SAN
FRANCISCO DECEMBER OF '82 LED TO
DROP AND PROGRESSIVE ENHANCEMENT
OF THOSE DEFERRALS, ABOUT A
TENFOLD REDUCTION OF HIV RISK
PRIOR TO THE AVAILABILITY OF
SCREENING SO A STRONG INDICATION
OF THE IMPACT OF DONOR SAFETY
SELECTION CRITERIA. SO ONE FIRST
BIG STUDY BUT THE NEXT ONE I
WILL SHARE IS A STUDY THAT WE
FUNDED EARLY ON FROM NHLBI IN
THE UPPER RIGHT, ANOTHER LONG
TERM MENTOR. THIS WAS A STUDY OF
AFTER SCREENING WAS IMPLEMENTED
WE REALIZE THE TRANSMISSIONS
WERE STILL HAPPENING SO IN
COLLABORATION WITH TEAM I MOVED
TO THE BLOOD BANK WE SAVED
75,000 IDENTIFIED PURIFIED
PBMCs FROM 25,000 SERO
NEGATIVE DONATION P AND DID POOL
TESTING SO CONCEPT OF POOL
TESTING WHICH IS OF COURTS
EMPLOYED IN THE U.S., -- OF
COURSE EMPLOYED IN THE U.S.
BEGAN IN A SENSE CREATING POOLS
OF PBMCs FROM DONORS AND PCR
AND CULTURE TESTING ENDED UP
BEING PERFORMED ON THOSE POOL
SAMPLES AND IDENTIFYING VIE
REAMIC INFECTIOUS UNITS MISSED
BY SCREENING. SO TO BEGIN MY
CAREER, I WAS LUCKY TO GET INTO
BIG STUDIES. SERIES OF SLIDES TO
MAKE A POINT HERE, EVERYTHING WE
DO IN MY EXPERIENCE HAS
RAMIFICATIONS WELL BEYOND
TRANSFUSION SAFETY. WITH HIV,
EARLY WORK WINDOW PERIOD AND HOW
TO CLOSE THE BIN DOE PERIOD FROM
A BLOOD SAFETY PERSPECTIVE LED
TO DEVELOPMENT OF STAGING SYSTEM
FOR IDENTIFYING CATEGORIZING
NEWLY DIAGNOSED PEOPLE TO WHAT
STAGE OF INFECTION THEY ARE IN
AT THE TIME OF DIAGNOSIS AND
THIS IS STILL USED GLOBALLY AS
THE STAGING SYSTEM USED IN IF
ALL CURE TRIALS, ET CETERA. FOR
IDENTIFYING WHEN PEOPLE
CATEGORIZE WHEN PEOPLE ARE
INFECTED. WE ALSO DEVELOPED
EARLY ON IN ORDER TO MEASURE
RISK IN DONORS WE DEVELOP
INCIDENCE ASSAYS WHICH ARE
INITIALLY DETUNED LESS SENSITIVE
BUT NOW THERE IS A BATTERY OF
ALTERNATIVE APPROACH TO DETECT
RECENTLY INFECTED PEOPLE BASED
ON ANTIBODY MATURATION DYNAMICS.
SO THESE ARE EXTENSIVELY USED
ALL OVER THE WORLD TO MEASURE
HIV INCIDENCE WITH MUCH MORE
PRECISION AND CAN BE ACHIEVED
WITH MORE TRADITIONAL INCIDENCE
MEASUREMENT METHODS SO EXAMPLES
HERE HOW STUDIES IN BLOOD BANKS
CAN HAVE RAMIFICATIONS IN THIS
-- TELL THE SAME STORY FOR MANY
OTHER VIRUSES AND INFECTIOUS
DISEASE. JUST TO RECOGNIZE THE
REDS PROGRAM, I'M FORTUNATE AS
STEVE TO BE PEOPLE WHO HAVE BEEN
IN ALL THESE PROGRAMS. REDS 1
STARTED IN '88 YOU CAN SEE THE
FOLKS THERE AND REDS 2 IN 2004.
ALL THESE PROGRAMS RAN INITIALLY
FUNDED FOR FIVE YEARS BUT THEY
TYPICALLY RUN FEW MORE IN
EXTENSION BASIS EXTRAORDINARILY
PRODUCTIVE, YOU CAN SEE THE
CITATION AFTER THE REDS 1 AND 2
PAPERS REVIEW PAPER THAT STEVE
LED. NEXT SLIDE. THE REDS 3
PROGRAM FOR THE FIRST TIME
INCLUDED NOT ONLY DOMESTIC BUT
INTERNATIONAL SITES. SO AGAIN
CITATION HERE TO THE REVIEW
PAPER FOR THE REDS PROGRAM AND
DOMESTIC TEAM ABOVE LEFT AND
INTERNATIONAL GROUP LOWER RIGHT
YOU SEE SIMONE HAS JOINED IN
REDS 2S WETAT THEN TO NHLBI AND
TOOK OVER FOR GEORGE AND LED THE
PROGRAMS FROM ALL THOSE YEARS
AND INTERNATIONAL AND NATIONAL
COLLEAGUES ON THIS CALL. NEXT
SLIDE. THIS IS THE REDS 4 TEAM
STILL ACTIVE AND PRODUCTIVE. ALL
ARE EXTRAORDINARILY PRODUCTIVE
WITH MANY DIFFERENT PROJECTS
GOING ON SIMULTANEOUSLY,
ENORMOUS WORK BUT ENORMOUS
SUCCESS. SO THE REDS 1 PROGRAM
JUST TO MENTION EARLY ON FOCUSED
ON BLOOD SAFETY, SO DEALING WITH
OBVIOUSLY HIV AND EARLY FINDINGS
WITH HEPATITIS C AND D WORK ON
ASSESSMENT AND SOME WORK ON NEW
TRANSFUSION ON DONOR
EPIDEMIOLOGY AND BLOOD
AVAILABILITY NO SIGNIFICANT
STUDIES IN TRANSFUSION
RECIPIENTS. THE NEXT SLIDE.
ONE EARLY AGAIN COMMITMENTS OF
THE NHLBI WAS ESTABLISH
REPOSITORIES. I MENTIONED
TRANSFUSION SAFETY STUDY
REPOSITORY IN EARLY ON HARVEY
WALTER HAD HIS LARGE
REPOSITORIES VIRUS STUDY SO A
FEW CITATIONS TO REVIEW ARTICLES
THAT DISCUSSED THE INCREDIBLE
VALUE OF SPECIMEN BANKS BUILT
OFF OF DONOR SAMPLES ARE NOW
LINKED DONOR RECIPIENT SAMPLES
SO INCREDIBLY IMPORTANT IS TO
SAVE SAMPLES FROM BLOOD
DONATION, SOMETHING I WISH WE
COULD DO MORE AND WE DO IN A
STRATEGIC WAY NOW AS I WILL TALK
ABOUT A LITTLE BIT LATER BUT A
FEW CITATIONS INCLUDING ONE WITH
SIMONE ON THE IMPORTANCE OF
REPOSITORIES AND UTILITY. AND
THEN THE NEXT SLIDE -- THEY ARE
GLOBAL NOW, THE BIOLINK PROGRAM
IS IMPORTANT NHLBI RESOURCE THAT
SAVES THESE. SO NOT ONLY DOES
NHLBI FUND ESTABLISHMENT OF
RESPOSITORIES BUT IN A STRATEGIC
WAY THEY MAINTAIN THE SAMPLES
FOR DECADES AND MAKE AVAILABLE
TO BIOLINK INCLUDING FUNDING
OPPORTUNITIES TO DO STUDIES
USING ARCHIVE SAMPLES WHICH
BECAME VALUE IN DECADES LATER.
NEXT SLIDE. IN TERMS OF
TRANSFUSION RISK WE HAVE HAD
INCREDIBLE SUCCESS WITH
IMPLEMENTATION OF DONOR
CRITERIA, ILLEGIBILITY CRITERIA
BUT IMPORTANTLY THE FURTHER
ADVANCEMENTS IN SERO LOGIC
NUCLEIC ACID TESTING DRIVING
DOWN THE RISK OF THE MAJOR
TRANSFUSION VIRUSES, ON THE
LINES BUT THEN EVERY YEAR SEEMS
WE FACE A NEW EIV THREAT SO
NHLBI THROUGH THE REDS PROGRAM
AND OTHER GRANT FUND HAS
RESPONDED TO VIRTUALLY ALL OF
THESE THREATS AND ESTABLISHED
WHETHER THEY REALLY HAVE
TRANSFUSION PATHOGENS, WHETHER
SCREENING IS INDICATED OR
WHETHER THEY ARE TRULY
INFECTIOUS DISEASE BUT WE DON'T
SEE TRANSMITTED BY TRANSFUSION
OR CAUSING DISEASE OR SOME CASES
FALSE ALARMS. SO THINGS LIKE
XMRV, A DECADE OR SO AGO,
ALLEGED ASSOCIATED WITH CHRONIC
FATIGUE SYNDROME BUT PROVEN
CONTAMINATION EVENT. SO HUGE
PROGRESS BUT NEVER ENDING
CHALLENGE OBVIOUSLY AS WE NOW
DEAL WITH SARS 2. THERE IS
CRITICAL PAPERS COMING OUT SOON
PAPER LED BY (INDISCERNIBLE)
WILL BE APPEARING THIS WEEK THAT
FULLY DISPROVES ANY RISK OF SARS
COV-2 FROM TRANSFUSIONS AND NOW
DEALING WITH MONKEY POX DO WE
NEED TO ADDRESS THAT SO NEVER
ENDING NEED TO RESPOND TO
THREATS AND DO SO IN A
SCIENTIFICALLY RIGOROUS FASHION.
SUMMARIZE AS WE EVOLVE OUR
THINKING OVER DECADES TO ADDRESS
TRANSFUSION THREATS WE ARE
BUILDING A PROCESS TO CRANK THE
WHEEL, SAVE SAMPLES WE ESTABLISH
PREVALENCE AND RNAEMIA OR
DNAEMIA AND ESTABLISH
INFECTIVITY OF, VIS-A-VIS ANIMAL
MODEL TRANSMISSION STUDIES AND
HUMAN LINK DONOR RECIPIENT
TRANSFUSION STUDIES, STUDIES ON
CONSEQUENCES OF THESE DISEASES
IN PATIENTSES. THIS PROCESS HOW
TO ASSESS WHETHER NEWLY
IDENTIFIED POTENTIAL TRANSFUSION
THREAT IS A PROBLEM AND HOW TO
RESPONDS TO IT IS SOMETHING THAT
WE THINK OVER DECADES LEARN HOW
TO DO, IT TAKES TIME AND MONEY
BUT IT IS SOMETHING WE
EFFECTIVELY ACHIEVE AND THE
BLOOD SUPPLY IS EXTRAORDINARILY
SAFE THE MOST RECENT FUNDING,
ALWAYS THROUGHOUT DECADES THE
REDS PROGRAM HAS BEEN
FOUNDATIONAL PROGRAM THOUGH THE
BULK OF THE SCIENCE EXECUTED HAS
OVER TWO DECADES FOCUS ON DONOR
ISSUES AND DONOR RECIPIENT
EFFICACY QUESTIONS, THE PROGRAM
ON WHICH NHLBI ADDS RESOURCES TO
ADDRESS NEW THREATS, WITH
RESPECT TO SARS COV-2 WHERE THE
RESPONSE PROGRAM WAS SUPPLEMENT
TO REDS SPORE PROGRAM TO
ESTABLISH FREQUENCIES OF RNAEMIA
DONATIONS TO DO TRANSFUSION
STUDIES AND INCLUDING ANIMAL
MODEL STUDIES. SO THIS IS A
SUMMARY OF THE KINDS OF STUDIES
THAT WE HAVE DONE OVER THE LAST
FEW YEARS WITH RESPECT TO SARS
COV-2COV-2. ONE STUDY WAS SERO
PREVALENCE THAT STARTED AS REDS
4 STUDY IN FIVE CITIES ACROSS
THE U.S. AND EXPANDED TO THE
BLOOD DONOR PROVIDENCE STUDY, SO
A BIG STUDY WE ESTABLISHED THAT
INCLUDES 50 STATES AND PUERTO
RICO AND WASHINGTON D.C.
TRACKING EVOLUTION OF BOTH
INFECTION AND VACCINATION OVER
THE LAST TWO AND A HALF YEARS NO
DETAIL ON THE FINDINGS BUT TO
ILLUSTRATE WE CAN ACHIEVE THESE
STUDIES THROUGH REACHING OUT TO
BLOOD ORGANIZATIONS THROUGHOUT
THE U.S. WHO ARE ALWAYS
COLLABORATIVE AND COOPERATIVE
WITH RESPECT TO PROVIDING
SAMPLES AND LINKING TOGETHER
THOSE SAMPLES WITH NEW
TECHNOLOGY TESTS, IN THIS CASE
SERO SURVEILLANCE. WORKING WITH
EXPERT GROUPS IN THIS CASES
WETAT TO EXECUTE WAITING --
WESTAT WAITING TO INFER FROM
BLOOD DATA THE RATINGS AND
IMPACT OF VACCINATIONS AND
IMPACT OF VARIANTS ON
TRANSMISSION OVER TIME. SO THIS
WAS MONTHLY CROSS SECTIONAL
TESTING OF 170,000 SAMPLES PER
MONTH, BUT WE REALIZE THE END OF
LAST YEAR THAT APPROACH WAS
REACHING SATURATION, COULDN'T
MAKE MUCH SENSE OF IT SO THAT IS
WHY WE MOVE TO THIS NEW
APPROACH, A REPEAT DONOR COHORT
SO THIS INVOLVES ABOUT 160,000
DONORS FROM RED CROSS AND VITALA
FREQUENT REPEAT DONORS HAD
SAMPLES SAVED DURING PERIODS
WHEN UNIVERSAL SCREENING WAS
GOING ON AND WE FLAGGED DONORS
IDENTITIES ANDTURING SAMPLES
EVERY TIME THESE DONORS DONATE
GOING FORWARD FROM JULY 2021,
CAPTURING SAMPLES AND STUDYING
THEM FOR CONTINUED EVOLUTION OF
THEIR INFECTION. THIS ALLOWS US
TO DETECT VACCINE BREAK THROUGH
INFECTION AND REINFECTION,
FUNDED FOR ANOTHER YEAR BUT
HOPEFULLY GO ON BEYOND THAT.
WITH THE VISION JUST TO MENTION
THIS CONCEPT OF A GLOBAL
IMMUNOLOGIC OBSERVATORY SO USING
SERIAL SAMPLES FROM REPEAT BLOOD
DONORS AND FLAG AND CAPTURE
SAMPLES FROM THE TESTING LABS
ARCHIVE THOSE SAMPLES AWAY, THAT
GETS US THE ABILITY TO RAPIDLY
RESPOND TO FUTURE PANDEMIC
THREATS AND UNDERSTAND WHEN
VIRUSES ENTERED THE BLOOD
SUPPLY. SO THE REDS PROGRAM
EVOLVED, I APOLOGIZE IT SHOULD
SAY REDS 2 AND 3 IN THE UPPER
BARS HERE. BUT THE REDS 2
PROGRAM BEGAN TO LOOK AT DONOR
SAFETY ISSUES, THINGS LIKE
TROLLY AND TACO BUT THE REDS 3
PROGRAM NEXT SLIDE REALLY DID
SOMETHING NEW AT THE TIME, TO
LINK DONORS AND RECIPIENTS AND
BUILD FOR THE FIRST TIME A LINK
DONOR COMPONENT RECIPIENT
DATABASE. THAT IS WHERE AGAIN I
WANT TO FOCUS MOST OF MY
SUBSEQUENT COMMENTS,S THE POWER
AND THE IMPORTANCE OF THOSE
LINKED DONOR RECIPIENT DATABASE,
A LOT COME OUT THROUGH THE
WORKING GROUP DISCUSSION IN THE
PAST COUPLE OF DAYS. SO IN IS
EARLY STUDY DANA SHOWED VERSION
OF THIS THATNA READ ROUBINIAN
SHOWED WHERE E H LINKED THE
BLOOD DONOR CHARACTERISTICS
EPIDEMIOLOGIC FACTORS GENDER
AGE, COMPONENT CHARACTERISTICS
IN TERMS OF THINGS LIKE
IRRADIATION AND STORAGE, WITH
RECIPIENT OUTCOME VARIABILITIES
AND DEMOGRAPHICS. AND WAS ABLE
TO SHOW CERTAIN DONOR
CHARACTERISTICS COMPONENT
CHARACTERISTICS IMPACT THE
EFFICACY. THAT LED TO A
FOLLOW-UP LARGE PROGRAM
TRIGGERED BY MARK AND TAMIR IN
THE WORK THEY DEMONSTRATED HIGH
BOTH SIDESSED DONOR VARIATION
INCLUDING GENDER AND AGE BUT
GENETIC VARIATION AFFECT
HEMOLYTIC PROPENSITY AND
CONSEQUENCE RECOVERY AND
EFFICACY OF TRANSFUSION. THE
NEXT SLIDE IS THE STUDY WE BUILT
ONE BIGGEST THING WE HAVE DONE
IS RBC OMICS STUDY, INVOLVED IN
ENROLLING 14,000 DONORS
PERSPECTIVELY USING DIVERSION
SAMPLES TO CAPTURE ALLOQUATS OF
THE PRODUCED RED CELLS, USING
THE REDUCTION FILTERS TO CAPTURE
WHITE CELLS AND CHARACTERIZING
PHENOTYPICALLY THE PROPERTIES OF
STORED RED CELLS STORED IN
SPECIAL TRANSFER BAGS AND
CHARACTERIZE END OF STORAGE,
WITH RESPECT TO HEMOLYTIC TO
PROSENSITIVE WE RECALL LARGE SUB
OAT AND SHOWED PHENOTYPE
REPRODUCIBLE WINDOW NORS SO
HERITABLE AND EXECUTED A LARGE
GWAS STUDY TO IDENTIFY LARGE
NUMBER OF TRAITS CORRELATED WITH
THE HEMOLYTIC PROPENSITY OF
THOSE RED CELLS THAT HAD BEEN
STORED FOR 42 DAYS. THOSE
SAMPLES HAVE NOW BEEN
EXTENSIVELY CHARACTERIZED BY
ANGELO D'ALESSANDRO'S TEAM BY
METABOLOMICS AND WE LOOK AT
TRANSFUSION EFFICACY IN TERMS OF
PRODUCTS DERIVED FROM THE UNITS
-- THESE CHARACTERIZED DONORS.
NEXT SLIDE. THIS SUMMARIZES NO
DETAIL HERE BUT THIS IS
PUBLISHED IN RECENTLY IN JCI BY
PAIGE STATISTICIAN OVERSEEING
THIS WORK AT RTI. THESE ARE
MAJOR GENE FINDINGS, MANY TURNED
OUT TO BE PROTEINS EXPRESSED ON
SURFACE OF RED CELLS, AND
FUNCTIONAL AND INVOLVED IN
PATHOLOGICAL CONDITIONS. IN A
SENSE NO SURPRISE THESE PROTEINS
AND POLYMORPHISMS WITHIN THESE
PROTEINS INFLUENCE ABILITY OF
RED CELLS TO TOLERATE STORAGE.
IMPORTANT NEW CAPACITY TO
UNDERSTAND MECHANISTIC REASONS
WHY RED CELLS FUNCTION
DIFFERENTLY. NEXT SLIDE PLEASE.
ANOTHER FOLLOW-UP FROM NAREG,
PUBLISHED IN JCI WHICH TOOK
GENETIC FINDINGS FROM THE GWAS
AND ADDED THOSE TO HIS ANALYSIS
OF TRANSFUSION EFFICACY.
EFFICACY DEFINED BASED ON
CHANGES POST TRANSFUSION CHANGES
AND HEMOGLOBIN CREATININE AND
BILIRUBIN. AND A NUMBER OF HITS
IDENTIFIED BASED ON IN VITRO
HEMOLYSIS CHARACTERIZATION OF
SAMPLES URNED THE OUT
SIGNIFICANT WITH RESPECT TO
TRANSFUSION EFFICACY IN
MULTI-VARIANT ANALYSIS ACCOUNTED
FOR ALL THE OTHER BLOOD DONOR
COMPONENT RECIPIENT FACTORS.
GREAT. ANGELO AND TRAVIS, HAS
DONE ENORMOUS WORK ON THE OMICS
SAMPLES AND ONE INTERESTING
PAPER THAT HE HAS STUDIED THAT
HE DEVELOPED WAS RELATED TO
EXPOSOME SO TURNS OUT THESE
DONOR SAMPLES THAT WE SAVE
FROZEN FROM METABOLOMICS
ANALYSIS CHARACTERIZE TO
IDENTIFY EXTENSIVE DIETARY
MICROBIOME AND POLLUTANTS AND
DRUGS IN DONOR SAMPLES SO OUR
DONORS ARE HUMAN BEINGS AND
EXPOSE NOT ONLY TO GENETIC
CHARACTER RICKS BUT EXPOSURE
CHARACTERISTICS DIFFERENT FROM
DONOR TO DONOR. WE CAN IDENTIFY
THOSE COMPOUNDS IN THE
METABOLOMIC PROFILES AND
CORRELATE THE IMPACT OF
FUNCTIONAL PROPERTIES OF RED
CELLS IN VITRO CHARACTERIZATION.
NEXT SLIDE SHOWS ONE RECENT WORK
PRODUCTS OF ANGELO'S AND GRIER
PAGE'S EFFORTS WHICH IS TO
COMBINE GENETIC DATA WITH
METABOLOMICS DATA IN
QUANTITATIVE TRAIT LOCI
ANALYSIS, THE PAPER IS UNDER
REVIEW BUT FOR THE FIRST TIME
REALLY INTEGRATED THE FINDINGS
FROM THE GENETIC POLYMORPHISMS
WE IDENTIFIED WITH THE
METABOLOMICS DATA THAT IS RICH
AND DEMONSTRATES EVERYTHING
MAKES SENSE, THAT THE GENETIC
POLYMORPHISM IN DIFFERENT GENES,
INFLUENCE PROTEIN FUNCTION,
REFLECTED IN METABOLOMIC
PROFILES OF THOSE RED CELLS. THE
REDS 4 PORTFOLIO, NOT GOING TO
GO INTO BUT IT INCLUDES
EXTENSIVE WORK TO TRY TO
IDENTIFY NEW BIOMARKERS OF RED
CELL SEQUENCING USING OMIC
SAMPLES AND USES WORK TO
ESTABLISH BIO RBC TECHNOLOGIES
FOR TRACKING SURVIVAL RECOVERY
AND FUNCTION OF CELLS AND
CHARACTERIZATION OF CELLS THAT
DO SURVIVE. THERE IS THE VEIN TO
VEIN DATABASE AND LARGE
MULTI-SITE PROTOCOLS WHICH
INCLUDED PRE-TERM INFANT AND RBC
IMPACT STUDY WHICH WILL USE A
TRANSFUSION MEDICINE ARRAY THAT
IS DEVELOPED AND INCLUDES
FINDINGS FROM RBC OMICS AND
EXTENSIVE ADDITIONAL
CHARACTERIZATION OF GENETICS OF
DONORS AND BLOOD GROUP
POLYMORPHISMS. THEN THE RAPID
RESPONSE CAPACITY BOTH WITH
RESPECT TO THE CONCERNS OVER
PREP AND DONORS AND THE SARS
COV-2 RESPONSE PROGRAM, I
REFERENCED EARLIER. CITATION
AVAILABLE FOR THAT. WHAT WE HAVE
DONE HERE IN THE U.S., WE DON'T
WANT TO SAY WE ARE THE ONLY ONES
WHO DO THESE BY NO MEANS
INCREDIBLE WORK DONE IN
COUNTRIES PARALLELLING WHAT WE
ACHIEVE AND I WILL TOUCH ON A
FEW OF THESE OVER THE NEXT FEW
SLIDES. GUSTAF IS SHOWN HERE IN
THE SCANDAT PROGRAM, I REMEMBER
WRITING WITH BRIAN EDITORIAL
THAT ACCOMPANIEDED THE FIRST
SCANDAT PAPER 15 YEARS AGO MAYBE
LONGER, AND THIS IS A LINKAGE OF
THE SWEDISH AND DANISH DONOR AND
TRANSFUSION DATABASES WITH THE
REGISTRIES, THE DISEASE
REGISTRIES WITHIN THOSE TWO
COUNTRIES SO BY NATIONAL
REGISTRY THAT IS NOW UPDATED AND
GOES BACK 20 YEARS. ALLOWS YOU
TO LOOK AT DONOR
CHARACTERISTICS. THERE'S NO
SAMPLES, NO DETAIL
CHARACTERIZATION BEYOND ROUTINE
DONOR DATA BUT BECAUSE NATIONAL
IDEA OF ALL DONORS AND PATIENTS
EVERYONE IN THEIR LIVES, THEY
EXECUTE EXTRAORDINARY STUDIES
AND DOZENS OF PUBLICATIONS FROM
GUSTA IF AND TEAM FROM THE
SCANDAT PROGRAM. CHRISTIAN
ERICSON, THE DANISH DONOR STUDY,
THE SCANDAT TOOK A STEP FURTHER
NATIONAL BLOOD COLLECTION
ORGANIZATION AND ABILITY TO
ESSENTIALLY CONSENT ALMOST 100%
DANISH BLOOD DONORS TO
PARTICIPATE IN THE STUDY, THEY
HAVE BEEN ABLE TO ACQUIRE
LONGITUDINAL SAMPLES FROM DONORS
AND STUDY THEM WITH RESPECT TO
MANY CRITICAL QUESTIONS THAT
WERE ALL INTERESTED IN TERMS OF
IRON SUPPLEMENTATION, SO
EXTENSIVE GWAS DATA GENERATED
AND BIOMARKER STUDIES LINK DONOR
RECIPIENT SAMPLES. IS THE
AUSTRALIAN SYSTEM WHICH WAS
UNAWARE OF, THIS IS ERICA WOOD
WHO LED THE PROGRAM OF
ESTABLISHING THE AUSTRALIAN
NATIONAL TRANSFUSION DATA SET.
NEXT SLIDE HAS HIGH LEVEL
OVERVIEW OF THAT PROGRAM BUT IT
IS GOLD STANDARD IN MY OPINION
AND BEING FINALIZED AND BUILT
BUT IT IS REALLY BUILDS THE
LINKAGE FROM THE DONORS AND
INCLUDING CAPTURING SAMPLES FROM
THE DONATIONS, THROUGH TO THE
HOSPITAL TRANSFUSION SERVICES,
AND THE RECIPIENTS AND THEN
LINKING THAT WITH CLINICAL
REGISTRIES THROUGHOUT AUSTRALIA
IN TERMS OF DISEASE REGISTRIES
AND HEALTH OUTCOME REGISTRIES.
SO THIS IS THE KIND OF BIG DATA
I THINK IS FUTURE OF THE FIELD I
WANT TO RECOGNIZE NANCY AND THE
CANADIANS HAVE BEEN FABULOUS
WORK AND NANCY IN PARTICULAR HAS
ALWAYS BEEN A CHAMPION OF
METHODOLOGY AND THIS IS FROM THE
LAST TRANSFUSION PUBLISHED
OUTSTANDING REVIEW OF HOW BIG
DATA RESEARCH TRANSFUSION
MEDICINE SHOULD BE DONE IN TERMS
OF OPPOSED HYPOTHESIS DRIVEN
BASED RESEARCH WHICH IS ALWAYS
INVESTIGATIONAL STUDIES THAT
INVOLVE RANDOMIZATION, THOSE ARE
ALWAYS IMPORTANT AND SHOULD BE
DONE BUT WHEN YOU CAPTURE AND
ACCURATELY CURATE AND ANALYZE
BIG DATA YOU CAN ACHIEVE
INCREDIBLE INSIGHTS THAT FEED
INTO THE NEXT FIELD OF
HYPOTHESIS DRIVEN RESEARCH.
COMING TO THE END HERE, I WANT
TO SAY ALL THESE GREAT IDEAS AND
ACCOMPLISHMENTS, CROSS
FERTILIZATION COLLABORATION,
CONCEPTION, PASSION, DEPENDS ON
PEOPLE. THIS IS A SLIDE OF GROUP
OF PEOPLE IN THE PERKINS LIBRARY
THAT UNFORTUNATELY ABOUT TO BE
CLOSED AS WE MOVE TO A NEW
FACILITY BUT THIS INCLUDES STEVE
KLINEMAN AND GUSTAV AND NAREG
AND OTHERS AND I THINK PHILLIP
OR ANGELO ARE STANDING UP TAKING
THE PICTURE BUT THERE IS NO
SUBSTITUTE FOR HUMAN BEINGS
REALLY BOUNCING IDEAS OFF EACH
OTHER AND CONSOLIDATING STUDIES
AND CONCEPTUALIZING THEM INTO
REAL PROTOCOLS THAT NEED TO BE
TRANSLATED INTO MANUALS OF
OPERATION AND EMPOWERMENT
ANALYSES AND SIMONE AND WE
EXECUTE THOSE STUDIES AND
ACHIEVE WHAT IS REALLY BEEN I
THINK A REALLY INCREDIBLE
PROGRESS IN OUR FIELD THAT WE
HAVE ACHIEVED OVER MY CAREER AND
SEE IT CONTINUING WITH MY
SUCCESSORS AS WELL AS THE TEAM
ON THIS CALL. JUST THIS QUOTE
WHICH I SPOTTED IN A TRANTAS
FUSION ABB SMART BRIEF, BUT FEEL
STRONGLY ABOUT, HAVING PEOPLE
WHO ARE PASSIONATE WORKING
TOGETHER FOR LONG PERIODS OF
TIME IS THE ANSWER. LOT OF
PEOPLE THAT REALLY WATCHING THAT
IS FINE BUT PEOPLE WHO ARE
PASSIONATE AND ACHIEVE IT THAT I
THINK ALLOW US TO ACHIEVE WHAT
IS IN THE LAST SLIDE WHICH IS
THE PRODUCT OF THIS MEETING
WHICH IS THE EVOLUTION OF OUR
FIELD TO PRECISION TRANSFUSION
MEDICINE VISION. THANK YOU FOR
YOUR ATTENTION. IF THERE IS TIME
I WILL HAPPILY ANSWER QUESTIONS
>> THERE IS TIME SO YES, PLEASE
THANK YOU VERY MUCH MIKE FOR
YOUR COMPREHENSIVE CONVERSATION
ABOUT THE FUTURE AND THE PAST
ALL TOGETHER. HAPPY FOR PEOPLE
TO ASK MIKE ANY QUESTIONS THEY
WOULD LIKE.
PEOPLE MAY BE A LITTLE
OVERWHELMED WITH ALL THAT
HONESTLY BUT I WILL ASK A
QUESTION. IT IS A BEAUTIFUL
VISION. BUT THERE IS A LOT OF
ELEMENTS TO PRECISION
TRANSFUSION MEDICINE THAT WE
HAVE TO WORK THROUGH. SO HOW DO
WE START? DO WE JUST START WITH
PATH OF OUR OWN OR SHOULD WE BE
DOING FOCUS RESEARCH THAT HELPS
UNDERSTAND FOR EXAMPLE, HOW MUCH
DONORS ARE WILLING TO
PARTICIPATE IN THOSE ACTIVITIES
>> IT IS A BIG MULTI-FACETED
PROCESS BUT I DO THINK WE HAVE
STARTED WELL ALONG THE PATH AND
IT IS CONTINUING AND AGAIN ALL
THE WORKING GROUPS ALL ENJOYED
THE WORKING GROUP 1 AND DONOR
WHAT DOES IT TAKE TO RECRUIT
INSCENT AND ENCOURAGE PEOPLE TO
GIVE. AS ALLUDED TO EARLIER, A
BIG PIECE OF THIS IN THE U.S.
THOUGH WE ARE INCREDIBLY
FORTUNATE TO HAVE THE RESOURCES
WE HAVE, IN TERMS OF NIH FUNDING
AND SUPPORT FROM OTHER NATIONAL
ORGANIZATIONS, THERE NEEDS TO BE
A COMMITMENT IN THE BLOOD
ORGANIZATIONS THEMSELVES.
OBVIOUSLY THEY CARE DEEPLY, THEY
NEED THE DONORS SO THEY CARE
ABOUT DONOR RECRUITMENT AND
RETENTION, RESEARCH THAT WAS
DISCUSSED. THEY WANT THEIR
PRODUCTS TO BE EFFICACIOUS, THEY
WANT NEXT GENERATION BETTER
TRANSFUSION PRODUCTS. SO I THINK
THEY NEED TO INVEST IN
ESTABLISHING CAPACITY TO CONSENT
DONORS ROUTINELY TO BE ABLE TO
CAPTURE SAMPLES FROM OPTIMALLY
SELECTED SUB SETS OF DONORS TO
BE ABLE TO LINK THAT TO
TRANSFUSION OUTCOMES OPTIMALLY,
CAPTURING SAMPLES AND SAVING
THEM AND THAT COULD BE ACHIEVED
THROUGH THE NATIONAL CENTRALIZED
TESTING LABS. SO WE CAN'T EXPECT
THE NIH AND THE CHALLENGE THAT I
FELT OVER TIME IS EVERY TIME WE
BUILD GREAT REPOSITORIES AND
GREAT LINK DATA SETS THAT THE
STUDIES EXPIRE. THERE'S NO MORE
FUNDING TO SUSTAIN THOSE
DATABASES FROM REDS 2, TO REDS 3
OR 4. SO I FEEL LIKE IN A
CHAMPIONING TO THE HIGHER
ORGANIZATION AND OTHERS THAT THE
BLOOD COLLECTION ORGANIZATIONS
AND TESTING LABORATORIES IN THE
U.S. NEED TO PARTNER TOGETHER
AND SUPPORT INFRASTRUCTURE ON
WHICH THEN RESEARCH PROGRAMS CAN
BUILD AND EXECUTE THE SCIENCE,
DISCOVERY WORK AND THEN THE
TRANSLATIONAL WORK TO MOVE THESE
PRECISION TRANSFUSION MEDICINE
TOOLS INTO ACTUAL PRACTICE.
>> THANK YOU, MIC. LOOKS LIKE
SUNNY, YOU HAVE A COMMENT? FEEL
FREE.
>> I DO, I HAVE A COMMENT AND A
QUESTION FOR MIKE. FIRST IT IS
REALLY HARD TO FOLLOW MIKE WITH
ANYTHING. YOU LISTEN TO A
PRESENTATION WITH MIKE IT IS
ALWAYS IN A CLASS BY ITSELF. SO
IT IS AN OPPORTUNITY JUST TO SAY
THE OBVIOUS, WHICH IS TO
CONGRATULATE YOU ON A JUST
STUNNING CAREER EVERY TIME YOU
SUMMARIZE ONE-TENTH OF WHAT YOU
HAVE DONE, IT IS MIND BOGGLING.
BUT ANYWAY THAT IS NOT WHAT I
NEEDED. ONE THING THAT CAME UP
IN TOWARD THE END OF THE SOS, I
THINK WAS REALLY IMPORTANT, YOU
TOUCHED ON IT MIKE. WITH YOUR
COMMENTS TRYING TO PREPARE NEXT
GENERATION. WE HEARD A LOT OF
INTERESTING COMMENTS ABOUT THE
IMPORTANCE OF TRANSFUSION
MEDICINE EDUCATION ESPECIALLY IN
TRAINING RESEARCH IN TRANSFUSION
MEDICINE. THE INADEQUACY OF A
ONE YEAR FELLOWSHIP TRAINING
PROGRAM. CLINICAL TRANTAS FUSION
MEDICINE IN ONE YEAR GOD FORD BY
ALSO DOING RESEARCH TECHNIQUES
AND HOW TO POOL OFF RESEARCH SO
YOU SAID YOU WERE INCREDIBLY
LUCKY TO HAVE FALLEN IN THE
CIRCUMSTANCES THAT FOSTERED YOUR
RESEARCH. AND I TAKE THAT POINT.
I SEE THE ELEMENT OF LUCK THAT
WAS THERE BUT WE KNOW IT WASN'T
JUST LUCK, RIGHT? THERE WAS
SOMETHING ABOUT YOU AND
SOMETHING ABOUT THE PEOPLE WHO
HELPED TRAIN YOU AND GUIDE YOU.
I WOULD BE INTERESTED IN
REFLECTING ON YOU REFLECTING
YOUR OWN CAREER. IF YOU COULD
HAVE ANYTHING, WITH RESPECT TO
TRAINING FUTURE TRANSFUSION
MEDICINE RESEARCHERS, WHAT WOULD
THAT BE? HOW DO YOU THINK WE
SHOULD CHANGE WHAT WE DO TO
IMPROVE GENERATION OF
RESEARCHERS?
>> THANKS FOR THE COMMENTS. I
FEEL THE SAME ABOUT YOU AND YOUR
CAREER. FABULOUS. I DID I GUESS
STUMBLE IN TO A SITUATION BUT I
PUT MY HEART AND SOUL INTO IT
FOR THE SUBSEQUENT 40 YEARS. I
DID IT WITH PEOPLE WHO ARE
PASSIONATE AND COMMITTED. SO HE
CAME INTO WORK UNTIL A WEEK
BEFORE HE DIED IN '92. LOVED
EVERY MINUTE OF TRAINING PEOPLE,
HE CONTINUED TO TRAIN ALL THE
FELLOWS AND LEAD THE TRANSFUSION
MEDICINE FELLOWSHIP PROGRAM.
USDS IS STILL ACTIVE TRYING TO
GET MONEY SUCCESSFULLY BUT JUST
BEEN EXAMPLE OF SOMEONE WHO HAS
JUST PUT THE METAL ALL THE TIME.
SO I FEEL LIKE I WAS FORTUNATE
AND AGAIN WITH NIH AND PEOPLE
LIKE GEORGE AND SIMONE ON MY
SIDE. BUT I THINK WHAT IS ALSO
TRUE IS I CARE DEEPLY AND
SURROUNDED -- BEEN FORTUNATE TO
RECRUIT AND SURROUND MYSELF WITH
YOUNG PEOPLE WHO DID STAY ON.
THEY DID THE TRANSFUSION
MEDICINE FELLOWSHIP AND THEN
THEY EITHER STAYED OUR INSTITUTE
FOR BRIEF PERIOD, MANY OTHERS
WHO BECOME GREAT LEADERS IN THE
FIELD, OR THEY STAYED ON AND
BECOME INCREDIBLY PRODUCTIVE AND
COLLABORATIVE IN OUR INSTITUTE.
THAT REQUIRED THE INSTITUTE.
WHAT WE HAVE SEEN UNFORTUNATELY
IS DEMICE OF ALMOST ALL WHAT
USED TO BE SUCCESSFUL
TRANSFUSION MEDICINE RESEARCH
PROGRAMS IN THE US. I WON'T
NAME NAMES BUT MANY OF THEM HAVE
EITHER STOPPED COMPLETELY OFFER
STRUGGLING TO MAINTAIN INTERNAL
FUNDING TO SUPPORT RESEARCH
PROGRAMS. THIS IS A TRAGEDY. THE
PROGRAMS LIKE OURS THAT ARE ABLE
TO CONTINUE TO BENEFIT FROM
INTRAMURAL FUNDING IS WHAT IS
CRITICAL, WE JUST MOVING INTO A
BRAND NEW INSTITUTE FACILITY.
THE INVESTMENT OF OUR TALENT TO
DO THAT IS WONDERFUL. A
COMMITMENT TO SUPPORT
INVESTIGATORS AT ALL STAGES TO
SUPPORT SUMMER INTERNSHIPS AND
FELLOWSHIP PROGRAMS, WE CAN'T
EXPECT AND WE ARE A SMALL FIELD
SO WE CAN'T SUCCESSFULLY COMPETE
IN MANY CASES FOR LARGE SCALE
TRAINING GRANTS, THE ONE WE HAD
HISTORICALLY THAT ARE BROOD BANK
FOCUSED UCSF NOW MOVED TO
CELLULAR THERAPY FOCUS. THEY
CHANGE TACK. SO IT REQUIRES
COMMITMENT BACK TO EARLIER
COMMENTS, IT REQUIRES
COMMITMENTS OF THE NATIONAL
BLOOD ORGANIZATIONS THAT WE NEED
TO SUSTAIN AND RECOGNIZE THE
INSTITUTES, WE LIKE TO SEE
TRAINING GO ON EVERYWHERE
RESEARCH OPPORTUNITIES, NATIONAL
THANKS TO LARGE PROGRAMS NHLBI
FUNDED, THAT BECOMES
COLLABORATIVE ACTIVITY THAT
DISSEMINATES OUT BEYOND THE
HANDFUL OF INSTITUTES THAT LEAD
IT AND DRIVE IT. BUT I THINK IT
IS THAT LONG TERM COMMITMENT OF
THE BLOOD ORGANIZATIONS THAT I
FEEL LIKE WE MANAGE TO MAINTAIN
BUT BARELY AND WE NEED TO KEEP
ON THEM TO SUPPORT RESEARCH AND
SUPPORT INFRASTRUCTURE.
>> DR. YOUNG, WOULD YOU LIKE TO
MAKE A COMMENT?
>> HI. FIRST OF ALL,
CONGRATULATIONS ON JUST SUCH
INCREDIBLE CAREER. IT IS GREAT
TO HAVE LUMINARIES LIKE YOU TO
LOOK UP TO AND THANK YOU FOR THE
GREAT TALK. ONE THING I HAVE
BEEN THINKING ABOUT AS I LISTEN
TO YOUR TALK AS WELL AS OTHERS
IN THIS AFTERNOON, AND MORNING
MUCH OF TRANSFUSION MEDICINE IS
NOT ISN'T AMENABLE TO HYPOTH
HYPOTHESIS. HYPOTHESIS BASED
RESEARCH, A LOT IS QUITE
EXPLORATORY. LOOKING AT DONOR
MOTIVATION IS EXPLORATORY
RESEARCH. NOT HYPOTHESIS DRIVEN.
.
AS IS SORT OF THE DONOR
RECIPIENT DATABASE, REALLY LENDS
ITSELF TO LOT OF EXPLORATORY
RESEARCH, NOT NECESSARILY
HYPOTHESIS DRIVEN AT THIS STAGE,
NOT A LOT OF MECHANISTIC
QUESTIONS, AVAILABLE IN OUR
FIELD WHICH IS DIFFERENT THAN
MAYBE SOME OTHER AREAS OF
MEDICINE. I GUESS MY QUESTION
IS, HOW WILLING IS NIH TO
SUPPORT THIS FIELD AND THIS TYPE
OF APPROACH BECAUSE THAT IS IN
MY EXPERIENCE BEEN ONE OF THE
CHALLENGES IN PROPOSING AND
GETTING FUNDED
>> THAT MIGHT BE A QUESTION
FORESI MOAN. I THINK THE OTHER
POINT TO MAKE IN RESPONSE THINGS
HAVE EVOLVED SO DRAMATICALLY
WITH COVID-19 THE LAST TWO DAYS
HAVE BEEN A STRUGGLE BECAUSE
FROM MIDNIGHT MY TIME UNTIL 8
A.M. OVERLAPPING BEGINNING OF
THIS MEETING THERE'S BEEN A WHO
WONDERFUL MEETING ABOUT HOW TO
BE READY FOR THE NEXT PANDEMIC
X, IT IS JUST -- BUT IT IS
CHANGED OUR LIVES PRETTY
DRAMATICALLY AND I THINK IT IS
CHANGED RESEARCH. VIRTUALLY
EVERYONE WHO IS DOING ANY KIND
OF RESEARCH FROM BASIC THROUGH
TRANSLATIONAL AND EPIDEMIOLOGIC
OBSERVATIONAL RESEARCH PIVOTED
TO WORK ON COVID-19. A LOT OF
INCREDIBLE PRODUCTIVITY HAS BEEN
ACHIEVED THROUGH OBSERVATIONAL
STUDIES AND JUST RESPONDING
URGENTLY TO CRISIS WE HAVE LIVED
THROUGH. SO I HI IT IS KIND OF
AN OPPORTUNITY FOR RESET AND I
WOULD LIKE TO HEAR NHLBI
RESPONSE AND OTHERS, I FEEL LIKE
RESEARCH WE DO IS REAL RESEARCH
AS STEVE SAID AT THE BEGINNING
THERE'S ALL DIFFERENT KINDS OF
RESEARCH AND IT HAS TO BE GOOD
RESEARCH AND HAS TO BE IMPACTFUL
BUT THERE IS VALUE TO THE KIND
OF RESEARCH YOU JUST SUMMARIZED
INCLUDING OPERATIONAL ISSUES
LIKE DONOR MOTIVATION RETENTION
THIS IS CRITICAL. SIMILAR MOAN
ARE YOU ON?
>> I'M ON AND I WANT TO SAY THAT
ABSOLUTELY I THINK THOSE LAST
TWO DAYS HAVE SHOWN ACTUALLY THE
VERY IMPORTANT RESEARCH
QUESTIONS THE FIELD HAS. SO OF
COURSE THIS IS FOR THE WHOLE
COMMUNITY TO CONSIDER. AS YOU
KNOW, BUT OF COURSE NHLBI WILL
ALSO LOOK AT THOSE PRIORITIES.
CLEARLY, I'M PERSONALLY ALTHOUGH
AS YOU KNOW I REALLY LOVE THIS
FIELD, BUT I'M STILL IN AWE
ABOUT BREADTH OF THE RESEARCH
AND POSSIBILITIES YOU HAVE IN
FRONT OF YOU. I ENCOURAGE YOU TO
WHEN YOU HAVE A RESEARCH IDEA IN
MIND YOU COME UP WITH SOME AIMS
AND CALL US.
>> ALL RIGHT, THANK YOU VERY
MUCH DR. GLYNN. ENCOURAGEMENT, I
THINK YOU WILL HEAR FROM PERHAPS
MORE THAN A FEW PEOPLE. I MAKE
ONE COMMENT, MIKE. LINKING TO
WHAT YOU SAID. I THINK ADMIRAL
LEVINE OPENING COMMENTS AT
HIGHEST LEVEL OF HHS THERE IS A
CURRENT CLEAR INTEREST THAT, IS
A LEVERAGE POINT FOR US SO WE
NEED TO TAKE ADVANTAGE OF THAT.
WE WILL DO OUR BEST AS CO-CHAIRS
AND ORGANIZING COMMITTEE OF THE
STATE OF THE SCIENCE TRANSFUSION
MEDICINE TO DO THAT. WHAT WE
WILL DO NOW IS TURN TO SOME WRAP
UP COMMENTS THAT NAREG AND I
WILL MAKE ABOUT WHAT WE HEARD
THE LAST COUPLE OF DAYS AND
WHERE WE GO FROM HERE. SO TURN
IT TO YOU TO START NAREG.
>> CAN YOU SEE MY SCREEN?
>> YES.
>> THANK YOU MIKE FOR THE
PRESENTATION ONE SEGUE. AS A
PULMONOLOGIST BROUGHT INTO FIELD
OF TRANSFUSION MEDICINE, REALLY
WAS BEING SURROUNDED BY GREAT
MENTORS, BY PEOPLE AROUND YOU
MADE THE DIFFERENCE FOR ME
PERSONALLY. FEW COMMENTS, THE
ORGANIZING COMMITTEE PICKED A
FEW EXAMPLES OF COMMON THEMES
RESEARCH PRY YOURS ACROSS THE
WORKING GROUPS THAT
INDEPENDENTLY IDENTIFIED AREAS
OF FOCUS. AREAS OF FOCUS TO
BRING US BACK TO THE LET ME MOVE
MY SCREEN, I AM LOOKING. THERE
IS A FOCUS FOR THE 2022 STATE OF
SCIENCE TRANSFUSION MEDICINE,
INCLUDE INCREASING DIVERSIFYING
THE BLOOD DONOR POOL IDENTIFYING
WHICH BLOOD PRODUCTS WIDOW NORS
BEST MEET THE CLINICAL NEEDS OF
SPECIFIC RECIPIENT POPULATIONS
HELPING ENSURE SAFE EFFECTIVE
TRANSFUSION STRATEGIES
RECOGNIZING THESE MAY DIFFER FOR
DIFFERENT RECIPIENT POPULATIONS.
SO I THINK OVER THE PAST TWO
DAYS WE HAVE TOUCHED ON NUMBER
OF THESE CONCEPTS ACROSS THE SIX
WORKING GROUPS. MAINTAINING
ROBUST DIVERSE BLOOD DONOR POOL,
THIS IS AS NOTED RECENTLY BEEN
AMPLIFIED IN SETTING OF BLOOD
SHORTAGE INCLUDING PART OF
COVID-19 AS WELL AS NEEDS FOR
SPECIAL POPULATIONS. WE HAVE
SPOKEN ABOUT NEEDS FOR
COMPONENTS AND RECIPIENTS, WIDOW
NORS WHICH PRODUCTS FOR BROAD
RANGE OF RECIPIENTS ACROSS THE
RANGE INCLUDING NEONATE AS WELL
AS FOR VARIOUS CLINICAL
SCENARIOS, BE IT SURGICAL,
NON-SURGICAL, SITUATIONS OF
HEMORRHAGE, PATIENTS WITH
MALIGNANT CONDITIONS. THEN WITH
OVERLAP FOCUSED ON BLOOD SAFETY
AND EFFECTIVENESS, MINIMIZING
MITIGATING RISK. IDENTIFYING
EXPANDING UPON EFFICACY
EFFECTIVENESS OUTCOMES AND AGAIN
IN VARIOUS PARTICULAR
POPULATIONS, WITH EVEN COMMENTS
DURING THE BREAK OUT ABOUT RED
CELL OR PLATELET EFFECTIVENESS
OR CLEARANCE NOT JUST POST
TRANSFUSION BUT DOWNSTREAM. WITH
MIKE'S PRESENTATION, FOR
BRINGING THIS TOGETHER THIS
VISION OF PRECISION TRANSFUSION
MEDICINE. CAN WE INTERFACE
BETWEEN BASIC CLINICAL SCIENCE
TO IDENTIFY WIDOW NORS USING FOR
EXAMPLE, GENOMIC OR GENOTYPING
METABOLOMICS OR HEMOLYSIS
MEASURES OR OTHER BIOMARKERS
MEET THE NEED FOR SPECIFIC
RECIPIENTS ACROSS THE AGE
SPECTRUM BY TRANSFUSION
INDICATION OR CO-MORBIDITY. THAT
INCLUDES DONOR OUTREACH
SELECTION AND RETENTION IN MANY
CASES SO THIS IS CONCEPT OF
PERSONALIZED PRECISION MEDICINE
IS ONE THAT HAS COME UP OVER
PAST FEW DAYS ACROSS THE THREAD
OF SIX WORKING GROUPS AND JUST
WANTED TO TOUCH ON THAT AS WELL
AS LET BRIAN DO SO.
>> THANK YOU, I AM GOING TO
BUILD ON WHAT NAREG SAID. SO WE
HAVE VISION FOR PRECISION
TRANSFUSION MEDICINE. SOME MIGHT
CALL IT PERSONAL TRANSFUSION
MEDICINE. WHAT I THINK RAISES IS
AN OPPORTUNITY BUT WE SEE IT AS
DIRECTLY MEETING THE CHALLENGES
THAT WE HAVE TO FACE HEAD ON
WITH RESPECT TO HEALTH
DISPARITIES. CAN WE HAVE THEM
BOTH. SO NO, WE CAN'T HAVE THEM
BOTH. WE HAVE TO FIGURE HOW TO
OVERCOME HEALTH DISPARITIES AND
ACCESSING DONORS, TO PROVIDE
COMPONENTS TO RECIPIENTS BUT
DOING SO IN WAYS THAT ARE
APPROPRIATE TO THE COMMUNITIES
THAT WE SERVE. I SEE THIS AS A
HUGE OPPORTUNITY BUT PERHAPS
EVEN MORE REALLY IMPORTANT
CHALLENGE WE FACE. THERE IS A
LOT TO UNPACK AROUND THAT.
CLEARLY WE WILL BE TRYING TO DO
SO AS PART OF THE PROCEEDINGS OF
THIS MEETING. THAT IS ALL TO SAY
ABOUT THAT. I WILL GO ON TO
SIMPLER TOPICS WHICH ARE EASIER
JUST TO START TO SUMMARIZE NAREG
SHARED THOUGHTS ON COMMON THEMES
AND I WILL SHARE A COUPLE BEFORE
WE TALK NEXT STEPS. SO WE HAD
DISCUSSIONS AROUND INCREASING
DIVERSIFYING THE BLOOD DONOR
POOL AND SPECIFIC WORKING GROUPS
FOCUSED ON DIFFERENT ASPECTS OF
THAT. HONESTLY THAT WAS MY
INTENTION, WE WANTED PEOPLE
THINKING ABOUT HOW WE BRING
DONORS IN, WHAT ARE THE ISSUES
RELATED TO SUFFICIENCY OF THE
SUPPLY BUT WE ALSO WANTED AN
INDEPENDENT VOICE, WHAT DO WE
HAVE WITH RESPECT TO DONOR
RECIPIENT DISPARITIES AND HOW
IMPORTANT ARE THOSE. BUT THERE
ARE THOSE THEMES THAT CLEARLY
ARE VERY CLOSE CONNECTED WITH
THE WORK THOSE TWO DIFFERENT
WORKING GROUPS DONE, ONE ARE
MOTIVATORS AND BARRIERS TO
INITIAL AND REPEAT DONATION.
PARTICULARLY AMONG YOUNGER
INDIVIDUALS AN PEOPLE WITH
DIVERSE BACKGROUNDS CURRENTLY
UNDERREPRESENTED IN DONOR POOL
AND WHAT ARE EFFECTIVE
STRATEGIES FOR OVERCOMING
BARRIERS PARTICULARLY DIVERSE
POPULATIONS OR COMMUNITY OF
COLOR. SO WORK TOGETHER TO MELD
TWO WORKING GROUP PRIORITIES
INTO RESEARCH AGENDA THAT
ADDRESSES ALL THAT
SIMULTANEOUSLY OR WE WON'T BE
SUCCESSFUL. WE HAVE THIS BROADER
OR ADDITIONAL ASPECT OF THE
SOCIAL MILIEU OR THE SITUATION
WE FIND OURSELVES IN IN.
UNRELATED TO RESEARCH
PARTICIPANTS AND WILLINGNESS TO
BE PART OF STUDIES, THAT IS MUCH
MORE THAN JUST INDIVIDUAL
CONVERSATION THAT IS ALL OF
THOSE OTHER FACTORS THAT
CONTRIBUTE TO WILLINGNESS TO
PARTICIPATE OR NOT AND WORK WITH
US SO WE FACE CHALLENGES BUT
OPPORTUNITIES. THIS IS
RECOGNIZING TWO VERY DIFFERENT
WORKING GROUPS FOCUSED ON
THINKING ABOUT THESE THEMES BUT
COMMON IDEA HOW THE USE SOCIAL
MEDIA, OR DIGITAL COMMUNICATIONS
TO BE MORE EFFECTIVE
COMMUNICATORS WITH BLOOD DONORS
OBVIOUSLY DATA SCIENCE UNDERPINS
THAT HOW THE FIELD IS GOING BUT
THERE IS MORE DIRECT HOY IS IT
EFFECTIVE AND HOW TO MEASURE
EFFECTIVENESS IN DONORS
THEMSELVES SO NO ANSWERS JUST
COMMON THEMES THAT ALLOW US TO
PROPOSE RESEARCH QUESTIONS AND
STUDIES THAT CAN LOOK AT THIS IN
MORE DETAIL.
>> PARALLEL ACROSS THREE WORKING
GROUPS WE SAW COMMON THEMES
RELATED TO VEIN TO VEIN DATAB
DATABASES, THE DATA METHODS
GROUP MULTI-DIMENSIONAL VEIN TO
VEIN DATABASES CURATED TO ANSWER
SPECIFIC RESEARCH QUESTIONS AND
SPECIFIC FOCUS ON SPECIAL
POPULATIONS OR RARE OUTCOMES
WHERE LARGE SCALE DATABASES IS
PERHAPS NECESSARY. OPTIMIZING
FOCUS ON EFFECTIVENESS BUT
LINKING IN WHAT THE ROLE OF
DONOR COMPONENTS WERE AS PART OF
VEIN TO VEIN DATABASE. ONE CAN
VIEW ROLE OF CONVALESCENT PLASMA
AS ANOTHER FORM OF VEIN TO VEIN
DATABASE RECOGNIZED IN
OBSERVATIONAL STUDIES THAT THERE
WERE FACETS OF THE DONOR
INCLUDING THEIR IMMUNE TITERS,
ANTIBODY TITERS RELEVANT TO
OUTCOME OF RECIPIENT AND HOW
THIS WAS NEEDED TO BE STUDIED IN
CLINICAL TRIAL AND OBSERVATIONAL
FASHIONS. INTEGRATING GENOMICS
INTO CLINICAL TRANSFUSION WORK
FLOW, THIS IS RECOGNIZED AN
APPROACH TO RARE GENOTYPES BUT
IDENTIFYING THE BEST DONOR FOR
RECIPIENT IS ANOTHER FACET OF
THIS CONCEPT. THE EVER PRESENT
FOCUS ON BLOOD SAFETY IS --
REMAINS HIGHLY RELEVANT. THIS
CAME UP IN FOUR WORKING GROUPS.
IN THE BREAK OUT SESSION THIS
WAS RAISED TO SOME EXTENT
OPTIMIZING CLINICAL OUTCOMES
NON-INFECTIOUS HAZARDS OF
TRANSFUSION PART OF THE EMERGING
INFECTIONS WORKING GROUP ROLE OF
PATHOGEN REDUCED BLOOD PRODUCTS
TO MITIGATE EMERGING PATHOGENS.
MECHANISTICALLY SPEAKING
RECOGNIZING THESE ADVERSE
OUTCOMES AND RECIPIENTS HOW WE
MORE BROADLY UNDERSTAND
PATHOYENSIS OF ADVERSE EVENTS
AND BETTER UNDERSTAND QUALITY IN
TERMS OF MITIGATING EVENTS.
RECOGNIZING THERE ARE
DISPARITIES IN MINORITY DIVERSE
BACKGROUND POPULATIONS WHERE WE
SEE HIGHER ADVERSE EVENT RATES
AND HOW CAN WE BETTER STUDY
THOSE AND MITIGATE THOSE IN THE
FUTURE. THEN MEASURING
EFFECTIVENESS, ACROSS MULTIPLE
WORK GROUP GROUP GROUPS. CLINICN
MAKING FOR RED BLOOD CELL
TRANSFUSION WAS EVER PRESENT
TOPIC IN THE OPTIMIZING CLINICAL
OUTCOMES GROUP. THIS IS AN AREA
OF FOCUS TRYING TO UNDERSTAND
HEMOSTATIC AND NON-HEMOSTATIC
PROCESSES FOR PLATELET
TRANSFUSION IMMUNE ASPECT OF THE
TRANSFUSION THAT ARE NOT WELL
UNDERSTOOD. CLEARLY
MECHANISTICALLY APPROACHES TO
BETTER UNDERSTANDING WHAT WE ARE
DOING, HOW WE ARE DOING IT AND
WHY WE ARE DOING IT FOCUSING ON
METHODS AND STRATEGIES FOR
UNDERSTANDING BOTH BLOOD PRODUCT
EFFECTIVENESS AND EFFICACY.
MECHANISMS FOR TRANSFUSION.
LASTLY, FOR THE FOCUS ON NEW
RESEARCH METHODS, THE USE OF BIG
DATA OR SCALABLE TECHNOLOGIES
ARTIFICIAL INTELLIGENCE, MACHINE
LEARNING BLOOD FLOWS ON THE
BLOOD BANKING SIDE AS WELL AS
TRANSFUSION MEDICINE, THIS TOPIC
ALSO CAME UP IN BREAK OUT
SESSION FOR OPTIMIZING CLINICAL
OUTCOMES RECOGNIZING PERHAPS
LABORATORY TRANSFUSION
THRESHOLDS SUCH AS
PRE-TRANSFUSION HEMOBLOW BIN
LEVEL OR PLATELET COUNTS ARE NOT
THE MOST EFFECTIVE APPROACH TO
TRANSFUSION DECISION MAKING AND
MAY TAKE USE OF LARGER SCALE
HEMODYNAMIC OR PHYSIOLOGIC
DAYTIME ON PATIENTS AND
UNDERSTANDING -- DATA ON
PATIENTS AND WHICH IS CLINICAL
DECISION MAKING AND
EFFECTIVENESS OF WHAT THAT
TRANSFUSION IS, USING LARGER
SCALE DATA. SO THIS IS THE
FIRST STEP OF PROCESS. WE HAD
THE OPPORTUNITY TO PRESENT DRAFT
RESEARCH PRIORITIES AND RECEIVE
YOUR FEEDBACK AND INPUT. NEXT
IS TO HAVE WORKING GROUPS
RECONVENE TO DIGEST AND THINK
THROUGH COMMENTS RECEIVED AND
HOW THAT MAYBE MAY FORMALLY
REVISE PRIORITIES. WE HAVE
OPPORTUNITY FOR ADDITIONAL
DIALOGUE AND FEEDBACK DURING THE
UP COMING AABB MEETING IN
OCTOBER. WE ALSO HAVE AN EMAIL
ADDRESS WHICH WILL BE PROVIDED
DIRECTLY TO REGISTRANTS BUT LET
YOU KNOW ADDRESS WILL DIRECTLY
REACH MEMBERS OF THE ORGANIZING
COMMITTEE AND MEMBER OF NHLBI
AND OASH. AS HAS BEEN DONE IN
THE PAST, THERE MAY BE SPECIFIC
WORKSHOPS OR SYMPOSIUM THAT
BASED UPON THIS DISCUSSION, WILL
BE HELD IN THE FUTURE BY NHLBI
AND OASH.
>> SO YES, AS INDICATED THERE IS
AN OPPORTUNITY FOR FURTHER
DIALOGUE SO WE DO ALL RECOGNIZE
THE EXPERIENCE OF HAVING TO TRY
TO HAVE THE STATE OF THE SCIENCE
IN TRANSFUSION MEDICINE AS
VIRTUAL MEETING, NOT HAD NEARLY
THE TIME TO REALLY HAVE SIDE BAR
CONVERSATIONS AND OPPORTUNITIES
FOR SPARK IDEAS. SO WE ARE VERY
HAPPY TO BE ABLE TO SAY WILL IS
ONE MORE IN PERSON OPPORTUNITY
FOR PEOPLE TO GET TOGETHER AND
TALK ABOUT THE WORK DONE HERE BY
ALL WORKING GROUPS AND WHAT IS
PRESENTED THE LAST COUPLE OF
DAYS. THAT IS GOING TO BE THE
AABB NATIONAL BLOOD FOUNDATION
RESEARCH AND DEVELOPMENT FORUM
THAT WILL TAKE PLACE AT THE
ANNUAL MEETING. TO BE HELD
OCTOBER 3 FROM 7 A.M. TO 8:30,
NOT A LONG PERIOD BUT IT IS
GOING TO ALLOW US SIX
SIMULTANEOUS ROUND TABLE
DISCUSSIONS LED BY ONE OR MORE
WORK GROUP CHAIRS AND MEMBERS.
SO AGAIN PEOPLE WILL MEET
SIMULTANEOUSLY, THIS MEANS YOU
WILL HAVE TO CHOOSE SPECIFIC
GROUP IF YOU CHOOSE TO
PARTICIPATE IN THE MEETING
ITSELF, BUT WHAT IT ALSO WILL BE
IS AN OPPORTUNITY FOR ADDITIONAL
60 MINUTES OF CONVERSATION ABOUT
EACH OF THE RESEARCH PRIORITIES
SO WHAT YOU CAN DO IS IF YOU DO
SIGN UP FOR THE AABB ANNUAL
MEETING YOU CAN SELECT ONE OF
THE ACTUAL ACTIVITIES YOU WILL
ATTEND SO IT IS IMPORTANT FOR
YOU TO BE ABLE TO -- IF YOU WANT
TO PARTICIPATE IN THAT SIGN UP
SO THEY CAN MAKE SURE TO
ACCOMMODATE ALL INTERESTED
INDIVIDUALS WHO WANT TO
PARTICIPATE. IN ADDITION TO
THAT DIALOGUE, BETWEEN NOW AND
BEGINNING OF OCTOBER IS A CHANCE
FOR THE WORKING GROUPS TO
RECONVENE AND THINK HOW THEY
MIGHT MODIFY OR LISTEN TO AND
REFLECT ON THE COMMENTS
RECEIVED. THEN THERE IS THE
LISTENING SESSION AND
OPPORTUNITY FOR THE ROUND TABLE
DISCUSSIONS AS PARTS OF THE
FORUM, WHAT HAPPENS WITH ALL
THAT INFORMATION? THERE IS
DIFFERENT REPORTS GENERATED, OF
COURSE VERY MUCH IN KEEPING WITH
PREVIOUS STATE OF THE SCIENCE
AND TRANSFUSION MEDICINE. FIRST
REPORT WILL BE WRITTEN REPORT
PRIORITIES DEVELOPED AND WORK
CLOSELY TO DEFINE NHLBI WEBSITE
AND SHARED WITH OTHER
ORGANIZATIONS. THIS WILL BE THE
FIRST FORMAL REPORT OF THE
PROCEEDINGS, OF THE 2022 SOS
TRANSFUSION MEDICINE. IT WILL
INCLUDE OVERARCHING INTRODUCTORY
COMMENTS WE WILL WRITE AS
ORGANIZING COMMITTEE AND HIGH
LEVEL SUMMARY OF THE LIST OF
PRIORITIES DEVELOPED BY EACH
WORKING GROUP. WE ALSO WILL
FOCUS ON CROSS CUTTING THEMES
IDENTIFIED BY MORE THAN ONE
GROUP WHAT WE THINK THAT MEANS,
EXPECTED TIME LINE FOR THIS IS
LATE OCTOBER TO EARLY NOVEMBER.
WHERE THIS WOULD BE AVAILABLE ON
THE WEBSITE SO WE HAVE TO WORK
THROUGH THAT BUT THAT IS THE
EXPECTED TIME LINE SO IT WILL BE
ABOUT A MONTH AFTER THE MEETING
THAT THIS IS AVAILABLE. IN
ADDITION THERE IS A FORMAL
PUBLICATION THAT WILL BE -- THE
TRUE PROCEEDINGS AS REPORTED,
MANUSCRIPT DEVELOPED COMBINING
ALL THE DIFFERENT PRIORITIES AND
ALSO INCLUDING REFLECTION ON
PROGRESS WE HAVE MADE AS A
SCIENTIFIC COMMUNITY SINCE 2015
STATE OF SCIENCE TRANSFUSION
MEDICINE. SO WHATEVER WE
ACHIEVE, WHAT WE HAVE YET TO
ACHIEVE AND HOW THE NEW
PRIORITIES LINK TO PREVIOUS
STATES IN THE SCIENCE. IN
ADDITION, ONE OF THE THINGS WE
HAVE BEEN EXCITED TO BE ABLE TO
TELL ALL THE WORKING GROUP
MEMBERS AND PARTICIPANTS IS THE
OPPORTUNITY FOR TRUE DEEP DIVE
THEY HAVE DONE THINKING WHAT THE
RESEARCH PRIORITIES SHOULD BE,
AND OPPORTUNITY TO WITHIN THAT
WORKING GROUP PUBLISH ALL NOSE
PRIORITIES ALLOWING MORE
INFORMATION OPT PRIORITIES
THEMSELVES, THEY HAVE DEVELOPED
AND EXTANT LITERATURE THAT
UNDERPINS, SO THAT IS AVAILABLE
BUT NOT A REQUIREMENT FOR EACH
WORKING GROUP TO BE ABLE TO TAKE
ON OR TACKLE. I SUSPECT ALL SIX
WORKING GROUPS MAY END UP
DEVELOPING THE -- THERE WILL BE
SOME CRITICAL PUBLICATIONS THAT
FELLOWS HERE IN 2022 OR
REALICSICLY 2023 STATE OF THE
SCIENCE WITH RESPECT TO EACH SIX
PRIMARY TOPICS THAT HAVE BEEN
THE THEMES FOR THE DIFFERENT
WORKING GROUPS. WE HAVE COVERED
A LOT. IN THE LAST COUPLE OF
DAYS AND WE WANT TO THANK
EVERYONE OF YOU FOR
PARTICIPATING IN THE 2022 STOT
OF THE SCIENCE TRANSFUSION
MEDICINE AND FOR ALL THE
COMMENTS AND DIALOGUE EVEN
THOUGH THIS VIRTUAL FORMAT IS
NEW FOR EXCHANGING SCIENTIFIC
IDEAS WE HAVE HAD A FANTASTIC
INPUT FROM WORKING GROUP
PARTICIPANTS AND PEOPLE WHO
PARTICIPATED AS JUST BEING PART
OF THIS TWO DAY INTERACTION.
AGAIN, THANK YOU ALL VERY MUCH.
I ALSO WANT TO THANK DR. NAREG
ROUBINIAN FOR BEING CO-CHAIR,
DR. GLENN FOR THE SUPPORT FROM
THE ORGANIZING COMMITTEE, THE IT
STAFF AND EVERYBODY ELSE AT
NHLBI, THANK YOU SO MUCH. L WE
ARE NOT DONE. WE ARE JUST
BEGINNING P DIALOGUE BUT YOU CAN
SEE WHAT I PRESENTED ON THE LAST
SLIDE WHAT THE NEXT STEPS WILL
BE OVER THE COUPLE OF COMING
MONTHS. THANK YOU, EVERYBODY.