Hematology fascinates scientists – from students to antiquarians

Aug. 1, 2010

Clement A. Finch (1915 – 2010)

Clement (Clem) Alfred Finch, MD, born on July 4, 1915, in upstate New York, 94, a pioneering hematologist whose research on iron helped improve nutrition and led to advances in diagnosing and treating anemia, died June 28 at his La Jolla, CA, home outside of San Diego. His death, less than a week before his 95th birthday, was confirmed by his wife, Genia. Finch was the first chief of hematology at the University of Washington-Seattle, from 1949 to 1981, and he remained on the faculty there for more than 60 years. His research helped define iron metabolism — how the body acquires, uses, stores, and loses iron, which is essential to the formation of the oxygen-carrying pigments: hemoglobin in the blood and myoglobin in the muscles. He also was involved in initiatives to lengthen the storage time for blood intended for transfusions, particularly in the military. Finch was president of ASH in 1966.

Minority students gain mentors for research and careers
In June, the American Society of Hematology (ASH) announced the selection of 14 participants for its 2010 Minority Medical Student Award Program, which encourages minority medical students to pursue an interest in hematology research. Each recipient receives the support of a research mentor and a career-development mentor, travel stipends to attend the ASH annual meeting, and a subscription to Blood, ASH's official scientific journal. The award winners spend eight to 12 weeks with their mentors on a hematology-related research project; subjects this year's winners will investigate include human embryonic stem cells, leukemia, thrombocytopenic purpura, cord-blood transplantation, and multiple myeloma. The 2010 participants come from

  • Meharry Medical College;
  • Mercer University School of Medicine;
  • Ohio State University College of Medicine;
  • Rush Medical College;
  • University of Alabama School of Medicine;
  • University of Arkansas for Medical Sciences.
  • University of Buffalo School of Medicine and Biomedical Sciences, University of Illinois-Chicago (with four participants);
  • University of Iowa;
  • University of Southern California's Keck School of Medicine; and
  • Wake Forest University School of Medicine.

High rate of deaths in young adults due to bleeding injuries
An international trial involving more than 20,000 participants in 40 countries was featured in the June 14, 2010, online issue of The Lancet. Labeled CRASH-2 and funded by England's National Institute for Health Research Health Technology Assessment program, the trial's results indicated that, if recently injured patients with serious bleeding were to be given an early injection of a cheap ($4.50 per gram), widely available off-patent drug — tranexamic acid or TXA, a drug that reduces clot breakdown — tens of thousands of lives would be saved worldwide yearly. (Smaller studies have shown the drug reduces bleeding in patients undergoing major surgery.) TXA showed no evidence of side effects or no increase in complications of heart attacks, strokes, or blood clots in the lungs. Injury is a leading cause of death in young adults throughout the world: some 600,000 injured people bleed to death yearly around the globe, and bleeding out is the second largest killer of people between ages 5 and 45 years; HIV/AIDS is first.

Vitamin E offers hope for AD relief
According to a recent Swedish study conducted in Stockholm by the Karolinska Institutet's Aging Research Center and published in the Journal of Alzheimer's Disease (July 2010), high levels of several vitamin E components in the blood are associated with a decreased risk for Alzheimer's disease (AD) in advanced age. The study suggests that vitamin E may help prevent cognitive deterioration in elderly people. The blood levels of all eight natural vitamin E components were measured at the beginning of the study. Subjects with higher blood levels were compared with subjects who had lower blood levels to verify whether the two groups developed dementia at different rates. After adjusting for various confounders, the risk was reduced by 45% to 54%, depending on the vitamin E component. The lead researcher commented that the findings need to be confirmed by other studies, “but they open up the possibility that the balanced presence of different vitamin E forms can have an important neuroprotective effect,” against AD in individuals aged 80+. For more information, consult www.medicalnewstoday.com/articles/193893.php.

Hematologists bound for Hollywood fame and fortune?
If you have not yet seen “Blood Detectives,” which aired earlier this year on the Discovery Health Channel, Washington DC's WETA, or PBS-affiliated stations around the country, you can now watch it online at www.bloodthevitalconnection.org/blood-detectives/Default.aspx. The hour-long documentary focuses on the highly specialized medical professionals — hematologists — who unravel the secrets and mysteries of human blood. The film not only examines the lives of patients affected by both common and deadly blood disorders but also features the hematologists as they race against time to find treatments for conditions ranging from leukemia to bleeding disorders and more. A DVD is available for use in the waiting room as an educational tool for patients, or for medical students to inspire them to pursue a career in hematology. “Blood Detectives” discussion guides are available to help facilitate a dialogue with participants about topics seen in the film. Joseph Lovett is the documentary's producer and director.

Sunny Florida is December site for 2010 meeting/expo
The 52nd annual meeting of the American Society of Hematology (ASH) is scheduled for Dec. 4-7 this year at the Orange County Convention Center in Orlando, FL. Advance registration and housing is available from Aug. 3 through Nov. 4; early-bird registration ended Aug. 2. From Oct. 21-28, the extremely competitive late-breaking abstract submissions will be open; only six abstracts will be selected, regardless of the number of submissions. This deadline is not intended as an extension of the general submission deadline, and focuses on abstracts with ground-breaking, novel data that, otherwise, could not be presented at the annual meeting. Official ASH headquarter hotels are The Peabody Orlando and the Rosen Centre for ASH members only. For hotel and other travel information, go to www.hematology.org/Meetings/Annual-Meeting/General/2744.aspx.WFH supported by Baxter International
Medical News TODAY reported that Baxter International launched “Our Lives with Hemophilia: The Stories of Vaibhav and Paul” at the Hemophilia 2010 World Congress of the World Federation of Hemophilia (WFH), July 2010. The video podcast provides a look into the daily lives of two young men — Vaibhav Nehra of New Delhi, India, and Paul Wilton of London, Canada — from diverse backgrounds living with severe hemophilia A. This podcast is the final episode in the educational series: “Achieving Treatment for All: Hemophilia and Bleeding Disorders,” which was developed to encourage a global dialogue as well as action based on the need for broad-based access to care and treatment for patients worldwide — 75% of them do not receive appropriate care. See the podcast at www.wfh.org/index.asp?lang=EN.

Intriguing information on blood substitutes
In May 2010, a paper, “Blood Substitutes,” by Sara J. Grethlein, MD, and professor at the State University of New York Upstate Medical University, and Arun Rajan, MD, a Clinical Fellow at the National Cancer Institute/National Institutes of Health, covers the more than seven decades' attempt to develop a viable blood substitute. Presumably, say the authors, if a blood substitute were developed, it would play a major role in the trauma-care and elective-surgery settings, and would benefit patients with medical conditions who need long-term blood transfusions. A successful blood substitute could be used as an organ preservative to prevent or decrease reperfusion injury to donor organs, as well as be accepted by various religious and ethnic groups with concerns regarding the use of human-derived blood products. The authors also point out that the still prevalent but small risk of transmission of bloodborne pathogens (i.e., HIV) has served as one stimulus to develop a synthetic substitute for human blood, and more specifically for a red blood cell (RBC) substitute. All efforts to date have essentially focused on the ability of RBCs to carry oxygen, yet no oxygen-carrying blood substitutes are approved for use by the U.S. Food and Drug Administration. Learn more at http://emedicine.medscape.com/article/207801-print.

Columbia U's oral histories, plus timeline highlight hematology
While the ASH celebrated its 50th anniversary two years ago, the history of hematology itself was considerably enhanced by a series of oral histories collected by the Columbia University Oral History Research website. A brief description of the project can be found in Nancy Tomes' September 1991 article, “Oral History in the History of Medicine” in the Journal of American History, Vol. 78, No.2, pp. 607-617.

The Columbia U interviews — conducted under the sponsorship of the American Society of Hematology — document the history of the development of the science of hematology and the history of the ASH. They offer a fairly complete introduction to the development of blood science and blood-science technology. Among the areas discussed are the development of the techniques of transfusion, the development of blood plasma, the organization of hematology as a discipline, early leaders in the field, major institutions sponsoring research, the relationship between blood diseases and cancer, the relationship of hematology to other medical practices, and the establishment and leadership of the ASH.

Another website, www.aphon.org/files/public/timeline_chart.pdf, reveals a timeline of major hematology landmarks, beginning with “Ancient Egypt” where blood-letting instruments were used, and ending with a brief notice for the 2000s: “The possibilities are endless ….” From ancient Egyptian bloodletting techniques to using antiseptics, to control infection during transfusions (Joseph Lister in 1842), to “butterfly” needles and intercaths developed in the 1950s to make IV access easier and safer, the history of hematology is a fascinating one that all medical laboratory students should peruse.

Cord blood acceptable for transplant in leukemia
Medpage TODAY highlights a review of an international study reported by its researchers online in Lancet Oncology. Their study found umbilical cord blood's use as an alternative to peripheral blood progenitor cells or bone marrow for stem-cell transplantation in adults with acute leukemia, despite a higher rise of transplant-related mortality. The gold standard involves the use of peripheral blood progenitor cells or bone marrow matched for eight human leukocyte antigen or HLA alleles, but only 50% of white patients and even fewer of other ethnic groups have an HLA-matched donor available. According to the National Marrow Donor Program (NMDP) (www.marrow.org), while there are many HLA markers, a small number of them are most important to transplant outcomes. The NMDP sets six HLA markers (two A, two B, and two DRB1) as minimum matching levels that must be met before a donor or cord blood unit from its Be The Match Registry can be used for a transplant. Read more about this study at www.medpagetoday.com/tbprint.cfm?tbid=2070.

Advanced clinical parameters
Evidence suggests that we will see a shift from the traditional paradigm of chronic disease diagnosis and management to one of disease prevention, early treatment, tailored therapy, and genome/proteome/cellulome-guided disease management. As such, best-in-class automated hematology systems with advanced, clinically relevant parameters that can potentially impact treatment guidelines, care pathways, patient flow, and return on investment are essential. For example, does the hematology instrument's capability include reticulocyte hemoglobin or RET-He analysis? RET-He, which directly measures the mean hemoglobin content of red blood cell precursors (reticulocytes), assists with early recognition of functional iron deficiency that is critical when caring for patients with end-stage renal disease (ESRD). What about other reportable FDA-cleared parameters, such as immature granulocyte enumeration, or IG, and immature platelet fraction, or IPF? By thoroughly considering quality, instrument reliability, and the ability to provide advanced clinically relevant results, laboratory managers can impact overall healthcare efficiencies operationally, clinically, and financially.

Ralph Taylor
Vice President
Marketing and Medical Affairs
Sysmex America
Maker of Sysmex XE-5000

APIC survey finds hospitals still struggle with HAIs, CRBSIs
According to a survey conducted by the Association for Professionals in Infection Control and Epidemiology (APIC), hospitals still struggle to prevent avoidable healthcare-associated infections or HAIs. Half of those hospitals surveyed agree that catheter-related bloodstream infections (CRBSIs) continue to be a problem and cite lack of time, resources, and commitment of hospital leadership as hindering their ability to combat these infections more aggressively. For purposes of the APIC survey, CRBSIs included infections resulting from central lines, peripheral lines, dialysis lines, and implanted ports. The survey was designed to uncover barriers to hospital adoption of best practices to prevent CRBSIs, one of the most costly and deadly infections transmitted in healthcare facilities. “Bloodstream infections from catheters are nearly 100% preventable with clear, actionable steps, says APIC's president. An estimated 80,000 U.S. patients develop CRBSIs, and about 30,000 die from them; this accounts for approximately one-third of the 99,000 deaths yearly from HAIs. The average cost of care for a patient with this type of infection can exceed $30,000, costing the U.S. healthcare system more than $2 billion annually. About half of survey respondents agree they spend so much time on surveillance or reporting that they do not have time to work on CRBSI prevention. Seven in 10 believe they do not have enough time to train others adequately on how to prevent bloodstream infections. For more information, visit www.apic.org.

Hematology at the core of next stage
We are seeing increased demand for total lab automation that combines hematology and hemostasis analyzers with other testing disciplines like chemistry and immunoassay systems — the next stage of the core lab concept. Digital microscopy is also gaining wider acceptance as a workflow tool in the routine lab. We believe that coordination of this kind of image-based information — with other hematology results through the use of multi-disciplined IT solutions — will become the standard for efficiency in the delivery of healthcare results. Using this combination of both image-based and in vitro-generated information will enable physicians and clinical laboratories to provide better patient care.

Fred Stelling
Director of Global Marketing, Hematology
Siemens Healthcare Diagnostics
Maker of ADVIA 2120i and ADVIA Autoslide stain maker