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12th Earl W. Davie Symposium: a focus on the next-generation of blood researchers


Thursday, December 13, 2018

This post was contributed by Stefanie Novakowski, a PhD candidate in the Kastrup laboratory (Michael Smith Laboratories and the Centre for Blood Research, University of British Columbia). Tseday Tegegn and Bronwyn Lyons, also trainees at the Centre for Blood Research, contributed.

In November, the University of British Columbia Centre for Blood Research (CBR) hosted its 12th annual Earl W. Davie Symposium in Vancouver, BC. During the event, researchers, students, clinicians and patients discussed successes and ongoing challenges in hematology, from understanding basic mechanisms of clotting to improving patient care. Details of the invited talks can be found on the CBR’s blog here; however, a major part of what makes the day special is the enthusiastic participation of the CBR trainees. Throughout the day, the audience heard talks from four trainees, while 26 students presented their work during the poster sessions.

“Three of the invited speakers today told me how special the trainees are here at CBR. I have this on multiple occasions before!  I think that CBR not only has an excellent recruitment process in place, but we also offer very good training programs.” - Dr. Ed Pryzdial, Canadian Blood Services scientist and associate director of the CBR

Trainee talks: from blood clotting to neuroinflammation

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Parker Jobin (Overall Laboratory, University of British Columbia) presents his research during one of the day’s four trainee talks (Photo courtesy of the Centre for Blood Research.)

While the key proteins involved in blood clotting were identified by Dr. Earl W. Davie and his colleagues over 40 years ago, many questions remain, including questions about the role of coagulation factor XII (FXII) in regulating clotting. In the first trainee talk of the day, Tammy Truong (Weitz Laboratory, McMaster University), described her work characterizing the interaction between FXII and histidine-rich glycoprotein, a protein found in plasma and platelets. This work could aid in developing new treatments for blood clotting disorders, reducing the risk of bleeding associated with current drugs. Tammy was a recipient of the CBR’s newly-established travel awards, made possible through the Sheldon Naiman and Linda Vickars Hematology Endowment Fund.

Most people attending a symposium on blood research would not expect to hear about the impact of dietary fibre on their health; however, this was not the case at this year’s Symposium. In an engaging talk, Hannah Robinson, (Osborne Laboratory, University of British Columbia), described how high dietary levels of guar gum, a soluble fiber, provides protection in animal models of multiple sclerosis, preventing entry of immune cells into the nervous system. While guar gum can be found in ice cream, Hannah was quick to point out that “ice cream is not the cure for multiple sclerosis.”

Occasionally, new roles can be found for well-characterized proteins. In his talk, Parker Jobin, a MD/PhD student in Overall Laboratory (University of British Columbia), described how tryptophanyl-tRNA synthetase, a protein typically found within cells, can be released and alter cell growth in blood vessels, regulating inflammation. During the poster session, he shared how the Symposium has helped him in his professional development:

“At the Symposium, there’s a mix of both familiar and new faces. This provides an opportunity to hone your presentation skills in with colleagues you are comfortable with, while still meeting with many distinguished researchers and clinicians.” - Parker Jobin, Overall Laboratory

Poster presentations: the expanding realm of blood research

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Sreeparna Vappala (Kizhakkedathu Laboratory, University of British Columbia) shares her work with an engaged attendee. (Photo courtesy of the Centre for Blood Research.)

At the Symposium, each of the poster presenters have the opportunity to practice their elevator pitches with 30-second ‘shotgun’ talks. Maria-Elizabeth Beava (Jefferies Laboratory, University of British Columbia) gave a particularly enthusiastic talk that highlighted how the field of blood research has grown since the early focus on blood clotting proteins, as her work focuses on possible links between eye disease and Alzheimer’s Disease. The Symposium offers both trainees and researchers a chance to learn about research outside of their area of study, an opportunity many trainees value.

“At the Symposium, you can meet patients, scientists and doctors. I had the opportunity to talk to a trauma surgeon today, which gave me a new perspective on my research. This Symposium is a great event that provides wonderful opportunities for students!” -Wayne Zhao, Devine Laboratory

Wayne is studying how temperature affects the quality and function of platelets used for transfusion, which are currently stored at room temperature. There is growing interest in storing platelets in the cold, as this may help improve their activity in patients with trauma and it may allow an extension of the shelf-life of platelets, which is currently limited to 7 days. Wayne’s findings may help inform Canadian Blood Services and other blood operators as they explore new possibilities with platelet products.

Platelets are also capable of mediating inflammation, and are known to bind to and internalize pathogens, including viruses. Tseday Tegegn (Pryzdial Laboratory) is following protein synthesis in platelets, with the goal of understanding how platelet interactions with the Dengue virus alter proteins in the cell. She is investigating whether this contributes to low platelet levels (thrombocytopenia) during infection. Moving from platelets to the immune system, Linda Yang (Scott Laboratory) is focused on adoptive cell immunotherapy, a promising potential treatment for cancer. She is studying what the cells used in this therapy release and deliver to cancer cells, to identify which specific components reduce cancer cell growth.

Throughout the day, posters were judged by the CBR’s post-doctoral fellows, research assistants, and investigators. This year’s winners were Emel Islamzada (3rd place), Tammy Truong (2nd place) and Stefanie Novakowski (1st place).

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12th Earl W. Davie Symposium

It’s all about the trainees: Dr. Stefanie Mak, Education Program Manager at the CBR, presents the 1st place poster award to Stefanie Novakowski (Photo courtesy of the Centre for Blood Research.)

Both Stefanie and Emel’s research demonstrate the roles of new technologies in blood research. Stefanie (Kastrup Laboratory, University of British Columbia) developed a method for delivering genetic material to platelets using nano-sized delivery systems, with the goal of creating modified platelets with improved activity during trauma or with extended shelf-life. Emel (Ma Laboratory, University of British Columbia) studies how red blood cells decrease in flexibility during storage using microfluidic devices, which allow single cells to be isolated and characterized. Her findings could potentially be used to identify ‘superdonors’, donors whose blood cells do not deteriorate during storage, leading to improved activity after transfusion.

From developing new drugs to learning how dietary fibre might impact our health, the 2018 EWD Symposium was a diverse and enlightening experience, and this based solely on the student presentations! The CBR symposia are always an invaluable learning experience for attendees, from trainees to patients to established researchers, and this year was no different.

The Centre for Blood Research at the University of British Columbia hosts three Canadian Blood Services scientists and affiliated staff, postdoctoral fellows and students. Canadian Blood Services and the Centre for Innovation are proud to partner with the Centre for Blood Research to deliver training and education events including the annual Earl W. Davie Symposium.


Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

Centre for Blood Research summer students visit Canadian Blood Services


Wednesday, November 21, 2018

By Sarah Bowers, Undergraduate Student, Brown Lab, Centre for Blood Research

This post was originally published on the Centre for Blood Research blog. It has been republished here with permission with minor edits.

 

What is involved in getting blood that has been donated at a mobile clinic in Campbell River to a patient on the operating table at Vancouver General Hospital?

On Tuesday, July 24th, the Centre for Blood Research (CBR) Summer Students headed to Canadian Blood Services’ Vancouver location to find out. The donor centre and production labs are located at Oak Street and 32nd Avenue, right next to BC Children’s Hospital. Our tour was led by Dr. Tanya Petraszko, a hematologist and medical director at Canadian Blood Services.

Created in 1998, Canadian Blood Services is a not-for-profit charitable organization that manages the Canadian blood supply. With 36 fixed donor centres and more than 14,000 donor centre events every year, they are responsible for recruiting and collecting blood, plasma, and platelets all the way from Halifax to BC. The only exception is in Québec, where Héma-Québec operates. Dr. Petraszko pointed out that this national scope is one of the things that makes Canadian Blood Services so special.

First, we headed to the donor centre where people were in the process of giving blood. As the CBR summer students had recently been on a tour of the Blood for Research facility (a special donor centre and lab — a part of the Canadian Blood Services Centre for Innovation), we were interested to learn how this centre compared.

The main difference here is that because the donated blood components are intended for use by hospitals for medical care, patient safety must be considered in addition to donor safety. 

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Canadian Blood Services - Vancouver

Canadian Blood Services in Vancouver. Photo credit: Canadian Blood Services.

The Vancouver location that we toured also houses the production laboratory where blood from all over BC comes for processing. The protocols for transport change based on a number of factors, including the weather. Red blood cells aren’t fans of the July heat! When we arrived in the lab it was fairly quiet. Dr. Petraszko explained that often the busiest time is at night as units that have been donated throughout the day arrive. Samples of these units will have been sent for testing for things like infectious diseases and blood groups. Once the units arrive, blood components such as red blood cells, plasma, and platelets, are separated and stored in appropriate conditions, just like at the blood for research facility. We watched as labels were placed on products to reconcile them with their test results. Once testing and production are complete, the products are released to inventory and are ready to be distributed as needed to hospitals.

Many of us were not aware of the other services that Canadian Blood Services provides to Canadians. Dr. Petraszko explained that Canadian Blood Services purchases plasma protein products on behalf of Canadians, and also operates a Cord Blood Bank, and the OneMatch Stem Cell and Marrow Network. Dr. Petraszko highlighted that Canadian Blood Services now manages programs and services related to organ and tissue donation and transplantation. We were interested to learn about the Kidney Paired Donation program that allows people who aren’t a match for a loved one to still help through the swapping of compatible kidneys through multiple donor-recipient pairs to start ‘domino’ chains of transplants. Canadian Blood Services recently facilitated the 1000th kidney transplant through its programs!

The CBR Summer Students would like to extend a big thank-you to Dr. Petraszko, others at the Canadian Blood Services' Vancouver location, and Julie Kora for the opportunity to tour the facility. We now have a much better understanding of the work being done by Canadian Blood Services, and a new appreciation for its breadth.

Visit UBC's Centre for Blood Research to learn more


Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

Blood on the Move


Wednesday, September 06, 2017

By Lisa Bendall, Health Writer

This feature article was originally published in the Canadian Journal of Medical Laboratory Science (CJMLS) in Summer 2016. The CJMLS is a publication of the Canadian Society of Medical Laboratory Science. Please note that clarifications, updates and some additional content have been added (see italics) by Canadian Blood Services. Also note that within this article transfusion service providers (Canadian Blood Services' customers) are described as blood banks, banks, transfusion labs, hospitals and regional health authorities. 

Most days, across Canada, blood is on the move

It’s expected that our population will need nearly a million units of donated red blood cells this year. It’s undeniably gratifying to be a link in the lifesaving supply chain, as any donor or transfusion specialist will probably tell you. But what happens when the blood supply is critically low and not every patient can quickly get the components they need? How does the health care team make challenging ethical decisions?

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Most of the time, the blood banks of hospitals across Canada are sufficiently endowed. Canadian Blood Services (or Héma-Québec, in that province), which manages the collection and supply of blood, is in daily contact with hospitals and (regional) health authorities across the country to review their inventory levels and resupply needs.

“We move inventory almost every weekday,” says Rick Trifunov, Director of the Supply Chain Operations Planning Group at Canadian Blood Services. “We’re constantly trying to make sure that things are level-loaded and we’re not skewing toward shortage anywhere.”

Transfusion labs (in hospitals) make inventory requests based on what they have in stock and what cases are coming up, such as a full-term pregnant mother with a rare blood type. No hospital wants to find itself short on blood in a crisis. But neither would it be ethical to overstock on products that will expire before they’re used, or to deprive patients at other hospitals.

"It’s a daily balancing act," says Shelley Solomon, a Medical Laboratory Technologist at Mount Sinai Hospital’s Blood Transfusion Services department in Toronto. “We have a level which we’re supposed to keep the blood at, but sometimes we might ask for a bit more, because we don’t want to run out in an emergency. When you’re working by yourself [at night], the last thing you want to see is that the bank’s empty.”

No one can predict what tomorrow will bring. Despite its best efforts, a hospital’s blood bank may prove inadequate. In 2014, the blood transfusion laboratory at Toronto’s University Health Network (UHN) was left scrambling when two patients with the same rare IgA deficiency both needed blood on-hand for unexpected surgery. Since just one in 700 blood donors shares this rare deficiency, Canadian Blood Services was unable to deliver compatible blood in time.

In the end, the UHN blood transfusion team and Canadian Blood Services worked together to prepare “washed” blood — the Canadian Blood Services production department removed most of the IgA protein from regular donor units. Often, though, hospitals in busy urban centres have a special advantage when they run low without notice: they can do a little red blood cell swapping, instead of waiting for a resupply from Canadian Blood Services. “We are fortunate to have neighbouring hospitals around us, that have even bigger supplies than we do, as a resource,” says Solomon. It works both ways. “If we see something getting close to expiry, we can always hand it off to a trauma centre that can use it quickly, instead of it dying on our shelves.”

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That swapping strategy won’t work everywhere. For Queen Elizabeth Hospital on Prince Edward Island, the next-closest hospital is in Moncton, three hours away. The nearest Canadian Blood Services (distribution site) is five hours away.

“We’ve had trauma patients where we’ve had to wait for more blood to arrive, where the bank is depleted,” says Georgette Turner, Chief Technologist at the PEI Transfusion Service Lab. “Our biggest concern is always a storm and how we’d get the shipment here. We’re more concerned about the logistics of transportation than shortages.”

Fortunately, Turner has a procedure to follow: If she observes that inventory is running low, she immediately puts in an order for more. Outside regular delivery hours, a medical taxi is set up to make the drive. Blood products can also be flown in by Air Canada if timing is critical.

“Canadian Blood Services makes every effort to get it to us,” Turner says. “We’ve never had to say no to someone [in need of transfusion].”

What if the blood shortage is national and there isn’t enough product available anywhere in Canada to redistribute where it’s needed?

“We’re normally in a favourable inventory position,” says Rick Prinzen, Chief Supply Chain Officer, “but there are rare occasions where the national inventory has dropped to levels that are less than desirable.” In January (2016), Canadian Blood Services declared an Amber Phase for platelet inventory levels.

An Amber Phase is called when the blood component supply is not high enough to meet all routine patient needs; a Red Phase means it’s insufficient even for patients who need non-elective transfusions.

Canada has never reached a Red Phase which would likely be triggered by a combination of misfortunes such as labour strikes, pandemics, extreme weather, and a catastrophic failure in the supply chain.

“Typically, it’s not going to be just one thing,” says Trifunov. In the case of January 2016’s Amber Phase, blood donations had fallen off because of the New Year’s holiday weekend, while demand unexpectedly rose. That Amber Phase lasted just 36 hours. “That reflects the effectiveness of all hospitals taking similar steps to manage a supply,” notes Prinzen. “It was quite effective to get us through that low-inventory period.”

 

Inventory phases in Canada are determined by the National Emergency Blood Management Committee (NEBMC). They develop recommendations and provide advice to the Provincial/Territorial Ministries of Health, hospitals/Regional Health Authorities and Canadian Blood Services to support a consistent and coordinated response to critical blood shortages in Canada. The NEBMC includes individuals from the groups noted above and is led by the current chair of the Canada’s National Advisory Committee on Blood and Blood Products (NAC).

Prior to declaring a blood shortage phase, the NEBMC takes a number of factors into consideration. This not only includes Canadian Blood Services’ collection/recovery capacity and national inventory but also hospital inventory, as typically the majority of Canada’s blood supply is held within hospitals at any given time. 

 

All hospitals and (regional) health authorities must have an emergency blood management committee, with reps from several departments, including an MLT in the transfusion service lab who can report on the current blood inventory and discuss what options are available. In the case of an Amber or Red Phase, these committees will ensure their facilities are adhering to a national (blood shortages) management plan. That way, every hospital is handling the shortage the same way, making the same clinical decisions that have been carefully worked out ahead of the crisis.

 

In 2009, the NAC and the Canadian Blood Services jointly created a plan to maximize the effectiveness of a national response to any crisis which impacts the adequacy of the blood supply in Canada. The current plan, titled The National Plan for the Management of Shortages of Labile Blood Components (or The National Blood Shortages Plan) is available at the NAC website.

 

“It’s that whole concept of trying to do more equitable distribution of a national resource,” says Dr. Susan Nahirniak, who is a member of the National Emergency Blood Management Committee, and has worked on The National Blood Shortages Plan (Dr. Nahirniak is the chair of a working group that makes revisions to this plan). “It makes everybody treat their patients and their inventory the same.” For example, during an Amber Phase, the national plan dictates that hospitals cancel elective surgeries and adjust their optimal inventory levels. Units may be split to benefit more patients, or even used past their expiry if it’s medically justified.

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During a Red Phase, when resources are strictly rationed, hospitals with massively bleeding patients have a triage tool to guide complex decision-making over ‘who gets what first’.

“This is what I go through on a fairly regular basis as a transfusion medicine physician,” says Nahirniak, who practises in Edmonton. She recalls trying to help a patient on ECMO (cardiac/respiratory life support). “We couldn’t get control of the bleeding. It was just continual request for product after product. We weren’t in Amber Phase, but we were not with a robust inventory here locally.” If she continued transfusions, she’d be putting other patients in jeopardy. Nahirniak was obliged to gather the patient’s medical team, and together they assessed the likelihood of survival with a good outcome.

This demonstrates the importance of having a framework to follow during a potential Red Phase blood shortage, one that reflects careful thought, and extensive consultations with all stakeholders. In a country-wide crisis, no one, including MLTs, would be forced to make weighty ethical decisions alone.

Nahirniak would like to see improved awareness that the national plan exists. After every simulation or real-life shortage situation, her advisory committee conducts a review and revises the plan.

“In our platelet Amber Phase in January (2016), we identified some problems with communication. There’s still some misunderstanding of what the plan is trying to achieve and what the parameters are in there,” she says. She’s concerned, for instance, that technologists who aren’t very familiar with the protocols might be uncomfortable issuing expired platelets. “That has caused some angst with MLTs in the past.”

A strong, communicative team makes a difference. Although PEI’s Turner has never had to apply the Red Phase framework, she’s confident she and her colleagues would follow it closely. “Our medical director would have a good handle on it, and we have good communication here between technologists and the medical director,” she says. “I would have absolutely no concerns.”

Nahirniak’s group, meanwhile, is continuing to lead workshops and simulation activities. “We need that awareness so that the plan can happen seamlessly,” she says. “Sometimes those lessons learned, when you’re in those shortage situations, it doesn’t connect. If we can get better understanding, I think we’ll be more successful in a potential or true shortage.”

Canadian Blood Services is continually focused on ways to better manage, and most importantly avoid, severe blood shortages in Canada. Not only does Canadian Blood Services participate in Dr Nahirniak’s working group, we are always looking at ways to improve our own processes, external communication mechanisms and education materials. Recent improvement initiatives and areas of focus include: development of our own blood shortages plan, a more comprehensive inventory monitoring system to identify and avoid shortages, enhanced holiday collection/production planning, more effective inventory levelling across Canada, targeted donor recruitment activities, sharing of best practices around inventory management and utilization, better understanding of hospital inventories and demand through enhanced mechanisms for hospital reporting, assisting in hospital inventory optimization, and preventable discard reduction, to name a few.

From widespread education about a national management plan, to ongoing discussions among health care team members, to regular dialogue between hospital sites and Canadian Blood Services locations, it’s clear that communication puts every stakeholder on the same page. Ultimately, it is how we’ll all be protected in the event of a nation-wide blood crisis.

References:

We are very grateful to the author Lisa Bendall and the Canadian Journal for Medical Laboratory Science for allowing us to republish this article. 

 


 

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

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