Transfusion

2018-2019 Centre for Innovation annual progress report now available


Thursday, August 15, 2019

Housed within Canadian Blood Services’ Medical Affairs and Innovation division, the Centre for Innovation conducts and supports research, development, and knowledge mobilization to ensure a safe, effective, and responsive blood system. This last year was another outstanding one for the Centre for Innovation – the heart of Canadian Blood Services’ research and development activities – as highlighted in the 2018-2019 annual progress report, which was recently published. 

2018-2019 highlights include: 
  • The Centre for innovation supported 124 investigators across Canada through funding and products for research programs. 
  • The Centre for Innovation’s research and innovation network published 163 peer-reviewed publications, delivered over 300 presentations at local, national, and international conferences, and wrote 26 technical reports to share with Canadian Blood Services and partners to support decision-making. 
  • Research from the Centre for Innovation informed improvements to the monocyte monolayer assay, a test that can help choose the safest blood for hard-to-match patients. These improvements helped develop the assay for use in the clinical laboratory, and it will soon “go live” in the Edmonton diagnostics laboratory.  
  • The Centre for Innovation’s product and process development group supported the introduction of a new platelet pooling set, which received Health Canada approval in 2018-2019. The new platelet pooling set is used during production of platelet components from whole blood donations and results in more consistent platelet yields. 
  • The Centre for Innovation published discovery research linking a plasma protein with platelet clotting and suggesting a new link between diet and heart health. Lead scientist, Dr. Heyu Ni, received a prestigious Canadian Institutes of Health Research Foundation Grant. 

The Centre for Innovation is proud to support Canadian Blood Services’ efforts to continuously improve products and processes and to help every patient, match every need, and serve every Canadian and is honoured to be part of “the connection between the profound discoveries of science and the joyful restoration of health.”  

Learn more about Canadian Blood Services’ mission.  

Read the 2018-2019 Centre for Innovation annual progress report in English or French.

1.	Members of the Canadian Blood Services research network at the 2018 ISBT Congress in Toronto
Members of the Canadian Blood Services research network at the 2018 ISBT Congress in Toronto.
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2.	Training international students to perform the monocyte monolayer assay. Charlotte Paquet (France), Mairead Holton (Ireland), and Elodie Dupeuble (France) watch Selena Cen (Branch laboratory, Canadian Blood Services) perform the monocyte monolayer assay.
Training international students to perform the monocyte monolayer assay. Charlotte Paquet (France), Mairead Holton (Ireland), and Elodie Dupeuble (France) watch Selena Cen (Branch laboratory, Canadian Blood Services) perform the monocyte monolayer assay.

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.

Highlights from the Canadian transfusion community’s annual conference


Thursday, July 18, 2019

Calgary, Alberta, in the foothills of the Canadian Rockies, played host to this year’s Canadian Society for Transfusion Medicine (CSTM)/Canadian Blood Services/Héma-Québec annual conference. Canadian Blood Services is proud to be a key partner in this conference, which represents the major gathering of Canada’s transfusion medicine and science community each year. Many Centre for Innovation members attend the CSTM conference to network and exchange knowledge with colleagues across Canada. The Centre for Innovation also holds its annual Research Day in the same place and around the same time as the CSTM annual conference each year. I had the opportunity to attend both events and share my highlights here. 

Looking to the future: Centre for Innovation annual Research Day 

On May 29, the extended Canadian Blood Services research network got together to hear the latest developments and discoveries supported by the Centre for Innovation. The Centre for Innovation’s 2019 Research Day looked to the future. A series of talks described work the Centre for Innovation is conducting on “Blood Products of the Future”, which includes research to characterize cold-stored platelets – a transfusion product being explored for use in patients requiring massive transfusion – and to prepare for pathogen inactivation technologies. The “Scientists of the Future” session was an opportunity for Centre for Innovation-affiliated research trainees to give two-minute talks about their research. There were also sessions on new technologies, and advances in the areas of donor and clinical research. Dr. Paul Kubes, an invited speaker from the University of Calgary, gave an excellent talk about his research using advanced microscopy to image platelets in the body – studies that reveal fascinating details about the behaviour of these cell fragments in the body. 

Canadian Blood Services chief scientist Dr. Dana Devine led a discussion of the role of research in “Transfusion Medicine of the Future”. Touching on topics as diverse as the impact of new technologies, products and changing patient needs, to the system-wide challenges that may emerge as a result of climate change, this engaging discussion took full advantage of having a large portion of our usually dispersed research network in the same room.  

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Group photo of scientists and trainees
Centre for Innovation Research Day brought together more than 50 members of our internal and external research network.

CSTM 2019: Transfusing wisely 

The CSTM annual conference began the next day. It brings together nurses, physicians, technologists and others involved in transfusion medicine to share information, learn about the most recent developments in the field and appreciate one another’s contributions to providing effective transfusion therapy. Congratulations to all presenters from Canadian Blood Services – with 16 presentations at the conference’s workshops or oral sessions, and 39 poster presentations, Canadian Blood Services’ participation in the program was high as always.  

MSM Research 

For me, a stand-out session was “Changing Donor Management – MSM and Transgender Considerations”. In this session, some eagerly-awaited but still preliminary results from two projects funded by the MSM Research Program were presented. Mike Morrison,  an award-winning writer and entertainment and lifestyle blogger from Calgary, gave an excellent presentation in which he showed the human side of the MSM deferral policy and its impacts. 

Research highlights 

I enjoyed two sessions that highlighted the latest research being conducted by Canadian Blood Services and Héma-Québec: the “Research Highlights” session and the “Selected Oral Abstracts – Scientific” session. During these we heard about cutting edge research linking viruses and viral infectivity to clotting, new technologies that deepen understanding of blood products, including microfluidics devices to analyze red blood cells and a new type of analyzer for white blood cells. We learned about exciting research to develop monoclonal antibodies as alternative therapies that may someday replace IVIg. There were also talks about the application of research to address issues related to donor health, including iron deficiency anemia. 

A tale of two Canadas 

A final highlight was the session “Transfusion Considerations in the Indigenous Populations and Remote Locations.” This featured three presentations. Jennifer G. Daley Bernier, who has worked in Nunavut and the Northwest Territories for over a decade, described transfusion medicine challenges in Northern Canada. Ann Wilson described transfusion services in Northern Quebec. Darlene Richter and health worker Deanna Twoyoungmen provided the perspectives of Stoney First Nations towards medicine and laboratory procedures. Together these presentations highlighted the many unique challenges to the provision of medical services in northern Canada and to Indigenous people.  

While issues related to geography, weather and dispersed populations abound, it was eye-opening to learn about other perhaps less obvious issues. Communication can be a barrier. For example, there are 11 official languages in the Northwest Territories. To have a system accessible to all, hospital signage and information must be translated into all languages. Many challenges related to the effects of colonization remain. In transfusion medicine, medical histories are critical, but it can be difficult or impossible to get accurate medical histories from people who for various reasons may not have full knowledge of their medical past or who do not trust the medical system. Acknowledging cultural and socio-economic differences and adapting can help ensure everyone in Canada has access to the best care possible. 

These are a few of my highlights. The CSTM conference runs parallel sessions, so it’s impossible to cover everything! Did you attend CSTM 2019 in Calgary? Please comment below to let us know your highlights! 

 

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Button that reads We are the science behind the medicine

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.

Stories worth sharing: Effectively communicating “Research that matters!”


Thursday, July 04, 2019

Highlighting a recent blog post from Science Borealis, this “stories worth sharing” post gives background on the welcome support the Centre for Innovation’s 2018 Lay Science Writing Competition received from two key partners. 

The Centre for Blood Research (CBR) and the Centre for Innovation have a long-standing relationship. We partner regularly to deliver training and education events. The CBR helped to develop the competition and promoted it to their large network of trainees, support that helped guarantee that this inaugural competition ran smoothly and successfully.  

The Centre for Innovation also looked to Science Borealis, Canada’s leading national community of science writers and communicators, to lend their expertise as science communicators and champions of science communication in Canada. It was a pleasure to receive support from Science Borealis, and to work with Lené Gary, its general sciences editor, who supported the competition process.  

To learn more, read Gary's post about the competition, originally published on the Borealis Blog in June 2019.


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.

International effort leads to better clinical guidelines for a serious illness affecting fetuses and newborns


Thursday, June 20, 2019

The International Collaboration for Transfusion Medicine Guidelines (ICTMG) creates and promotes evidence-based clinical guidelines to optimize transfusion care in Canada and worldwide. The Centre for Innovation is proud to support the ICTMG by supporting ICTMG chair, Nadine Shehata, and hosting the ICTMG secretariat.


What is Fetal and Neonatal Alloimmune Thrombocytopenia?

FNAIT is a rare disease that occurs when a baby inherits platelet proteins from its father that are foreign to its mother. In response, the expectant mother’s immune system makes antibodies that destroy the developing baby’s platelets. Platelets circulate in blood and help prevent bleeding. When a fetus’ platelets are destroyed, the number of platelets in their blood is reduced (called “thrombocytopenia”), leaving the fetus vulnerable to bruising or bleeding. When bleeding occurs in the brain, FNAIT can become a devastating illness that leads to brain damage or death.

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ICTMG Fetal and Neonatal Alloimmune Thrombocytopenia
Image from the ICTMG Fetal and Neonatal Alloimmune Thrombocytopenia patient information pamphlet

Why does this sound familiar?

Perhaps you have a good memory! There was a R.E.D. blog post in June 2017 about an earlier systematic review to determine the safest antenatal (before birth) treatment for FNAIT, which you can re-visit to learn more about this disease. That review found that treating the mother with intravenous immunoglobulin (IVIG - a solution of concentrated antibodies purified from donated plasma) was safer for the mother and fetus than more invasive treatments.

Or you may have heard of a more common disease called Hemolytic Disease of the Fetus and Newborn. This similar disease occurs when there is an incompatibility between a mother and father’s blood type, which leads to destruction of the baby’s red blood cells. Hemolytic Disease of the Fetus and Newborn is the reason women’s blood type is checked during pregnancy. Some women whose babies are at risk of this disease can be offered Rh Immune globulin (or “anti-D”) injections to protect the baby.

What is new now?

The same group that performed the systematic review in 2017 has published a new guideline in British Journal of Haematology. In total, this group has now completed three systematic reviews related to the management of FNAIT: one looked at antenatal (before birth) management of FNAIT (published in Blood); one looked at postnatal (after birth) management of FNAIT (published in The Journal of Perinatology) and the third examined the value of diagnostic tests in FNAIT (published in Vox Sanguinis). 

The new guideline has 22 recommendations. The guideline group development team found that it is better to treat babies born with low platelets with whatever platelet product is available. It had previously been thought that these babies should receive matched platelets, but while matched platelets will work better, if they are not immediately available, it is better to begin treatment with whatever platelets are available than to wait. 

Who are these guidelines for?

These guidelines provide doctors with evidence-based information that will help mothers and their babies benefit for the best pre- and post-natal care available for FNAIT. To ensure these guidelines are disseminated broadly and appropriately used, the ICTMG also developed resources for physicians to accompany the guidelines. These include a podcast about the guideline for physicians, a PowerPoint presentation and treatment algorithms. The ICTMG also developed patient pamphlets in seven languages and a podcast about FNAIT for patients.

Where can I learn more?

You can learn more about FNAIT on the ICTMG website, where you’ll find links to all the physician and patient resources mentioned above. Naitbabies.org, a patient organization run by families affected by FNAIT, also provides a lot of valuable information. You can also learn about research conducted by the Centre for Innovation to help understand FNAIT and uncover new treatments for this disease here.


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.

Trainees shine at the 2019 Norman Bethune Symposium


Tuesday, June 11, 2019

This annual symposium honours Canadian physician, Dr. Norman Bethune. A controversial figure, Dr. Bethune is remembered as a fearless doctor, an innovative biomedical engineer, an early proponent of socialized medicine, and a trailblazer who operated the earliest practical mobile blood banks. Reflecting his legacy, the Norman Bethune Symposium offers a platform for researchers and clinicians to present strategies and challenges experienced within transfusion medicine.

The program for this year’s symposium was developed by Dr. Dana Devine, Canadian Blood Services’ chief scientist, and Dr. Edward Conway, Centre for Blood Research director. The agenda struck a balance between providing well-established experts the opportunity to present their work and showcasing trainees and early-career investigators. As Dr. Devine noted, the symposium has much to offer trainees: it provides “a chance to reunite with friends and colleagues, and encourages networking opportunities for trainees, including the opportunity to meet high-profile investigators, which can be particularly valuable for trainees and those early in their careers”.

Trainees presented an impressive six talks and 20 posters on topics ranging from the ethical debate around paid plasma donations to innovative materials to stop bleeding in trauma patients. In this post, I'll focus on the excellent contributions of trainees. Visit the Centre for Blood Research blog to read about the day's invited talks.

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Massimo Cau
Massimo Cau making his presentation

 

Researching the ethics of commercial plasma donation

Kelsey Johnson, a social scientist and PhD candidate from the department of geography at the University of British Columbia presented research she is conducting in partnership with Canadian Blood Services and the Centre for Blood Research on the ethical debates surrounding the history of commercialization of donor plasma. Kelsey is a recipient of the prestigious UBC Public Scholars Award, which supported a four-month research term in Atlanta, Georgia, during which she studied the history of paid plasma by trawling through media archives. Her findings highlight the shifting public perception and stigmatization of paid plasma donors in the southern US over the past several decades, research that is particularly relevant as the debate over paid plasma continues to play out in Canada.

Innovative research to better manage bleeding

Over coffee during the trainee poster session, I chatted to graduate student, Wayne Zhao (Devine Lab, University of British Columbia), who has attended three Centre for Blood Research symposia since he began his graduate studies. He commented on why he keeps coming back: “These symposia are a great platform for research trainees to receive input from researchers in different disciplines. This allows you to expand the horizons of your own research.”

Wayne, who is funded by the Canadian Blood Services’ graduate fellowship program, is researching cold-stored platelets. Platelets are usually stored at room temperature, because when exposed to cold, platelets become activated and are quickly cleared from the blood circulation once transfused. Recently, however, there’s interest in using cold-stored platelets as an alternative product for patients with massive trauma. Transfusing already activated platelets may be an advantage in helping those patients clot faster and prevent further blood loss. Wayne is testing the characteristics of cold-stored platelets in the laboratory, to better understand how they might behave in patients.

Trainee Massimo Cau (Kastrup Laboratory, University of British Columbia) is taking a different approach to preventing bleeding. He is using a novel technology self-propelling particles that drive drugs directly into the wound to stop deadly bleeds. He hopes they may be used to treat challenging or difficult-to-reach bleeds such as stomach bleeds. Using a model of upper gastrointestinal bleeds in pigs, Massimo found that treatment with self-propelling particles halted bleeding six-times faster than a similar treatment that is FDA approved.

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Attendees at the 2019 Norman Bethune Symposium
Attendees view poster presentations at the symposium
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Ahmed Al-Arnawoot with his poster presentation
Ahmed Al-Arnawoot with his poster presentation
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2019 Norman Bethune Symposium winners
Winners of the poster awards. (L-R) Stefanie Mak, CBR Education Program Manager, with winners Wayne Zhao, Emel Islamzada and Aparna Gopal

Understanding red blood cells

Another recipient of a graduate fellowship from Canadian Blood Services, Emel Islamzada (Ma Laboratory, University of British Columbia) described a new method to monitor stored red blood cell quality. She is using a microfluidic device developed by the Ma Laboratory that sorts red blood cells based on how rigid or flexible they are a known marker of the cells’ quality. She hopes to use this method to find “super-storers” – blood donors whose red blood cell quality remains particularly high during the storage period.

Dr. Narges Hadjesfandiari, a postdoctoral fellow (Devine laboratory, University of British Columbia) used product quality control data from Canadian Blood Services to understand factors that influence the quality of red blood cells. She showed that the time to production (i.e. the length of time between collection of a whole blood donation and the production of a red blood cell component from that donation) is important. Red blood cell units that had a shorter time to production had lower hemolysis, indicating better quality. She is also investigating factors in donors that may impact quality.

Travel bursary awardee

Master’s student, Ahmed Al-Arnawoot (Dr. William Sheffield Laboratory, McMaster University) was the recipient of a travel bursary from Canadian Blood Services Centre for Innovation to attend the 2019 Norman Bethune Symposium. He presented a poster and talk describing new approaches to find therapies for auto-immune vasculitis. He engineered natural inhibitors to target an enzyme in neutrophils that may cause inflammation in blood vessels. Ahmed used several rounds of screening of phage display libraries (a technique that won its developers the 2018 Nobel Prize in Chemistry) to develop a library of peptide candidate inhibitors that mimic the natural enzyme in the body.

“I am happy to be here! It is great that there’s an opportunity for Canadian Blood Services trainees to travel to Vancouver and present their work. Presenting here has been a great conference experience; there are lots of opportunities for dialogue with many high-profile investigators in my field.” – Amhed Al Arnawoot, McMaster University

I've described here the work of the trainees who gave invited talks, but trainees contributed much more to the 2019 Norman Bethune symposium. Many trainees presented posters, and each one gave a 30-second summary of their research at a “shot-gun talk” session. The brief snapshots presented covered research ranging from age-related macular degeneration to factors that affect red blood cell lysis during storage.

To culminate a day filled with valuable networking and knowledge dissemination, poster award winners were announced: 3rd place went to Wayne Zhao (Devine Lab, University of British Columbia), 2nd to Aparna Gopal (Karsan Lab, British Columbia Cancer Research Centre), and 1st place to Emel Islamzada (Ma Lab, University of British Columbia). Congratulations to award winners!

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 Norman Bethune 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.

Creating platelets 2.0: stronger, faster, and with twice the life-saving power


Thursday, June 06, 2019

The ability to genetically modify a cell is a powerful tool. Genetically modified cells have advanced our understanding of how the body works and how diseases develop. They are currently used as treatments for a range of diseases, from cancers to bleeding disorders. Yet not all cells are easily modified. This is true of small cells that are indispensable for stopping blood flow during injury. 

Stefanie Novakowski
Dr. Stefanie Novakowski

Why modify platelets? Platelets are currently used in the clinic to stop ongoing bleeding, caused by trauma or surgery. However, during severe bleeding platelets become dysfunctional, and these platelet transfusions no longer work. Correcting platelet dysfunction during trauma could be addressed by modifying platelets. For example, platelets could be engineered to produce proteins that activate clotting or stabilize blood clots after they form. Platelets are also given to patients with low platelet counts, which can be caused by a variety of factors, including certain cancers. While the platelets are given to patients to prevent bleeding, platelets also naturally interact and communicate with cancer cells. Modified platelets have the potential to deliver cancer-fighting materials to tumour cells, while also preventing bleeding. 

Unfortunately, commonly used methods for delivering genetic material to platelets either don’t work well or induce unwanted changes to the platelets. Currently, the best method for creating modified platelets is to modify the cells they develop from, called hemopoietic stem cells. These stem cells can be grown inside of a laboratory, modified, and then transplanted back into an individual. This approach has been used to treated inherited diseases. However, this method permanently changes a person’s platelets, and would not be useful in scenarios where only temporary modifications to the platelets are required, such as during active bleeding. Platelet BioGenesis, a company based in the United States, has recently developed a technology for growing large numbers of platelets from modified hemopoietic stem cells, but it will be years these laboratory-grown platelets can be used in hospitals. 

To address this problem, the Kastrup Laboratory at the University of British Columbia is taking a novel approach to directly modifying platelets. Using small, synthetic spheres called lipid nanoparticles, we successfully delivered genetic material into platelets without inducing unwanted changes to the platelets. By using specific lipids, or fats, to build the nanoparticles, we identified nanoparticles that deliver messenger RNA to the platelets. Like DNA, messenger RNA is a type of genetic material that is read by a cell to create new proteins. Unlike most cells, platelets do not have their own DNA, so genetically modifying platelets requires delivery of messenger RNA. 

Microscope images of platelets (red) that have taken up foreign genetic material (green). Adapted from: Novakowski et al: Delivery of mRNA to platelets using lipid nanoparticles. Scientific Reports 2019: 9; 552.
Microscope images of platelets - Stefanie Novakowski


By testing various classes of these nanoparticles, we determined characteristics of the nanoparticles that are important for uptake. These characteristics included a small size for the particle, and positive charge on its surface. Platelets treated with nanoparticles still had the ability to aggregate and spread, processes that are important to their ability to stop blood flow. We also found that the RNA taken up by the platelets was then released back out under certain conditions, indicating that modified platelets have the potential to be used a delivery vehicle for RNA-based drugs. This might be useful for creating cancer-fighting platelets, as RNA that promotes cancer cell death could be delivered to tumours by the RNA-treated platelets. 

Delivery of RNA to the platelets is only the first step in creating genetically modified platelets. To modify a platelet, the RNA has to be read by the cell, creating a new protein that alters the platelet’s function. Unfortunately, the RNA that we delivered could not be read by the platelets. To address this, we are now varying the composition of the nanoparticles, using different types of lipids to build the particles. This may alter where the RNA is delivered within the platelet and allow the RNA to be read by the platelets. Further experiments are also needed to see whether RNA-treated platelets can function once they are placed back into a patient. Currently, the platelets are modified after they have been isolated from whole blood from healthy individuals, and their function has only been assessed in a test tube. Whether these platelets still circulate and respond to signals within circulating blood remains to be seen. 

Platelets are involved in bleeding, cancer, and even immune and inflammatory disorders. The ability to directly modify platelets would extend our knowledge of platelet biology, and hopefully lead to improved therapeutics for a range of diseases. Platelet transfusions are already essential to treating bleeding. If researchers are successful in creating modified platelets that can be used in hospitals, there may be even more opportunities for platelets to act as a life-saving therapy in Canada and the throughout entire world. 

In January 2019, Dr. Stefanie Novakowski completed her PhD at the University of British Columbia in the laboratory of Dr. Christian Kastrup. There, she developed new tools for modifying platelets small cells found within the blood that are responsible for blood clotting. As a graduate student, Stefanie discovered a passion for knowledge translation, and the Canadian Blood Service's inaugural writing competition provided the perfect opportunity for her to hone her writing skills. Stefanie’s own work provided the perfect inspiration for her writing, since it was a story she knew but rarely shared outside of academia. Now that she has completed her degree, Stefanie hopes to start a career in science communication. 

The 2018 Canadian Blood Services Lay Science Writing Competition was organized by the Canadian Blood Services’ Centre for Innovation with welcome support from Science Borealis and the Centre for Blood Research at the University of British Columbia.


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.

Iron deficiency in pregnancy – a matter of public health


Tuesday, May 28, 2019

Red blood cells are like delivery trucks. They deliver oxygen to the vital organs in our body. Iron is the flatbed of the truck which holds the oxygen in place. Iron is a key ingredient to build red blood cells and when you don’t have enough iron, your body doesn’t make enough red blood cells. This is called anemia. We get iron from the foods we eat such as meat, leafy green vegetables and legumes – all rich in iron.  Our body loses iron when we lose blood, so women are at the highest risk for low iron since blood is lost monthly during childbearing years.

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Heather VanderMeulen
Dr. Heather VanderMeulen of the University of Toronto. It takes the iron of 177 steaks to build a baby.

Imagine a woman’s iron stores as a bank account, and because of menstrual periods leading up to pregnancy most women enter pregnancy with low balances. Also, pregnancy itself is like taking out substantial iron withdrawals every day because it takes over one gram of iron to make a baby – that’s equivalent to 177 steaks! So, if the withdrawals are larger than the deposits, she empties her account and anemia develops, which puts the mother at risk for severe fatigue, difficulty concentrating, shortness of breath and postpartum depression. Also, without enough iron, a woman’s red blood cell count can drop dangerously low, prompting a blood transfusion.  For babies, iron deficiency anemia can be even worse as it leads to low birth weight, preterm delivery, delayed development, poor future academic performance and even early death. Luckily, treating iron deficiency in pregnancy is straightforward: it involves making regular small bank deposits with oral iron supplements or getting a big paycheck with intravenous iron.

Why is a blood transfusion particularly worrisome in women of childbearing age? It is because being exposed to someone else’s red blood cells can trigger a woman to make antibodies. These antibodies can then complicate a future pregnancy as they target and destroy the fetus’s red blood cells, causing potentially life-threatening anemia. So, iron deficiency in pregnancy is a big deal – it carries important risks to mother and baby for this and future pregnancies.

We wanted to know how commonly women are being transfused during pregnancy at our hospital and if they are being transfused for unrecognized, untreated iron deficiency anemia. In other words, we wanted to know how often women and their babies are being put unnecessarily at risk. To answer this question, we looked at all pregnant women transfused in the last 5 years and reviewed their medical records to see if they were tested and treated for iron deficiency. We also compared each woman’s results to those of an age-matched woman who was not transfused, because we wanted to know what differentiates the transfused women from the non-transfused women.

We found that transfused women were over 3 times more likely than non-transfused women to have uncorrected iron deficiency anemia. This highlights how important iron is for building red blood cells and avoiding blood transfusion. We also found that twin or triplet pregnancies and emergency C-sections both increase the risk of requiring a blood transfusion.

For example, consider Shelly, a 31-year-old woman with low iron stores before pregnancy who is now pregnant with twins. Her iron and red blood cell levels have been dropping throughout her pregnancy, and on the day of delivery both are very low. She has a normal vaginal delivery and loses a small amount of blood. The next morning, her red blood cell count is extremely low, and she receives a blood transfusion. Shelly started pregnancy with a low bank account balance. The daily withdrawals from her bank account were doubled (twins), and her deposits were insufficient to compensate. Iron deficiency anemia was a predictable and preventable outcome that should have been recognized early and treated with iron. Our goal is to target patients like Shelly.

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Blood transfusions to pregnant women
Blood transfusions to women of childbearing age can complicate future pregnancies.

Our research shows that 1 in 3 pregnant women did not have their iron levels checked. In women who were identified as being deficient, less than half were treated with iron. This highlights an important gap in prenatal care and we believe that this problem is not unique to our hospital. All women should have iron stores checked and their iron supplementation tightly managed throughout pregnancy. Unrecognized, unprioritized iron deficiency in pregnancy is a universal public health problem.

Understanding why women are being transfused in pregnancy helps us identify areas for improvement. Obstetricians are on the front lines and feeding this information back to them is key to addressing the under-recognition and under-treatment of iron deficiency in pregnant women. The next step is to empower obstetricians to identify at-risk women early and prevent iron deficiency anemia throughout pregnancy. If we can prevent empty bank accounts, we can minimize blood transfusions to a vulnerable patient population and prevent the development of antibodies that can complicate future pregnancies.

Dr. Heather VanderMeulen is a third year Internal Medicine resident and soon-to-be Hematology fellow at the University of Toronto. Under the mentorship of Dr. Jeannie Callum and Dr. Michelle Sholzberg, she has developed a passion for women’s health and hematology. Her goal is to improve the quality of care provided to women of childbearing age with hematologic disorders.

The 2018 Canadian Blood Services Lay Science Writing Competition was organized by the Canadian Blood Services’ Centre for Innovation with welcome support from Science Borealis and the Centre for Blood Research at the University of British Columbia.


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.

Canadian Blood Services’ scientist recognized for his mentorship of graduate students


Wednesday, May 22, 2019

Congratulations to Canadian Blood Services' Dr. Jason Acker, who was awarded the University of Alberta Graduate Students’ Association Graduate Student Supervisor Award at a ceremony on March 22, 2019. This award recognizes "those faculty members who excel in the supervision of graduate students”. What makes this award even more special – Dr. Acker was nominated by one of his graduate students, Ruqayyah Almizraq. We chatted to Dr. Acker to learn more.

Dr. Jason Acker
Dr. Jason Acker and Ruqayyah Almizraq at the University of Alberta Graduate Students’ Association award ceremony

 

Q: Tell us more about this award?

"I have been very fortunate to have had the opportunity to mentor and work alongside an outstanding group of graduate students over the past 17 years that I’ve been at the University. While the GSA Graduate Student Supervisor Award is intended to recognize faculty who excel in the supervision of graduate students, I think this award really recognizes the environment that we create to allow students to explore and grow as researchers. At Canadian Blood Services we have been very intentional in providing our scientists and clinicians with the resources and tools to create a supportive environment for our trainees to excel in transfusion science research. This award is a testament to our pursuit of excellence in training the next generation of transfusion scientists.”

Q: What makes this award so special for you?

“I am particularly humbled by this event as it was a student-nominated award presented by the Graduate Students’ Association which I received. To be nominated by the graduate program would have been great, but to be nominated and selected by the students is extra special!

I do not see myself as the wise man sitting on the mountain and the students as the seekers of knowledge or wisdom. I see myself as the experienced tour guide who has been fortunate to have traveled many of the back roads and trails of an interesting scientific discipline. While I may be worldly in my travels, I am not the world’s traveler and as such I do not have all of the answers nor have I come to my final destination. I enjoy traveling together with my students as I am a learner too!"


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.

Writing competition runner up: Phlebotomy to improve surgical outcomes and donor blood economy – a redemption story


Tuesday, May 21, 2019

For thousands of years, traditional medicine placed blind trust in phlebotomy, which involves the withdrawal of blood from a patient for therapeutic purposes.1 Considering the paradigm of medical knowledge at the time established by Hippocrates, the Father of Medicine himself, there was some plausibility to this practice: if illness was caused by an imbalance in the four humours that course throughout our bodies, then removal of excess humour (blood) would be the cure.1 Galen, an avid follower of Hippocrates, employed the most lethal weapon to perpetuate this notorious medical malpractice: pen and paper.1 He wrote extensively to validate phlebotomy, and these works were translated to persist vastly across geography and time.1 Worldwide, phlebotomy became so deeply ingrained in medical practice that it was the first line treatment for ailments that we know today would be worsened from blood removal.1 From fevers, convulsions, to child-birth, phlebotomy was the answer that nobody questioned.1 

Today, phlebotomy as a treatment is reserved for select few and rare ailments, and is otherwise labelled as a major misstep in the history of medicine.1 However, our research group believes that phlebotomy has come full circle. Considering it has been shown to decrease blood loss and the need for blood transfusion during liver surgeries, phlebotomy appears as a promising solution to the current donor blood over-expenditure.2,3,4 

The liver is the largest solid organ in the body, which, like any organ, has the innate ability to develop primary cancers. Additionally, it contains a large blood vessel network, which helps perform its major function to detoxify blood; these vessels act like highways providing increased opportunity for cancers from other parts of the body to infiltrate as metastases. 

One of the most commonly used treatment for liver cancers is surgical removal.2,5 Although liver resections offer the potential for cure, they are associated with significant morbidity, largely due to major bleeding during surgery when the aforementioned blood vessels are disturbed.2,3.5 Significant bleeding may require blood transfusion to restore the lost volume, which, although sometimes necessary, is by no means the perfect solution.6 Blood transfusions pose risk of infection, allergic reaction, and possibly even worse prognosis following cancer surgery.6 Furthermore, blood is a rare commodity that is dependent on donors for inventory stability.7 With current demands far exceeding supply, donor blood is limited and costly with an estimated price tag of US$761 per unit.7 Considering the associated risk, expense, and limited supply, there is great urgency to find ways to optimize donor blood use. With the steady rise in liver cancers, prevalence of liver resection surgeries has also increased, along with the demands for donor blood due to persisting bleeding risks associated with these operations.8 Therefore, countless interventions have been tried by anesthesiologists and liver surgeons with the goal of reducing blood loss and the need for transfusion.2,3 

Our lab has launched investigation into a novel method called hypovolemic phlebotomy (HP).2,3 This procedure, as performed by our forefathers, involves the intentional withdrawal of a large volume of blood from the patient.2,3 However, this is done while the patient is asleep from anesthesia and in a controlled fashion so no more blood than necessary is removed. Target phlebotomy volume is around 7-10ml of blood for every 1 kg of a patient’s body, which is taken from the patient just before the surgeon cuts into the liver.2,3 

HP is theorized to reduce bleeding through its ability to decrease circulating blood pressure in the vessels that are most likely to bleed during liver surgery.2,3 A reduction in blood loss is linked with a decrease in blood transfusion.2,3 A preliminary study at The Ottawa Hospital demonstrated that the use of HP in patients undergoing liver resections was associated with both decreased bleeding and transfusion need compared to patients who underwent the same surgery without HP.2,3 Furthermore, there were no differences between these two patient groups with respect to surgical complications, injury to organs or death.2,3 A formal systematic review of the literature drew similar conclusions.4  

At present, more research is required to confidently attest to the safety and effectiveness of HP.4 However, our research demonstrates a promising signal that merits further exploration. If found to effectively reduce blood loss and transfusion need, this technique would have a significant impact on our blood donor economy. 

Although a story of impending redemption, only time and further research will tell what all this truly means. Perhaps, we are the modern-day Galen, entranced by the promise of phlebotomy once again. We would like to think otherwise, but have decided to take a page from his book and advocate for further investigations into phlebotomy in the Galen-like fashion that has proven successful – pen and paper. After all, “when there’s no place for the scalpel, words are the surgeon’s only tool”7 and as the saying goes, the pen is mightier than the sword.

Lily Park is a medical student at the University of Ottawa. She is fortunate to be working as a student research assistant with Dr. Martel, Dr. Fergusson and the hepatopancreaticobiliary (HPB) surgery team at The Ottawa Hospital. Her research interests lie at the intersection of surgery and transfusion medicine, as well as innovations in medical education. Lily entered the Lay Science Writing Competition to share the incredible work of her research group, while taking a break from conventional scientific writing to try her hand at a more creative piece. She hopes her submission will provide a glimpse into the exciting work of the Ottawa HPB team, that strives to improve patient outcomes and blood donor economy in the near future. Lily would like to thank Dr. Laura Baker for her support in writing this piece as well as her continued mentorship.
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Lily Park

 

The 2018 Canadian Blood Services Lay Science Writing Competition was organized by the Canadian Blood Services’ Centre for Innovation with welcome support from Science Borealis and the Centre for Blood Research at the University of British Columbia.

Further reading:

1.     Parapia LA. History of bloodletting by phlebotomy. British Journal of Haematology. 2008 Nov;143(4):490-5.

2.     Rekman, J., Wherrett, C., Bennett, S., Gostimir, M., Saeed, S., Lemon, K., Mimeault, R., Balaa, F. and Martel, G. (2017). Safety and feasibility of phlebotomy with controlled hypovolemia to minimize blood loss in liver resections. Surgery, 161(3), pp.650-657.

3.     Baker L, Bennett S, Rekman J, Workneh A, Wherrett C, Abou-Khalil J et al. Hypovolemic phlebotomy in liver surgery is associated with decreased red blood cell transfusion. HPB [Internet]. 2018. 

4.     Park, L., Gilbert, R., Shorr, R., Workneh, A., Bertens, K., Abhou-Khalil, J., Balaa, F. and Martel, G. The safety and effectiveness of hypovolemic phlebotomy on patients. Can J Surg. 2018 Aug; 61(4 Suppl 2): S94–S174.

5.     Kingham, T., Correa-Gallego, C., D’Angelica, M., Gönen, M., DeMatteo, R., Fong, Y., Allen, P., Blumgart, L. and Jarnagin, W. (2015). Hepatic Parenchymal Preservation Surgery: Decreasing Morbidity and Mortality Rates in 4,152 Resections for Malignancy. Journal of the American College of Surgeons, [online] 220(4), pp.471-479.

6.     Bennett S, Baker LK, Martel G, Shorr R, Pawlik TM, Tinmouth A, et al. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review. HPB. 2017;19(4):321-30.

7.     Shander A, Hofmann A, Gombotz H, Theusinger OM, Spahn DR. Estimating the cost of blood: past, present, and future directions. Best Pract Res Clin Anaesthesiol. 2007;21(2):271-89.

8.     McColl, R., Brar, B., Ghali, W. and Dixon, E. (2009). Hepatic resection in Canada: rates and geographic variation. Canadian Journal of Surgery, [online] 52(6), pp.264-268.

9.     Kalanithi P, Verghese A, Kalanithi L. When breath becomes air. New York: Random House; 2016.


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.

University of Alberta’s Timothy Caulfield receives James Kreppner Award


Tuesday, May 14, 2019

The 2018 Canadian Blood Services’ James Kreppner Award has been awarded to Timothy Caulfield, professor and research director in the Health Law Institute at the University of Alberta.   

Valued at $50,000, the award will support Professor Caulfield’s project to analyze the marketing practices of private cord blood banks, assess their claims, and consider how regulatory tools can help ensure services marketed are done in a scientifically informed and evidence-based manner.    

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Canadian Blood Services' James Kreppner Award awarded to Timothy Caulfield

“The entire Health Law Institute team is thrilled about this award, and we truly appreciate the opportunity to dig into the complex issues associated with donation, blood products and policy development,” says Professor Caulfield. “The research seems both timely and needed. We are lucky to have an award of this nature and hope our work will reflect James Kreppner's fearless analysis of controversial issues.”  

James Kreppner was a former board member of Canadian Blood Services, a lawyer, and a strong advocate for patients’ rights and blood safety. He suffered a severe form of hemophilia-A – a genetic disorder that makes it difficult for blood to clot, and his condition often required transfusions of blood products. In 1985, he became infected with HIV and hepatitis C through tainted blood products.  

Mr. Kreppner became a key figure in establishing the public inquiry into contaminated blood and testified twice before The Krever Commission. He was also a long-time volunteer and member of the Canadian Hemophilia Society before his passing ten years ago on May 14, 2009.   

This annual award named in his honour supports one high-quality research project that explores legal and policy questions relevant to the products and services provided by Canadian Blood Services. The award’s research priorities include the legal and regulatory aspects of (a) donation, collection, storage, and use of blood, blood products, and hematopoietic stem cells; and (b) organ and tissue donation and transplantation.   

Through a series of funding programs and research collaborations, the Canadian Blood Services’ Centre for Innovation conducts and supports research in key priority areas, including projects that span the translational continuum from “bench to bedside.”  

The 2019 competition for the James Kreppner Award will open for applications in Fall 2019 and will support one project with up to $50,000 for a period of one year.   

Find out more about current and past James Kreppner Award program projects:  

Further reading:  


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.

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.