A transfusion medicine physician at an academic medical center was recently updating lecture materials for teaching transfusion medicine to residents and medical students. Much to the transfusion medicine physician's surprise, another pathologist (not a blood banker) stated there was no reason to waste time updating transfusion medicine lectures each time they are given, since transfusion medicine is a static discipline. The transfusion medicine physician wonders what e-Network colleagues might suggest as a response to the non-blood banker physician. Do e-Network colleagues agree or disagree, and if you disagree, why?

The following replies were submitted in response to the above.

1. A transfusion medicine physician from New York wrote that in his view there have been more exciting and fundamental new insights into transfusion immunology and effective clinical transfusion practice in the last ten to twenty years than in any other period since Landsteiner described the ABO blood group. There is no research in pathology that he is aware of during the last twenty years that currently affects as many patients as the recent advances in transfusion medicine. He wonders if the non-blood banker pathologist missed the awarding of the Lasker Award to Harvey Alter for his magnificent work on essentially eliminating post-transfusion hepatitis C, and hepatitis B before that; the appearance of one of the first randomized trials of transfusion utility to define the role of transfusion in modern medicine (the TRICC study); or the evolving story of transfusion's effects on host immunity. Many of these new findings are leading to improvements in clinical outcomes with greater impact on patient care than anything in transfusion medicine since the advent of infectious disease testing itself more than thirty years ago. In the New Yorker's hospital, perhaps 20-25% of patients are transfused. Nationwide, 500,000-700,000 cardiac surgeries are performed each year. What about two randomized trials from the Netherlands demonstrating 50-60% reductions in mortality in cardiac surgery by altering transfusion practice (use of leukoreduction). The potential exists to save 10-20,000 patients' lives through new research. Is that useful and novel enough? Finally, the New Yorker asks what advances in pathology affect such a large number of patients? Where are the randomized trials of pathology innovations demonstrating improved patient outcomes, as opposed to the pie in the sky promises about the revolution that molecular pathology will bring about "any day now"?

2. A transfusion medicine physician from Texas wrote that no one who has noticed the advent of NAT testing and the way HIV-transfusion risks have changed over the last decade can think this area is not changing. It is a more important topic to patients than to physicians, as patients are disproportionately interested in the risk of transfusion. Also, the studies suggesting increased mortality with transfusion are intriguing.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator