Dr. Joe Chaffin was teaching basic transfusion medicine at a pathology review course in 1997. Nothing was unique about this particular event – classes during the day and Q&A sessions in the evening. On a break, prior to one day’s evening Q&A event, he was riding down the elevator – dressed casually, apparently blending in with the attendees. He recognized two of the people that had been in his course earlier that day. He tried not to stare but he was struck by how exhausted they both looked. He recalls the ensuing conversation, noting that one of them leaned against the wall of the elevator and, in an exasperated tone, asking the other: “Can you tell me, why are we going down to listen to this blood bank guy again?” It was just fantastic. I burst out laughing and they were totally embarrassed, realizing who I was. In that moment, a silly name was born, and it stuck with me: The Blood Bank Guy.
Dr. Chaffin has a passion for helping people understand complex things in a simple, memorable way. He went from being a pathology resident in the United States Army at Walter Reed Army Medical Center to the medical director of the military’s largest transfusion service responsible for teaching residents and students in what he describes as what felt like a very short period of time.
Quite frankly, I was not in any way ready for it. Like many things in the military, you get thrown into situations that you’re not ready for. I went to a pathology course one day as someone who was just reviewing for their boards and thought, “Wow, this would be fun to do.” I sent a letter to the gentleman who ran the course: “If you’re ever looking for a transfusion medicine lecturer, I’d love to help one day.” I got a call what felt like the next day. “Next course, you’re on.” I said, “I’m sorry, what? I’m the one who has to stand up there and talk? You realize I was just at your course as an attendee?” He’s like, “Yeah, sure, go ahead.” I was thinking, “Wow, I’m really frightened by, a) your screening process for speakers and b) having to actually do this.” But I put together a three-hour talk on the basics of transfusion medicine. And that started a 20-year relationship, teaching tens of thousands of pathology residents.
As time went on, and he continued to teach, Dr. Chaffin found himself surprised by the comment’s residents would make. Things like, “Well, I’ve never heard some of the stuff that you’re talking about.” It became quite clear there was a knowledge gap, and he knew he needed to find a way to close it.
The internet was becoming more and more popular. I decided that I would try and put together a website. I coded that sucker just with pure, raw HTML. I had to teach myself HTML to learn exactly how to program a website. The first versions of the Blood Bank Guy website are preposterously silly but the whole idea was simply to teach people the essentials of transfusion medicine. That became my niche. To help people understand the basics. Dr. Chaffin walks us through the top three.
Largest gaps in transfusion medicine
- Understanding why we transfuse, what product and when
This is the most basic question in transfusion medicine from a clinician’s perspective. The patient blood management movement has done enormously great work in trying to educate clinicians on this topic, but I think we started from a really big hole. We have literally decades of people who didn’t understand transfusion medicine trying to teach transfusion medicine to other people who didn’t understand it. Unfortunately, for forever, docs weren’t listening. I get a little nervous when I start hearing hospital administrators talk to me about how I need to come in and help fix these bad doctors who are transfusing too much. That is not our goal in patient blood management. Our goal is better patient outcomes through appropriate transfusion. Yeah, okay, there’s a financial benefit. But when the motivation becomes beating on, quote-unquote, bad clinicians, I really get nervous about that entire concept.
- Pathogen-reduction technology
The treatment of blood products to eliminate pathogens, and other beneficial effects, is the way that transfusion medicine is heading and should head in the future. We have it in the United States now, and it’s certainly more advanced in some other countries.
We’ve been very fortunate to have had the patient blood management movement in the last 10 years because we have seen the number of transfusions decline almost year-by year in parallel. If that (PBM programs) had not been there, we would be talking more today about a blood donor crisis of epic proportions. It’s unbelievable to me the amount of times that we find ourselves in blood shortages. It appears to me right now that the younger generation needs a good reason to donate. And a good reason is not there are people that could die if you don’t do this. That doesn’t seem to move some of the younger donors now. It’s just not been their experience. They don’t see it the same way. I truly believe that there is a very large blood donor crisis in the United States and around the world right now that we have not yet figured out, specifically in how to reach younger donors.
Dear Hospital Administrator
Dr. Chaffin continued to share his passion for the value of the physician leader of the local blood center acting as a partner to the hospital in all of the areas above, and more. Hospitals that talk to their blood center(s), invite them to meetings, invite them to talk about transfusion medicine, or give grand rounds to educate on current developments and indications for blood products can greatly improve transfusion practice at their facilities.
I really truly believe that blood donor centers are an under-utilized resource for many, many hospitals. There’s a lack of understanding of how much close communication with a blood center can offer. When you look at a large academic center, most have someone who specializes in transfusion medicine, and that’s great. [But in smaller hospitals,] they are in a situation where they’ve got someone who’s the medical director of the transfusion service, usually it’s a pathologist, and hospital pathologists have a lot on their plate. They may not be able to keep up with current new developments in transfusion medicine. That’s where working closely with your blood center, where there is a transfusion medicine specialist, can really, really help.
What I’m most proud of is hospitals that I have worked with who now call us proactively about situations, who we work with collaboratively to make sure that we’re getting them the right products for their patients and at the same time, they work with us to help serve the community for situations when they’re over-stocked because they trust that we’re going to help when they’re in that position. There is so much that a hospital blood center and the people at that blood center can do for you.
Transitioning to the current healthcare crisis, we asked Dr. Chaffin to weigh in on the blood product spotlight throughout COVID-19: convalescent plasma.
Convalescent Plasma: The New Holy Grail?
Dr. Chaffin starts by clarifying that convalescent plasma is not new; it’s been used for over a century – during the Spanish Flu pandemic, the SARS-1 outbreak in 2003, the Middle East Respiratory Syndrome outbreak, and the Ebola outbreak. It’s a passive immunotherapy, taking plasma from someone who’s recovered from a disease and hoping that the antibodies they now carry will help someone who currently has the disease. The problem is a lack of prospective data to show demonstrate it really works.
When this pandemic started, blood centers all over the United States, led by the New York Blood Center, started collecting plasma products from recovered COVID-19 patients. We followed guidance from the FDA in terms of how donors should be qualified, and most patients were getting products under the Expanded Access Program from Mayo Clinic’s research study. The hope was to get data from that study to show whether or not convalescent plasma was going to be effective for COVID-19 patients. I was a little bit surprised with the FDA decision to issue an Emergency Use Authorization here, as making this an EUA eliminated the need for getting it under a research protocol. The Mayo study shut down, the current transfusing protocol went away and there were a whole new set of things we needed to do. And the confusion continued as to whether or not convalescent plasma had been proven to be effective.
What people need to understand is that EUAs do not confirm something has been proven. They simply imply that evidence to date suggests there may be more benefit than harm from a particular thing.
The most important protocol change is labeling product with a high titer or low titer designation. Unfortunately, blood centers don’t have a readily available pathway to label current plasma as high or low titer because few use the test required to do so. Every hospital, everyone working in a hospital transfusion service, should talk to their blood center about their transition plan. Hospitals need to figure out how their blood center is going to transition and what they need to be doing with their patients in the interim. There are some new requirements for hospitals too, i.e. obtaining an informed patient consent noting understanding of receiving investigational plasma. And all updates must be in place by December 1 per the FDA.
Next for The Blood Bank Guy
His goal remains the same, to this day: teach the essentials of transfusion medicine to learners everywhere. The Blood Bank Guy Essentials podcast will continue to be THE driving platform in achieving this goal. I interview people way smarter than me and help them teach people that need to know the basics, the essentials. I’m also working on a new video educational series. I’m so passionate about doing everything I can to help people learn the essentials of transfusion medicine that I don’t see myself stopping any time in the near future!