Musings by Malcolm Needs: Notable colleagues
This blog is a follow-up to an earlier one and presents musings by Malcolm Needs on the notable transfusion professionals he has met over the years and anecdotes that readers may appreciate. It's a question I asked Malcolm because I knew the list of colleagues was long and included many 'rock stars' of the transfusion universe. See Malcolm's first blog for the scope of those involved.
MALCOLM'S MUSINGS: NOTABLE COLLEAGUES
As can be seen from what I wrote earlier, I have been lucky to have been in the “right position at the right time” to have met many luminaries in the world of blood transfusion and blood group serology, almost throughout the whole of my career.
How many people of my age, starting out in a career in the early 1970’s can say that they have met
Prof. Robin Coombs, Dr. Arthur Mourant and Dr. Rob Race, the
authors of the original paper describing the antiglobulin test? Of those that have, how many can say that they have Robin Coombs’ autograph on a document up on their lounge wall? Other autographs on this document (the speakers at a symposium celebrating 50 years of the
International Blood Group Reference Laboratory) include Dr. Patricia Tippett, Prof. Winifred Watkins, Dr. Geoff Daniels, Prof. Marion Scott, Dr. Carolyn Giles, Joyce Poole, Prof. Patrick Mollison, Dr. Belinda Kumpel, Dr. Andrew Hadley, Prof. Dave Anstee and Dr. Harold Gunson, most of whom appear in the excellent new book by Steven Pierce and Marion Reid:
I have made something of a
hobby of collecting the autographs of the authors of the blood transfusion/blood group serology textbooks I have bought over the years, and am proud to say that I am the owner of, amongst others
- 6th edition of Blood Groups in Man, signed with a personal message, by both Rob Race and Ruth Sanger;
- 2nd edition of Immune Hemolytic Anemias, signed with personal messages by both Lawrence Petz and George Garratty;
- 3 editions of Human Blood Groups, all signed by Geoff Daniels;
- Several editions of Mollison’s Blood Transfusion in Clinical Medicine, variously signed by Patrick Mollison alone, and then in conjunction with Paul Engelfriet and Marcela Contreras, and latterly by Dave Anstee (I still have to catch up with Harvey Klein!);
- 4th edition of Applied Blood Group Serology signed by both Peter Issitt and Dave Anstee, and, of course;
- 3rd edition of The Blood Group Antigen Facts Book signed by Marion Reid, Christine Lomas-Francis and Martin Olsson.
- At one point, I was the very proud owner of an Ortho Diagnostic booklet on the Rh Blood Group System signed by Philip Levine, but, sadly, this was “borrowed and never returned”, which taught me a lesson!
This is not to denigrate those other books and authors I have not mentioned above, but these are amongst my “favourites”.
Without a doubt, however, and despite the immense amount of knowledge available to me from all the textbooks I have read, my interest in blood group serology was first sparked, in particular, by working with
Carolyn Giles and
Joyce Poole, both of whom have continued to educate me, enthuse me, inform me and, when I have got “over-enthusiastic”, slap me back down to Earth, and these two true friends continue to influence me to this day.
Other people I hold in extremely high regard, who have taught me a lot, and who I have not mentioned above, are Nicole Thornton,
Dr. Nay Win (my Consultant Haematologist at NHSBT-Tooting Centre, with whom I have collaborated in many papers and posters), Carole Green, Jill Storry, Shane Grimsley, Louise Tilley, Kirstin Finning and Vanja Karamatic Crew (these last four in particular, for trying, against considerable odds, to get me to understand the molecular side of blood groups), latterly, Joe Chaffin (
Blood Bank Guy), who has a magnificently eccentric and enthusiastic way of lecturing that allows me, if not others, to learn intricate concepts easily, but there are so many, many more than I list here.
I think that the main thing that both
Carolyn Giles and Joyce Poole taught me was to perform tests
properly, however long it took, and to record what I saw,
not what I wanted to see (although, apparently, the Red Cell Reference Laboratory of the IBGRL still use the term, “a Malcolm weak”, when there are a couple of cells “kissing” and people misinterpret these as agglutination – as did I, all too frequently), and to interpret what I saw and recorded in a dispassionate way. I hope that I have passed these traits on to those I have had the honour to train and educate.
Here, though, I must recount a
case that amused me (and made me immensely proud) from a few years ago, just before Joyce retired.
We had been following a pregnancy in the Reference Laboratory at Tooting for some time, as the mother had an anti-D at a level that was causing us some concern. Amongst other things, the woman typed as K+k+. Her male partner was typed as rr, K-. The baby was eventually born, and we found it to be D Positive, but K+k-.
We re-tested the sample and got the same result. We obtained a new sample of blood from the baby, and obtained the same result. It was “proved” that there was no “baby swap”, no egg donation and the woman denied “carnal knowledge” of any other man. We sent the sample of the baby’s blood down to the IBGRL for Kell typing. They made the Kell type K+k+. Did this mean that our anti-k was not detecting the k antigen for some reason, or did it mean that we had forgotten how to k type?
It so happened that I was down at the Filton Centre to give a lecture more or less at the same time, and I had a word with Joyce, and persuaded her to ask Vanja Karamatic Crew to sequence the KEL gene (I think, as much as anything, this was to shut me up and to humour me, rather than because Joyce thought that a mutation may have been present in the gene). Anyway, it so happened that, when Vanja had finished her work, there was indeed a mutation in the KEL gene, but it was remote from the K/k locus. This did not worry me too much, as the KPA/KPB/KPC locus, and yet the KPA gene can affect the expression of the k antigen. Sadly, we were never able to take the case further, but I did get an official report from Joyce, and the final phrase was, “Well done Sherlock!”. This was the closest I ever got to getting one over Joyce!
To have a laugh at my own expense, for a long time, when I was working with Joyce in Carolyn Giles’ laboratory,
I thought that anti-Vel was more common than anti-D. This was because, at the time, Dr. Bertil Cedegren of Uppsala University was undertaking a study looking at the
frequency of the Vel Negative phenotype in Sweden and he used to send these to the IBGRL for confirmation. Inevitably, these included individuals who had produced an anti-Vel, and so I saw a good number of samples containing this specificity on its own, but I only rarely saw a sample containing an anti-D on its own, as these were “filtered out” by the hospitals and the NHSBT reference laboratories!
PAT'S MUSINGS
Malcolm was indeed fortunate to have worked in the UK among many of transfusion medicine's greats.
In the hopes that readers may contribute comments about some of the transfusion 'rock stars' they've worked with, I'll include some that I have known.
Although working with many accomplished transfusion professionals, probably the only 'great' I worked with personally was
Dr. John (Jack) Bowman of Winnipeg, Canada, world renowned expert in treating and preventing Hemolytic Disease of the Fetus and Newborn (HDFN), whose work helped save hundreds of lives directly and hundreds of thousands indirectly. I blogged about Dr. Bowman on the occasion of his death in 2005 (Further Reading). Dr. Bowman won the AABB's Karl Landsteiner Memorial Award in 2001. In 1971 two other Winnipeggers won this award,
Marion Lewis and
Bruce Chown, but I never had the pleasure of meeting them.
Once in Edmonton I was fortunate to meet
Dr. Donald Ian Buchanan, a great and beloved man after whom the CSTM named an award given at its annual conference to a medical laboratory technologist, because of his strong support of them over many years. Most of his publications include
med lab technologists as co-authors long before it was the norm.
And, of course, I know many well published Canadians who are making a difference, including
Mark Yazer in Pittsburgh and
Nancy Heddle in Hamilton, who was awarded the AABB's
Emily Cooley Memorial Award and Lectureship in 2016.
Small anecdote about Mark Yazer. When he first came to the University of Alberta's Faculty of Lab Med & Pathology circa 1999 to suss out if it was the place for him to do a hematopathology residency, one day the 'powers that be' sent Mark to me. At the time I'd just left Med Lab Science (MLS), where I taught transfusion science for 22 years, and was the assman* at Canadian Blood Services (*how the QA dept. addressed mail to the assistant lab manager responsible for diagnostic services).
Because Mark did do his residency in Edmonton, I'm going to bask in the reflected reflected glory of his career. I suspect the main selling points were my telling Mark he'd be working with two incredible women, Drs. Susan Nahirniak and Gwen Clarke, both of whom I'd taught when they were MLS students. Plus, I also assured him that the University of Alberta Hospital transfusion service was challenged by many serological problems. Unlike many resident physicians, Mark was a bit of a red blood cell serology nerd from the get-go. I recall he later got off on what appeared to be a weak group B subgroup.
Stay tuned for a third blog in which Malcolm muses on regrets and concerns.
Comments are most welcome. Please add to the record of what it was (or is) like to work as a transfusion professional, perhaps contrasting your experiences with Malcolm's. Have you worked with any of TM's rock stars or those making a difference?
Further Reading