August 03, 2022
In late 2007 (AABB’s 60th year), AABB News asked four leaders to identify the most significant developments in recent years that had shaped the field and had the potential to continue to make meaningful changes into the future. With the advantage of hindsight, their assessments seem right on point.
Gazing into the Crystal Ball
For the above-mentioned assessments, Paul M. Ness, MD; Jacquelyn Fredrick, MBA, MT(ASCP)SBB; Graham Sher, MD, PhD; and Thomas Lane, MD shared their thoughts, which are summarized as follows:
Three topics were arbitrarily chosen for a deeper dive into the decade’s progress.
The Paradox of Infectious Diseases
The dawn of a new century saw a marked decrease in transfusion-transmitted threats such as HIV, hepatitis B virus and hepatitis C virus. Donor screening questions, antibody testing, leukocyte reduction, bacteria detection testing, pathogen reduction—as well as combined efforts—had, indeed, reduced the risk to a point where transmission rates could be estimated only through modeling instead of prospective clinical studies.
Yet, the emergence of new threats demanded continued vigilance. The new century brought with it many emerging infectious diseases, including West Nile virus, Zika virus, dengue, chikungunya, Chagas disease and babesiosis. AABB’s Transfusion Transmitted Diseases Committee collected and categorized the overwhelming amount of new knowledge with a set of fact sheets on emerging infectious diseases, which they continued to update.
Thankfully, the increasing pace of disease emergence was matched by the ability to manage each new crisis as it unfolded. At least one paradox remains, however; that is, the impact of globalization.
Only time will tell if the world population’s increased mobility as a factor in disease spread is adequately counterbalanced by international response and cooperation in preventing pandemic contagion.
Disaster Preparedness and Response
The terrorist attacks on September 11, 2001 cast a long shadow over the next 10 years, and the transfusion medicine and cellular therapies community was no exception. By January 2002, AABB had formed the Interorganizational Task Force on Domestic Disasters and Acts of Terrorism.
The Task Force includes representatives from US blood services, associations, and commercial entities, as well as liaisons from governmental agencies at multiple levels. For disaster preparedness, they ensure that safe and adequate blood product inventories are in place at all times. For response, the Task Force operates as a mechanism to assess the need for collections and/or transportation of blood should a disaster occur.
The Task Force began with a focus to ensure that 1) blood collection efforts resulting from disasters and acts of terrorism are managed properly and 2) clear and consistent messages are delivered to the public regarding the status of America’s blood supply. The Task Force “hit the ground running” and rapidly developed the following tools:
Much of their first decade was devoted to setting up protocols, identifying ancillary systems that might be affected in a crisis (eg, transportation, communication), cross-training to ensure adequate back-up, participating in nationwide practice drills (eg, the TOP-OFF exercises) and fine-tuning as lessons were learned (eg, Hurricane Katrina, earthquake in Haiti).
Hemovigilance systems in Europe launched in the 1990s, in part because of the way transfusion services were organized on a national level. In the United States, hemovigilance existed on a more local level, with hospitals and blood centers collecting and analyzing their own data. Data were also being collected by numerous organizations, including the following:
Ultimately, all existing efforts were combined under a single public/private system with the assistance of many, including the FDA Advisory Committee on Blood Safety and Availability and transfusion medicine experts convened by AABB. Under the umbrella of the CDC’s network, definitions were developed for accurately categorizing adverse events, incident, and errors; the network scope and structure were outlined; and 9 hospitals participated in a pilot program. With lessons learned along the way incorporated into the network, the system in its entirety launched late in the decade. Meaningful data were not long in appearing, and the system remains a vital tool that is updated as the world around us changes.
Then and Now
No matter how far away 1947 (or even 2000) may seem, many echoes from an earlier AABB still resonate today. For instance, one of the first AABB committees to be formed was on disaster response. The massive explosion in Texas City harbor less than a year before AABB was formed must have been on the minds of AABB leadership during the initial governance discussions. Today’s leaders continue the commitment. Likewise, because emerging pathogens will likely be with us forever, continued responsiveness to infectious agents is still required. Even today, the Transfusion Transmitted Diseases Committee is preparing a new set of fact sheets on emerging infectious diseases. Also still in AABB’s organizational DNA is the drive to collaborate and share knowledge. A unified, coordinated hemovigilance network is a prime example of a present reality that may once have been visible only in someone’s crystal ball.