White Coats: Colleen Gilstad on Advancements in Patient Blood Management

“White Coats” is an AABB News series that interviews the experts who are transforming the fields of transfusion medicine and biotherapies. Join AABB today to read the rest of this month’s issue.

Colleen Gilstad, MD, is the medical director of transfusion services at Medstar Georgetown University Hospital, where she completed a transfusion medicine fellowship while on active duty in the U.S. Navy. She received a Bachelor of Science degree in electrical engineering at the U.S. Naval Academy and medical degree at the Uniformed Services University of the Health Sciences.

During her naval career, she was the transfusion medicine specialty leader and consultant to the Navy Surgeon General and the Armed Services Blood Program Office. She has been a member of the AABB’s Patient Blood Management (PBM) subsection since 2020. Gilstad spoke to AABB News about her career path in pathology, as well as advancements in patient blood management.

AABB News: How did you become interested in the blood field in general and, more specifically, patient blood management?

Gilstad: I discovered I loved pathology in medical school. The U.S. taxpayer paid for my undergraduate education and medical school, so I’ve always had an obligation to serve my fellow citizens. After my first assignment as a solo AP/CP pathologist at an overseas naval hospital, the Navy sent me to train in transfusion medicine and blood banking to take over as a medical director of the Armed Services Blood Donor Center and the transfusion service in Bethesda, Md. I've always advocated for an active hospital blood utilization review committee in making sure blood components were used appropriately and not wasted. I did not know much about PBM before arriving at Georgetown, but I had to learn fast because it already had a robust program that was the first to achieve AABB/Joint Commission accreditation. Involvement with the AABB PBM subsection has been very helpful in getting me up to speed.

AABB News: How has your early research shaped your career?

Gilstad: During my fellowship, Dr. Jerry Sandler was a great mentor who taught me about gaps that can exist between what is scientifically known and what beliefs are applied in practice. I did some bench work at the blood lab at the Walter Reed Army Institute of Research using thromboelastography and after fellowship worked with Robert Valeri at the Naval Blood Research Lab to try to get FDA licensure for frozen platelets. I saw that there was a huge lack of appreciation of the hemostatic function of platelets, as opposed to believing in the primacy of survival in circulation.

AABB News: What is the most important research impacting your work today?

Gilstad: Poorly designed and inappropriately interpreted randomized trials are making my job difficult. Randomized trials have resulted in a misinterpretation of the benefit of COVID-19 convalescent plasma. People who are severely thrombocytopenic should not be maintained at the restrictive hemoglobin threshold of 7 g/dL when they are actively bleeding from a non-surgical cause. There are systematic reviews and meta-analyses of randomized controlled trials that lead providers to think they have the highest level of evidence to support this misguided practice.

AABB News: How has PBM evolved over the past decade?

Gilstad: I used to think the goals of PBM could be accomplished with just a vigorous transfusion committee or blood utilization review committee (BURC). I became aware that PBM is not just a fancy BURC. The traditional BURC has no impact on things that can be done earlier in a patient encounter to prevent a bedside provider from even contemplating the need for a transfusion. A PBM program is needed for that.

AABB News: How have advancements in PBM helped to improve patient outcomes? What do you see as the next big development?

Gilstad: More patients are avoiding transfusions with big surgeries by techniques to reduce blood loss during surgery and bedside provider education to feel comfortable using a lower hemoglobin threshold in asymptomatic patients. We’ve helped many patients avoid the morbidity of an adverse reaction to transfusion. The next development will be getting more patients who have nutrient deficiency anemia diagnosed and treated before undergoing surgery, which will prevent more perioperative and post-operative red blood cell transfusions.

AABB News: What are the most challenging and rewarding aspects of your career as a pathologist?

Gilstad: I am continually seeing new cases that challenge what I know. Sharing these new insights via publication and possibly helping the care of future patients is very rewarding. Also, quickly initiating a COVID-19 convalescent plasma donor recruitment and transfusion pipeline that resulted in some severely ill patients having a dramatic recovery very early in the pandemic was extremely rewarding.

AABB News: You previously co-authored a paper on anaphylactic transfusion reactions. Can you share some of the most important findings from your research?

Gilstad: The anaphylactic reaction paper probes a question of biology but also contributes to the message of PBM that we need to be more cautious about transfusions. It is highly likely that group B plasma or platelets are not safe for group O patients with alpha-gal meat allergy. In the span of six months, we observed severe anaphylactic reactions in three group O patients to group B plasma and platelets. I am concerned enough that I implemented a “no blood group B” restriction in a fourth group O patient known to have severe alpha gal allergy but hasn’t been transfused with platelets or plasma yet. The peer review process has since allowed us to improve the paper, and I am hoping that publication in a peer reviewed journal soon will make a better case about the concern.

AABB News: What are your favorite leisure activities outside of work?

Gilstad: Reading books found browsing used bookstores or the library that are about all sorts of things, and gaining knowledge based on a chance encounter.