Today's Eventsno events today
While my guitar gently weeps
Musings on the seduction of technology | By Pat Letendre
- The main item deals with a molecular assay to identify 35 red cell antigens from 11 blood groups.
- The other, included to illustrate the blog's theme but mainly here for fun, focuses on the clinical uses of platelet-rich plasma (PRP).
- Boston Children’s Hospital ends bad blood between donors, patients (24 Mar. 2015)
- Hospitals aim to better match blood donors and recipients (19 Jan. 2015)
- Dubai plastic surgery boom includes PRP facial rejuvenation (6 Apr. 2015)
- Can PRP penis and vagina injections give a better sex life? (14 Mar. 2015)
- See Further Reading below for more information.
Typing of blood group antigens at the molecular level has been in the works for years. Now it's moving beyond its original special uses because of technological advances, decreasing costs, and lobbying by vested interests.
However, its cost-effectiveness is still unproven. Immucor's PreciseTypeTM HEA test costs ~$350 USD but that likely varies significantly depending on individual contracts. And any cost study I've read in journals like AABB's Transfusion is so dependent on assumptions as to be almost meaningless and needs to be read carefully and critically.
Also, molecular blood typing is not the be-all, end-all for the 100s of blood group antigens that exist, since not all are DNA-defined. But the list of antigens covered is impressive and includes nearly all clinically important blood group systems (see Further Reading).
Of course, other companies besides Immucor compete in the molecular blood typing business, including BloodChip® by Progenika Biopharma.(Source: Greg Denomme's paper in Further Reading)
Regardless, molecular blood typing has no end of proponents, mild and strong. For example:
- Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC) thinks it's inevitable.
- AABB, on the other hand, perhaps seeing a money-making opportunity for its publications and consultant branch, developed 'Standards for Molecular Testing for Red Cell, Platelet and Neutrophil Antigens'.
- AABB actively promotes DNA typing, even to the point of petitioning the US government to fund testing (Nov. 5, 2014).
- Snip, snip the party's over (Dec. 2010)
- Suggest you read it later, if the mood strikes. My predictions have come true but they were no-brainers.
But many experts like Donna Dickenson, emeritus professor of medical ethics and humanities at the University of London and research associate at the HeLEX Centre, University of Oxford caution that
- 'Me medicine' could undermine public health measures (New Scientist, Sept. 2013)
I'd read several news items over the years about PRP's use in orthopedics, particularly for athletes:
With that as background, recent news items on PRP's expanding clinical uses caught my attention. Medical tourism grows daily, at least for the rich. Seems Dubai now has more plastic surgeons per capita than any other city in the world and hopes to attract half a million medical tourists by 2020.
The penis and vagina PRP nonsense was included just for fun. But really, Academy Award nominees got a coupon for a Priapus Shot? You cannot make this stuff up.
- Where there's a buck to be made or an agenda to be advanced, clinical uses of diagnostic tests and products will inevitably expand well beyond what's evidence-based.
But what's surprising, at least to me, is how few voices, especially in the TM community, question the *expanded use* of innovations like molecular typing of red blood cell antigens under the guise of me-medicine. Particularly since our so-called 'thought leaders' are so into evidence-based these days.
I understand why advances that help solve real TM problems are celebrated. But why the uncritical approach? Is it because blood typing at the molecular level is
- A marvelous innovation and all want to be seen as on DNA's bandwagon? Versus being old-fogeys who resist change?
- Way to develop a business line and maximize earnings in a shrinking field like TM in age of 'blood conservation 'über alles', e.g., AABB?
- Outright self-interest for those who specialized in molecular technology and need to maximize their career's life-span?
- Seen as eliminating humans from the equation, such as interpreting serological test results, thus must be good?
- High-throughput automated innovation, another way to decrease costs by eliminating those pesky creatures, aka staff, with their costly salaries, benefits, and pensions?
- Better to give money to international companies than keep staff, aka tax payers and community builders, employed at home?
- Plus many staff are probably contemplating retirement anyway and eliminating their jobs will help make that decision easier?
- Viewed as best thing since sliced bread, not just a significant innovation with specific uses, motivating proponents to abandon whatever critical thinking skills they ever had?
- 'Boston Children’s Hospital ends BAD BLOOD between donors, patients' (Emphasis is mine)
- #136 on Rolling Stone's "The 500 Greatest Songs of All Time"
- #7 on its list of 100 Greatest Guitar Songs of All Time
- #10 on its list of The Beatles 100 Greatest Songs.
While my guitar gently weeps (Paul McCartney and Eric Clampton tribute to George Harrison, Queen's Golden Jubilee, London 2002)I don't know why nobody told you How to unfold your love I don't know how someone controlled you They bought and sold you.
I look at the world and I notice it's turning While my guitar gently weeps With every mistake we must surely be learning Still my guitar gently weeps
As always the views are mine alone and comment are most welcome.
FURTHER READING References for those who want to delve further into the blog's topics. Molecular blood typing
- PreciseTypeTM HEA, first blood compatibility molecular assay used in transfusion medicine approved by FDA (Press release, 22 May 2014)
- Molecular typing for red blood cell antigens (AACC's Clin Lab News, 1 Mar. 2015)
For molecular blood typing in detail, see these papers from 2009. Info overload but fascinating insight into predicting the future (All papers free full text):
Molecular blood group diagnostics.Transfus Med Hemother. 2009 Jun; 36(3): 154–155.(editorial)
Five expert opinions on the question ‘Will genotyping replace serology routine blood grouping in the future?’
Interpretations are mine. (Author origins refer to where they worked then, not necessarily nationality.)
- Opinion 1: Only partly. Unlikely unless... (Germany)
- Opinion 2: Probably (Switzerland)
- Opinion 3: For some applications (Austria)
- Opinion 4: Personalized versus Universal Blood Transfusions – Combining the Efforts: Probably but in combination with enzymatic conversion (ECO) to remove A and B antigens (Sweden)
- Opinion 5: Yes (Netherlands)
- Power of platelets (Nov. 2014)
- Plasma fraction market - Global industry analysis and forecast 2014-20 (Press release, 6 Apr. 2015)
- Platelet rich plasma market to treat orthopedic injuries, cosmetic surgeries expected to grow (23 Mar. 2015)
As always comments are most welcome.
Pat Letendre is the webmaster for the TraQ website of the BC Provincial Blood Coordinating Office in Vancouver, British Columbia, Canada.
Pat specializes in developing transfusion-related websites and managing mailing lists for health professionals. She has extensive experience as an educator and clinical instructor.
View Pat's Full Bio
30 Apr 2017