Trending Today: George Garratty



Q#1:      Tell us a little bit about your facility and current position. 

I work for American Red Cross Blood Services, Southern California Region.  I came to the U.S. in 1968 to carry out research with Dr. Larry Petz in San Francisco.  After 10 years of 100% grant-dependent research in San Francisco, I was offered a job as scientific director to start a research program at the ARC Blood Center in Los Angeles.  After a few years, I “inherited” two other departments:  Reference Services (red cell and HLA/platelet immunology) and Community Education.  Our blood center was built about 7 years ago; it is on the campus of California State University in Pomona.  We are one of the largest Red Cross centers, serving about  150 hospitals in Southern California.

Q#2:      What are some projects you are working on (or have worked on) that you are most passionate about?   

Projects that I have worked on that I am most passionate about include developing laboratory approaches to help physicians arrive at the correct diagnosis and select the best blood for patients who are suspected of having immune hemolytic anemia; developing a test to predict clinical significance of alloantibodies (monocyte monolayer assay); applying flow cytometry to study blood group antigen/antibodies; and  8 years of research on production of “stealth RBCs” [using polyethylene glycol (PEG) to block all RBC antigens on RBC membranes].  We were successful in doing this, but in the end, stopped the research as we found antibodies to PEG were quite common, and the antibodies could destroy PEG-RBCs in vivo.  Although I have worked on drug-induced immune hemolytic anemia (DIIHA) for more than 40 years, recently, we have become excited about several aspects that contribute directly to patient care.  For instance, some surprising results associated with piperacillin therapy, [either alone or together with a beta-lactamase inhibitor (e.g., Zosyn, Wyeth, Philadelphia, PA)].  Piperacillin is now the most common drug that we find associated with DIIHA.  The latter can mimic autoimmune hemolytic anemia (AIHA) and delayed hemolytic transfusion reactions.  Patient’s plasma can react with RBCs in vitro, with no added piperacillin and the serology will look like an autoantibody (even having anti-e specificity).  Unfortunately, the hematologists will also suspect AIHA and start unnecessary treatment with steroids.  If piperacillin is not suspected, the drug therapy will be continued and there will be enough drug in the patient’s plasma to allow the piperacillin antibody to react with RBCs without adding drug in vitro.  There is a simple solution: 1) stop the drug, and 2) test for piperacillin antibodies.  After 24 hours, usually, there will be no circulating drug and the “autoantibody” reactions will no longer be detected.  The patient’s “AIHA” will resolve without any further treatment.  It is very satisfying for us to directly help the patient and receive praises from the hematologists.

Q#3:      What’s an accomplishment that you are proudest of?

I am most proud of the results I have achieved in educating people (of all levels) who have attended my lectures, and read my scientific publications and textbooks.  A good
example of this occurred at the recent ISBT meeting in Mexico.  On the first day, a hematologist came up to introduce himself.  He said “Dr. Garratty, I have wanted to thank you for many years.  About 20 years ago, you gave some lectures in Venezuela.  I had just started my career and your lectures and textbooks inspired me to pursue hematology as a career.”  These types of interactions have occurred many times, especially at international meetings. They are a great source of satisfaction to me.

Q#4:      What do you see as the most important change to the industry in the next 5 years? 

Five years is a short time for changes to occur, but I will mention a few that hopefully will be accelerated.  There is no doubt that DNA-based approaches will get more and more efficient and cost-effective, leading to more applications in immunohematology (RBC, WBC, and platelet immunology).  Such changes are slower than might be expected in the U.S. because FDA and some patents are involved.  The history of DNA and blood groups go back to the early 1990s, so 20 years has passed and there are only three companies producing platforms/kits, and only one of these has submitted data to the FDA.  I would like to see pathogen inactivation of platelets and RBCs approved in the U.S., but whether it will be in the next 5 years is doubtful.  Methods for cultivating stem cells into mature RBCs  (“blood pharming”) suitable for transfusion is
proceeding at an interesting rate, but usable products will not be within 5 years (nor will any other form of “artificial blood”).

Q#5:      What’s a typical day for you?

I get up at 4:15 to 4:30 a.m., leaving my home at 5 a.m.  I do this because I have a 54 mile, one way commute and I can miss traffic jams this way. I arrive at work at 6 a.m.  It is relatively peaceful at that time, so I can review/reply to emails and phone East Coast colleagues; many of the emails (e.g., concerning patient problems, need me to review literature before I reply).  Most days I have internal meetings after 8 a.m. (e.g., research group, management group), meetings with my direct reports [e.g., RBC and platelet reference labs, community education (including SBB school)].  Some days I give lectures in-house (e.g., once a week we have a 2-hour lecture for our hospitals and SBB students), or at local hospitals.  Some days we have visitors from California, other states, or international.  We have Blood Transfusion Medicine Fellows and pathology residents spend several days to several weeks with us.  Most days I get phone calls concerning unusual cases of immune hemolytic anemia; many of these are from outside California. I try to get on the freeway by 3 p.m. (every 30 minutes it gets worse after 3 p.m.).  I work at home Friday (and Saturday, and Sunday mornings) to get my writing (publications) and lectures done, and work on papers submitted to Transfusion (I am an Associate Editor).

Q6:         What are three events that helped to shape your life/career?

It is difficult to select three, but the first would be my good luck to start my career in the Hematology Department at Hammersmith Hospital in London.  The head of the department was Professor Sir John Dacie, one of the world’s greatest hematologists.  Down the corridor was a Research Unit directed by Professor Patrick Mollison who, at the time, was performing his seminal work on RBC antibodies and their clinical significance.  Both of these giants produced textbooks that became the bibles of their field.  It exposed me to many visiting hematologists from all over the world.  One of these was an American Hematology Fellow, Dr. Larry Petz, who spent 2 years in Dacie’s department.  The next event was when I went (in 1968) to San Francisco to work with Larry for 10 years. The third major event, in 1978, was an offer from the Red Cross in Los Angeles to start a research program.  I am still there!

 

www.scabb.org/ e-Pulse AugSeptOct 2012