Gregory A. Denomme1, Jin Ye Yeo2
1Grifols Laboratory Solutions, San Marcos, Texas, USA; 2AOB Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. AOB Editorial Office, AME Publishing Company. Email: aob@amegroups.com
Expert introduction
Dr. Gregory A. Denomme (Figure 1) is a clinical and academic trained scientist. He has worked in transfusion medicine his entire career; initially obtaining Canadian medical lab scientist credentials with advanced certification in immunohematology. Following his clinical training, he obtained a doctorate in microbiology and immunology at the University of Western Ontario and held two postdoctoral fellowships; one in platelet immunology at the Canadian Red Cross Society, and the other in pathology and molecular medicine at McMaster University, Canada. After his fellowships, he was promoted through to Associate Professor of Laboratory Medicine and Pathobiology at the University of Toronto, Canada. Thereafter, Dr. Denomme was the Senior Director of Immunohematology and Innovation at Versiti Blood Center of Wisconsin, where he held a Senior Investigator position with Versiti’s Blood Research Institute. Presently, he is Laboratory Director and Head of Research and Development at Grifols Laboratory Solutions. His applied research integrates blood group genetics and immunohematology to the study of blood group antigen expression and the impact on immune-mediated hemolytic disorders.
Dr. Denomme is a recipient of the North Carolina Association of Blood Bankers, Petteway-Shepherd Award, the AABB Sally Frank Award and Lectureship, a Harvard Medical School Margot S. Kruskall Lectureship, the Michigan Association of Blood Banks Kay Beattie Lectureship, and the Canadian Blood Services Kenneth J Fyke Award for innovation in health services. He is a distinguished fellow of the Canadian Society for Medical Laboratory Sciences. Dr. Denomme has published over 130 peer-reviewed manuscripts along with a dozen book, book chapters, and monographs.
Figure 1 Dr. Gregory A. Denomme
Interview
AOB: Could you share what drove you into the field of transfusion medicine?
Dr. Denomme: I took an interest in laboratory medicine in my senior year of high school when I worked as a kitchen helper at my local hospital. I was walking along the hallway where the labs were located and one day asked a microbiologist some questions. He showed me stained slides of cocci and bacilli under the microscope and I never looked back. We are still friends to this day. I found and continue to find scientific inquiry very fascinating, and I enjoy working on the bench and the intellectual challenge that goes with designing and performing lab experiments.
AOB: Could you provide a brief overview of the current publication landscape in blood group genotyping? Are there any new findings that stood out to you?
Dr. Denomme: We are getting better at understanding the molecular basis of blood group antigen expression and continue to characterize new blood group system genes. That success is due to new technologies and the ability to create longer nucleic acid sequencing reads to confirm variant nucleotide cis/trans relationships. Sometimes we forget that most of the action is happening among the antigens represented on an antibody identification antigram panel; Rh, MNS, Kell, Fy, Jk, and a few others. There is so much a blood center can do with a donor blood group database. Transfusion recipients can have access to the right blood at the right time, while chronic transfusion recipients are better served. Concurrent testing can find the rare units that can be shared nationally or frozen for later use. Let’s not forget, that by the 1930s, transfusion medicine was ‘daring enough’ to bank all ABO blood groups, whereas prior to that, only Group O were blood donors. We learned how to segregate the major ABO/Rh blood types nearly 100 years ago. Today, it should be commonplace to label blood on the basis of extended types and provide better matches for a broader patient population.
The most memorable moment was the publication of the molecular basis for the RHD-negative genotype, that is, the complete deletion of RHD. The work antiquated the practice of paternal phenotyping to determine the most probable genotype in anti-D alloimmunized pregnancies. Also, it had an immediate impact on fetal RHD genotyping using amniotic fluid-derived DNA. Amniotic fluid cellular pellets, typically discarded after centrifugation to obtain supernatant to determine the level of bilirubin, became liquid gold in molecular immunohematology.
AOB: Based on your extensive research on transfusion medicine, which aspects of transfusion medicine do you feel have been overlooked or received insufficient attention?
Dr. Denomme: Not so much overlooked or insufficient attention, but the human immune system is extremely complex. We have made some gains but have missed the mark on understanding monocyte phagocytic function leading to extravascular hemolysis. It is intriguing that healthy blood donors can have a positive IgG DAT yet have a normal hemoglobin. On the other hand, many of us in immunohematology serology labs have identified IgG low-affinity autoantibodies that cause significant warm autoimmune hemolytic anemia. Why is that the case? In the past few years, scientists have been looking at the patient’s monocyte/macrophage function, rather than studying random research-acquired biospecimens. We know there are monocyte functional differences. The biological reasons for the varying degree of phagocytosis still eludes us to this day. Ultimately, the work should dovetail into a better understanding of the immune factors leading to alloimmune response.
AOB: Recently, the International Collaboration for Transfusion Medicine Guidelines (ICTMG) Intravenous Albumin Guideline Group developed guidelines for the use of albumin (1). What are some other areas of transfusion medicine where you feel a guideline is urgently needed or requires updating?
Dr. Denomme: The ICTMG published an important international guideline on red blood cell product specifications for patients with hemoglobinopathies (2). The committee recently reviewed relevant studies on antigen-matching for the transfusion recipients with a hemoglobinopathy since the publication in 2018, and we hope to see that peer-reviewed publication in the near future.
AOB: As the recipient of numerous awards for your innovation in health services, what advice do you have for aspiring researchers who wish to excel in this field?
Dr. Denomme: If you are uncertain that you have the skills needed to become an aspiring researcher, give yourself time to be comfortable working in a lab. Working as a laboratory-trained technologist for a few years helped me hone my skills, as I attended undergraduate classes. The laboratory experience I received prior to undergraduate and graduate programs created a solid skillset that helped me avoid the frustration of technical challenges while I was taking classes, learning theory, and getting those lab courses completed.
AOB: How has your experience been as an Editorial Board Member of AOB?
Dr. Denomme: I have enjoyed reviewing submitted manuscripts. It seems there is always some small facet of transfusion medicine that is new for me, and a well-written manuscript usually provides a good citation list for further reference.
AOB: As an Editorial Board Member, what are your expectations for AOB?
Dr. Denomme: I will continue to participate in the peer-review process. Putting a face to a name at international meetings is part of the reward for participating in manuscript review.
References
- Callum J, Skubas NJ, Bathla A, et al. Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines. Chest. Published online March 4, 2024. doi:10.1016/j.chest.2024.02.049
- Compernolle V, Chou ST, Tanael S, et al. Red cell specifications for patients with hemoglobinopathies: a systematic review and guideline. Transfusion 2018;58(6):1555-1566.