Beyond Traditional Boundaries

An interview with Dr. William Savage, Johns Hopkins Hospital

Recently, I became involved in a research project with an infectious disease investigator. We were evaluating HIV-associated cytopenias. Through this collaboration, I was struck by the tremendous breadth of research in which hematologists can become engaged, extending even beyond the traditional boundaries of our field. Even as a hematology trainee, there are opportunities to participate with other subspecialties in a diverse range of investigative projects. A growing number of hematology trainees are now seeking additional post-graduate training opportunities in collaborative fields, thus bringing a unique perspective to the field of hematology. This was apparent at the 2008 Clinical Research Training Institute where hematology fellows and junior faculty presented a number of different clinical and translational projects. 

At the Clinical Research Training Institute (CRTI), I met William Savage, MD. His training epitomizes the coupling of hematology with a second subspecialty. Dr. Savage completed a fellowship in pediatric hematology and oncology at Johns Hopkins University and has gone on to further training in transfusion medicine at the same institution. I recently had the opportunity to interview Dr. Savage and feel that his experience highlights the strengths that hematology trainees can bring to other subspecialties and may encourage junior investigators to broaden their vision of potential research objectives or collaborations.

Dr. Bixby: Tell me about your current and long-term research objectives?

Dr. Savage: As a member of a biomarker discovery project, I have been working on brain injury in sickle cell disease, and I will soon transition into my own project looking for candidate plasma biomarkers of iron overload. I am also initiating studies that investigate the extent to which various chronic red cell transfusion regimens are associated with morbidity in sickle cell disease. My long-term goal is to reduce the morbidity of chronic red cell transfusion through evidence-based transfusion strategies.

Dr. Bixby: What drew you to transfusion medicine, and were there any pivotal experiences during your training that influenced you to pursue both hematology and transfusion medicine?

Dr. Savage: I learned about hematopoiesis and growth factors as a laboratory technician in a preclinical hematopoiesis department at a biotechnology company for three summers during college. I learned about erythroid and myeloid maturation while doing necropsies on mice and rabbits, among other things. I didn't really understand the practical application of this knowledge until medical school, but the seed had been planted, and I was hooked on hematology.

As for my interest in transfusion, I noticed during my pediatric hematology and oncology fellowship that blood transfusion sometimes seemed more of a nuisance to patients and doctors than a significant intervention. Given the complexity of blood, I found it amazing that serial allogeneic blood component transplants didn't cause more problems. Then I learned how so few are doing clinical research in the field. I thought that maybe more is going on with transfusion than we think, and we should be paying more attention to it. I saw my move into transfusion as a research opportunity.

Dr. Bixby: Given that your training spanned several departments, was there programmatic support in place that helped encourage this cross-departmental training? Were there hurdles that hindered your decision?

Dr. Savage: Every person I talked with was supportive and thought it was a good idea. Making it happen was just as simple as applying for another fellowship. I think this is a testament to how supportive my mentors are at Johns Hopkins. They agreed with me that being non-traditionally trained would be an asset, and I currently continue to work in both transfusion medicine and pediatric hematology.

Dr. Bixby: Are there advantages to your diverse background when applying for grants?

Dr. Savage: Having dual training makes a compelling case for why I'm uniquely qualified to study areas where hematology and transfusion medicine overlap, such as iron overload in sickle cell disease. I'll let you know later if the study section agrees! 

Dr. Bixby: Is there a need for others to bring a hematology background into transfusion medicine and why?

Dr. Savage: I think it would be extremely useful to have more hematologists involved in transfusion medicine. So much hematology goes on in the hospital without a hematologist's involvement: massive bleeds in the operative room or requests for factor VIIa, to name two. In addition, all of the pheresis decisions are directly controlled in transfusion medicine. Most of the issues that come up don't require advanced hematology training, but I draw on my clinical and hematology training several times a day to sort out problems with complex patients, especially those who do not have a hematologist caring for them. I can offer a different perspective on blood product and pheresis management because I've been on the clinical side managing the same problems. I am qualified to help people in the blood bank understand various clinical realities, and I can help clinicians understand the realities of the blood bank. I get a lot of curbside consults as a result of my dual training, so I hear about more interesting cases hospital-wide than I ever did before.

Hematology expertise is being sought in a growing number of career fields and reminds us to think outside of the box, thus revealing novel opportunities for collaborative research.