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Division of Transfusion Medicine


Email pness@jhmi.edu
Phone (410) 955-6583

Paul M. Ness, M.D.

Director, Division of Transfusion Medicine
Primary Appointment in Pathology; Secondary Appointments in Medicine, Oncology


Our laboratory has a long standing interest in development of assays for detecting red cell antibodies and small populations of heterogeneous red cells using a quantitative enzyme-linked antiglobulin test. This assay has proved useful in the study of fetal-maternal hemorrhage, red cell survival studies, and autoimmune hemolytic anemia. We are also studying Rh immunization in pregnancy taking advantage of molecular testing methods for blood grouping. Ongoing clinical studies in transfusion medicine include the use of blood components in trauma and cardiac surgery, the effects of the age of stored red cells and methods to reduce these defects, clinical investigations of pathogen reduced blood components, multiple studies on transfusion reduction in patient blood management settings, the development and use of hemoglobin-based oxygen carriers as blood substitutes, and several projects on international blood safety including HIV and hepatitis reduction and blood utilization patterns in China.

Publications
Steiner ME, Ness PM, Assman SF, Triulzi DJ, Sloan DR, Delaney M, Granger S, Bennett-Guerrero E, Blachman MA, Scavo V, Carson JL, Levy JH, Whitman G, D'Andra P, Pulkrabek S, Ortel TL, Bornikova L, Raife T, Puca KE, Kaufman RM, Nuttall GA, Young PP, Youssef S, Engelman R, Greilich PE, Miles R, Josephson CD, Bracey A, Cooke R, McCullough, J, Hunsaker R, Uhl L, McFarland JG, Park Y, Cushing MM, Klodell CT, Karanam R, Roberts PR, Dyke C, Hod EA, Stowell CP. Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med 372:1419-29, 2015.

Frank, S. M., Rothschild, J. A., Masear, C. G., Rivers, R. J., Merritt, W. T., Savage, W. J., & Ness, P. M. Optimizing preoperative blood ordering with data acquired from an anesthesia information management system. , Anesthesiology 118(6), 1286-1297, 2013

Savage WJ, Tobian AAR, Savage JH, Hamilton RG, Ness PM. Atopic predisposition of recipients in allergic transfusion reactions to apheresis platelets. Transfusion 51; 2337-2342, 2011.

Anderson KC, Ness PM. Scientific basis of transfusion medicine: Implications for clinical practice. Second Edition, WB Saunders, Philadelphia PA 1999.




Email ebloch2@jhmi.edu
Phone (410)-614-4246
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Evan M. Bloch, M.B.Ch.B., M.D., M.S.


Dr. Bloch is originally from South Africa where he completed his medical school (University of Cape Town) and clinical training, which first spurred an interest in infectious disease. Following completion of a combined residency in Anatomic and Clinical Pathology (Tufts Medical Center), post-graduate fellowship in Transfusion Medicine (University of California San Francisco [UCSF]) and Masters in Global Health (UCSF) he continued research at Blood Systems Research Institute, while continuing to teach at UCSF in Laboratory Medicine and Global Health Sciences. He joined the faculty at Johns Hopkins University in the Department of Pathology in 2015.

Dr. Bloch has long been interested in babesiosis and other transfusion transmitted infections. Babesiosis is a tick-borne parasitic infection that is endemic to parts of the United States. Although infection is characterized by mild illness (e.g. flu-like symptoms) in immune competent adults, it poses significant risk to those patients at extremes of age, the immunocompromised and the asplenic. These high-risk groups are notably overrepresented among the transfused population accounting for complicated disease and even death in transfusion-transmitted babesiosis (TTB). Despite an increase in both naturally acquired- and TTB, there are currently no effective strategies to prevent TTB, nor any FDA licensed tests for blood product screening. Dr. Bloch has participated in studies to develop both antibody and molecular testis for detection of Babesia in blood donors. The studies have also been used to understand the biology of Babesia infection.

Dr. Bloch is also interested in blood safety in resource-constrained settings. He is an investigator on the Recipient Epidemiology and Donor Evaluation Study (REDS-III) in South Africa where he has helped lead a series of studies on transfusion practice and HIV in the obstetric population. Blood transfusion is a severity outcome measure for a variety of disease states; as such it can be used to highlight deficiencies in care, thereby informing rational intervention. Dr. Bloch also participated in an evaluation of transfusion infectious screening in twelve African countries; the findings highlighted the challenges surrounding extant testing methods and emphasized the need for proficiency testing for donor screening in Africa. He has been actively involved in education and operational outreach related to blood safety in Africa.

Dr. Bloch’s research has been funded through the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) through SBIR and R21 grant mechanisms.

The author of 25 peer-reviewed publications, Dr. Bloch is a member of the International Society of Blood Transfusion infectious disease working party (co-chair parasite sub-group) and has consulted on policy and development of clinical transfusion guidelines. He continues to be interested in rare and neglected infections and hopes to use blood transfusion as a platform for infectious surveillance so as to guide programmatic support, particularly in low-resource settings.

Publications

Bloch EM, Vermeulen M and Murphy E. Blood Transfusion Safety in Africa: A literature review of infectious disease and organizational challenges. Transfus Med Rev 2012;26: 164-80.

Bloch EM, Herwaldt BL, Leiby DA, Shaieb A, Herron RM, Chervenak M, Reed W, Hunter R, Ryals R, Hagar W, Xayavong MV, Slemenda SB, Pieniazek NJ, Wilkins PP, and Kjemtrup AM. The Third Described Case of Transfusion-Transmitted Babesia duncani. Transfusion 2011;52: 1517-22

Bloch EM, Jackman RP, Lee TH, Busch MP. Transfusion-associated microchimerism: the hybrid within. Transfus Med Rev 2013;27: 10-20.

Bloch EM, Lee TH, Krause PJ, Telford SR 3rd, Montalvo L, Chafets D, Usmani-Brown S, Lepore TJ, Busch MP. Development of a real-time polymerase chain reaction assay for sensitive detection and quantitation of Babesia microti infection. Transfusion 2013;53: 2299-306.

Levin AE, Williamson PC, Erwin JL, Cyrus S, Bloch EM, Shaz BH, Kessler D, Telford III SR, Krause P, Wormser GP, Ni X, Wang H, Krueger NX, Caglioti S, Busch MP. Determination of Babesia microti Seroprevalence in Blood Donor Populations using an Investigational Enzyme Immunoassay. Transfusion 2014;54: 2237-44.

Goodell AJ, Bloch EM, Krause PJ and Custer B. Costs, consequences, and cost-effectiveness of strategies for Babesia microti donor screening of the US blood supply. Transfusion 2014;54: 2245-57.

Bloch EM, Shah A, Khaidarova Z, Laperche S, Lefrere JJ, Hasselt JV, Zacharias P and Murphy EL supported by the Anglophone Africa Transfusion Research Group. A study of laboratory proficiency In transfusion screening for HIV, HCV and HBV in twelve African countries. Vox Sang 2014;107: 333-42

Pruett CR, Vermeulen M, Zacharias P, Ingram C, Tagny CT and Bloch EM. The use of rapid diagnostic tests for transfusion infectious screening in Africa: a literature review. Transfus Med Rev 2015;29: 35-44.

Bloch EM, Crookes RL, Hull J, Fawcus S, Gangaram R, Anthony J, Ingram C, Ngcobo S, Croxford J, Creel DV, Murphy EL, International Component of the REDS-III. The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa. Transfusion 2015;55: 1675-84.

Kane MA, Bloch EM, Bruhn R, Kaidarova Z and Murphy EL. Demographic Determinants of Syphilis Seroprevalence among U.S. Blood Donors, 2011-2012: A Retrospective Data Analysis. accepted January 2015 at BMC Infectious Diseases.

Prugger C, Laperche S, Murphy EL, Bloch EM, Kaidarova Z, Tafflet M, Lefrère JJ, Jouven X. Screening for Transfusion Transmissible Infections using Rapid Diagnostic Tests in Africa: a Potential Hazard to Blood Safety? Accepted Vox Sanguinis July 2015.

Bloch, EM, Simon, MS and Shaz, BH. Emerging Infections and Blood Safety in the 21st Century. Accepted Annals of Internal Medicine February 2016.

Bloch EM, Crookes RL, Hull J, Fawcus S, Gangaram R, Anthony J, Ingram C, Ngcobo S, Croxford J, Creel DV, Kane MA, Bloch EM, Bruhn R, Kaidarova Z and Murphy EL. Demographic Determinants of Syphilis Seroprevalence among U.S. Blood Donors, 2011-2012: A Retrospective Data Analysis. BMC Infect Dis 2015; 15: 63.

Vo MT, Bruhn R, Kaidarova Z, Custer BS, Murphy EL, and Bloch EM. A Retrospective Analysis of False Positive Infectious Screening Results In Blood Donors. Transfusion 2016; 56(2): 457-65




Email pbrunke1@jhmi.edu
Phone (410) 614-5171
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Patricia Brunker, M.D., Ph.D.

Primary Appointment in Pathology


Molecular hematology testing was initiated in 2009 at the Johns Hopkins Hospital as an outgrowth of the reference serology lab. Particularly in cases of complicated alloimmunization, such as that found in sickle cell disease, or in warm autoimmune hemolytic anemia, molecular characterization of patients and/or blood products has informed an even more patient-centered and individualized approach to transfusion medicine practice since its inception. Projects in this area include increased utilization and outcomes research in molecular testing, including weak and partial Rh testing, cell-free, fetal DNA, and real-time PCR. Our projects to understand genetics of the basis of alloimmunization include the evaluation of rapid-responder and non-responder status in pregnancy and family studies of alloimmunization including microchimerism analysis.

Publications
Brunker, P. A. (2013). Chimerism in transfusion medicine. Chimerism, 4(4).

Brunker, P. A., & Flegel, W. A. (2011). Scianna: the lucky 13th blood group system. Immunohematology/American Red Cross, 27(2), 41.

Leider, J. P., Brunker, P. A., & Ness, P. M. (2010). Convalescent transfusion for pandemic influenza: preparing blood banks for a new plasma product?. Transfusion, 50(6), 1384-1398.

Ramaley, P. A., French, N., Kaleebu, P., Gilks, C., Whitworth, J., & Hill, A. V. (2002). HIV in Africa: chemokine-receptor genes and AIDS risk. Nature, 417(6885), 140-140.

Hellier, S., Frodsham, A. J., Hennig, B. J., Klenerman, P., Knapp, S., Ramaley, P., ... & Hill, A. V. (2003). Association of genetic variants of the chemokine receptor CCR5 and its ligands, RANTES and MCP‐2, with outcome of HCV infection. Hepatology, 38(6), 1468-1476.




Email seshlem@jhmi.edu
Phone (410) 614-4734
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Susan H. Eshleman, M.D., Ph.D.

Primary Appointment in Pathology
Member, Graduate Program in Cellular and Molecular Medicine; Member, Graduate Program in Pathobiology


The HIV viruses in an infected individual are genetically diverse and evolve at a rapid rate in response to selective pressures. My laboratory studies HIV diversity and its impact on HIV infection and disease progression. Other areas of interest include analysis of HIV drug resistance, evaluation of interventions for HIV prevention, and the development of novel laboratory methods for HIV analysis.

Publications
Eshleman SH, Hudelson S, Redd AD, Wang L, Debes R, Chen YQ, Martens CA, Ricklefs SM, Selig EJ, Porcella SF, S Munshaw, SC Ray, Piwowar-Manning E, McCauley M, Hosseinipour MC, Kumwenda J, Hakim JG, Chariyalertsak S, de Bruyn G, Grinsztejn B, Kumarasamy N, Makhema J, Mayer KH, Pilotto J, Santos BR, Quinn TC, Cohen MS, and Hughes JP. Analysis of genetic linkage of HIV from couples enrolled in the HIV Prevention Trials Network 052 trial. J Infect Dis. 2011; 204:1918-1926.

Cousins MM, Konikoff J, Laeyendecker O, Celum C, Buchbinder SP, Seage GR, Kirk GC, Moore RD, Mehta SH, Margolick JB, Brown J, Mayer KH, Koblin BA, Wheeler D, Justman JE, Hodder SA, Quinn TC, Brookmeyer R, and Eshleman SH. HIV diversity as a biomarker for HIV incidence estimation: including a high resolution melting diversity assay in a multi-assay algorithm. J Clin Microbiol. 2014; 52:115-121.

Coates TJ, Kulich M, Zelaya CE, Celantano DD, Chariyalertsak S, Chingono A, Gray G, Mbwambo JKK, Morin FS, Richter L, Sweat M, van Rooven H, McGrath N, Fiamma A, Laeyendecker O, Piwowar-Manning E, Szerekes G, Donnell D, and Eshleman SH. Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial. Lancet Global Health. 2014. 2:e267-e277.




Email kking@jhmi.edu
Phone (410) 955-6583
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Karen E. King, M.D.

Primary Appointment in Pathology
Secondary Appointment in Oncology
Co Director, Pathology Residency Program
Director, Transfusion Medicine Fellowship Program


My research is focused in two areas: 1) the evaluation, treatment and prevention of adverse events due to transfusion, and 2) novel indications for apheresis. My interests involve the complications related to transfusion including alloimmunization, febrile non-hemolytic transfusion reactions, allergic transfusion reactions and septic transfusion reactions. I am particularly interested in the role of transfusion and transfusion-related complications in the care of patients with sickle cell disease, especially issues due to multiple transfusions and alloimmunization, including delayed hemolytic transfusion reactions and the phenomenon of bystander hemolysis. In the area of apheresis, I have studied the role of apheresis in novel clinical settings including ABO and HLA incompatible kidney transplantation, HLA incompatible progenitor cell transplantation and neurologic diseases such as Stiff Person Syndrome. In the Hemapheresis and Transfusion Support (HATS) service, our resources include apheresis technology and staff skilled in performing therapeutic and donor apheresis. Our platelet coordinators manage platelet transfusion therapy for multitransfused, refractory patients. The translational aspects of this service facilitate close interactions with research and clinical investigators in many fields. I am also involved in clinical trials related to transfusion medicine and novel apheresis technologies.

Publications

Transfusion-related Adverse Events:
King KE, Shirey RS, Lankiewicz MW, Young-Ramsaran J, Ness PM. Delayed hemolytic transfusion reactions in sickle cell disease: simultaneous destruction of recipients' red cells. Transfusion 1997;37:376-381. PMID: 9111274

Ness PM, Shirey RS, Weinstein MH, King KE. An animal model for delayed hemolytic transfusion reactions. Transfusion Medicine Reviews 2001;15:305-317. PMID: 11668437

Shirey RS, Boyd JA, Parwani AV, Tanz WS, Ness PM, King KE. Prophylactic antigen-matched donor blood for patients with warm autoantibodies: an algorithm for transfusion management. Transfusion 2002;42:1435-1441. PMID: 12421216

King KE, Shirey RS, Thoman SK, Bensen-Kennedy D, Tanz WS, Ness PM. Universal leukoreduction decreases the incidence of febrile non-hemolytic transfusion reactions to RBCs. Transfusion 2004;44:25-29. PMID: 14692963

Tobian AAR, Fuller AK, Uglik K, Tisch DJ, Borge PD, Benjamin RJ, Ness PM, King KE. The impact of platelet additive solution apheresis platelets on allergic transfusion reactions and corrected count increment. Transfusion 2014;54:1523-1529. PMID:24251374.

Apheresis:
Montgomery RA, Zachary AA, Racusen LC, Leffell MS, King KE, Burdick J, Maley WR, Ratner LE. Plasmapheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into crossmatch positive recipients. Transplantation 2000;70:887-95. PMID: 11014642

Montgomery RA, Locke JE, King KE, Segev DL, Warren DS, Kraus ES, Cooper M, Simpkins CE, Singer AL, Stewart ZA, Melancon JK, Ratner L. Zachary AA, Haas M. ABO incompatible renal transplantation: a paradigm ready for broad implementation. Transplantation 2009;87:1246-1255. PMID: 19384174

Montgomery RA, Segev DL, Lonze BE, Haas M, King KE, Kraus ES, Locke JE, Warren DS, Cooper M, Simpkins CE, Dagher NN, Singer AL, Samaniego-Picota MD, Ratner LE, Kucirka LM, Leffell MS, Zachary AA. Desensitization in HLA-incompatible kidney recipients and survival. New England Journal of Medicine 2011;365:318-326. PMID: 21793744

Gladstone DE, Zachary AA, Fuchs EJ, Luznick L, Kasamon YL, King KE, Brodsky R, Jones RJ, Leffell MS. Partially mismatched transplantation and human leukocyte antigen donor-specific antibodies. Biology of Blood and Marrow Transplantation 2013;19:647-652. PMID:23353119

Pagano MB, Murinson BB, Tobian AAR, King KE. Efficacy of therapeutic plasma exchange for treatment of stiff person syndrome. Transfusion 2014;54:1851-1856. PMID: 24527774.




Email atobian1@jhmi.edu
Phone (443) 287-0527

Related Websites
Division of Transfusion Medicine

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Aaron A. R. Tobian, M.D., Ph.D.

Primary Appointment in Pathology
Secondary Appointment in Medicine and Epidemiology
Member, Graduate Program in Pathobiology


My research is focused in two main areas associated with transfusion. 1) We are evaluating the biological mechanisms of adverse events associated with platelet transfusions, methods to prevent these reactions, and the appropriate settings for transfusions. 2) I collaborate with the Rakai Health Sciences Program (RHSP) in Uganda, and have established a research program evaluating the epidemiologic risk factors of HIV and other sexually transmitted infections. Working closely with the RHSP, we are evaluating the efficacy of male circumcision to prevent sexually transmitted infections in men and their female partners. In addition, using foreskin mucosal tissue, we are assessing the genital cellular immune milieu associated with sexually transmitted infections to develop novel HIV prevention therapies.

Publications
Platelet transfusion:

Tobian AAR, Savage WJ, Tisch DJ, Thoman S, King KE, and Ness PM. Prevention of allergic transfusion reactions to platelets and red blood cells through plasma reduction. Transfusion. 2011; 51: 1676-1683.

Goel R, Ness PM, Takemoto C, King KE, Krishnamurti L, and Tobian AAR. Platelet transfusions in platelet consumptive disorders are associated with in-hospital arterial thrombotic complications and mortality. Blood. 2015; 125(9):1470-1476.

Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O’Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, Webert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, and Tobian AAR. Platelet transfusion: a clinical practice guideline from the AABB. Annals of Internal Medicine. 2015; 162:205-213.

HIV and sexually transmitted infections:

Tobian AAR, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O, Charvat B, Ssempijja V, Riesdel M, Oliver AE, Nowak RG, Moulton LH, Chen MZ, Reynolds SJ, Wawer MJ, Gray RH. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med 2009; 360:1298-309.

Tobian AAR and Gray RH. The medical benefits of male circumcision. JAMA. 2011; 306: 1479-1480.

Tobian AAR, Kigozi G, Manucci J, Grabowski MK, Serwadda D, Musoke R, Redd AD, Nalugoda F, Reynolds SJ, Kighoma N, Laeyendecker O, Lessler J, Gray RH, Quinn TC, Wawer MJ and the Rakai Health Sciences Program. HIV shedding from male circumcision wounds in HIV-infected men: a prospective cohort study. PLoS Medicine. 2015; 12(4): e1001820.

Grabowski MK, Gray RH, Makumbi F, Kagaayi J, Redd AD, Kigozi G, Reynolds SJ, Nalugoda F, Lutalo T, Wawer MJ, Serwadda D, Quinn TC, Tobian AAR. Use of injectable hormonal contraception and women’s risk for herpes simplex virus type 2 acquisition: a prospective study of couples in Rakai, Uganda. Lancet Global Health. 2015; 3:e478-86.


 


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