September 10, 2025 • 19 mins
5 Questions is a new series of Blood, Sweat and Smears, hosted by our Senior Director, Bjorn Stromsness, who asks 5 questions to physicians in and around the disease areas we work in.
In this episode, we are joined by Dr. Christen Ebens, MD, MPH, Associate Professor in the Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy Program at the University of Minnesota.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:00):
Hello, and welcome to Blood, Sweat, and Smears,
your Macheon Diagnostics podcastwith tag team hosts, including
our medical director, Dr.
Brad Lewis, senior director,Bjorn Stromsnes, that's me, and
other guest hosts.
We hope you find these podcastsinteresting and informative.
(00:23):
Thank you for listening, andaway we go.
Hi, my name is Bjorn, continuingour series Five Questions,
posing five questions tophysicians in and around the
disease areas we work in.
Today, we head north to the landof 10,000 lakes and lutefisk.
SPEAKER_01 (00:39):
Oh, no.
You can't talk about lutefisk.
It's disgusting.
SPEAKER_02 (00:44):
It's disgusting.
I apologize on behalf of mypeople.
SPEAKER_01 (00:49):
We are
SPEAKER_02 (00:49):
joined today by Dr.
Kristen Evans, AssociateProfessor in the Division of
Pediatric Bone and MarrowTransplantation.
at the University of Minnesota.
Thank you for joining us today,Dr.
Evans.
SPEAKER_00 (01:02):
Thank you for inviting me, Bjorn.
SPEAKER_02 (01:04):
Absolutely.
Please step aboard our long shipof exploration.
I'm really leaning into it as weget into five questions.
All right.
SPEAKER_00 (01:15):
Whoa.
Is that appropriate?
I
SPEAKER_02 (01:19):
think so.
Nordic
SPEAKER_00 (01:22):
Viking.
A little Viking.
SPEAKER_02 (01:24):
We're tapping into the Viking heritage here.
Okay, here's our first question.
As you look at what you do todayand then look back at your
medical education, what do youwish you would have learned more
about?
SPEAKER_00 (01:35):
Great question.
Medical education.
That was a while ago, to behonest with you.
I have a friend whose kids liketo say, was that in the 1900s?
It was not for me, not quitethat long ago, but it was a
while back.
I feel like things that commonlycome up are like, did we get
enough about how to to talk topatients, listen to patients.
(01:59):
And I feel like actually mymedical education did a pretty
good job at the direct patientinteraction pieces.
And, you know, our field's a lotof breaking bad news and
expectation management.
I think what really would havebeen helpful, and this is going
to be very based on what I do inmy career, and not everyone
would need more of this, but Ithink business sort of things,
(02:23):
finance things, kind of thebusiness of medicine place such
a larger role in every day thatI hadn't expected.
And that can be like myindividual research projects,
right?
Like managing a budget, grantfunds, like spending down a
grant before the money goesaway.
(02:44):
The time it takes to getsomething reimbursed is way
different than I would expectwhen I buy something on a credit
card and pay for it, right?
Like that's the turnaround timeis so different.
And so I think on that level,having more training and that
would be great.
But I think as a field, wereally need to have expertise in
(03:09):
business and finance helping usmove forward in some of our
newer therapies.
So one of our, I would say,really big hurdles in cell and
gene therapy right now is how totake these really fascinating
novel cellular therapies thatare so so much less toxic than
what we traditionally do in stemcell transplant and make them
(03:31):
affordable and available topatients in an equitable way,
right?
Like not everybody has cash onhand that they, you know, I have
a disease, I'll pay whatever ittakes.
Like that's not where mostpeople are.
And some of the price tags ongene therapy product may start
at 3 million and that's not evenpaying for like hospitalization
(03:53):
and delivery and everythingaround it.
And then you get into a raredisease when you're developing
these therapies for handfuls ofpatients, you just lose the
economies of scale there, right?
It's not like dealing with heartdisease in adults.
So we really need experts thatcan help us devise platform
approaches that are financiallyviable for the field as a whole.
(04:13):
And that's not something I'mgonna be doing personally, but
it affects me that we don't havethose people invested in this
area.
And I think someone who has themedical background and a
business background, are peoplelike that.
And I think they can really behelpful, but gosh, even on the
little day-to-day smaller grantstuff, like really understanding
(04:35):
a little bit more about businessand finance, I think would be
helpful.
SPEAKER_02 (04:38):
Yeah, I can see that.
And I've heard similar comments.
All right.
So question number two,pediatric BMT seems an area with
some stunning wins and ratherheartbreaking losses.
So how do you manage movingbetween those extremes?
SPEAKER_00 (04:52):
That's accurate.
I would say that the ups anddowns are, I mean, there's a a
lot of in the middle, but thoseups and downs are pretty, pretty
steep.
So I think going into the field,I think having that experience
and seeing how you personallyhandle the wins and the losses
and how you frame them foryourself is important to know
(05:12):
you can handle those challenges.
For me, it's a lot aboutperspective taking and kind of
staying grounded in my owneveryday reality.
Like my relationship with myfamily, my husband, my kids,
they'll kind to bring me back toreality.
I always joke like when my kidshave something that is like a
crisis in their life, it is themost minor thing compared to
(05:35):
what a given patient is facing,right?
But I can't hold them to thesame sort of ruler.
It's just different.
And for them, it is important.
And I have to like bring myselfback to recognizing that and
respecting that.
I think one of the things thatreally helps with the wins and
(05:56):
the losses is just being veryrealistic and honest with
patients and families going intoall of these things and managing
those expectations, including myown.
Like there are definitely timeswhere I have in my head that, oh
gosh, you know, this kid's ingreat shape.
Disease status is wonderful.
We have a perfect donor.
(06:16):
Like this is going to gosmoothly.
And then it doesn't.
And so I think recognizing allthe points of difficulty or, you
you know, failure even andknowing like what a tenuous
situation it is and justapproaching that realistically
is really kind of what keeps mein a sane place with, with
(06:38):
processing grief and losses.
But yeah, some of, some of thelosses in particular hit really
hard and they stick with you.
But on the other hand, I have,you know, a lot of really cool
patient interactions wherethere's a huge, huge win, like
a, a that someone who's had adisease for 10 years and
(07:00):
nobody's diagnosed something andI happen to be in a meeting and
hear something that soundssimilar and suddenly we figure
it out and then change treatmentcourse and hear someone's been
sick their whole life and thenyou change that for them just by
being in the right place at theright time and open to thinking
about it or like a new treatmentthat comes on board in a case
(07:23):
you think really has no optionsand no realistic long-term hope.
And you give it a try knowingthat it might not work, but it
does.
So the field's always changing.
And that's what I think keeps usin transplant in a hopeful spot.
The longer you're in it, you seepatients doing better and
(07:44):
better, but then managing thoseexpectations for the times when
something comes up along andjust knocks you off course
again, because it's hard.
You're dealing with people Solosses are quite big sometimes.
SPEAKER_02 (08:01):
Well, we've dealt with life and death.
So now we move on to the reallyimportant question, which is
more fun and why the complimentcascade or the clotting cascade?
SPEAKER_00 (08:12):
The cascades that you row on are better or
fishing.
I don't know.
You're a fisherman.
Do you get much fish aroundcascades or they stay away from
the rough water?
SPEAKER_02 (08:22):
Oh, sure.
No, they need the rough water.
SPEAKER_00 (08:25):
Yeah, right.
Okay.
Okay, so that is better than thecompliment cascade or the
clotting cascade.
And I would catch no fish and itwould still be better.
SPEAKER_02 (08:33):
Are they real?
SPEAKER_00 (08:36):
Yeah, they're real.
Fish, compliment or clotting?
SPEAKER_02 (08:40):
Yeah, compliment or clotting.
SPEAKER_00 (08:42):
So clotting, I once tried to consult and by once, as
if it's in the past, it might'vebeen a few months ago, I took
consult a hematology colleaguein the workroom next door when
one of our patients had a clotAnd I was laughed at and
reminded that I all, you too area hematologist.
I'm like, yeah, but I reallydon't like COAG.
(09:04):
And he said, yeah, I also reallydon't like COAG.
And he's like, but nothing haschanged since your training.
I'm like, oh, still a lowvanoxin anti-10A levels.
He's like, yeah.
I'm like, okay, fine.
I'll do my own consult.
I don't really love either ofthem.
I interact a lot more withcomplement.
(09:25):
Clotting Yes, we inflame ourpatients, but we also obliterate
their ability to make platelets.
So clotting is a little lessfrequent unless they're like
crazy sick and we've reallyscrewed up.
Complement and thromboticmicroangiopathy.
I mean, that pulls the twotogether.
I think I'm going off courseother than fishing, which I
(09:47):
would like to be good at, but Idon't know anything about.
More interesting processes.
Thymopoiesis.
Yeah, these cells.
Skid all the ways you can getsevere combined immune
deficiency.
Those pathways are so fun.
Telomeres.
(10:08):
Telomere maintenance, shelteringcomplex proteins.
Come on, Bjorn.
This is good stuff.
SPEAKER_02 (10:14):
There's a lot to be excited about is what I'm
getting at.
Right,
SPEAKER_00 (10:18):
right.
DNA repair.
I mean, gosh.
And you ask about complement andclotting.
SPEAKER_02 (10:24):
There's a lot there.
I know.
Yeah.
Those are where we live most ofthe time.
SPEAKER_00 (10:28):
No, I understand.
I understand.
I think when I took key monthboards and was doing like a
review course, something in theclotting cascade had changed
since I had learned it.
And I was livid.
These are set in stone things.
It's like the declaration ofindependence, right?
(10:48):
These truths, but no, no, Ithink they're real.
Will they change again?
They may.
Will I learn that?
I probably won't and I'llprobably Google it.
I'm just kidding.
SPEAKER_02 (11:02):
There we go.
All right.
Question four.
So we met at NICER a couple ofyears back.
It was a bit of an introductionto me to immunohematology.
So when you think ofimmunohematology, where does
that fit into the medicallandscape?
SPEAKER_00 (11:19):
It overlaps so many things.
And okay, so the immune systemis derived from the blood
forming cells, right?
So they're inextricably linked,immuno and heme, right?
In my field in transplant, onething that's really cool about
immuno disorders or immuno hemedisorders is that because they
(11:41):
come from those blood formingcells, we can treat and I dare
say cure problems in that areaby stem cell transplant, right?
A little control alt delete, toa certain extent, we try not to
be like super, super aggressiveand myeloblative, but enough
that we need to, to get rid ofthe cells that aren't working
and replace them and get rid ofthe immunoheme disorder.
(12:04):
But it's interesting, everydifferent program I've been
through training at, and I'vedone my training all over, every
program, you'll kind of findwhat you think of as an
immunoheme patient population ina different medical setting.
So Some places will have like animmunoheme group.
(12:25):
It's usually multidisciplinary,but some people will have like
that's their main focus andthat's what they do.
But it might include hematology,transplant, immunology,
genetics, infectious disease,rheumatology.
So all these areas.
Some places, those patients arefollowed by one of those groups.
(12:48):
So some centers have in theirallergy immunology division, a
really big immunology focus.
Some places don't, or they don'thave immunology at all.
And so then those patients kindof fall to whoever's most
passionate about managing theircare.
So it's interesting.
And then flip side of thingsthat can go wrong in immunoheme,
(13:09):
you certainly have like the lackof cells or the dysfunction or
inadequate function of cells.
So risk for infection, but youalso have that risk for
dysfunctional immune cells orimmune dysfunction that ends up
lending itself towardsautoimmune complications or
malignant formation orpremalignant conditions.
(13:33):
So it really depends on where apatient pops up if, you know,
and where they're managed, justdepending by different centers.
So it's a cool area.
I think we all really enjoy itbecause we interface with so
many colleagues with differentsort of toolboxes and different
approaches to things and ways ofthinking about disease and
(13:55):
learning from therheumatologists all the
different monoclonal antibodiesthey use and why and when do
they use them.
And we come in with oursledgehammers, but is that
appropriate, right?
So as far as the medicallandscape, if it's everywhere,
all over the place inpediatrics, in adult land, it's
like the forgotten stepchildsometimes.
(14:16):
And these patients that havelike survived but always had a
little something going on, andnobody could figure out or
suddenly something presents inadulthood.
So some of my favoriteimmunoheme colleagues are the
adult providers that are reallybringing their expertise to
these patients that have nohome.
(14:37):
You know, we need moreimmunologists for sure.
And across the board, peds andadult.
So yeah, immunohemes everywhere.
I don't think you can get awayfrom it.
SPEAKER_02 (14:47):
It's been very interesting to see some of that
up close.
All right.
So our fifth question, what isthe absolute best part of your
job?
SPEAKER_00 (14:58):
Best part, best part, best part.
I love people.
And I think you'll hear likewe're humans are social beings.
Some people would argue withthat.
Some people are like anti-socialbeings, but I thrive on the
interpersonal relationships thatI have in my job.
And that's with all the membersof the team that I work with and
(15:24):
not just colleagues orsubspecialists, but my nurse
coordinator, my pharmacists, myadvanced practice providers on
the team, the dietician, nurseson the unit, all these people.
And then you also have all thepatients and their families and
who supports them.
And those relationships and thefact that they're often in these
(15:47):
really challenging moments wheretheir whole life is disrupted
and they're coming to transplantor cell therapy and we're
working together to makedifficult decisions and get them
through that.
you know, I feel like we becomepart of the family for better or
worse, whether they want us ornot.
Respecting that and kind ofowning that, but also really
(16:08):
valuing that is one of the bestparts of my job.
I think in direct competitionfor first place, there is the
just constant intellectualstimulation.
I mean, even just in the lastfive years, the growth in cell
and gene therapy in particularthat will be putting a lot of
(16:29):
transplant out of date at somepoint is phenomenal and in vivo
approaches now is really cooland really all about immunology
too, right?
Like how do you get something inthat you want in and not
recognized by the immune systemsuch that it's not rejected?
What sort of payload can you getinto?
(16:52):
What sort of vector?
There's just so many cool thingshappening that on the surface
seem like science fiction butnow it's like science
non-fiction which is super coolso yeah though i think i i will
never be done learning and ithat's i'm all about that
SPEAKER_02 (17:11):
that sounds great yeah all right so if you're
keeping score at home that isfive questions and we have a
bonus question of course whichis what is something you'd
recommend it could be absolutelyanything
SPEAKER_00 (17:25):
anything well i would not recommend lutefisk
we've already established thatthis delicacy is only for our
grandparents of the nordic typemy grandma loved it and i wish i
didn't know what it was before ihad tried it because the concept
but also the taste What would Irecommend?
(17:47):
I would recommend knowing thatlife and your career is what you
make it and you never are out ofoptions.
So I think as we go throughtraining and each step you're
selecting a path, but it feelslike you're closing doors to
other paths.
Turns out you can always likeopen them in some sort of way
(18:11):
into what you're doing and pullthat interest in.
There's just two many ways totake your expertise and apply it
across realms that keep you keepyou engaged and feeling like
you're making a difference so Ithink just never feeling stuck
and that goes for mental healthsort of things too I'm very open
(18:33):
and honest talking with peopleabout mental health and I think
everybody has struggles atdifferent times and some people
have struggles all of the timebut knowing that you have
options and that you don't haveto be stuck and that if you
continue you what you're doing,you've chosen to do that, that
that's your choice.
I think that's what I recommend,like knowing that you have the
(18:54):
ability to make your ownchoices.
SPEAKER_02 (18:56):
Fantastic.
Well, thank you for making thechoice to come on the podcast.
I really appreciate your time.
So thank you.
SPEAKER_00 (19:04):
Thanks, Bjorn.
Appreciate it.
Have a good one.
SPEAKER_02 (19:07):
That's it for us here at Blood, Sweat& Smears, a
podcast produced by MacheonDiagnostics, your reference lab
and CRO specializing inthrombosis, hemostasis, and rare
disease.
Thank you for listening.
And if you have a question orcomment, or there's a topic
you'd like Dr.
Lewis to speak to, please sendus an email to blood, sweat, and
smears atmachiondiagnostics.com.
(19:29):
That's M-A-C-H-A-O-Ndiagnostics.com.
You can follow Machion atTwitter at MachionDX.
Be sure to subscribe to stay inthe know, share this podcast
with clinicians you think mightappreciate it.
And we hope you'll join us nexttime here at Blood, Sweat, and
Smears.
UNKNOWN (19:46):
you
Hello, and welcome to Blood, Sweat, and Smears,
your Macheon Diagnostics podcastwith tag team hosts, including
our medical director, Dr.
Brad Lewis, senior director,Bjorn Stromsnes, that's me, and
other guest hosts.
We hope you find these podcastsinteresting and informative.
(00:23):
Thank you for listening, andaway we go.
Hi, my name is Bjorn, continuingour series Five Questions,
posing five questions tophysicians in and around the
disease areas we work in.
Today, we head north to the landof 10,000 lakes and lutefisk.
SPEAKER_01 (00:39):
Oh, no.
You can't talk about lutefisk.
It's disgusting.
SPEAKER_02 (00:44):
It's disgusting.
I apologize on behalf of mypeople.
SPEAKER_01 (00:49):
We are
SPEAKER_02 (00:49):
joined today by Dr.
Kristen Evans, AssociateProfessor in the Division of
Pediatric Bone and MarrowTransplantation.
at the University of Minnesota.
Thank you for joining us today,Dr.
Evans.
SPEAKER_00 (01:02):
Thank you for inviting me, Bjorn.
SPEAKER_02 (01:04):
Absolutely.
Please step aboard our long shipof exploration.
I'm really leaning into it as weget into five questions.
All right.
SPEAKER_00 (01:15):
Whoa.
Is that appropriate?
I
SPEAKER_02 (01:19):
think so.
Nordic
SPEAKER_00 (01:22):
Viking.
A little Viking.
SPEAKER_02 (01:24):
We're tapping into the Viking heritage here.
Okay, here's our first question.
As you look at what you do todayand then look back at your
medical education, what do youwish you would have learned more
about?
SPEAKER_00 (01:35):
Great question.
Medical education.
That was a while ago, to behonest with you.
I have a friend whose kids liketo say, was that in the 1900s?
It was not for me, not quitethat long ago, but it was a
while back.
I feel like things that commonlycome up are like, did we get
enough about how to to talk topatients, listen to patients.
(01:59):
And I feel like actually mymedical education did a pretty
good job at the direct patientinteraction pieces.
And, you know, our field's a lotof breaking bad news and
expectation management.
I think what really would havebeen helpful, and this is going
to be very based on what I do inmy career, and not everyone
would need more of this, but Ithink business sort of things,
(02:23):
finance things, kind of thebusiness of medicine place such
a larger role in every day thatI hadn't expected.
And that can be like myindividual research projects,
right?
Like managing a budget, grantfunds, like spending down a
grant before the money goesaway.
(02:44):
The time it takes to getsomething reimbursed is way
different than I would expectwhen I buy something on a credit
card and pay for it, right?
Like that's the turnaround timeis so different.
And so I think on that level,having more training and that
would be great.
But I think as a field, wereally need to have expertise in
(03:09):
business and finance helping usmove forward in some of our
newer therapies.
So one of our, I would say,really big hurdles in cell and
gene therapy right now is how totake these really fascinating
novel cellular therapies thatare so so much less toxic than
what we traditionally do in stemcell transplant and make them
(03:31):
affordable and available topatients in an equitable way,
right?
Like not everybody has cash onhand that they, you know, I have
a disease, I'll pay whatever ittakes.
Like that's not where mostpeople are.
And some of the price tags ongene therapy product may start
at 3 million and that's not evenpaying for like hospitalization
(03:53):
and delivery and everythingaround it.
And then you get into a raredisease when you're developing
these therapies for handfuls ofpatients, you just lose the
economies of scale there, right?
It's not like dealing with heartdisease in adults.
So we really need experts thatcan help us devise platform
approaches that are financiallyviable for the field as a whole.
(04:13):
And that's not something I'mgonna be doing personally, but
it affects me that we don't havethose people invested in this
area.
And I think someone who has themedical background and a
business background, are peoplelike that.
And I think they can really behelpful, but gosh, even on the
little day-to-day smaller grantstuff, like really understanding
(04:35):
a little bit more about businessand finance, I think would be
helpful.
SPEAKER_02 (04:38):
Yeah, I can see that.
And I've heard similar comments.
All right.
So question number two,pediatric BMT seems an area with
some stunning wins and ratherheartbreaking losses.
So how do you manage movingbetween those extremes?
SPEAKER_00 (04:52):
That's accurate.
I would say that the ups anddowns are, I mean, there's a a
lot of in the middle, but thoseups and downs are pretty, pretty
steep.
So I think going into the field,I think having that experience
and seeing how you personallyhandle the wins and the losses
and how you frame them foryourself is important to know
(05:12):
you can handle those challenges.
For me, it's a lot aboutperspective taking and kind of
staying grounded in my owneveryday reality.
Like my relationship with myfamily, my husband, my kids,
they'll kind to bring me back toreality.
I always joke like when my kidshave something that is like a
crisis in their life, it is themost minor thing compared to
(05:35):
what a given patient is facing,right?
But I can't hold them to thesame sort of ruler.
It's just different.
And for them, it is important.
And I have to like bring myselfback to recognizing that and
respecting that.
I think one of the things thatreally helps with the wins and
(05:56):
the losses is just being veryrealistic and honest with
patients and families going intoall of these things and managing
those expectations, including myown.
Like there are definitely timeswhere I have in my head that, oh
gosh, you know, this kid's ingreat shape.
Disease status is wonderful.
We have a perfect donor.
(06:16):
Like this is going to gosmoothly.
And then it doesn't.
And so I think recognizing allthe points of difficulty or, you
you know, failure even andknowing like what a tenuous
situation it is and justapproaching that realistically
is really kind of what keeps mein a sane place with, with
(06:38):
processing grief and losses.
But yeah, some of, some of thelosses in particular hit really
hard and they stick with you.
But on the other hand, I have,you know, a lot of really cool
patient interactions wherethere's a huge, huge win, like
a, a that someone who's had adisease for 10 years and
(07:00):
nobody's diagnosed something andI happen to be in a meeting and
hear something that soundssimilar and suddenly we figure
it out and then change treatmentcourse and hear someone's been
sick their whole life and thenyou change that for them just by
being in the right place at theright time and open to thinking
about it or like a new treatmentthat comes on board in a case
(07:23):
you think really has no optionsand no realistic long-term hope.
And you give it a try knowingthat it might not work, but it
does.
So the field's always changing.
And that's what I think keeps usin transplant in a hopeful spot.
The longer you're in it, you seepatients doing better and
(07:44):
better, but then managing thoseexpectations for the times when
something comes up along andjust knocks you off course
again, because it's hard.
You're dealing with people Solosses are quite big sometimes.
SPEAKER_02 (08:01):
Well, we've dealt with life and death.
So now we move on to the reallyimportant question, which is
more fun and why the complimentcascade or the clotting cascade?
SPEAKER_00 (08:12):
The cascades that you row on are better or
fishing.
I don't know.
You're a fisherman.
Do you get much fish aroundcascades or they stay away from
the rough water?
SPEAKER_02 (08:22):
Oh, sure.
No, they need the rough water.
SPEAKER_00 (08:25):
Yeah, right.
Okay.
Okay, so that is better than thecompliment cascade or the
clotting cascade.
And I would catch no fish and itwould still be better.
SPEAKER_02 (08:33):
Are they real?
SPEAKER_00 (08:36):
Yeah, they're real.
Fish, compliment or clotting?
SPEAKER_02 (08:40):
Yeah, compliment or clotting.
SPEAKER_00 (08:42):
So clotting, I once tried to consult and by once, as
if it's in the past, it might'vebeen a few months ago, I took
consult a hematology colleaguein the workroom next door when
one of our patients had a clotAnd I was laughed at and
reminded that I all, you too area hematologist.
I'm like, yeah, but I reallydon't like COAG.
(09:04):
And he said, yeah, I also reallydon't like COAG.
And he's like, but nothing haschanged since your training.
I'm like, oh, still a lowvanoxin anti-10A levels.
He's like, yeah.
I'm like, okay, fine.
I'll do my own consult.
I don't really love either ofthem.
I interact a lot more withcomplement.
(09:25):
Clotting Yes, we inflame ourpatients, but we also obliterate
their ability to make platelets.
So clotting is a little lessfrequent unless they're like
crazy sick and we've reallyscrewed up.
Complement and thromboticmicroangiopathy.
I mean, that pulls the twotogether.
I think I'm going off courseother than fishing, which I
(09:47):
would like to be good at, but Idon't know anything about.
More interesting processes.
Thymopoiesis.
Yeah, these cells.
Skid all the ways you can getsevere combined immune
deficiency.
Those pathways are so fun.
Telomeres.
(10:08):
Telomere maintenance, shelteringcomplex proteins.
Come on, Bjorn.
This is good stuff.
SPEAKER_02 (10:14):
There's a lot to be excited about is what I'm
getting at.
Right,
SPEAKER_00 (10:18):
right.
DNA repair.
I mean, gosh.
And you ask about complement andclotting.
SPEAKER_02 (10:24):
There's a lot there.
I know.
Yeah.
Those are where we live most ofthe time.
SPEAKER_00 (10:28):
No, I understand.
I understand.
I think when I took key monthboards and was doing like a
review course, something in theclotting cascade had changed
since I had learned it.
And I was livid.
These are set in stone things.
It's like the declaration ofindependence, right?
(10:48):
These truths, but no, no, Ithink they're real.
Will they change again?
They may.
Will I learn that?
I probably won't and I'llprobably Google it.
I'm just kidding.
SPEAKER_02 (11:02):
There we go.
All right.
Question four.
So we met at NICER a couple ofyears back.
It was a bit of an introductionto me to immunohematology.
So when you think ofimmunohematology, where does
that fit into the medicallandscape?
SPEAKER_00 (11:19):
It overlaps so many things.
And okay, so the immune systemis derived from the blood
forming cells, right?
So they're inextricably linked,immuno and heme, right?
In my field in transplant, onething that's really cool about
immuno disorders or immuno hemedisorders is that because they
(11:41):
come from those blood formingcells, we can treat and I dare
say cure problems in that areaby stem cell transplant, right?
A little control alt delete, toa certain extent, we try not to
be like super, super aggressiveand myeloblative, but enough
that we need to, to get rid ofthe cells that aren't working
and replace them and get rid ofthe immunoheme disorder.
(12:04):
But it's interesting, everydifferent program I've been
through training at, and I'vedone my training all over, every
program, you'll kind of findwhat you think of as an
immunoheme patient population ina different medical setting.
So Some places will have like animmunoheme group.
(12:25):
It's usually multidisciplinary,but some people will have like
that's their main focus andthat's what they do.
But it might include hematology,transplant, immunology,
genetics, infectious disease,rheumatology.
So all these areas.
Some places, those patients arefollowed by one of those groups.
(12:48):
So some centers have in theirallergy immunology division, a
really big immunology focus.
Some places don't, or they don'thave immunology at all.
And so then those patients kindof fall to whoever's most
passionate about managing theircare.
So it's interesting.
And then flip side of thingsthat can go wrong in immunoheme,
(13:09):
you certainly have like the lackof cells or the dysfunction or
inadequate function of cells.
So risk for infection, but youalso have that risk for
dysfunctional immune cells orimmune dysfunction that ends up
lending itself towardsautoimmune complications or
malignant formation orpremalignant conditions.
(13:33):
So it really depends on where apatient pops up if, you know,
and where they're managed, justdepending by different centers.
So it's a cool area.
I think we all really enjoy itbecause we interface with so
many colleagues with differentsort of toolboxes and different
approaches to things and ways ofthinking about disease and
(13:55):
learning from therheumatologists all the
different monoclonal antibodiesthey use and why and when do
they use them.
And we come in with oursledgehammers, but is that
appropriate, right?
So as far as the medicallandscape, if it's everywhere,
all over the place inpediatrics, in adult land, it's
like the forgotten stepchildsometimes.
(14:16):
And these patients that havelike survived but always had a
little something going on, andnobody could figure out or
suddenly something presents inadulthood.
So some of my favoriteimmunoheme colleagues are the
adult providers that are reallybringing their expertise to
these patients that have nohome.
(14:37):
You know, we need moreimmunologists for sure.
And across the board, peds andadult.
So yeah, immunohemes everywhere.
I don't think you can get awayfrom it.
SPEAKER_02 (14:47):
It's been very interesting to see some of that
up close.
All right.
So our fifth question, what isthe absolute best part of your
job?
SPEAKER_00 (14:58):
Best part, best part, best part.
I love people.
And I think you'll hear likewe're humans are social beings.
Some people would argue withthat.
Some people are like anti-socialbeings, but I thrive on the
interpersonal relationships thatI have in my job.
And that's with all the membersof the team that I work with and
(15:24):
not just colleagues orsubspecialists, but my nurse
coordinator, my pharmacists, myadvanced practice providers on
the team, the dietician, nurseson the unit, all these people.
And then you also have all thepatients and their families and
who supports them.
And those relationships and thefact that they're often in these
(15:47):
really challenging moments wheretheir whole life is disrupted
and they're coming to transplantor cell therapy and we're
working together to makedifficult decisions and get them
through that.
you know, I feel like we becomepart of the family for better or
worse, whether they want us ornot.
Respecting that and kind ofowning that, but also really
(16:08):
valuing that is one of the bestparts of my job.
I think in direct competitionfor first place, there is the
just constant intellectualstimulation.
I mean, even just in the lastfive years, the growth in cell
and gene therapy in particularthat will be putting a lot of
(16:29):
transplant out of date at somepoint is phenomenal and in vivo
approaches now is really cooland really all about immunology
too, right?
Like how do you get something inthat you want in and not
recognized by the immune systemsuch that it's not rejected?
What sort of payload can you getinto?
(16:52):
What sort of vector?
There's just so many cool thingshappening that on the surface
seem like science fiction butnow it's like science
non-fiction which is super coolso yeah though i think i i will
never be done learning and ithat's i'm all about that
SPEAKER_02 (17:11):
that sounds great yeah all right so if you're
keeping score at home that isfive questions and we have a
bonus question of course whichis what is something you'd
recommend it could be absolutelyanything
SPEAKER_00 (17:25):
anything well i would not recommend lutefisk
we've already established thatthis delicacy is only for our
grandparents of the nordic typemy grandma loved it and i wish i
didn't know what it was before ihad tried it because the concept
but also the taste What would Irecommend?
(17:47):
I would recommend knowing thatlife and your career is what you
make it and you never are out ofoptions.
So I think as we go throughtraining and each step you're
selecting a path, but it feelslike you're closing doors to
other paths.
Turns out you can always likeopen them in some sort of way
(18:11):
into what you're doing and pullthat interest in.
There's just two many ways totake your expertise and apply it
across realms that keep you keepyou engaged and feeling like
you're making a difference so Ithink just never feeling stuck
and that goes for mental healthsort of things too I'm very open
(18:33):
and honest talking with peopleabout mental health and I think
everybody has struggles atdifferent times and some people
have struggles all of the timebut knowing that you have
options and that you don't haveto be stuck and that if you
continue you what you're doing,you've chosen to do that, that
that's your choice.
I think that's what I recommend,like knowing that you have the
(18:54):
ability to make your ownchoices.
SPEAKER_02 (18:56):
Fantastic.
Well, thank you for making thechoice to come on the podcast.
I really appreciate your time.
So thank you.
SPEAKER_00 (19:04):
Thanks, Bjorn.
Appreciate it.
Have a good one.
SPEAKER_02 (19:07):
That's it for us here at Blood, Sweat& Smears, a
podcast produced by MacheonDiagnostics, your reference lab
and CRO specializing inthrombosis, hemostasis, and rare
disease.
Thank you for listening.
And if you have a question orcomment, or there's a topic
you'd like Dr.
Lewis to speak to, please sendus an email to blood, sweat, and
smears atmachiondiagnostics.com.
(19:29):
That's M-A-C-H-A-O-Ndiagnostics.com.
You can follow Machion atTwitter at MachionDX.
Be sure to subscribe to stay inthe know, share this podcast
with clinicians you think mightappreciate it.
And we hope you'll join us nexttime here at Blood, Sweat, and
Smears.
UNKNOWN (19:46):
you
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