Peer-to-Peer, Featuring Fred Plapp

Ivan Damjanov interviews Fred Plapp

Fred Plapp is a man who wears many hats – researcher, inventor, clinical pathologist, transfusion medicine physician, and even web guru. His professional history is similarly varied; he has practiced at a community blood center, a large private health care system, and an academic medical center. His primary areas of academic interest are clinical chemistry, immunology, transfusion medicine, and apheresis – but because of his wide experience, he also brings a unique perspective to education in pathology and laboratory medicine. Many of you may be aware of his inventions, his peer-reviewed publications, or the web resource he has developed to educate medical professionals about lab test results. Here, Ivan Damjanov uncovers the history behind the advancements…

How do you view your role as clinical pathologist and medical director?

The clinical laboratory plays a vital role across the entire continuum of health care. Virtually every practicing physician depends upon it for the care of their patients. And so, clinical pathologists provide consultation to referring physicians regarding:

• Maintenance of an up-to-date laboratory test menu
• Introduction of new tests and deletion of obsolete ones
• Inclusion of laboratory tests in clinical order sets
• Appropriate test utilization
• Interpretation of clinical laboratory test results
• Investigation of discrepant or unexpected results
• Lab results reporting in the electronic medical record

A clinical pathologist also needs to be accessible to the laboratory staff 24/7. We maintain an effective working relationship with laboratory management and hospital administration by actively participating in their meetings and assisting them in developing goals, objectives, policies, and procedures. We also advise in long-range planning and the acquisition of capital equipment.

Clinical pathologists monitor and evaluate the quality and appropriateness of laboratory services rendered within the context of an institution’s overall quality management plan. We assure the quality of laboratory results by reviewing quality control, proficiency surveys, and patient data.

The medical director must make certain that the laboratory maintains a constant state of inspection readiness – after all, accreditation agencies may make unannounced inspections at any time. Not only is it vital to be prepared for such eventualities, but it also improves the overall performance of the laboratory. Last – but certainly not least – an important aspect of the medical director’s job is to demonstrate to hospital administration how the laboratory provides added value for hospital operations, safety, and patient care.

When I am covering the transfusion service, I see patients almost every day for apheresis procedures including plasma exchange, red blood cell exchange, and white blood cell removal. Many of these patients are critically ill, so we work closely with our critical care physicians. One of my fondest memories is caring for a young woman who developed life-threatening autoimmune hemolytic anemia after a hematopoietic stem cell transplant. She was admitted comatose with a hemoglobin level of 2.8 g/dL. She fully recovered following several therapeutic plasma exchanges and a complete red blood cell exchange. Several months later, I received a wonderful Christmas card thanking me for helping her enjoy the holidays with her family.

What contributions have you brought to hospitals and blood banks?

An increasingly important role of the medical director is active participation in utilization management initiatives, such as the Choosing Wisely campaign, that seek to eliminate unnecessary laboratory tests. I worked with our medical informatics team to develop a multi-pronged strategy for test utilization. We established duplicate alerts for tests that should only be ordered once per admission and high-volume test alerts for commonly ordered tests, such as complete blood counts and chemistry panels. We also added best practice alerts for expensive tests (those costing more than US$500) and send out tests with long turnaround times. So far, these test utilization initiatives have resulted in annual cost savings of $920,000.

After completing my pathology residency, I wanted to pursue basic research. I became interested in determining the biological function of red blood cell antigens, so my graduate students and I developed several innovative techniques to purify and identify blood group antigens. Eventually, we realized that some of these methods could be used to automate blood group serology, which at that time was performed manually in individual test tubes. Over the next five years, our small research team invented the solid phase red cell adherence method for pre-transfusion serologic testing. Once we realized its potential commercial value, we worked with a local intellectual property attorney to patent every facet of this technology. Gradually, we also invented blood grouping dipsticks and image recognition software to automatically interpret solid phase reactions.

I think that my first patent, for solid phase red cell adherence, has also been the most consequential one I’ve obtained. After patenting that technology, we met the three founders of a startup company looking for a novel technology to distinguish them from the established blood bank companies. After we transferred our technology to them, they became a leading international blood banking company. In fact, they still use our technology today in their workstations and automated analyzers.

My research team was awarded the Morton Grove-Rasmussen Memorial Award by the American Association of Blood Banks in 1999 in recognition of our invention of solid phase blood banking. It was a very interesting experience, because I sat next to Kary Mullis, who received the Karl Landsteiner Memorial Award for the invention of the polymerase chain reaction (PCR). However, far more than the award, I value the fact that our work is still being used 35 years on – so it has clearly withstood the test of time.

But not all good inventions make it through the commercialization maze. In the early days of HIV, I invented technology to open vacutainer tubes safely without creating an aerosol. I sold this patent to a local company, which was soon bought out by a major pharmaceutical company. They shelved this project and, unfortunately, it was never pursued commercially.

How important is teaching as part of your role?

I have always enjoyed teaching. During my career, I have had the opportunity to teach medical students, residents, faculty, medical laboratory scientists, and nurses. Although I have given many lectures to large classes over the years, I particularly enjoy one-on-one teaching. I never pass up the opportunity to introduce young minds to the exciting field of pathology and laboratory medicine.

All of us who teach pathology have spent endless hours preparing teaching materials. Over the years, I have written descriptions of hundreds of laboratory tests, test utilization recommendations, and transfusion guidelines – and, eventually, I decided that I wanted to find a way to disseminate this educational material to a wider audience. Fortunately, my son Chris acquired the skills for website development in high school and began to host websites for several small businesses. In college, he majored in both fine art and computer science – a unique combination of interests that enhanced his ability to design websites that were both functional and aesthetically pleasing.

Together, we founded a company and created the website ClinLabNavigator.com. My son provides the technical expertise and I write the medical content. Chris has crafted a site that is very easy to use, even for those of us who are less technologically inclined, so all I have to do is tell him what content I would like to include and he determines the best way to display it. The site has steadily evolved over many years because of the changes he has made to improve readership. Today, thanks to our complementary skills and good working relationship, ClinLabNavigator.com contains over 1,000 laboratory test interpretations and guidelines. We’re now looking into growing our organic search traffic and even experimenting with mobile applications. Our little web page has evolved into a comprehensive resource for healthcare professionals!