Women leaders in hematology: Inspirations &amp; insights
Authors: Tammuella Singleton, David L. Cooper, Sriya Gunawardena
Journal: American Journal of Hematology (2016)

Hematology is a unique and dynamic medical field. Due to constant innovations in the field, hematologists (both past and present) have been successful in bringing exciting cutting edge bench research to the bedside on a regular basis, resulting in advances in clinical care. Many individuals have contributed to the advancement of the study of hemostasis and thrombosis in many ways over the past few decades; it is especially interesting to note that a number of female physicians and researchers have played a key role in the development of the field. In 1964, Dr. Judith Graham Pool published her discovery of cryoprecipitate, a frozen blood clotting product made from plasma, which was used primarily to treat patients with hemophilia 1. She also described how a high-potency concentrate of antihemophilic globulin can be prepared in a closed-bag system in any hospital or blood bank. In the early 1960s, Dr. Shelby Dietrich, a pediatrician, set up a multispecialty team for comprehensive care of hemophilia at the Orthopaedic Hospital in Los Angeles, with funding from the federal government 2. At the time, this was a very innovative concept and is believed to be the beginning of the “comprehensive care” model for hemophilia in the United States 3. In 1977, hematologist Dr. Margaret Hilgartner, along with Dr. William Arnold at the Hospital for Special Surgery in New York, NY, developed the first classification of hemophilic arthropathy 4. Her other major research contributions were in the areas of complications of transfusion/infusion therapy, treatment of inhibitors 5, and the infectious complications of hemophilia such as hepatitis and human immunodeficiency virus (HIV) 6. Many other women have done pioneering work in the area of hemostasis and thrombosis and have successfully advanced the field during the past few decades. This supplement will celebrate the contributions and highlight the achievements of some of the female leaders to the field of benign hematology in the United States, especially in the area of hemostasis and thrombosis. It will also describe how they have inspired and helped mentor other female hematologists to advance their careers and achieve their goals. Most of the women interviewed for this supplement decided to enter medicine during a period when it was not considered a suitable career for a woman, when the number and percentage of women in medical school classes was very low, and where the choices of specialties were more limited than today. However, they were fortunate to have found one or more mentors who engaged them in the challenges of managing coagulation disorders and guided them toward successful careers as hematologists, both as clinicians and researchers. Ultimately, this guidance enabled them to make significant contributions to the field of hemostasis and thrombosis. Although the number of women entering medical school across the country has increased over the last decade 7, the field of benign hematology still urgently needs to recruit new, talented clinicians and researchers to advance care for pediatric and adult patients 8. According to data from the Association of American Medical Colleges, women comprise 47% of the total medical college enrollment for the 2015 to 2016 school year 9. More women are in the medical field now than ever before, particularly in pediatrics and its subspecialties. Innovations like shared-job positions have made it easier for both women and men with young families to achieve work/life balance. Despite these advances in medicine as a career choice for women, men still appear to dominate leadership positions within the medical profession. In this sense, the field of benign hematology may be an exception, especially for the area of hemostasis and thrombosis. Women have been pioneers in this area, significantly contributing to the advancement of the field and rising to top leadership positions in professional societies and academic medicine. Leading women in hematology, such as those profiled in this supplement, have mentored other women interested in this therapy area, helping develop the next generation of leaders in hemostasis and thrombosis. Emulating their mentors as role models, this next generation is, in turn, mentoring residents, fellows, and young faculty. This supplement presents interviews of 11 women leaders in hemophilia who were chosen based upon consistent nominations by peers over many years. These choices are validated by the recognition and awards these women have received from professional societies and patient advocacy organizations. The profiles are based on interviews conducted by women they have mentored, trained, and worked with, commonly for a decade or more, and whose careers and accomplishments have been positively impacted by their ongoing relationship with their mentors. In addition, each mentee has written a personal perspective describing how the mentor–mentee relationship helped her career, how the profiled individual has contributed to the area of coagulation disorders (especially hemophilia), why the profiled leader is considered a role model for women interested in this area, and highlighting the profiled individual's greatest contribution to the area of hemostasis and thrombosis. At a time when it is critical to identify and recruit new women and men to the field of benign hematology, it is important to understand the perspectives and drivers behind the accomplishments of the mentors profiled in “Women Leaders in Hematology,” as well as the way in which those accomplishments have impacted the next generation to take on leadership roles. Dr. Carol Kasper: A true pioneer in the field, Dr. Kasper has made significant contributions to the field of hemophilia through research and clinical care. She established a coagulation laboratory at the Orthopaedic Hemophilia Treatment Center to help diagnose patients with bleeding disorders in 1966 and has been involved in clinical research in the diagnosis and treatment of hemophilia for over 40 years. Her greatest contributions include her national and international leadership devoted to improving care for patients with hemophilia. In 1975, Dr. Kasper chaired a committee that helped define a more uniform measurement of factor VIII inhibitors, the Bethesda Assay, which is still in use today 10. Dr. Kasper was interviewed by Dr. Doris Quon, who is the current Medical Director of the Orthopaedic Hemophilia Treatment Center in Los Angeles and says: “Dr. Kasper had been an integral part of my training since I was a fellow at UCLA—and even to today!” Dr. Jeanne Lusher: Regarded as one of the most distinguished figures in the hemophilia and bleeding disorders community, Dr. Lusher has been recognized internationally over the last several decades as an expert in the development and management of factor VIII and factor IX inhibitors 11. Dr. Lusher was also actively involved in pioneering clinical research of new clotting factor concentrates for the treatment of bleeding disorders. She has held many leadership roles within the therapeutic area throughout her career and, though retired, continues to be actively involved in hemostasis-related national organizations. Dr. Lusher was interviewed by Dr. Meera Chitlur, the Director of the Hemophilia Treatment Center and Hemostasis Program and the Barnhart-Lusher Hemostasis Research Endowed Chair at Wayne State University and the Children's Hospital of Michigan. Dr. Chitlur first met Dr. Lusher during her fellowship training and says: “Words cannot express my gratitude for Dr. Lusher's mentorship, and I hope to repay this by being a mentor to someone else as she has been to me.” Dr. Roshni Kulkarni: A true believer in equal access to healthcare regardless of gender or geographic location, Dr. Kulkarni is an advocate for raising global awareness of women, adolescents, and babies with bleeding disorders 12. She is well known as a pioneer in care delivery through telemedicine for those with hemophilia, and her passion for her work led her to co-found the Foundation for Women & Girls with Blood Disorders. She also served as a Division Director and later as distinguished hematology consultant at the Division of Blood Disorders, Center for Disease Control and Prevention (CDC; Atlanta, GA) that added a public health perspective of blood disorders to her experience. Dr. Kulkarni was interviewed by Dr. Madhvi Rajpukar, Chief of the Division of Hematology and Director of the Pediatric Thrombosis Program at Children's Hospital of Michigan. When asked about Dr. Kulkarni, Dr. Rajpurkar said: “With her unfailing and infectious enthusiasm, she has often motivated me to do more and be more! I have learned the art of lateral thinking from her, and I feel extremely privileged to be mentored by her.” Dr. Marilyn Manco-Johnson: An avid researcher in pediatric hemostasis and thrombosis with a passion for patient care, Dr. Manco-Johnson is well known for her pioneering work in the Joint Outcomes Study. Results of this study led to a dramatic change in clinical practices in the United States toward adoption of primary prophylaxis therapy in children to prevent long-term joint damage 13. She has also contributed significantly to other areas of research in hemostasis and thrombosis, including diagnostic global assays for bleeding and clotting disorders, pediatric thrombotic disorders, and preventative treatments and neonatal hematology. Dr. Manco-Johnson was interviewed by Dr. Mindy Simpson, a pediatric hematologist/oncologist at Rush Hemophilia and Thrombosis Center in Chicago, IL. Dr. Simpson first met Dr. Manco-Johnson during her fellowship training at University of Colorado and says: “I am humbled and honored to have Dr. Marilyn Manco-Johnson as a personal friend and career mentor, and I am grateful to have experienced true mentorship from her and accept that learning and mentoring are life-long processes.” Dr. Margaret Ragni: Dr. Ragni is a prolific clinical researcher with a diversity of interests and expertise in the area of hemophilia and bleeding disorders who has been at the forefront of the field for many years. She is well known for her innovative work in the area of liver disease in hemophilia and HIV/hepatitis C virus co-infection in hemophilia 14. Dr. Ragni was interviewed by Dr. Sarah O'Brien, Director of Experimental Therapeutics (Hematology/Oncology/BMT) and Principal Investigator at the Center for Innovation in Pediatric Practice at Nationwide Children's Hospital in Columbus, OH. Dr. O'Brien first met Dr. Ragni almost 20 years ago as a second year medical student at the University of Pittsburgh School of Medicine. In Dr. O'Brien's own words: “When Dr. Ragni stood at the front of the room and reviewed the coagulation cascade step-by-step, I had no idea that I would be a hematologist someday, much less one who specializes in hemostasis and thrombosis. However, her enthusiasm and passion as she taught us was truly memorable.” Dr. Joan Gill: With an unwavering dedication to her patients and quest to further the clinical understanding of bleeding disorders, Dr. Gill continues to conduct innovative research in many areas of hematology, including von Willebrand disease 15, hemophilia, and thrombotic disease. She has been successful in integrating research into the clinical care setting, making it possible to improve clinical care more efficiently and rapidly with the active participation of patients. She was a founder and is a long-term officer of the Hemostasis and Thrombosis Research Society. Dr. Gill was interviewed by Dr. Veronica Flood, Associate Professor, Pediatrics (section of Hematology/Oncology/BMT) at Medical College of Wisconsin, who says: “As someone lucky enough to have had her as a mentor, it is her generosity that stands out to me. She is always willing to take time to listen, both to patients and to colleagues, and most especially to mentees.” Dr. Diane Nugent: A renowned expert in rare blood disorders including platelet disorders, Dr. Nugent has performed innovative research in the area of platelets and factor XIII 16. Her research is fueled by her interest and fascination with the area of coagulation and its impact on long-term maternal, fetal, and neonatal health. She is a strong advocate for female physicians, and her enthusiasm for teaching and clinical care has been a key factor in attracting younger female physicians to the field. Dr. Nugent was interviewed by Dr. Loan Hsieh, Director of Ambulatory Hematology at Children's Hospital-Orange County, CA, who first met Dr. Nugent at her hematology rotation as a fourth year medical student. Dr. Hsieh says that “Dr. Nugent leads by example and consistently makes time for people, whether it is a researcher interested in collaborating with her or a team member needing her advice. She is committed to her faculty's growth, and never misses an opportunity to connect them to other experts in the field.” Dr. Donna DiMichele: Well known for her innovative work in the area of inhibitors, including immune tolerance therapy 17, Dr. DiMichele has extensive research experience in hematology and rare bleeding and clotting disorders. Her immense clinical expertise in hematology helps her in her current role as the deputy director of the Division of Blood Diseases and Resources at the National Heart, Lung, and Blood Institute to identify areas that could benefit from translational research initiatives. Dr. DiMichele has mentored many trainees and students who have pursued careers in the area of hemostasis and thrombosis. She was interviewed by Dr. Suchitra Acharya, a pediatric hematologist at the comprehensive hemophilia treatment center at Long Island Jewish Medical Center in New York. Dr. Acharya was mentored by Dr. DiMichele during her fellowship and post-fellowship years and says: “During the second year of my fellowship, I had decided to pursue hematology as a career, but this choice was not clear until I was taught by Dr. DiMichele, who sparked an interest in me to pursue hemostasis and thrombosis.” Dr. Barbara Konkle: An internationally recognized expert in laboratory diagnosis and treatment of bleeding and clotting disorders, Dr. Konkle is interested in translational research that connects scientific discovery and improves patient care. She has done innovative research in aging hemophilia patients and studied cardiovascular disease in hemophilia 18. Her current project involving genotyping patients with hemophilia and developing a research repository will likely have an incredible impact in the hemophilia community. She is a founding board member of the Foundation for Women & Girls with Blood Disorders. Dr. Konkle was interviewed by Dr. Suman Sood, who was mentored by Dr. Konkle during her fellowship training at the University of Pennsylvania. She continues to collaborate with Dr. Konkle on many research projects and says: “Dr. Konkle has had a huge impact on my career both through the opportunities she has opened to me, and as a role model. She has been an incredible mentor to me over the years, and these days I try to model her behavior as much as possible with my own mentees.” Dr. Cindy Leissinger: Well known for her pioneering research involving prophylaxis in patients with hemophilia A who have inhibitors 19, Dr. Leissinger has a diversity of interests and expertise in coagulation disorders. She has conducted extensive research in hematology, especially in the area of coagulation, and has made significant contributions to the field. Dr. Leissinger was interviewed by Dr. Rebecca Kruse-Jarres, who was mentored by Dr. Leissinger during her fellowship training in Hematology/Oncology at Tulane University in New Orleans, LA, and as a junior faculty member at Tulane University, Department of Medicine (Hematology/Oncology). They continue to collaborate on research studies. Dr. Kruse-Jarres says: “This mentorship was never just scientific; it has been academic, about how to be a woman in this environment, about networking and interacting with peers, and largely about life in general.” Dr. Amy Shapiro: Although very active in clinical research to improve the treatment and outcomes for people with bleeding disorders, Dr. Shapiro is well known for her innovative work in creating an excellent system to provide the highest quality comprehensive healthcare services to patients with bleeding and clotting disorders in the modern era. In particular, she has developed innovative programs to address the needs of the Amish community. Indiana Hemophilia & Thrombosis Center (IHTC), in Indianapolis, IN, was co-founded by Dr. Shapiro in 1999 and is now one of the largest federally-funded hemophilia treatment centers in the United States. It is the first hemophilia treatment center in the United States to become a certified medical home by the Accreditation Association for Ambulatory Health Care, which recognizes excellence in quality patient-centered health care for organizations that provide medical care on an outpatient basis 20. She is also credited with establishing at IHTC the National Hemophilia Foundation-endorsed “The Partners in Bleeding Disorders Education Program” 21, which serves to promote excellence in care through basic and advanced education for nurses and other healthcare providers who serve patients with bleeding disorders. Dr. Shapiro was interviewed by Jennifer Maahs, MSN, PNP, who first met Dr. Shapiro about 22 years ago as a part-time nurse while pursuing her Pediatric Nurse Practitioner degree, who said: “Dr. Shapiro was truly [the patients’] champion and their dedication to her was unparalleled. I learned how to listen carefully to patients, develop a plan of care, and work to overcome obstacles to achieve the desired outcome.”