The best red comes in a bag, not a bottle

18 March 2016

Blood—poets ascribe romantic, mythical powers to it, doctors are more prosaic about its lifesaving properties, and for ordinary people its appearance is mostly an alarm bell. 

For Dr Lee Cheuk Kwong, blood is an important window into human behaviour, communities, and disease. As the Chief Executive and Medical Director of the Hong Kong Red Cross Blood Transfusion Service, he leads the organisation in a multidimensional approach to public health. While Red Cross and Red Crescent societies are renowned for their humanitarian services, the Hong Kong branch’s work on blood transfusion has become known for its interdisciplinary research and community health programs. “Many people think of blood banks and donations in a very simple way,” Lee says, “you go, you give blood because it’s nice to give back if you can, and then you don’t think about it—but it’s really a continuous stream of data for us.”

A platoon of people do think about it long after blood donors have finished their cookie and pulled off their gauze. Blood speaks; and doctors, researchers, epidemiologists, public policy officials, and others contributing to public health services are eager to listen in.

Lee’s own background reflects this diversity of interest. After specialising in clinical haematology at the University of Hong Kong, he went on study oncology and transplantation at University College London with the Croucher Foundation’s support. However, he found himself feeling restless, missing the challenge of haematology, the exciting new possibilities in the field, and particularly the collaborative research and training prioritised by Lee’s mentor Professor Sir David Todd. New subspecialties were being encouraged, employing modern technologies, driving pioneering work in haematology, “and I booked a flight,” Lee laughs. Blood transfusion services were relatively new at the time, but recognised as a crucial part of modern medical treatment. Lee quickly found his niche here, drawing on his clinical research to study transfusion-related infection, HIV, hepatitis, and bacteria. The data collected through such study and donor blood testing piqued his interest, yielding general health trends in the community, donor types and behaviour, and other characteristics.

Transitioning to a public health focus at the BTS was a natural progression of Lee’s research interests. “There came a time when I again felt the need for change, and wanted a chance to apply my clinical experience and look at the healthcare system from a different angle,” he explains. The cross-section of the public who are blood donors allow engagement with the wider population as well as monitoring of general community health. Plus, “altruism makes for more cheerful and chatty patients,” he laughs.

Lee cites the high level of collaboration as a perk of the job, a trend he hopes will continue throughout the medical field. His role oversees everything from blood safety, risk management at donor and transfusion points, collecting demographic and health data, and helping solve clinical problems—besides maintaining the only blood bank serving all Hong Kong hospitals. Clinical doctors treat only a certain group of people, but donors, patients, young people and old, of varying clinical interests pass through Lee’s office every day. As a result, Lee’s department is ground zero for haematologists, anaesthesiologists, physiologists, cardiologists, public policy officials, and other specialists. “This is where we establish baselines for community health and do real-time research on cardiovascular health and behaviour, set new guidelines and screening tests for better indicators, and the spread of infectious diseases. As a resource portal, it’s the best of the lab and the clinic.”

Apart from the medical side, Lee also studies donor behaviour, monitoring strategies for donor recruitment, retention, and frequency to maintain a stable inventory. This requires balancing challenges of an ageing population, research needs, hospital requirements, and a diverse blood catalog. Keeping the donor base robust is a high priority given the small percentage of donors and usable blood, about 250,000 donations in a population of 7.3 million. Mobile donor centres across Hong Kong, taking the clinic to different communities, helps getting the right kind and number of donations. Analysing donor behaviour and recurrence has been an interesting study for a number of years, looking at who donates and why. For example, recruitment at universities tends to be popular, but still some use it as a means for blood testing or a free physical check-up. Initial cultural hesitance for donating blood has given way to more modern views, but younger demographics tend to be more willing and regular.

The importance of the blood bank’s vital work has also taken centre stage during the SARS, avian, and swine flu epidemics. “Those infections had serious repercussions, but provided us with an opportunity to look at our clinical and public health roles from a different perspective, such as emergency preparedness and contingency response plans, including convalescent plasma for clinical treatment,” Lee says. His previous experience in disease transmission research was applied to aggregating data on donors, testing clinical treatment protocols, and mapping treatment efficacy and recovery.

The service’s scope is continually adapting to social and medical needs, strengthening its ability to provide better patient outcomes and flexibility for rapid response and longer-term action. Doctors are interested in preventive care and real-time research, public officials are concerned about burdens on the healthcare system, and Lee is a portal to people. Multi-service plans rely on accessing a diverse picture of society, especially as people live longer and diseases such as diabetes and certain cancers become more common. Based on BTS data, iron deficiency patterns were identified and contributing factors scrutinised. The team found that the food supply was less of a factor than eating in the right way, and government partners were able to better implement a solution. A project to map genetic profiles among older donor pools for cancer predispositions, smoking, and other factors is also pending.

“It is not just about memorising theory anymore,” he notes, “Focusing on disease or specimens is not so one-directional now, maybe because there are so many frontiers of disease and treatment options. You need to understand why something is happening, to whom, and where. There is a beauty in turning something from research into practical change making lives better, so this work is always an adventure.”

Dr Lee Cheuk Kwong completed his medical degree and specialisation in clinical haematology at the University of Hong Kong, and received a Croucher Scholarship in 1996 to support his graduate work at University College London. He is currently the Chief Executive and Medical Director of the Hong Kong Red Cross’ Blood Transfusion Service. Lee also serves as Honorary Clinical Assistant Professor in the Department of Pathology at the University of Hong Kong and Adjunct Associate Professor at the Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine at the Chinese University of Hong Kong.

To view Dr Lee's personal Croucher profile, please click here.

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