5 Questions with Dr. Kelly Davidson

Summary

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Blood, Sweat and Smears: "5 Questions with Dr. Kelly Davidson"

Podcast: Blood, Sweat and Smears
Host: Bjorn (guest host, in for Dr. Brad Lewis)
Guest: Dr. Kelly Davidson, Associate Professor of Hematology/Oncology, Section Head for Classical Hematology at University of Virginia
Date: March 18, 2025
Episode Focus: A candid and insightful conversation with Dr. Davidson about the evolving landscape and terminology of hematology, nuances of adult vs pediatric care, interdisciplinary collaboration, medical education, breakthroughs in gene therapy, and a personal recommendation.

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Episode Overview

In this episode, guest host Bjorn sits down with Dr. Kelly Davidson for the show's recurring "5 Questions" format. The discussion offers a deep dive into the language, challenges, partnerships, and innovations within hematology—especially so-called "benign" or "classical" hematology. Dr. Davidson brings forward thoughtful commentary on the importance of evolving terminology, shares her experiences working across specialties, reflects on the complexities of adult hematology, and expresses enthusiasm for recent advances in gene therapy. The show wraps up with her travel and reading recommendations.

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Key Discussion Points and Insights

1. Nomenclature: "Benign Hematology" vs. "Classical Hematology"

[01:13–03:10]

• Background: The term "benign hematology" is traditionally used to differentiate from malignant (cancerous) blood disorders, but Dr. Davidson finds it misleading.
• Dr. Davidson’s Take:
  • The word "benign" underestimates the seriousness of many conditions (like catastrophic clotting disorders, TTP, and sickle cell disease) that can be life-threatening.
  • "Classical hematology," though somewhat traditional or “old-fashioned,” better encompasses the critical, non-malignant focus of the specialty.
  • Other terms like "non-malignant heme" are unsatisfying because they define the field by what it isn’t.
  • Suggests "comprehensive hematology" as a possible alternative, signaling the broad scope of the field.
• Notable Quote:

  “If you tell someone with catastrophic clotting disorder or TTP or sickle cell disease that they have a benign disease... these are really not benign diseases.” — Dr. Davidson [01:56]

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2. Interdisciplinary Collaboration in Hematology

[03:10–04:45]

• Dr. Davidson often finds herself consulting with nearly every medical and surgical specialty, except pediatrics.
• Frequent collaboration with:
  • Pathology/Hematopathology: Weekly tumor boards; specialized diagnosis.
  • Special Coagulation Lab and Blood Bank: Relying on expertise for test interpretation, transfusions, and plasma exchange.
  • Immunology and Rheumatology: Many shared patients with autoimmune cytopenias or overlapping conditions (e.g., mast cell disorders).
• The comprehensive reach of hematology requires constant interaction across departments.

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3. Adult vs. Pediatric Hematology – Mutual Advantages

[04:45–06:35]

• Admiration for Pediatrics:
  • Stronger institutional, state, and federal support, particularly for rare diseases.
  • More curative options and higher survival rates for pediatric blood cancers.
  • Lower comorbidity burden in pediatric populations.
• Appreciation for Adult Care:
  • Ability to have direct, mature conversations with patients who can advocate for themselves.
  • Greater therapeutic options, as most drugs are trialed in adults first.
• Notable Quote:

  “By the time they reach adulthood, these chronic conditions—they now have adult disorders too, and it makes treating them even more complicated.” — Dr. Davidson [05:33]

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4. Hard-learned Lessons: The Grey Areas of Medicine

[06:37–08:04]

• Medicine is rarely black and white; significant parts remain “gray” and require nuanced judgment.
• Textbook cases are rare, and many diagnoses do not fit neatly into standard categories.
• It's important to recognize limits in knowledge—being open to consult colleagues or guidelines.
• Notable Quote:

  “Our patients didn’t read the textbooks, right? So patients don’t always fit into the box that we like...” — Dr. Davidson [07:17]
  “You’re always learning. I’m never going to know everything.” — Dr. Davidson [07:51]

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5. Excitement for Advances: Gene Therapy in Hematology

[08:17–09:28]

• Dr. Davidson expresses greatest excitement for gene therapies and gene editing, especially as FDA approvals emerge for conditions like thalassemia and sickle cell disease.
• Acknowledges challenges: cost, access, toxicity, and long-term efficacy are ongoing considerations.
• Sees these advances as transformative in potentially curing previously chronic, debilitating diseases.
• Hopes for expansion of in vivo gene therapy availability to improve equity in care.
• Notable Quote:

  “Gene therapy [is] really, really an exciting option for our patients.” — Dr. Davidson [09:24]

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Bonus: Recommendation – Travel and Reading

[09:40–11:07]

• Travel: Recommends Japan for its calm, respectful atmosphere, modernity, and excellent food.
• Book: The House in the Cerulean Sea; a story about magical children, acceptance, and community—timely and uplifting for today’s world.
• The hardback edition comes with creative blue-edged pages matching the book’s sea setting.
• Notable Quote:

  “It’s a really sweet, endearing story that I think is also very timely given state of the world, so would be a good choice of read.” — Dr. Davidson [10:54]

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Memorable Moments and Quotes

• On terminology:

  “Maybe comprehensive hematology…indicate like the wide scope of what we do.” — Dr. Davidson [02:32]

• On lifelong learning:

  “Knowing where to look and who to ask, and that it’s always—you’re always learning.” — Dr. Davidson [07:48]

• On gene therapy’s promise:

  “The goal would really be to be able to get this therapy in the hands of all the patients who need it.” — Dr. Davidson [08:52]

• On her book recommendation:

  “They made the edges of the book blue. This aqua blue of the sea. And it’s just a really sweet, endearing story…” — Dr. Davidson [10:45]

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Timestamps of Key Segments

• Introduction & nomenclature discussion: [00:32–03:10]
• Interdisciplinary collaboration: [03:10–04:45]
• Adult vs. pediatric hematology: [04:45–06:35]
• Lessons from practice: [06:37–08:04]
• Advances in gene therapy: [08:17–09:28]
• Travel and book recommendations: [09:40–11:07]

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This episode offers an accessible yet thoughtfully detailed exploration of hematology's changing landscape. Dr. Davidson’s insights benefit clinicians, students, and laypeople interested in the rapidly evolving world of blood disease care.

Transcript

[A]

Hello and welcome to Blood, Sweat and Smears, a podcast produced by Macheon Diagnostics. In this podcast series, we will be discussing thrombosis and hemostasis from the perspective of our host benign hematologist and medical director of Macheon Diagnostics, Dr. Brad Lewis. Please remember to subscribe and leave a review with that. I'll turn it over to Dr. Lewis. Brad, take it away.

[B]

Hi, my name is bjorn in for Dr. Lewis for our series 5 questions posing 5 questions to physicians in and around the disease areas we work in. The differential for this podcast is entertainment, humor and education. Although this episode may be more of a syndrome with elements of all of the above. Today I'm joined by Dr. Kelly Davidson, Associate professor of hematology, oncology and section head for Classical Hematology at the University of Virginia. Thank you for Joining us today, Dr. Davidson.

[C]

Thank you so much for having me. I'm really excited. I'm not sure how funny it's going to be, so it might be a little light on the humor, but.

[B]

Well, I may be responsible for the humor. We'll find out.

[C]

I'm going to, I'm going to hope so.

[B]

Yeah, you never know. These things, you know, they can be pretty interesting. We're going to dive right in. So the first question is, in the ongoing nomenclature wars, we have benign hematology and classical hematology. And I see that you have classical hematology in one of your titles here. So if you had a third party entry, what might that be?

[C]

So I like this question, although I'm not sure I have a great answer. I do like the idea of moving away from benign hematology. I think had a little bit of a crisis lately in benign or classical heme. You know, not as many providers going into it. We have so many patients and for the most part, you know, they don't have benign disease. I mean, if you tell someone with catastrophic clotting disorder or TTP or sickle cell disease that they have a benign disease, I mean, these are really not benign diseases. So I don't know that that's a great term. I mean, I understand where it started, but classical hematology is what we've moved to here at uva and I like it. I mean, I do think maybe it sounds a little old fashioned or, I don't know, like classical education or something. But I, I do like the term classical heme. I think, you know, non malignant heme is another term that's been tossed around, but that's kind of saying what it's not instead of what it is, you know, as far as a third party entry, I, I racked my brain a little bit for this because I think we don't really have another one, but maybe comprehensive hematology or something to maybe indicate like the wide scope of what we do. I mean, we really see the gamut. I mean, anything from, you know, iron deficiency anemia to really rare inherited hemolytic anemias and all things in between. And, you know, we interact with a lot of other specialties. So it really is a comprehensive service we provide. And so maybe something like that might be more encompassing than what we use now.

[B]

That sounds fair to me. And speaking of working with other specialties, as a hematologist oncologist, you may be called to work with many other subspecialties, be it immunology or nephrology or neurology, which is the other subspecialty you find yourself working with most often. And why is that?

[C]

Well, we work with basically every field I'm on consults right now, and I'm going to go to literally every part of the hospital, save pediatrics, because we do overlap with every other field. I think for me, I interact most with pathology, hematopathology, we have tumor board every week. We really rely on our hematopathologist to help us make a day diagnosis. Special coag lab, the pathologists that work there, specialized testing, we order, really rely on their expertise to perform and interpret those results. Parapathology, blood bank, transfusion, medicine. I mean, many of my patients are on chronic transfusion therapies or getting intermittent therapy or plasma exchange. So the blood bank expertise we rely on. And then in medicine, you know, I think the two that I say I would interact with the most, allergy, immunology and then rheumatology, you know, we see a lot of autoimmune cytopenias or people who have disorders that overlap among those fields. I take care of a lot of our mast cell disorder patients, so they're often coming from allergy immunology. So we really, we really do share patients with every medical and even surgical subspecialty. I mean, thinking about all the patients who have bleeding and clotting disorders and are needing surgery, really common that we're interacting with those, those teams as well.

[B]

Yeah, I could see that. So you mentioned not going to the pediatric wing. Is there anything you envy about pediatric hematology or that you think they should envy about adult hematology?

[C]

Yes, I do envy several things about my pediatric colleagues. One thing that I think they're really fortunate. They have a lot of institutional support and even state and federal support for rare disorders and different conditions. You know, I think, you know, they benefit a lot from a lot of programs that provide extra funding, you know, especially for rare diseases. I know here at uva, we in the last few years have had state support for our adult sickle cell program, but for, you know, 20 years, the pediatric team has had support. And we just recently got that. And so I think that's one thing. I also, you know, a lot of their diseases, they cure, especially in he malignancies. I mean, they. Their survival rates are really quite good. I would enjoy that. And I'm sure our patients would. And also kind of on the same line, a lot of the pediatric patients don't have the comorbidities that our patients do. So by the time they reach adulthood, these chronic conditions, they now have adult disorders too, and makes treating them even more complicated. So I think those are some of their benefits for the benefits of treating adults. I like having a patient that I can really have an adult conversation with. I think it would be really challenging to have the parents involved, you know, especially if the child is younger and maybe can't understand, you know, exactly what's going on. So having patients that can really advocate for themselves and understand what's going on without the involvement of parents, I think would be. Would be helpful. And then, you know, a lot of therapies. We have a lot more options in adult medicine because many of the drugs are initially trialed on adults and eventually make their way to pediatrics. But I think therapeutic options we have. My impression is we have more options in some cases than our pediatric colleagues.

[B]

Yeah, that makes sense.

[C]

Yeah.

[B]

What is one thing you have learned as an attending that you wish you had learned as a medical student?

[C]

Well, a lot. I think the biggest thing that's changed for me over time and it's that medicine really isn't black and white. It's really gray. It is an art to medicine. Right. I mean, sometimes the answer is clear, but often it's somewhere in the middle. And I think, you know, when you're a student, you know, especially most medical students and people in medicine in general are very type A, and two plus two is four, and they want the right answer. And I certainly have that tendency. And I think the reality is, you know, our patients didn't read the textbooks right. Like, so patients don't always fit into the box that we like as far as making a nice, clean, easy diagnosis. And so I think kind of Acknowledging that medicine's hard and that it's not always so crystal clear what the answer is. And I think also realizing that you don't have to have all the answers, but you know, you need to recognize your limitations and when you have questions, know where to look or who to ask. I mean, I think you're in school, you think you've got to memorize everything, understand, know everything and acknowledging that it's impossible to know everything and but realizing that you can ask colleagues, you can look at guidelines and I think just sort of knowing where to look and who to ask and that it's always, you're always learning, you know, I'm always learning. I'm never going to know everything. I may learn things and forget it. So I think knowing where to look.

[B]

Yeah, that's great. Yeah, there are always some advancements somewhere in the field. Is there one advancement in the field that you're particularly keen on?

[C]

Well, there's certainly a lot. I mean in classical heme right now it's just been an explosion of new therapies. Better we've understood the pathophysiology and genetic basis of a lot of these diseases. I mean it's been really cool to see in the last decade really rare diseases that we maybe see once or twice a year. All of a sudden they actually have therapies being studied, getting FDA approval. But I think the thing that I'm most excited about, that I think is the most transformative is gene therapy or gene editing for diseases like thalassemia, sickle cell disease. Now got FDA approved gene therapies. And while certainly there are issues with access, costs, is significant toxicities and question of long term benefit. I think this is really exciting and really going to transform patients lives. The goal would really be to be able to get this therapy in the hands of all the patients who need it. Which is. We're certainly far from that now, but it's certainly exciting. And I think in the years to come, in vivo gene therapy is going to hopefully expand the availability of this therapy to a lot more patients. So I think, you know, gene therapy just really, really an exciting option for our patients.

[B]

Sure is. So if we've been doing counting, that is five questions. Which brings us to our bonus question which is recommend something. And it could be absolutely anything.

[C]

Well, I just got back from Japan and while I didn't get to spend as long there as I would have liked, I was there for work. I just really loved it. It was really a fascinating, beautiful culture. I mean it was very calm Very modern, kind of understated, very respectful, very peaceful. The food was fabulous. I mean, it was. It was a great experience. So I think I would. I would recommend a trip to Japan if that ever is something that's an option. And while I was on my way, I read a book which I would like to mention called the the House in the Cerulean Sea. And it's so really. I don't know if you've heard of it. It's a really lovely story. It's about. It's probably going to sound a little odd. It's about this orphanage that, as you might expect, is in the Cerulean Sea and it's a home for magical children. And it's all these children who have these magical powers and the community and the world thinks they're very threatening because they have these powers. So they've got them kind of locked away in this orphanage kind of in the middle of nowhere and just kind of. It's a lovely story. I'll leave it at that. I try to read more on my Kindle, but I actually had the hardback book and they made the pages just kind of a little creative thing. They made the edges of the book blue. This aqua blue of the sea. And it's just a really sweet, endearing story that I think is also very timely given State of the World, so would be a good choice of read.

[B]

Fantastic. I will check that out. That sounds right up my alley.

[C]

Yeah, great.

[B]

That is everything. So thank you for your time today, Dr. Davidson. And yeah, we have some reading check out.

[C]

Yeah, thank you so much.

[A]

That's it for us here at Blood, Sweat and Smears, a podcast produced by Matrion Diagnostics, your reference lab, and CRO specializing in thrombosis, hemostasis and rare disease. Thank you for listening and if you have a question or comment or there's a topic you'd like Dr. Lewis to speak to, please send us an email to blood, sweat and smearsatriondiagnostics.com that's M A C H A O N diagnostics.com you can follow Matrian at Twitter ationdx. Be sure to subscribe to stay in the know. Share this podcast with clinicians you think might appreciate it and we hope you'll join us next time here at Blood, Sweat and Smears.