Michelle Roets

Dr Roets’ passion lies in peri-operative transfusion, in particular the development of novel insights and technology related to intraoperative cell salvage (ICS) and equipment in anaesthesia.

She recently completed a PhD with the University of Queensland (UQ); focussing on the impact of ICS on the patient’s immune response, clinically (patient outcomes) and in vitro, as well as relevant cost benefits.

She is an international expert on ICS, a technique used to collect and return a patient’s own blood, lost during surgery, thereby reducing reliance on scarce and costly donated blood products and reducing adverse outcomes. Despite these benefits, ICS is not universally provided due to traditional concerns, relative contraindications, and often misunderstood cost implications.

Within her PhD thesis she investigated these obstacles, advocating for broader adoption of ICS to enhance patient care and optimize blood resource management. She successfully achieved competitive grant funding (2017-2023, $731,983).

Results from this work, clinical and cost benefits of ICS and the significant international impact that the advancement of ICS equipment could achieve, now informs a business case to enable wider implementation of ICS.

Highlights of her PhD program were receiving invitations to present in the “Best Posters and Awards” sessions at “The Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA)” Annual Symposiums (top eight international posters, 2018, 2020), in Lisbon, Portugal (2018), and in Athens, Greece in 2020 (virtually due to COVID-19) and in 2023 (in-person).

Translation to patient care was demonstrated by citations within “The European guideline on management of major bleeding and coagulopathy following trauma” (Critical Care 2023) and “The NATA Scientific Newsletter” (2023); both influential and highly regarded international patient blood management (PBM) forums.

Allogeneic blood transfusion (ABT) is associated with transfusion related immune modulation (TRIM) and subsequent poorer patient outcomes including peri-operative infection, multiple organ failure and mortality. The precise mechanism(s) underlying TRIM remain largely unknown. One impediment to understanding the influence of the immune system on transfusion related adverse outcomes has been the inability to characterise immune profile changes associated with blood transfusion, including ICS.

Within the Transfusion Related Immune Modulation during Intraoperative Cell Salvage (TRIMICS) study, an in vitro model was used. Suppressed dendritic cell and monocyte function was significantly less marked following ICS compared to ABT exposure.

Through the Transfusion Related Immune Modulation during Intraoperative Cell Salvage, considering immune cell numbers (TRIMICS-Cell) study significant changes in immune cell numbers and function in transfused patients, not evident in those who did not receive transfusion, were identified. When considering the role of each type of cell within the immune response these changes may potentially relate to associated clinical outcomes.

Discovered evidence considered potential immune consequences, changes in immune competence and other important factors related to immune modulation during blood transfusion, anaesthesia and surgery.

To translate PhD study results from "The Cost of Missed ICS opportunity (COSTOMICS) study" into clinical care, development of a business case and international collaborations (Australia, Europe, the United Kingdom, Malaysia and The United States of America (USA)) is ongoing with the Royal Brisbane and Women’s Hospital (RBWH); increasing funding and broadening ICS use by more staff across more patients.