By Bill Atkinson
Alexis M. Elward, ’94, was hoping to finish up work late Friday afternoon on January 4 so she could spend time with her two young children. Then her phone rang. On the other end of the line was the dialysis unit at St. Louis Children’s Hospital with an urgent message: two young patients were having a severe reaction to their dialysis treatment. Their tongues and eyelids had swollen, their hearts were beating rapidly, and their blood pressure had plunged. Two other patients had similar reactions just weeks earlier. “These kids were on hemodialysis, something they couldn’t live without for very long,” says Elward, a pediatrician who specializes in infectious diseases at Washington University School of Medicine in St. Louis. The call thrust Elward into a nearly two week investigation and the biggest case of her career. Not only was she a co-leader of a team that uncovered the problem—the blood thinner heparin—but their actions undoubtedly saved lives.
Indeed, implications of the discovery were far reaching. Baxter International Inc., a global health care company, was forced to recall the tainted drug, recording a $19 million charge in the first quarter of 2008. And U.S. regulators with the Food and Drug Administration zeroed in on a dozen companies in China that manufactured and distributed heparin to the U.S. and ten other countries.
Elward, age 42, steps in when other physicians can’t figure out why a patient is sick. She is a physician, but part investigator who is deft at asking questions and getting to the bottom of the problem. Her world is one of infections, parasites, pathogens, bacteria, unusual viruses, and bugs so strong they are resistant to drugs. “Any organ can be involved,” Elward says. “One has to be a good pediatrician and a good internist. We’re looking at the whole patient.”
Elward grew up in Annapolis, Md., the older of two children. Her father is an attorney and her mother a nurse. “I was exposed to healthcare at an early age,” says Elward, who as a youngster worked for an internist preparing slides and doing urinalyses. During her teenage years she volunteered as a Candy Striper at the local hospital. And later, although majoring in philosophy at Loyola College in Baltimore, she took pre-med courses and volunteered in an emergency room. “It was pretty amazing to see desperately ill people recover,” she recalls.
Elward attended the Johns Hopkins Bloomberg School of Public Health before beginning medical school at Maryland. She trained at St. Louis Children’s Hospital, serving as chief resident in pediatrics in 1997.
Shortly after receiving that memorable telephone call on January 4, a crisis team of about 20 members was put together with Elward named as a co-leader. Members reviewed every instrument in the dialysis room, listed the names of medications the patients were receiving, reviewed endotoxin levels, tested the water for heavy metals, probed for bacteria and chemicals, and reviewed the foods the patients had eaten. The team bombarded the microbiology lab with about 50 cultures, and members even scouted to see if latex, which can cause life-threatening allergic reactions, was the culprit. “Could it have slipped in?” Elward wondered.
They contacted the U.S. Food and Drug Administration (FDA), Missouri Department of Health and Senior Services, and posted warnings on the Internet. Elward conducted a literature search to see if she could find any common threads. Her search led her to the Center for Disease Control (CDC), which had written about allergic outbreaks in dialysis units. After explaining the situation, the agency posted the information and more cases of patients having reactions during dialysis poured in. Soon the team was able to see a pattern, and all clues pointed to the blood thinner.
The crisis thrust Elward into the national spotlight, and her performance received high praise. “It was a huge effort,” she says, applauding the swift actions of the FDA, CDC, Baxter, and her colleagues. “We had a lot of brilliant minds around this one.”
Since January, the hubbub has died down and Elward’s life is back to normal, which means there is more time for her children. “I enjoy being both a doctor and a mom,” she says.
*Photo courtesy of the University of Washington School of Medicine in St. Louis
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