Ryan A. Metcalf

Ryan A. Metcalf, MD, CQA

Languages spoken: English

  • Dr. Metcalf is Section Chief of Transfusion Medicine, Medical Director of the Transfusion Service, Associate Professor of Pathology, and Inpatient Chief Value Officer for the Department of Pathology at the University of Utah Health and ARUP Laboratories. He completed a residency in Anatomic and Clinical Pathology and a fellowship in Transfusion Medicine at Stanford University and is board certified in these disciplines. He also has expertise in quality management and is a Certified Quality Auditor.

    Dr. Metcalf practices transfusion medicine and his specific interests include data-driven/informatics approaches to patient blood management, quality management, and innovation. He was previously Assistant Professor at the University of Washington where he helped build a new FDA-registered hospital-based transfusion service laboratory. He was recruited to the University of Utah and ARUP Laboratories in 2017. His research interests include the use of advanced data visualization to improve understanding of patient blood management (PBM) clinical practice quality, safe and effective use of artificial intelligence in healthcare, evidence-based clinical decision making, and data-driven approaches to improve our understanding of risks associated with blood transfusion. He is co-inventor of a novel advanced data visualization tool that evaluates PBM practice.

    Dr. Metcalf is Chair of the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee, a member of the AABB Patient Blood Management Standards Committee, and a member of the College of American Pathologists (CAP) Transfusion, Apheresis, and Cellular Therapy Committee. He is active in Transfusion Medicine education and received the department's Outstanding Teaching Award for Clinical Pathology faculty in 2020. He also received the Department's Bill Roberts Award for Excellence in Laboratory Medicine in 2023.

    Specialties

    Board Certification

    American Board of Pathology (Anatomic & Clinical)
    American Board of Pathology (Sub: Blood Banking/Transfusion Medicine)
    National Board of Medical Examiners

  • Dr. Metcalf is Section Chief of Transfusion Medicine, Medical Director of the Transfusion Service, Associate Professor of Pathology, and Inpatient Chief Value Officer for the Department of Pathology at the University of Utah Health and ARUP Laboratories. He completed a residency in Anatomic and Clinical Pathology and a fellowship in Transfusion Medicine at Stanford University and is board certified in these disciplines. He also has expertise in quality management and is a Certified Quality Auditor.

    Dr. Metcalf practices transfusion medicine and his specific interests include data-driven/informatics approaches to patient blood management, quality management, and innovation. He was previously Assistant Professor at the University of Washington where he helped build a new FDA-registered hospital-based transfusion service laboratory. He was recruited to the University of Utah and ARUP Laboratories in 2017. His research interests include the use of advanced data visualization to improve understanding of patient blood management (PBM) clinical practice quality, safe and effective use of artificial intelligence in healthcare, evidence-based clinical decision making, and data-driven approaches to improve our understanding of risks associated with blood transfusion. He is co-inventor of a novel advanced data visualization tool that evaluates PBM practice.

    Dr. Metcalf is Chair of the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee, a member of the AABB Patient Blood Management Standards Committee, and a member of the College of American Pathologists (CAP) Transfusion, Apheresis, and Cellular Therapy Committee. He is active in Transfusion Medicine education and received the department's Outstanding Teaching Award for Clinical Pathology faculty in 2020. He also received the Department's Bill Roberts Award for Excellence in Laboratory Medicine in 2023.

    Board Certification and Academic Information

    Academic Departments Pathology -Primary
    Board Certification
    American Board of Pathology (Anatomic & Clinical)
    American Board of Pathology (Sub: Blood Banking/Transfusion Medicine)
    National Board of Medical Examiners

    Education history

    Fellowship Transfusion Medicine - Stanford University School of Medicine Fellow
    Anatomic and Clinical Pathology - Stanford University School of Medicine Resident
    Fellowship Pathology - Stanford University School of Medicine Predoctoral Fellow
    Medicine - University of California, Davis School of Medicine M.D.
    Undergraduate Cell and Developmental Biology - University of California, Santa Barbara B.S.

    Selected Publications

    Journal Article

    1. Walker BS, White SK, Metcalf RA (2023). Bacterial Culture of Platelets with Large Volume Delayed Sampling. (Epub ahead of print) Ann Blood.
    2. Pagano MB, Stanworth SJ, Valentine S, Metcalf RA, Wood EM, Pavenski K, Cholette J, So-Osman C, Carson JL (2024). The 2023 AABB International Guidelines for Red Blood Cell Transfusions: What Is New? (Epub ahead of print) Transfusion.
    3. White SK, Walker BS, Schmidt RL, Metcalf RA (2023). The incidence of transfusion related acute lung injury using active surveillance: A systematic review and meta-analysis. Transfusion.
    4. Carson JL, Stanworth SJ, Guyatt G, Valentine S, Bakhtary S, Cohn CS, Dubon A, Grossman BJ, Gupta GK, Hess AS, Jacobson JL, Kaplan LJ, Lin Y, Metcalf RA, Murphy CH, Pavenski K, Prochaska MT, Raval JS, Salazar E, Saifee NH, Tobian AAR, So-Osman C, Waters J, Wood EM, Zantek ND, Dennis J, Pagano MB (2023). Red Blood Cell Transfusion 2023 Clinical Practice Guidelines. JAMA, 330(19), 1892-1902.
    5. Li N, Pham T, Cheng C, McElfresh DC, Metcalf RA, Russell WA, Birch R, Yurkovich JT, Montemayor-Garcia C, Lane WJ, Tobian AAR, Roubinian N, Seheult J, Goel R (2023). Blood Demand Forecasting and Supply Management: An Analytical Assessment of Key Studies Utilizing Novel Computational Techniques. Transfus Med Rev, 37(4), 150768-150768.
    6. Walker BS, Schmidt RL, White SK, Metcalf RA (2023). Meta-analysis of bacterial growth characteristics in platelet components: refining the inputs of a simulation analysis comparing the relative safety of testing strategies. Transfusion, 63(9), 1719-1727.
    7. Metcalf RA, Cohn CS, Bakhtary S, Gniadek T, Gupta G, Harm S, Haspel R, Hess AS, Jacobson J, Lokhandwala PM, Murphy C, Poston JN, Prochaska MT, Raval JS, Saifee NH, Salazar E, Shan H, Zantek ND, Pagano MB (2023). Current advances in 2022: A critical review of selected topics by the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee. Transfusion, 63(8), 1590-1600.
    8. Karafin MS, DeSimone RA, Dvorak J, Metcalf RA, Pagano MB, Park YA, Schwartz J, Souers RJ, Szczepiorkowski ZM, Uhl L, Ramsey G (2023). Antibody Titers in Transfusion Medicine: A Critical Reevaluation of Testing Accuracy, Reliability, and Clinical Use. Arch Pathol Lab Med, 147(12), 1351-1359.
    9. Walker BS, Schmidt RL, Moore RA, White SK, Fisher MA, Metcalf RA (2023). Bacterial culture time to detection in platelet components: an evidence synthesis and estimation of detection failures. Transfusion, 63(1), 182-192.
    10. White SK, Schmidt RL, Walker BS, Metcalf RA (2023). The Epidemiology of Transfusion-Related Acute Lung Injury (TRALI): A Scoping Review and Analysis. Transfusion, 63(1), 104-116.
    11. Potter S, Sudarshan D, Lazar-Molnar E, Baker S, Metcalf RA, Lin L (2022). Life Threatening Platelet Transfusion Refractoriness Due to an Anamnestic Human Leukocyte Antigen Alloantibody Response. Transfusion, 62(11), 2161-2162.
    12. Estcourt LJ, Cohn CS, Pagano MB, Iannizzi C, Kreuzberger N, Skeet N, Allen ES, Bloch EM, Beaudoin G, Casadevall A, Devine DV, Foroutan F, Gniadek TJ, Goes R, Gorlin J, Grossman BJ, Joyner MJ, Metcalf RA, Raval JS, Rice TW, Shaz BH, Vassallo RR, Winters JL, Tobian AAR (2022). Clinical Practice Guidelines from the Association for the Advancement of Blood and Biotherapies (AABB): COVID-19 Convalescent Plasma. Ann Intern Med, 175(9), 1310.
    13. Metcalf RA, Cohn CS, Allen ES, Bakhtary S, Gniadek T, Gupta G, Harm S, Haspel R, Hess A, Jacobson J, Lokhandwala P, Murphy C, Poston J, Prochaska MT, Raval JS, Saifee NH, Salazar E, Shan H, Zantek N, Pagano MB (2022). Current advances in transfusion medicine 2021: A critical review of selected topics by the Association for the Advancement for Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee. Transfusion, 62(7), 1435-1445.
    14. Evan M Bloch, Aaron AR Tobian, Shmuel Shoham, Daniel F Hanley, Thomas J Gniadek, Edward R Cachay, Barry R Meisenberg, Kimberly Kafka, Christi Marshall, Sonya L Heath, Aarthi Shenoy, James H Paxton, Adam Levine, Donald Forthal, Yuriko Fukuta, Moises A Huaman, Alyssa Ziman, Jill Adamski, Jonathan Gerber, Daniel Cruser, Seble G Kassaye, Giselle S Mosnaim, Bela Patel, Ryan A Metcalf, Shweta Anjan, Ronald B Reisler, Anusha Yarava, Karen Lane, Nichol McBee, Amy Gawad, Jay S Raval, Martin Zand, Matthew Abinante, Patrick B Broderick, Arturo Casadevall, David Sullivan, Kelly A Gebo (2022). How do I implement an outpatient program for the administration of convalescent plasma for COVID-19? Transfusion, 62(5), 933-941.
    15. Wang Z, Zhe S, Zimmerman J, Morrissey C, Tonna JE, Sharma V, Metcalf RA (2022). Development and Validation of a Machine Learning Method to Predict Intraoperative Red Blood Cell Transfusions in Cardiothoracic Surgery. Sci Rep, 12(1), 1355-1355.
    16. K Fennell, MA Keller, MA Villa, C Paccapelo, M Kucerakova, J Rosochova, C Clemente Dossantos, L Brackney, CJ Lee, R Metcalf, G Crovetti, M Barbieri, S Travali, G Barrotta, G Giuca, L Guerra, G Ochoa-Garay (2021). New ABO intron 1 variant alleles. Immunohematology, 37(4), 178-184.
    17. Benson AD, Metcalf RA, Cail K, Rollins MD, Warrick CM, Falkner D, Clark EAS, Nelson RA, Einerson BD (2021). Transfusion Preparedness on Labor and Delivery: An Initiative to Improve Safety and Cost. Obstet Gynecol, 138(5), 788-794.
    18. Allen ES, Cohn CS, Bakhtary S, Dunbar NM, Gniadek T, Hopkins CK, Jacobsen J, Lokhandwala PM, Metcalf RA, Murphy C, Prochaska MT, Raval JS, Shan H, Storch EK, Pagano MB (2021). Current advances in Transfusion Medicine 2020: A critical review of selected topics by the Association for the Advancement for Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee. Transfusion, 61(9), 2756-2767.
    19. Lin H, Metcalf RA, Wilburn J, Lex A co-first authors (2021). Sanguine: Visual Analysis for Patient Blood Management. Inf Vis, 20(2-3), 123-137.
    20. Corean J, White SK, Schmidt RL, Walker BS, Fisher M, Metcalf RA (2021). Platelet Component False Positive Detection Rate in Aerobic and Anaerobic Primary Culture: A Systematic Review and Meta-Analysis. Transfus Med Rev, 35(3), 44-52.
    21. Moore RA, Schmidt RL, Metcalf RA (2021). In reply: Window periods for secondary bacterial culture of platelets according to FDA Guidance. Transfusion, 61(4), 1343-1344.
    22. Karafin MS, Becker JL, Berg M, DeSimone R, Draper N, Hudgins J, Metcalf RA, Pagano MB, Park YA, Rossmann SN, Schwartz J, Souers R, Thomas L, Uhl L, Ramsey GE (2021). Heterogeneity in approaches for switching from universal to patient ABO type-specific blood components during massive hemorrhage: An international survey and review of the literature. Arch Pathol Lab Med, 145(12), 1499-1504.
    23. Self WH, Stewart TG, Wheeler AP, Atrouni WE, Bistran-Hall AJ, Casey JD, Cataldo VD, Chappell JD, Cohn CS, Collins JB, Denison MR, de Wit M, Dixon SL, Duggal A, Edwards TL, Fontaine MJ, Ginde AA, Harkins MS, Harrington T, Harris ES, Hoda D, Ipe TS, Jaiswal SJ, Johnson NJ, Jones AE, Laguio-Vila M, Lindsell CJ, Mallada J, Mammen MJ, Metcalf RA, Middleton EA, Mucha S, ONeal HR, Pannu SR, Pulley JM, Qiao X, Raval JS, Rhoads JP, Schrager H, Shanholtz C, Shapiro NI, Schrantz SJ, Thomsen I, Vermillion KK, Bernard GR, Rice TW (2021). Passive Immunity Trial for Our Nation (PassITON): study protocol for a randomized placebo-control clinical trial evaluating COVID-19 convalescent plasma in hospitalized adults. Trials, 22(1), 221-221.
    24. Silva O, Charu V, Ewalt MD, Metcalf RA, Zhao S, Castellanos EM, Orellana E, Natkunam Y, Luna-Fineman S (2021). Classic Hodgkin Lymphoma in Guatemalan Children of Age Less than Six Years: Analysis of Immune Regulatory Pathways and the Tumor Microenvironment. Leuk Lymphoma, 62(7), 1609-1618.
    25. Cohn CS, Estcourt L, Grossman BJ, Pagano MB, Allen ES, Bloch E, Casadevall A, Devine DV, Dunbar NM, Foroutan F, Gniadek TJ, Goel R, Gorlin J, Joyner MJ, Metcalf RA, Raval JS, Rice TW, Shaz BH, Vassallo RR, Winters JL, Beaudoin G, Tobian AAR (2021). COVID-19 convalescent plasma: interim recommendations from the Association for the Advancement for Blood and Biotherapies (AABB). Transfusion, 61(4), 1313-1323.
    26. Metcalf RA, Goodfellow J, Cail K, Blaylock R, Kawamoto K, Enniss T, Galaviz C, Lim M, Reddy S, Sharma V, Wanner N (2021). Electronic clinical decision support: evidence that default settings influence end user behavior. Transfusion, 61(3), 669-670.
    27. Moore RA, Schmidt RL, Metcalf RA (2021). The Impact of the Sample Time of Secondary Bacterial Culture on the Risk of Exposure to Contaminated Platelet Components: A Mathematical Analysis. Transfusion, 31(3), 873-882.
    28. Luetkens T, Metcalf RA, Planelles V, Zheng Y, Larragoite ET, Spivak E, Spivak AM, Steinbach M, Blaylock RC, Avila SV, Hankey K, Martins TB, Slev PR, Mannuel HD, Sajadi M, Rapoport AP, and Atanackovic D (2020). Successful transfer of anti-SARS-CoV-2 immunity using convalescent plasma in a multiple myeloma patient with hypogammaglobulinemia and COVID-19 . Blood Adv, 4(19), 4864-4868.
    29. Corean J, White SK, Schmidt RL, Walker BS, Fisher MA, Metcalf RA (2020). The incremental benefit of anaerobic culture for controlling bacterial risk in platelets: a systematic review and meta-analysis. Vox Sang, 116(4), 397-404.
    30. Walker BS, White SK, Schmidt RL, Metcalf RA (2020). Residual bacterial detection rates following primary culture as determined by secondary culture and rapid testing in platelet components: a systematic review and meta-analysis. Transfusion, 60(9), 2029-2037.
    31. Walker BS, Schmidt RL, Fisher MA, White SK, Blaylock RC, Metcalf RA (2020). The comparative safety of bacterial risk control strategies for platelet components: A simulation study. Transfusion, 60(8), 1723-1731.
    32. Pagano MB, Allen ES, Dunbar NM, Goel R, Harm S, Hopkins CK, Jacobsen J, Lokhandwala PM, Metcalf RA, Raval JS, Schwartz J, Spinella PC, Storch E, Cohn CS (2020). Current Advances in Transfusion Medicine: A 2019 review of selected topics from the Association for the Advancement for Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee. Transfusion, 60(7), 1614-1623.
    33. White SK, Schmidt RL, Walker BS, Metcalf RA (2020). Bacterial contamination rate of platelet components by primary culture: A systematic review and meta-analysis. Transfusion, 60(5), 986-996.
    34. Lim MY, Pagano MB, Metcalf RA (2020). Things we do for no reason: routinely prescribing transfusion premedication to prevent acute transfusion reactions. J Hosp Med, 15(11), 684-686.
    35. Metcalf RA, White S, Potter S, Barney R, Hunter C, White M, Enniss T, Galaviz C, Reddy S, Wanner N, Schmidt RL, Blaylock R (2019). The association of inpatient blood utilization and diagnosis related group weight: implications for risk-adjusted benchmarking. Transfusion, 59(7), 2316-2323.
    36. Gavva C, Barroso J, Gernsheimer T, Metcalf RA, Warner P, Pagano MB (2019). Response to Random Apheresis Platelets versus HLA-Selected Platelets versus Pooled Platelets in HLA-sensitized Patients. Transfusion, 59(7), 2276-2281.
    37. Pagano MB, Katchatag B, Khoobyari S, Van Gerwen M, Sen N, Haley R, Gernsheimer T, Hess JR, Metcalf RA (2019). Evaluating Safety and Cost-Effectiveness of Platelets Stored in Additive Solution (PAS-F) as a Hemolysis Risk Mitigation Strategy. Transfusion, 59(4), 1246-1251.
    38. Metcalf RA, Calvaresi E, Tonna JE, Blaylock R, Pearson L (2019). Severe Hemolysis Following Extracorporeal Right Ventricular Assist Device Placement. Transfusion, 59(4), 1178-1179.
    39. Murphy C, Parakh R, Metcalf RA, Pagano MB (2018). Transfusion Associated Chest Pain. Transfusion, 59(2), 463-469.
    40. Metcalf RA, Khan J, Andrews J, Mayock D, Billimoria Z, Pagano MB (2018). Severe ABO Hemolytic Disease of the Newborn Requiring Exchange Transfusion. J Pediatr Hematol Oncol, 41(8), 632-634.
    41. Metcalf RA, Pagano MB, Hess JR, Reyes J, Perkins JD, Montenovo MI (2018). A Data-Driven Patient Blood Management Strategy in Liver Transplantation. Vox Sang, 113(5), 421-429.
    42. Corean J, Al-Tigar R, Pysher T, Blaylock R, Metcalf RA (2018). Quality improvement after multiple fatal transfusion-transmitted bacterial infections. Am J Clin Pathol, 149(4), 293-299.
    43. Hess JR, Ramos PJ, Sen NE, Cruz-Cody VG, Tuott EE, Louzon MJ, Bulger EM, Arbabi S, Pagano MB, Metcalf RA (2018). Quality management of a massive transfusion protocol. Transfusion, 58(2), 480-484.
    44. Mays, JA, Greene DN, Metcalf RA, Pagano MB (2018). Transfusion support for transgender men of childbearing age. Transfusion, 58, 823-825.
    45. Pagano MB, Metcalf RA, Hess JR, Reyes J, Perkins JD, Montenovo MI (2018). A high plasma: red blood cell transfusion ratio during liver transplantation is associated with decreased blood utilization. Vox Sang, 113(3), 268-274.
    46. Hess JR, Hayden BK, Cruz-Cody VG, Louzon MJ, Tuott EE, Sen NE, Gary R, Ramos PJ, Daniel-Johnson JA, Metcalf RA, Pagano MB (2017). Building a new transfusion service. Am J Clin Pathol, 148(2), 173-178.
    47. Metcalf RA, Bakhtary S, Goodnough LT, Andrews J (2016). Clinical Pattern in Hypotensive Transfusion Reactions. Anesth Analg, 123(2), 268-73. (Read full article)
    48. Metcalf RA, Baker SA, Goodnough LT, Shah N (2016). Transportation Cooler Interventions Reduce Plasma and RBC Product Wastage. Am J Clin Pathol, 146(1), 18-24. (Read full article)
    49. Hartmann S, Winkelmann R, Metcalf RA, Treetipsatit J, Warnke RA, Natkunam Y, Hansmann ML (2015). Immunoarchitectural patterns of progressive transformation of germinal centers with and without nodular lymphocyte-predominant Hodgkin lymphoma. Hum Pathol, 46(11), 1655-61. (Read full article)
    50. Metcalf RA, Wang L, Deos PH, Chock E, Warnke RA, Natkunam Y (2015). Extracavitary Primary Effusion Lymphoma Presenting in a Lymph Node Without Lymphomatous Effusions. Hum Pathol (N Y), 2(2), 36-41.
    51. Treetipsatit J, Metcalf RA, Warnke RA, Natkunam Y (2015). Large B-cell lymphoma with T-cell-rich background and nodules lacking follicular dendritic cell meshworks: description of an insufficiently recognized variant. Hum Pathol, 46(1), 74-83. (Read full article)
    52. Metcalf RA, Monabati A, Vyas M, Roncador G, Gualco G, Bacchi CE, Younes SF, Natkunam Y, Freud AG (2014). Myeloid cell nuclear differentiation antigen is expressed in a subset of marginal zone lymphomas and is useful in the differential diagnosis with follicular lymphoma. Hum Pathol, 45(8), 1730-6. (Read full article)
    53. Metcalf RA, Bashey S, Wysong A, Kim J, Kim YH, Gratzinger D (2013). Intravascular ALK-negative anaplastic large cell lymphoma with localized cutaneous involvement and an indolent clinical course: toward recognition of a distinct clinicopathologic entity. Am J Surg Pathol, 37(4), 617-23. (Read full article)
    54. Sankaran VG, Ludwig LS, Sicinska E, Xu J, Bauer DE, Eng JC, Patterson HC, Metcalf RA, Natkunam Y, Orkin SH, Sicinski P, Lander ES, Lodish HF (2012). Cyclin D3 coordinates the cell cycle during differentiation to regulate erythrocyte size and number. Genes Dev, 26(18), 2075-87. (Read full article)
    55. Metcalf RA, Zhao S, Anderson MW, Lu ZS, Galperin I, Marinelli RJ, Cherry AM, Lossos IS, Natkunam Y (2010). Characterization of D-cyclin proteins in hematolymphoid neoplasms: lack of specificity of cyclin-D2 and D3 expression in lymphoma subtypes. Mod Pathol, 23(3), 420-33. (Read full article)

    Other

    1. Metcalf RA, Lex A (2022). Taking Data Visualization for Blood Management to the Next Level and Beyond. American Association of Clinical Chemistry (AACC) Clinical Laboratory News.

    Video/Film/CD/Web/Podcast

    1. Metcalf RA (2021). LabMind Podcast: Personalizing Transfusion Medicine [Podcast]. ARUP Laboratories.
    2. Metcalf RA (2020). Convalescent Plasma Therapy. LabMind Podcast hosted by Dr. Brian Jackson. [Podcast]. ARUP Laboratories.
    3. Metcalf RA (2020). Patient Blood Management [Video]. Clinical Chemistry Pearls.
    4. Metcalf RA (2017). Blood Utilization and The Transfusion Committee [Web]. Clincial Chemistry Pearls of Laboratory Medicine..

  • News & Podcasts