Jennifer Andrews, MD, MSc is a board certified Pediatric Hematologist/Oncologist and board certified Transfusion Medicine/Blood Banking physician. She practices benign hematology at Lucile Packard Children's Hospital Stanford, which includes care of children with anemia, thrombocytopenia, neutropenia and other blood disorders, such as thalassemia and sickle cell anemia. She also practices Transfusion Medicine, where she directs safe blood transfusions for patients at both Lucile Packard Children's Hospital Stanford and Stanford Hospitals and Clinics. Her main research interests include education of medical students, residents and fellows and Pediatric Transfusion Medicine.

Clinical Focus

  • Pediatric Transfusion Medicine
  • Pediatric Hematology-Oncology

Academic Appointments

Honors & Awards

  • Best Lecture or Presentation of 2014, Stanford University School of Medicine (2014)
  • Clinical Fellow Research Award, Stanford University Department of Pathology Research Retreat (2012)
  • Clinical Pathology Fellow Teaching Award, Stanford University Pathology Department (2012)

Professional Education

  • Board Certification: Pediatric Hematology-Oncology, American Board of Pediatrics (2013)
  • Board Certification: Blood Banking/Transfusion Medicine, American Board of Pathology (2012)
  • Fellowship:Stanford Hospital and Clinics (2012) CA
  • Fellowship:Emory University Hospital (2011) GA
  • Board Certification: Pediatrics, American Board of Pediatrics (2007)
  • Residency:University of North Carolina - Chapel Hill (2007) NC
  • Internship:University of North Carolina - Chapel Hill (2005) NC
  • Medical Education:University of South Florida (2004) FL

Research & Scholarship

Current Research and Scholarly Interests

My research interests include: education of clinical residents and fellows regarding safe and effective transfusion practices, iron overload from red blood cell transfusions in pediatric hematology/oncology patients and leveraging technology to improve clinical practice around blood transfusion.

Clinical Trials

  • Fibrinogen Concentrate vs Cryoprecipitate Recruiting

    One of the most common hemostatic derangements in pediatric open- heart surgery is an acute acquired hypofibrinogenemia. This compromises fibrin clot generation and platelet aggregation, resulting in increased bleeding and allogenic blood transfusions. Currently, fresh frozen plasma and cryoprecipitate are used to supplement fibrinogen in pediatric cardiac patients. We propose that replacing cryoprecipitate with fibrinogen concentrate will be as effective in treating post-CPB bleeding and will decrease total blood product exposure when used as part of a blood transfusion algorithm. We plan to include all patients undergoing cardiac surgery on CPB less than 12 months and a fibrinogen level <250mg/dL while on bypass. We hope to demonstrate that fibrinogen concentrate is at least as effective as the standard of care in the management of peri- operative bleeding in neonatal patients undergoing cardiopulmonary bypass. If we are able to demonstrate that fibrinogen is at least as effective as the standard of care, then we would plan a multi-center trial to demonstrate the safety and efficacy of this medication. If we are able to demonstrate that fibrinogen concentrate is effective, fibrinogen concentrate could replace allogenic products and potentially decrease transfusion related morbidity in mortality in this population.

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All Publications

  • Challenges with Navigating the Precarious Hemostatic Balance during Extracorporeal Life Support: Implications for Coagulation and Transfusion Management TRANSFUSION MEDICINE REVIEWS Andrews, J., Winkler, A. M. 2016; 30 (4): 223-229


    For the past four decades, extracorporeal life support (ECLS) has been used to treat critically ill adult and pediatric patients with cardiac and/or respiratory failure, and there are increasingly numbers of centers worldwide performing ECLS for numerous indications. Despite the progress with advancing the technology, hemorrhagic and thrombotic complications are frequently reported and associated with worse outcomes, but the exact cause is often elusive or multifactorial. As a result of the interaction between blood and an artificial circuit, anticoagulation is necessary and there is resultant activation of coagulation, fibrinolysis, as well as, an increased inflammatory response. While unfractionated heparin (UFH) remains the mainstay anticoagulant used during ECLS, there is a paucity of published data to develop a universal anticoagulation guideline and centers are forced to create individualized protocols to guide anticoagulation management while lacking expertise. From an international survey, centers often use a combination of tests, which in turn result in discordant results and confused management. Studies are urgently needed to investigate optimization of current anticoagulation strategies with UFH, as well as, use of alternative anticoagulants and non-thrombogenic biomaterials. Blood transfusion during extracorporeal support typically occurs for several reasons, which includes circuit priming, restoration of oxygen carrying capacity, maintenance of a hemostatic balance, and treatment of hemorrhagic complications. As a result, the majority of patients will have been exposed to at least one blood product during extracorporeal support and transfusion utilization is high. ECLS Centers have adopted transfusion thresholds based upon practice rather than evidence as there have been no prospective studies investigating the efficacy of red cell (RBC) transfusion in patients receiving extracorporeal support. In addition, RBC transfusion has been associated with increased mortality in ECLS in several retrospective studies. Additional studies are needed to establish evidence based thresholds for transfusion support and diagnostics to guide transfusion therapy to assess efficacy of transfusion in this population, as well as, exploration of alternatives to transfusion.

    View details for DOI 10.1016/j.tmrv.2016.07.005

    View details for Web of Science ID 000383816300012

    View details for PubMedID 27543261

  • Clinical Pattern in Hypotensive Transfusion Reactions. Anesthesia and analgesia Metcalf, R. A., Bakhtary, S., Goodnough, L. T., Andrews, J. 2016; 123 (2): 268-273


    Hypotensive transfusion reactions (HyTRs) may be underreported and have been associated with patients taking angiotensin-converting enzyme inhibitors (ACEIs) receiving poststorage leukoreduced blood products through negatively charged filters. Although bedside leukoreduction is no longer commonplace, HyTRs still occur and are insufficiently characterized in the prestorage leukoreduction era. We describe recently reported cases at our institution.We reviewed transfusion reaction records at Stanford Healthcare from January 2014 to April 2015. HyTRs were defined by National Health Safety Network Hemovigilance Module classification.Eleven HyTRs occurred in 10 patients. All were adults (mean age 71.7 years; range 45-92 years), 7 were male, and all underwent major surgery 0 to 2 days before the reaction. Nine patients underwent cardiac or vascular surgery, and all 10 were taking ACEIs with the last dose taken within 48 hours of the transfusion reaction in 9 patients. Nine patients were on extracorporeal circuits within 24 hours before the reaction (median duration 180 minutes; range 87-474 minutes). In 5 reactions, the implicated unit was restarted with resultant recurrent hypotension. Implicated units included 9 packed red blood cells, 1 apheresis platelet, and 1 plasma frozen within 24 hours.Contrary to what has been previously reported in the era of prestorage leukoreduction, HyTRs at our institution showed consistent patterns in patients at risk. Patients scheduled to undergo major surgery with cardiopulmonary bypass may benefit from earlier preoperative cessation of ACEIs or temporarily switching to an alternative drug class.

    View details for DOI 10.1213/ANE.0000000000001387

    View details for PubMedID 27284999

  • Anti-Mur as the most likely cause of mild hemolytic disease of the newborn TRANSFUSION Bakhtary, S., Gikas, A., Glader, B., Andrews, J. 2016; 56 (5): 1182-1184

    View details for DOI 10.1111/trf.13552

    View details for Web of Science ID 000378555700027

  • Transfusions for anemia in adult and pediatric patients with malignancies. Blood reviews Shah, N., Andrews, J., Goodnough, L. T. 2015; 29 (5): 291-299


    Anemia is present in over two-thirds of patients with malignant hematological disorders. The etiology of anemia predominates from ineffective erythropoiesis from marrow infiltration, cytokine related suppression, erythropoietin suppression, and vitamin deficiency; ineffective erythropoiesis is further exacerbated by accelerated clearance due to antibody mediated hemolysis and thrombotic microangiopathy. As the anemia is chronic in nature, symptoms are generally well tolerated and often non-specific. Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Conservative/restrictive RBC transfusion practices have shown equivalent patient outcomes compared to liberal transfusion practices, and meta-analysis has shown improved in-hospital mortality, reduced cardiac events, re-bleeding, and bacterial infections. The implications for a lower threshold for transfusion in patients with malignancies are therefore increasingly being scrutinized. Alternative management strategies for anemia with IV iron and erythropoietin stimulating agents (ESAs) should be considered in the appropriate settings.

    View details for DOI 10.1016/j.blre.2015.02.001

    View details for PubMedID 25796130

  • Infusion pump-mediated mechanical hemolysis in pediatric patients. Annals of clinical and laboratory science Hughes, J., McNaughton, J., Andrews, J., George, T., Bergero, C., Pyke-Grimm, K., Galel, S. A., Gonzalez, C., Goodnough, L. T., Fontaine, M. J. 2015; 45 (2): 140-147


    Hemoglobinuria was observed after packed red blood cell transfusion in a series of patients at our pediatric treatment center. Laboratory testing was suggestive of intravascular hemolysis with no support for an immunohematologic process.We investigated these adverse events to define a quality improvement plan and to prevent future hemolytic adverse events. Multiple factors were investigated, and the only change identified was the implementation of a new infusion pump (Pump A) that replaced a previous model (Pump B).In vitro pump analyses, a retrospective review of urinalyses, and prospective urinalysis and nursing surveillances were also performed.In in vitro analysis of the pumps, irradiated units with higher hematocrit at a low flow rate through Pump A had a greater than thirty-fold increase in free hemoglobin from baseline compared to minimal free hemoglobin changes seen with Pump B. Irradiated units with a lower hematocrit had a minimal change in free hemoglobin from baseline with both Pumps A and B at either low or high flow rate. Subsequently, only units with lower hematocrits were issued for transfusion of pediatric patients, and Pump A was replaced by Pump B in the outpatient unit. Retrospective and prospective surveillances found no additional unexplained cases of gross hemoglobinuria associated with transfusion.The investigation determined that infusion of higher hematocrit units using a specific commercial pump was associated with mechanical hemolysis. The change to units with lower hematocrit through an alternative pump has been an effective corrective action to date.

    View details for PubMedID 25887866

  • Evaluation of Febrile, Nonneutropenic Pediatric Oncology Patients with Central Venous Catheters Who Are Not Given Empiric Antibiotics JOURNAL OF PEDIATRICS Bartholomew, F., Aftandilian, C., Andrews, J., Gutierrez, K., Luna-Fineman, S., Jeng, M. 2015; 166 (1): 157-162


    To evaluate the practice of empiric antibiotics for febrile, nonneutropenic pediatric oncology patients with a central venous catheter (CVC) in place.Episodes of fever without neutropenia (absolute neutrophil count [ANC] ?500 cells/mm(3)) were reviewed retrospectively in pediatric oncology patients with a CVC undergoing chemotherapy. Characteristics and symptoms were compared between patients with bacteremia and patients without bacteremia.A total of 392 episodes of nonneutropenic fever in 138 subjects (52 females; 38%) were reviewed. In this cohort, the median age at an episode was 7 years, and the majority of patients had a diagnosis of acute leukemia (54%). Median ANC was 3100 cells/mm(3) (IQR, 1570-5980 cells/mm(3)). Median temperature was 38.7C (IQR, 38.3-39.2C). Twenty-four infectious episodes (6%) occurred in 18 subjects, and 5 CVCs required removal; all patients requiring removal admitted and received antibiotics owing to chills. There were no significant difference in age, sex, or ANC between patients with bacteremia and those without bacteremia; however, mean temperature was higher in the patients with bacteremia (39.4C vs 38.7C; P = .003). No deaths due to sepsis occurred, and no CVCs were removed because antibiotics were not administered empirically.Our practice of observing pediatric oncology patients undergoing chemotherapy with CVCs who are not neutropenic does not appear to lead to increased serious adverse outcomes and avoids antibiotic exposure for >90% of patients without a bacterial infection.

    View details for DOI 10.1016/j.jpeds.2014.09.008

    View details for Web of Science ID 000346584000032

    View details for PubMedID 25444524

  • Red Blood Cell Transfusion Is Not Associated with Necrotizing Enterocolitis: A Review of Consecutive Transfusions in a Tertiary Neonatal Intensive Care Unit JOURNAL OF PEDIATRICS Wallenstein, M. B., Arain, Y. H., Birnie, K. L., Andrews, J., Palma, J. P., Benitz, W. E., Chock, V. Y. 2014; 165 (4): 678-682
  • Red blood cell transfusion is not associated with necrotizing enterocolitis: a review of consecutive transfusions in a tertiary neonatal intensive care unit. journal of pediatrics Wallenstein, M. B., Arain, Y. H., Birnie, K. L., Andrews, J., Palma, J. P., Benitz, W. E., Chock, V. Y. 2014; 165 (4): 678-682


    To explore the association between red blood cell transfusion and necrotizing enterocolitis (NEC) in a neonatal intensive care unit with liberal transfusion practices.A retrospective cohort study was conducted for all infants weighing <1500g who received at least 1 packed red blood cell transfusion between January 2008 and June 2013 in a tertiary neonatal intensive care unit. The primary outcome was NEC, defined as Bell stage II or greater. The temporal association of NEC and transfusion was assessed using multivariate Poisson regression.The study sample included 414 very low birth weight infants who received 2889 consecutive red blood cell transfusions. Twenty-four infants (5.8%) developed NEC. Four cases of NEC occurred within 48hours of a previous transfusion event. Using multivariate Poisson regression, we did not find evidence of a temporal association between NEC and transfusion (P=.32).There was no association between NEC and red blood cell transfusion. Our results differ from previous studies and suggest that the association between NEC and transfusion may be contextual.

    View details for DOI 10.1016/j.jpeds.2014.06.012

    View details for PubMedID 25039042

  • Blood ordering from the operating room: turnaround time as a quality indicator TRANSFUSION McClain, C. M., Hughes, J., Andrews, J. C., Blackburn, J., Sephel, S., France, D., Viele, M., Goodnough, L. T., Young, P. P. 2013; 53 (1): 41-48


    Quality indicators in transfusion medicine are necessary for patient safety and customer satisfaction. The turnaround time (TAT) of issuing red blood cells (RBCs) has emerged as a quality indicator but is not an established benchmark. We examined the TAT for issuing RBCs from the blood bank to the operating rooms (ORs) at Vanderbilt University Medical Center (VUMC) and Stanford University Medical Center (SUMC).TAT was defined from time of request to when RBCs exited the blood bank. Cases eligible for analysis had completed type-and-screen results with requests for four or fewer RBC units. Patients with a positive antibody screen had serologically crossmatched units prepared and reserved for intraoperative use. We also e-mailed surveys to academic institutions to establish the current state of TAT monitoring and to anesthesiologists at VUMC to gauge the TAT expectations of the OR.The mean TATs at the two institutions were comparable (VUMC, 10??3.8?min; SUMC, 14??7.2?min) for orders of RBCs. The most common reasons for delayed TAT were overlapping orders, medical technologists occupied by phone calls, and oversaturation of pneumatic tube stations. Only 3 of 24 surveyed institutions actively monitored RBC TAT. Surveyed anesthesiologists (n?=?7) reported an expectation for RBC TAT of 5 to 15 minutes for urgent cases. Established internal TAT policies were 15 and 20 minutes at VUMC and SUMC, respectively, for crossmatched RBC requests for patients with complete diagnostic testing.Many of the surveyed institutions do not monitor stat RBC issue TAT as a quality indicator. This study serves as a starting point for establishing a benchmark for TAT for issuing RBCs from the blood bank to ORs.

    View details for DOI 10.1111/j.1537-2995.2012.03670.x

    View details for Web of Science ID 000313348900009

    View details for PubMedID 22536922

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