Speaking with Julia Coleman, MD on the phone, you immediately get a vivid sense of her enthusiasm, one that doesn’t come through in email – or indeed, probably in this article. She’s excited about sex hormones in much the way one experiences a flash of white heat with an epiphany. It’s like when you find the last piece of a puzzle - long missing under a sofa - and lock it into place: it clicks. And for Coleman, a trauma research fellow and general surgery resident at University of Colorado-Denver, estrogen and blood working in concert just makes sense.
A graduate of the University of Toledo in Ohio, Coleman says that she always had a passion for science and for service, and “that medicine was the perfect marriage of the two.” Coleman found herself part of an interdisciplinary team at University of Denver since 2015. There, her excitement for estrogen and blood led her to question the role that female sex hormones play in increasing blood coagulation during medical trauma. “Early on,” she stated in her fellowship application, “I developed an interest in studying sex dimorphisms in coagulation and how they may confer differential protective factors or clinical outcomes.” Harkening back on this statement now, she explains, “We think the mechanism of coagulation is hormone-affected.”
Coleman uses “we” to refer to the team of hematologists, Ob/Gyns, and scientists, who are working alongside her on her award-winning project “Sex Dimorphisms in Trauma-Induced Coagulopathy: A Mechanistic Exploration of a Sex-Specific Survival Benefit.” This project was the winner of our 2018 Research Grant Award: Promoting XXcellence in Women’s Health: Optimal Management of Women and Girls with Blood Disorders.
“We are appreciative of this grant because what we are doing is novel and hard to frame against any other organization,” she says, comparing her project to our unique mission to help doctors treat and manage bleeding and other blood disorders in women and girls. “This grant is nurturing the exact type of work and collaboration we need.”
Collaboration across specialties is Coleman’s forte. She believes she couldn’t have gotten this far without, for instance, her project mentor Dr. Christopher C. Silliman, a hematologist; or without her sponsor Dr. Stefka Fabbri, an Ob/Gyn. Other project collaborators include Ernest E. Moore, MD, Angela Sauaia, MD, PhD, Anirban Banerjee, PhD, Erik Peltz, DO, and Murphy Anderson, CRNA.
Not surprisingly then, collaboration is also woven into the underlying scientific question of her project: Do sex hormones affect clot formation and stability, thrombin formation and platelet function in vitro? If so, will differential levels of sex hormones in vivo confer differential thromboelastographic profiles in female populations and outcomes in female trauma patients?
“There’s a clinical arm and a basic science arm to this project,” Coleman explains. “It’s important to establish what’s normal, which is not well established, particularly at high elevations; that sets you up to understand what’s not normal and where the risk is. For instance, in postpartum hemorrhage, we can be guided to blood product resuscitation tactics when we know how the function is abnormal.”
In other words, the science lies in the ability of estrogen – a sort of “Wonder Woman” hormone – to help blood clot. The practice derived from this test tube knowledge is using estrogen to foster clot formation and stability, thrombin formation and platelet function in vivo.
But why is this not well-established medicine? “Animal research often happens exclusively with male rats and swine,” Coleman says. “You get a clean model of coagulopathy from the males, and the tendency has been to exclude female test subjects.” Indeed, this preference has been called out before. A study entitled “Sex Bias in Neuroscience and Biomedical Research*,” published by Annaliese K. Beery and Irving Zucker of the University of California, Berkeley, examined this trend of excluding female mammals from clinical research.
This bias poses a problem for female patients, and Coleman feels It’s important to differentiate between the sexes: “Coagulation in a female is different than it is in a male. You have to account for sex as a biological variable. It’s long overdue.”
While this research will more immediately affect women in trauma, Coleman sees an opening to help both sexes with the “superhero” hormone estrogen. “Neurosurgery has long investigated the use of estrogen and progesterone especially,” Coleman states. “Potentially, we might stretch to the point where we use estrogen in the treatment of males with coagulopathy.”
Back to all the pieces clicking into place for Dr. Coleman, “I was led to trauma surgery because it is such a privilege to be an advocate for people and their families during some of the hardest moments of their lives.”
The privilege, Doctor, is ours.