2022: Akshay Shah
Dr Akshay Shah studied medicine at the University of Nottingham, graduating in 2009, before moving to London to complete his Foundation Training and core training in anaesthesia. These early experiences helped him develop an interest in clinical research. In particular, they fostered an appreciation on how better clinical care is often driven by improved understanding of the basic mechanisms of disease, performing high-quality randomised controlled trials (RCTs) and systematic reviews of developments in the evidence base.
He moved to Oxford in 2014 to start a NIHR Academic Clinical Fellowship within NHS Blood & Transplant (NHSBT), which ran alongside speciality registrar training in Anaesthesia & Intensive Care. During this fellowship, he gained valuable skills and knowledge in research methodology, by completing a Diploma in Health Research with the University of Oxford. He used these skills to conduct literature and systematic reviews, and a laboratory study, to obtain preliminary data for a DPhil funding application.
In 2017, he was awarded a NIHR Doctoral Research Fellowship to undertake a project entitled “Understanding the role of intravenous iron to treat anaemia in survivors of critical illness” under the supervision of Professor Simon Stanworth, Professor Peter Robbins and Dr Stuart McKechnie.
During the four years of his fellowship, he was the chief investigator on the INTACT study - a multicentre, feasibility, RCT of intravenous iron in patients discharged from critical care with moderate-severe anaemia (haemoglobin ≤100 g/L). This trial was supported by the Oxford Clinical Trials Research Unit and published in the British Journal of Anaesthesia in 2022. He carried out observational studies that highlighted that up to 45% of ICU survivors have moderate to severe anaemia when they are discharged from hospital. This equates to nearly 100,000 patients per year in UK. Working with collaborators from Perth, Western Australia, he demonstrated that this anaemia is independently associated with prolonged hospitalisation, more hospital readmissions, increased risk of death and poor health-related quality of life.
Under the supervision of Professor Hal Drakesmith, he conducted a laboratory study measuring hepcidin (a key regulator of iron control in the circulation) in ICU survivors to better understand the role of iron in anaemia of inflammation (when iron stores are no longer used to make red blood cells, due to very high levels of inflammation). (This inflammation stops the body from using its own iron to make red blood cells, which results in anaemia. He found that although iron restriction is the dominant mechanism for this anaemia, up to one-third of ICU survivors may potentially have true iron deficiency, which is currently left untreated. He has also performed several systematic reviews on the efficacy and safety of iron therapy, in particular the risk of infection, across a wide range of clinical settings, and some of this work has informed international guideline recommendations.
In recognition of this work during his DPhil, he was awarded the Intensive Care Society’s Rising Star Gold Medal award in December 2021. This is given annually to a young investigator who has shown excellence in science relevant to intensive care. The topic (treating anaemia following intensive care) has now listed as a research priority by the UK Intensive Care Society.
During his DPhil, he also undertook the prestigious Anaesthesia Trainee Editor Fellowship. Together with Professor Mike Murphy, he helped set up and deliver 'Transfusion Camp' in Oxford – an international multidisciplinary postgraduate education programme in transfusion medicine that has now been successfully running for 4 years.
During the COVID-19 pandemic, he was redeployed and went back to working as a medic in the ICU at the John Radcliffe Hospital. At the same time, he continued with his research interests. Building on the collaborations with Prof Hal Drakesmith’s group and the Oxford Centre for Haematology, he investigated COVID-19-induced disturbances in iron homeostasis, and the epidemiology of thrombotic and bleeding complications in critically ill patients with COVID-19. Both these studies were published in Critical Care.
Dr Shah says that his DPhil work benefitted immensely from the highly collaborative and supportive environment between RDM, NHSBT and the MRC WIMM. Working with many different researchers allowed him as a clinician to learn about basic science methods, systematic reviews, observational research and a great deal about clinical trials.
Dr Shah has now been appointed as a NIHR Academic Clinical Lecturer and will continue to pursue his clinical and research interests at the interface of transfusion medicine, critical illness and perioperative care. He feels enormously privileged to have the opportunity to continue to work in such a multi-disciplinary and stimulating environment.