Discover and read the best of Twitter Threads about #bsh2019
Most recents (13)
128 granulocyte transfusions across 97 trusts. 61% patients had AML, 9% MDS. Is this a growing population who may benefit? #BSH2019
34% had lung infections which some worry maybe worsened if GTX cause pulmonary reactions #BSH2019
Prof Bowen delivering a talk for Prof Platzbecker on novel approaches to cytopenias in MDS #BSH2019
Around 30% of patients will respond to Eprex and license for MDS came last year
medicines.org.uk/emc/product/11…
Darbepoietin didn't meet its primary endpoint and so not licensed but real world experience is that both are in use for anaemia in MDS
#BSH2019
medicines.org.uk/emc/product/11…
Darbepoietin didn't meet its primary endpoint and so not licensed but real world experience is that both are in use for anaemia in MDS
#BSH2019
Median duration of response is 17 months. Sideroblastic patients respond less well. If EPO raised and transfusion dependent, only 10% will respond. All others should have a therapeutic trial. Even those with RAEB-1 may continue to respond for a good time #BSH2019
Next up @SimonStanworth on red cell transfusion in MDS.
A registry in S Australia showe cumulative incidence of alloimmunisation of 11% and these patients went on to increase their transfusion requirement
haematologica.org/content/early/…
A registry in S Australia showe cumulative incidence of alloimmunisation of 11% and these patients went on to increase their transfusion requirement
haematologica.org/content/early/…
Recent NCA in UK shows that a third of transfusions in haematology go to patients with MDS. Average threshold used across the country is approx 80 g/L #BSH2019
But what is the evidence to guide when to transfuse in MDS? Plenty of thresholds studies in non haematology patients but very little data to date in MDS and/or those with chronic anaemia #BSH2019
Prof David Bowen from Leeds talking on MDS. QOL so important in these patients. EQ5D is used to assess this but new tools in development. Compliance with completing assessments is 85%. A motivated group! #BSH2019
Novel ways to diagnose MDS without a marrow looking at blood glucose, creatinine and other markers. Could be very powerful. Marrow considered gold standard but even then diagnosis is not clear cut #BSH2019
Change in platelet count of 25% at 6 months is prognostic. If also become transfusion dependent in that time, median survival is 2y. Work from Raphael Itzykson in Paris #BSH2019
Amrana Qureshi on use of hydroxycarbamide in sickle cell disease
b-s-h.org.uk/guidelines/gui…
#BSH2019
b-s-h.org.uk/guidelines/gui…
#BSH2019
HU increases HbF%, reduces adhesion receptors, increases red cell hydration and survival and increases availability of NO #BSH2019
HU should be offered to
All infants aged 9m to 42m (following the BABY HUG study)
All adults and children post severe or recurrent ACS
All adults and children with recurrent crises affecting QOL
#BSH2019
All infants aged 9m to 42m (following the BABY HUG study)
All adults and children post severe or recurrent ACS
All adults and children with recurrent crises affecting QOL
#BSH2019
Next up: Interpretation of genetic variants in the setting of bleeding disorders; Keith Gomez. Full guideline here onlinelibrary.wiley.com/doi/full/10.11…
#BSH2019
#BSH2019
Mosaicism has been reported in up to 20% of haemophilia carriers. So interpretation of tests is not as simple as might initially be thought #BSH2019
'Variants of uncertain significance' is the label given to those mutations considered to have a 10-90% chance of being pathogenic. These findings need to be carefully explained to the patient and not used to guide clinical management #BSH2019
In the guidelines session, a review of recent @BritSocHaem guidelines #BSH2019
@nicola_curry first on the use of viscoelastic testing #BSH2019
@nicola_curry first on the use of viscoelastic testing #BSH2019
TEG, ROTEM and Sonoclot all currently available and all use similar methodology based on whole blood testing #BSH2019
Most TEG/ROTEM are introduced by non haematologists. How much should we be involved and in what capacity? #BSH2019
In the hbopathy session, Fiona Regan is talking on implication of technology on provision of blood in the UK #BSH2019
Current guidance advocates full Rh and kell matching for hbopathy patients, and many would like it for MDS too. But this is not being achieved. Extended matching (MNSs, Fy, Jk) would be even better, but currently not feasible... #BSH2019
Not enough donors are typed, and even if they were, there are not enough donors with the types required. Shorter shelf life for hbopthy (e.g. 7 days for red cell exchange) adds further restraints #BSH2019
In the general haematology top scoring abstracts session, initial results from the PADDOCK study of APL-2 in treatment naive patients with PNH pnhstudy.com/paddock/
And next the identification of IKRZF5 mutation as the cause of thrombocytopenia. Important to have accurate diagnosis to prevent unnecessary treatment for ??ITP and identify need for follow-up for any associated abnormalities (or none) #BSH2019
REALISM is a UK wide real life study of current rx of myelofibrosis. JAK2 inhibitors now recommended as first line for patients with symptomatic MF
BUT only NICE funded if int-2 or high risk disease #BSH2019
BSH guidelines here onlinelibrary.wiley.com/doi/full/10.11…
BUT only NICE funded if int-2 or high risk disease #BSH2019
BSH guidelines here onlinelibrary.wiley.com/doi/full/10.11…
Excellent MacFarlane-Biggs lecture by Prof Mark Crowther outlining the complexities of managing patients with true APS. 80% of patients with APS don't actually have the disease, he argues! #BSH2019
CAPS guidelines from his institution here ncbi.nlm.nih.gov/pubmed/29978552 #BSH2019
Moving on to anticoagulation reversal, Prof Crowther demonstrates this is still essentially an evidence free area of practice #BSH2019
Prof Dave Roberts now taking us through whether we should genotype all blood donors #BSH2019
Alloimmunisation is a significant source of morbidity and also causes a lot of extra work and time delays for treatment. Therefore best avoided if possible #BSH2019
12-15% sickle patients in a large centre who could benefit from exchange transfusion are not having this procedure as blood is not available for them due to having developed multiple antibodies #BSH2019
Dr Massey reminds us that _RHD_ is the gene which may or may not be translated into RhD or D protein #BSH2019
Assay for screening 'over diagnoses' D negativity. Performed after 11 weeks gestation #BSH2019
First transfusion session of the day @BritSocHaem . BBTS session chaired by @mikefmurphy looking at red cell genotyping. Dr Megan Delaney is going to take us through when red cell genotyping should be undertaken #BSH2019
In the setting of AIHA, providing matched blood can avoid the need for multiple adsorptions (if pt only receiving blood in your institution) #BSH2019
Phenotyping may not be possible with a strong warm autoab therefore genotyping may be useful #BSH2019
