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…
Most common symptoms of pts with MF are fatigue and weight loss. 13% had no documented symptoms. 47% of all pts were not started on treatment at diagnosis #BSH2019
@HaemSTAR_UK is a brilliant initiative of predominantly non research SpRs with a consultant mentor building a network to get widespread co-ordinated data collection at multiple sites.
IVIg in ITP was a ripe topic for national audit following NHSE guidance recommending a single dose of 1g/kg, repeated only if clinically indicated #BSH2019#blooducation
139 investigators, 39 sites and 10.5 weeks = data on 978 patients! An excellent model #BSH2019
71.2% first treatments were in line with current guidance. CR 35.7% and PR in 29.9%, in keeping with previous data #BSH2019
No difference in platelet response over time whether patient were given 1g/kg once or 1g/kg daily on 2 consecutive days (slightly faster response with double dose but ??clinically relevant) #BSH2019
I had a personal request to do a tweetorial for the #haemSpRs on haemovigilance. Here goes. A #blooducation 🧵
Haemovigilance is a systematic surveillance of adverse reactions and adverse events related to transfusion’ with the aim of improving transfusion safety. transfusionguidelines.org/transfusion-ha…
We are very lucky in the UK to have @SHOTHV1, one of the first in the world to collate adverse events relating to transfusion - since the 1990s.
This morning I met with the chair and vice chair of the Midlands Regional Transfusion Committee, the Midlands Patient Blood Management Practitioner and the Customer Services Manager. What are their roles and what does the RTC do?
A #blooducation 🧵
RTCs serve to bring together Hospital Transfusion Committees to discuss best practice, implement new guidance and provide educational resources and events. They are run by clinicians and scientists working in hospitals, supported by @NHSBT.
Teaching our incoming haematology doctors today about transfusion in haematology patients. So who needs irradiated blood and why? A #blooducation🧵
All blood in the UK is leucocyte reduced (except granulocytes, but that’s another story). Despite this, a unit of red cells or platelets can have around a million residual white cells, mostly lymphocytes.
Every doctor starting in a new trust does transfusion training as part of their mandatory training. But why?
50ml ABO incompatible blood can kill a patient. ABO antibodies are naturally occurring (“everyone” has them) and they are IgM; they can activate complement and cause *immediate* intravascular haemolysis, causing release of free haem, endothelial activation, renal failure and DIC.
In most hospitals, blood banks require 2 samples (one may be historic) before releasing group specific (non-O) blood for a patient. This is to increase the chances of identifying a *wrong blood in tube* (pt whose blood's in the tube is not the pt whose details are on the outside)
It can be difficult to know where to start with transfusion – you can’t go on a ward round to find patients. BUT you do start with lab induction and your helpful #BMSes will show you around.
Excellent session on emergency paediatric transfusion #AABB20. Cyril Jacquot talking on pre hospital transfusion and summarising the literature.
28 day mortality following haemorrhage is higher in children than adults (unpublished data and substudies from PROPPR and PROMMTT)
Observational studies of large numbers of patients but with only very small numbers of paediatric patients suggest that pre hospital blood is not associated with an excess of transfusion reactions and in some studies is thought to have improved survival.
Whole blood, group O, high titre neg, used in paediatrics in Pittsburgh appears to be safe with no haemolysin-mediated haemoylsis in non group O patients (Leeper et al JAMA Pediatrics 2018) ncbi.nlm.nih.gov/pmc/articles/P…