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Bull TP, McCulloch R, Nicolson PL, Doyle AJ, Shaw RJ, Langridge A, Sayar Z, Tucker DL, Pettit M, Perry R, Thomas W, Page C, Whalley I, Dutt T, Garth L, Lester W, Buka RJ, Subhan M, Ware V, Rayment R, Castle D, Etherington A, Carter‐Brzezinski L, Peters J, Corrigan C, Sharma N, Benson G, Challenor S, Skinner TS, Zhao R, McLeod‐Kennedy LA, Douglas K, Knott A, Smith S, Wolf J, Todd SA, McDonald V, Rampotas A, Dean C, Sangha G, Pavord S, Denny N, Jaafar S, McLaughlin DP, Ross JE, Karanth M, Beverstock SL, Mansonso L, Burrows SH, McLaughlin DP, Tauro S, Shenouda A, Bailiff BM, Kajita D, Hermans J, Goradia H, Finan EM, Alford S, Pickard K, Greystoke B, Fail T, Abdussalam A, Roberts LN, Clark JB, Heeney N, Young J, Maddox J, Srinath S, Khawaja J, Parkes J, Babiker S, Hunt BJ, Wheeldon SL, Kerr P, Tahhan M, Vickers M, Pike AC, Hill Q, Mustafa N, Almaremi A, Hughes E, McGoldrick SJ, Loizou E, James I, Boyce SR, Farmer I, Thanigaikumar M, Wheeldon SL, Kerr P, Wickenden K, Gooding R, Thornton K, Kane C, Cole A, Griffin J, Docherty S, Dixon KI, Crowe J, Sheridan M, De Lord C, Sud A, Austin A, Coooper N, Bailey C, Attwell L, Hall R, Gray B, Chauhan SR, Lokare A, Gudger A, Horgan C, Venkatadasari I, Kaddam I, Mapplebeck CL, Van Veen J, Raj M, De Abrew K, Belsham E, Gyansah C, Sadullah S, Salhan B, Murrin R, Williams RL, Stewart A, Cornish N, Otton S, Khan Z, Ackroyd S, Chen LY, Lafferty NP, Leonforte F, Pemberton N, Rawi E, Triantafyllopoulou D, Adiyodi J, Yong J, Jones E, Davies D, Peck RC, Philip R, Seddon T, Cahalin P, Prodger C, Dutton DA, Sternberg AJ, Chengal R, Polzella P, Scully M. Diagnostic uncertainty presented barriers to the timely management of acute thrombotic thrombocytopenic purpura in the United Kingdom between 2014 and 2019. J Thromb Haemost 2022; 20:1428-1436. [PMID: 35189012 PMCID: PMC9314944 DOI: 10.1111/jth.15681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute thrombotic thrombocytopenic purpura (TTP) is a life-threatening emergency and plasma exchange (PEX) is the initial treatment shown to reduce acute mortality. OBJECTIVES To compare current practice in the United Kingdom (UK) against the standards set out in the 2012 British Society of Haematology guideline, and to better understand the issues affecting prompt initiation of PEX. PATIENTS/METHODS The trainee research network HaemSTAR conducted a retrospective nationwide review of adults presenting to UK hospitals with a first episode of acute TTP. RESULTS Data on 148 patients treated at 80 UK hospitals between 2014 and 2019 demonstrated that 64.8% of patients received PEX within 24 h. Diagnostic uncertainty was the most commonly cited reason for delayed treatment. Conversely, a shorter time to PEX occurred in patients who had red cell fragments or severe thrombocytopenia identified on their first complete blood count. Availability of on-site PEX was associated with a greater proportion of patients receiving PEX within 8 h compared to patients transferred, but by 24 h there was no difference between the two groups and two-thirds of all patients had received their first PEX. The mortality rate for patients that received PEX was 9.2%, with 27.8% of deaths linked to delayed treatment initiation. CONCLUSIONS This is the first multi-center evaluation of treatment delays in acute TTP and it will inform targeted pathways to improve prompt access to life-saving intervention.
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Batty P, Austin SK, Khair K, Millar CM, Palmer B, Rangarajan S, Stümpel JP, Thanigaikumar M, Yee TT, Hart DP. Treatment burden, haemostatic strategies and real world inhibitor screening practice in non-severe haemophilia A. Br J Haematol 2017; 176:796-804. [PMID: 28198996 DOI: 10.1111/bjh.14543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/03/2016] [Indexed: 12/11/2022]
Abstract
Inhibitor formation in non-severe haemophilia A is a life-long risk and associated with morbidity and mortality. There is a paucity of data to understand real-world inhibitor screening practice. We evaluated the treatment burden, haemostatic strategies, F8 genotyping and inhibitor screening practices in non-severe haemophilia A in seven London haemophilia centres. In the 2-year study period, 44% (377/853) patients received at least one haemostatic treatment. Seventy-nine percent of those treated (296/377) received factor VIII (FVIII) concentrate. F8 genotype was known in 88% (331/377) of individuals. Eighteen per cent (58/331) had 'high-risk' F8 genotypes. In patients with 'standard-risk' F8 genotypes treated on-demand with FVIII concentrate, 51·3% episodes (243/474) were screened within 1 year. However, poor screening compliance was observed after 'high-risk' treatment episodes. In patients with 'standard-risk' F8 genotypes, 12·3% (28/227) of treatment episodes were screened in the subsequent 6 weeks after surgery or a bleed requiring ≥5 exposure days. Similarly, in the context of 'high-risk' F8 genotypes after any FVIII exposure, only 13·6% (12/88) of episodes were screened within 6 weeks. Further study is required to assess optimal practice of inhibitor screening in non-severe haemophilia A to inform subsequent clinical decisions and provide more robust prevalence data to further understand the underlying immunological mechanism.
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Affiliation(s)
- Paul Batty
- The Royal London Hospital Haemophilia Centre, QMUL, Barts and The London School of Medicine and Dentistry, London, UK
| | - Steve K Austin
- St George's Healthcare NHS Trust, Haemophilia Centre, London, UK.,The Centre for Haemostasis and Thrombosis, St Thomas' Hospital, London, UK
| | - Kate Khair
- Great Ormond Street Haemophilia Centre, London, UK
| | | | - Ben Palmer
- The United Kingdom National Haemophilia Database, Manchester, UK
| | - Savita Rangarajan
- The Centre for Haemostasis and Thrombosis, St Thomas' Hospital, London, UK
| | - Jan-Phillip Stümpel
- The Royal London Hospital Haemophilia Centre, QMUL, Barts and The London School of Medicine and Dentistry, London, UK
| | | | - Thynn T Yee
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Daniel P Hart
- The Royal London Hospital Haemophilia Centre, QMUL, Barts and The London School of Medicine and Dentistry, London, UK
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Patel RK, Lea NC, Heneghan MA, Westwood NB, Milojkovic D, Thanigaikumar M, Yallop D, Arya R, Pagliuca A, Gäken J, Wendon J, Heaton ND, Mufti GJ. Prevalence of the activating JAK2 tyrosine kinase mutation V617F in the Budd-Chiari syndrome. Gastroenterology 2006; 130:2031-8. [PMID: 16762626 DOI: 10.1053/j.gastro.2006.04.008] [Citation(s) in RCA: 208] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 01/16/2006] [Indexed: 01/11/2023]
Abstract
BACKGROUND & AIMS Budd-Chiari Syndrome (BCS) results from obstruction to hepatic venous outflow, with myeloproliferative disorder (MPD) accounting for up to 40% of cases. A number of BCS cases labelled as "idiopathic" do not fulfill the diagnostic criteria for MPD but have features suggestive of a latent form based on hyperplastic bone marrow and erythroid progenitor cell culture; these cases may subsequently develop overt MPD. A clonal mutation in JAK2 tyrosine kinase (JAK2V617F) occurs in a high proportion of patients with MPD and is of use in the characterization of latent MPD in BCS. METHODS We performed allele-specific polymerase chain reaction to screen for JAK2V617F in subjects with BCS (n = 41) and polycythemia vera (PV) (n = 20) and in hematologically normal controls (n = 27). RESULTS AK2V617F was detected in 24 of 41 (58.5%) subjects with BCS, 19 of 20 PV controls, and 0 of 27 hematologically normal controls. Mean hemoglobin concentration and hematocrit were significantly higher in patients with JAK2V617F. Bone marrow was hyperplastic in 16 of 41 subjects (12/16 JAK2V617F positive). Nine of 33 (27.3%) showed endogenous erythroid colony formation (7/9 JAK2V617F positive). Eleven of 41 subjects developed overt MPD (8/11 essential thrombocythemia, 3/11 PV) after the diagnosis of BCS (median, 49 months; range, 8-87 months), and in 90.9% of these JAK2V617F was detected. CONCLUSIONS JAK2V617F occurs in a high proportion of patients with BCS. Latent MPD was missed in a substantial number of our subjects by using standard techniques. Such cases should be screened for JAK2V617F and carefully observed for the subsequent development of overt MPD.
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Affiliation(s)
- Raj K Patel
- Department of Haematological Medicine, King's College Hospital, London, England.
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