16^th World Hematology Congress March 18-19, 2019 Rome, Italy

in 1986 which has more than 450000 donors in 2018. For more than 30 years, the foundation has been working with transplant physicians sharing the experience in donor and patient support. She is a Certified Hematopoietic Transplant Coordinator (CHTC) with more than 15 years of experience in the search for unrelated stem cell donors. She has built the foundation’s International Search Center to help transplant centers around the globe to identify the best matched unrelated donors for their patients in the worldwide database. In addition, she holds a Degree in Social Economics - Sozialwirtin (FH) and is Member of the World Marrow Donor Association (WMDA) and the European Group for Blood and Marrow Transplantation (EBMT).

Allogeneic hematopoietic stem cell transplantation (HSCT) has become an established therapy in the treatment of patients with a range of hematological and non-hematological disorders. The number of allogeneic stem cell transplants increases every year. The risks and options for the stem cell recipients are well defined and documented and transplant physicians are well aware of the procedures in their facility. Physiological and psychological factors for the recipient are part of the daily routine. In contrast to the situation for the recipients, hematopoietic stem cell donation is often considered a relatively safe procedure for the donor and the physiological and psychological impact on the donor is not the focus of the transplant physician. When donors are included in studies and become research objects the process gets even more complicated. The knowledge and understanding about the obstacles and challenges of all the parties involved in stem cell donation are fundamental for the success of the allogeneic hematopoietic stem cell transplantation. We believe it is necessary to create an understanding in the clinical community and the impact of the stem cell donation has on the donors and how important the exchange of information is with regard to preserving donor commitment and availability.

E Tjønnfjord took his Degree at Odense University Hospital, Denmark. He has worked in the field of hematology with a special interest in the benign hematology. He is now starting a PhD focusing on the treatment of ITP and how to improve it.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare aquired hematopoetic stem cell disorder characterized by the triad of intravascular hemolysis, thrombosis and bone marrow failure. The symptoms are caused by complement activation on the cell surface of hematopoetic cells. The detection of a PNH clone is made by analyzing GPI-anchored molecules on blood cells by flowcytometry. The only curative treatment, allogeneic stem cell transplantation is limited by short- and long-term consequences, and donor availability. Eculizumab, a humanized monocolonal antibody against terminal complement protein C5 is currently the most effective treatment.

Development of modern flow cytometric techniques have improved diagnostic accuracy and created possibilities for follow-up of small clones. Correct estimates of incidence and prevalence are of importance also health economically.

The Nordic countries have a unique system of record data bases and centralization of diagnostics to a few centers which allows characterizing incidence and prevalence accurately. Our aim is to describe PNH clones detected over a period of 6 years by flow cytometry in Denmark (Den), Finland (Fin), Norway (Nor), and Sweden (Swe).

 

Methods: Data was collected from the Stockholm and Gotland regions in Sweden, Copenhagen region in Denmark, Oslo region in Norway and from Finland. All laboratories used accredited methods. The study population included all patient samples referred to the laboratories for PNH testing between 2011 and 2016. We included all newly detected PNH clones in neutrophils between 0.1-100% in the study.

 

Results: The mean incidence of newly detected PNH clones between 0.1 and 100% was 2.33 per year and million inhabitants in the Nordics. of all newly diagnosed PNH clones, 41% were <1% and 17% >50%. The mean age at

detection of the clone was 52 years (6 to 90 years). PNH clones were evenly distributed between age groups, and there was no gender difference.

Conclusion: This is the first study to report incidence of PNH clones in the Nordic countries, which is higher (2.33/ million) than previously reported in other countries (1.3/million). In the Yorkshire data only 18% of the PNH clones were <1% compared to 41 % in our material. This may reflect increase in testing for PNH clones in patients with aplastic anemia, myelodysplastic syndrome or other conditions associated with PNH, or more sensitive modern

laboratory methods. In the Finnish data 49% of the patients had a clone <1% compared to 28%, 38% and 39% in Denmark, Norway and Sweden, respectively. This may explain the seemingly higher incidence of PNH clones in Finland. Our study has given an estimate of PNH incidence in the Nordic countries and important information for

further health economical studies.

Alaa is a Lecturer and Consultant of Hematopathology, at the faculty of medicine, Cairo University, Egypt. In 2013, she obtained her PhD in Hematology from Cairo University. Moreover, she has earned her postgraduate diploma in biomedical sciences from London Metropolitan University.

Background: Interleukin 17F (IL-17F) is a pro-inflammatory cytokine that is recently proved to have a crucial role in the emergence of autoimmune diseases; it induces the expression of various cytokines, chemokines and adhesion molecules. IL-17F polymorphism is subsequently related to enhanced IL-17F expression and activity; which may result in susceptibility to many autoimmune diseases including primary immune thrombocytopenia (PIT).

Aim of the study: This case- control study aimed to investigate the possible association between IL-17F gene single nucleotide polymorphism (SNP) at rs 7488A/G and PIT susceptibility in Egyptian pediatric patients.

 

Subjects and Methods: A total of 50 children with PIT with mean age of 7 years, together with 50 age and sex matched healthy controls were enrolled in the study for evaluation. Polymerase chain reaction- restriction fragment length

polymorphism (PCR-RFLP) was used for detection of IL-17F polymorphism at rs7488A/G.

 

Results: Regarding the genotypes distribution, the frequencies of the AA, AG and GG genotypes were 96, 2, and 2% in PIT patients and 90, 10 and 0% in the control group respectively. The A and G allele frequencies were 97 and 3%

in the patients group versus 95 and 5% in the control group. There was no significant difference in either genotypes or allelic distribution between PIT patients and the controls.

 

Conclusion: our study suggests that IL17F gene polymorphism at rs7488A/G may not contribute to the susceptibility in development of primary immune thrombocytopenia in the Egyptian children.

Background & Objective: The automated blood processing system has been developed for whole blood units semiautomated, the machine was developed to separate blood components and improves the accuracy. The aim of this study was evaluate the product specifications and quality of components produced after the semi-automated system.

 

Materials & Methods: Whole blood was processed using the semi-automated system and compared and validated. Leukodepletion of blood product and packed red cells was compared between two protocols. Platelet pooled units

were compared the value of volume, hematocrit, platelet contents and white blood cell contamination of LDPRC and LDPC by SPSS statistics.

 

Results: 408 samples of whole blood were processed with reveos system. Average of fresh frozen plasma, interim platelet and leuko packed were 217.52, 62.40 and 10.2 mL, respectively. The platelet index was more than 60 cells/u

is 75.8%. The quality of LDPRC; hematocrit equals to 55.8%, volume equals to 313 mL and white cell contamination equal 0.0X106 cells/u. SPSS statistics were found that the hematocrit, volume and white blood cell contamination

were not different (P>0.01, P>0.05 and P>0.05, respectively). The quality of LDPC (N=68); platelet contents equal 3.03X1011 cells/u, volume equal 255.8 mL and white cell contamination equal 0.0X106 cells/u. All values may not

differ statistically (P>0.05). PRC from two protocols are statistically significant and they are accepted hematocrit between 65-80%.

 

Conclusions: The automated and semi-automated system LDPRC, LDPC and PRC reached the recommended quality of Council of Europe (EU), American Association of Blood Banks (AABB), National Blood Centre and Thai

Red Cross Society (TRC).

Objective: DNA repair systems have been considered to maintain genomic integrity by countering threats caused by DNA lesions. Deficiency in the DNA repair pathways might make these lesions unrepaired or repaired incorrectly,

eventually leading to genome instability or mutations which may contribute directly to cancer. Thus, genetic differences, such as single nucleotide polymorphism (SNP) may contribute to carcinogenesis. Therefore, great

interests have been aroused in the exploration of the association of SNP of DNA repair proteins and cancer risk to provide better prediction of cancer. The deficiency of DNA repair capacity related to the polymor-phisms of DNA

repair genes might play a central role in the process of HCC tumorigenesis.

 

Materials & Methods: The study was conducted on 260 subjects classified into three groups; HCC group included 100 patients; a control group of 100 age and sex matched healthy volunteers and HCV positive HCC negative group

including 60 patients. Genotyping of XRCC1 3 and 7 genes were performed by real time PCR.

 

Results: XRCC1 G28152A (rs25487) heteromutant genotype (GA) was significantly higher in HCC patients than controls (57 % vs., 36%) and conferred almost three folds increase of risk among HCC (OR=2.735, 95% CI = 1.504 - 4.97, p value = 0.001), while the homomutant genotype (AA) was higher in HCC patients than controls (10% vs., 7%), but the difference was statistically non-significant (p value = 0.094). The frequency of XRCC3 C18067T (rs861539) variant genotypes were close to that of the controls and the difference was statistically non-significant (p value = 0.24, 0.37 for the CT, TT respectively). As for XRCC7G6721T (rs7003908) the heteromutant genotype (TG) was significantly higher in HCC patients than control (56% vs., 37%) and conferred almost 2 fold increases of risk of HCC (OR =2.167, 95% CI = 1.23-3.818, p value = 0.007). The homomutant genotype (GG) was lower in HCC patient than control (20 % vs., 32%), and the difference was statistically non-significant (p value =0.587). Coinheritance of the polymorphic variants of XRCC1 (GA, AA) and XRCC7 (TG, GG) was significantly higher in HCC cases than controls and was associated with increased HCC risk (OR = 2.765, 95% CI = 1.026 - 7.449, P value = 0.038).

 

Conclusion: The result obtained by the current study provide evidence that XRCC1 G28152A (rs25487) and XRCC7 G6721T (rs7003908) genetic polymorphisms have a role in susceptibility to HCC in Egyptian population.

Noha Bassiouny Hassan did her MD Clinical Pathology in Faculty of Medicine at Ain Shams University. She is working as a Lecturer of Clinical Pathology Hematology unit. She has a membership in the Egyptian Society of Thrombosis and Hemostasis.

Introduction & Aim: Immunohistochemistry (IHC) enables the examination of a greater number of trephine biopsy levels and is helpful in determining additional scattered malignant cells. The aim of this study is to detect extrapattern and subtle lymphomatous infiltration in bone marrow biopsies using CD20 and CD3 immunostaining.

 

Patients & Methods: This study was conducted on 100 newly diagnosed Non Hodgkin Lymphoma (NHL) patients. Their bone marrow trephine biopsies were assessed on routine histology [Hematoxylin and Eosin (H & E)] and were

further subjected to IHC using CD20 and CD3.

 

Results: Pattern of involvement by H&E was highlighted by IHC. It showed additional interstitial pattern in nine cases, parasinusoidal streaks in one case and highlighted a patchy pattern in another case with interstitial involvement

on H&E. IHC also detected subtle infiltrations on additional 5.5% cases compared with histology alone. It helped in differentiating reactive (12 cases) and malignant lymphoid infiltration (33 cases).

 

Conclusion: CD20 and CD3 immunostaining performed routinely on bone marrow trephine biopsies has the ability to reveal extra-pattern of infiltration and improve detection of subtle lymphoid involvement. A combined procedure identifying several distinctive features in particular histotopography and IHC, provides a promising way of discriminating reactive from neoplastic lymphoid infiltrates in bone marrow trephine biopsies.

 

 

Matthew Frome is Senior Manager of Business Development at Thermo Fisher Scientific. He brings over 20 years of industry experience. Most recently, he was VP of Business Development at Linkage Biosciences (acquired by Thermo Fisher Scientific in 2018), and Director of Business Development at Solazyme. Before Solazyme, author founded Focus Biology, a start-up bioinformatics company. Prior to Focus, he held various roles of increasing responsibility at GE Healthcare (Amersham Biosciences/Molecular Dynamics), Sangamo Biosciences, Applied Biosystems and Sungene Technologies. He received an MBA and Masters of Public Health from the University of California, Berkeley and a MS in Biology from Stanford University.

Statement of the Problem: Blood typing using serology can provide an inaccurate answer if a patient is recently transfused, taking oncology therapeutics like Darzalex, or has weak or partial antigens. Antisera are not always available for rare antigens. Chronically transfused patients can avoid alloimmunization by receiving antigen-negative blood units, but building a complete patient or donor antigen profile using serology is labor-intensive and can take days. Blood genotyping using traditional methods such as SSP and SSO overcome the limitations of serotyping, but require long, labor-intensive workflows and limited resolution. Blood genotyping using Sanger or NGS sequencing technology have high resolution, but are even more time and labor consuming, expensive and require interpretation by subject matter experts.

 

Solution: Thermo Fisher Scientific’s Link SÄ“q real-time PCR technology accelerates turn-around times reducing laboratory costs and provides medium to high resolution results that can be interpreted by clinicians and interrogated

by genotyping experts. LinkSÄ“q utilizes allele specific PCR reactions to identify important variants and its SureTyper™ software analyzes reaction results to automatically determine the genotype and predict a phenotype. LinkSÄ“q was developed over 10 years ago for genotyping the complex Human Leukocyte Antigen (HLA) system and can be performed on the same equipment as real-time PCR based HLA typing assays, which are widely used for deceased donor typing.

 

Conclusion & Significance: LinkSÄ“q blood genotyping solutions overcome the major challenges of molecular typing by providing a robust, automated approach that increases laboratory productivity and reduces turn-around time.

With less than 10 minutes of hands on set-up, no further operator intervention with reagents and SureTyper software by fully automating all analysis, LinkSÄ“q delivers genotyping and predicted phenotyping results in approximately 90 minutes.

Puthida Tantanapornkul has completed her bachelor’s degree from faculty of Associated Medical Science at Khon Kaen University, Thailand. She is working as a supervisor in blood transfusion science at Khon Kaen University.

Statement of the problem: Cross match and transfused ratio (C/T ratio) in 2015 in Srinagarind hospital was 1.6 the red cells (RC) unit requested was 33,508 units, transfused were 22,951 units and returned to blood bank were 10,557 units. 60% for RC supply brought wastes in blood expired and work load. They lead us to implement new method and set type and screen channel for un-risk diagnosis. Blood logistics was started at end of 2015 to transfer the RC units confirmed.

 

Methodology: RC units transfer by logistic system was collected in September 2016 to May 2018. The data was defined into diagnosis and monitor the transferred and transfused ratio (T/T ratio).

 

Objective: To evaluate in-patient’s diagnosis who risk to RC transfusion, to reduce blood supply and to reduce C/T ratio.

 

Finding: C/T ratio from 2015 to 2018 was 1.72, 1.72, 1.68 and 1.68, respectively and T/T ratio calculated 1.3, 1.3, 1.4 and 1.4 respectively. From 53 wards in tertiary hospital, 38 wards (71.7%) has T/T ratio <1.5; were intensive care units (MICU, PICU, SEICU, CCU, CVT ICU, NICU, NSICU), semi crisis units, chemotherapy patients, radiation patients. otherwise T/T ratio more than 1.5(28.3%).

 

Conclusion and discussion: T/T ratios lower than C/T ratio 37% and 28.3% from 53 wards can consider for on call matching. 31,818 USD (10,557 tests X 3.0 USD) from cross matching cost can provide to other plan. Therefore blood

stock should be re-considered and RC expired can be reduced from 6% to 4% in 2018.

 

Statement of the Problem: Breast cancer patients are at an increased risk for thrombotic events such as deep vein thrombosis (DVT) and venous thromboembolism (VTE), drastically affecting survival and quality life of patients post treatment. It has been proposed that this increased risk is caused by cancer associated inflammation induced hyper coagulation, a key factor involved in thrombus formation.

 

Methodology & Theoretical Orientation: This study utilized microscopy and rheological techniques to examine coagulation components during clot formation, in order to obtain a better understanding of how changes to these

components may increase thrombus formation and thus the risk of thrombotic events. Whole blood from treatment naïve breast cancer patients were compared to whole blood from healthy controls. Routine clinical tests were used to obtain an overall clinical picture of each participant. Scanning electron microscopy was used to study the fine ultrastructure of the red blood cells and platelets. Thromboelastography (TEG) was used to study the changes in clot

dynamics during coagulation.

 

Findings: SEM showed platelets to be activated as well as a presence of spontaneous fibrin fibre formation. Also, red

blood cells from the patient group showed more irregular surface membranes, increased agglutination and eryptosis

when compared to healthy controls. Results from the TEG showed that clots form faster in breast cancer patients with increased strength and rigidity, thus revealing the hypercoagulable nature of whole blood in this patient group.

The results in this study have revealed the marked differences in coagulation and associated blood components between healthy controls and treatment naïve breast cancer patients.

 

Conclusion & Significance: They provide a greater understanding of clot formation dynamics and have shown that even in a small sample size, breast cancer patients are at an increased risk of thrombotic events, traceable through

rheological techniques. This justifies further investigation into the utilization of these techniques in a clinical, point of care setting, in order to increase the chance of survival and quality of life for these patient’s post-treatment.

Pierluigi Alfieri, born in Taranto (Italy) in 1979, is a clinical hematologist with expertise in palliative care and home care for patients with leukemia, lymphoma,

myeloma. In 2005 he was appointed as visiting clinical fellow at Warwick Hospital. In 2008 he won a grant by European Hematology Association for a presentation on home transfusions. He has collaborated with several fundraising associations involved in delivering specialist onco-hematological care at home, such as AIL, LILT and GRADE.

In order to prevent discomfort due to prolonged hospitalization, driving distances and long waiting times and to maintain quality of life among unfit and frail patients with blood malignancies, home care is considered a valid integration to the standard in-hospital services. Since the late ‘90s in Italy domiciliary programs of supportive and palliative care for hematology patients have been run generally by local no-profit organizations and only more

recently by public health system. The home care team is usually composed by a hematologist and a specialist nurse with expertise in palliative care, who work side-by-side with general practitioners. According to the phase of disease, prognosis and type of interventions, we distinguish three different clinical settings: 1) home care for terminally ill patients requiring exclusively palliation, control of severe symptoms and end-of-life care; 2) home care for

chronically ill patients (i.e. myelodisplastic syndromes or myeloma) with the aim to provide supportive care outside the hospital; 3) home care for actively treated patients (i.e. after chemotherapy or bone marrow transplant) with

the purpose to anticipate discharge from hospital, reduce infectious risks and shorten recovery time. Blood and platelets transfusions and subcutaneous/oral chemotherapies are routinely delivered and administered at home, even in the setting of patients in advanced phases of disease when there is an expected improvement on fatigue, dyspnea, bleeding risks. One of the potential benefits for hematology patients assisted at home is the appropriateness of the place where to spend the end-of-life period until death. Regardless of cultural issues and preferences, patients with leukemia/lymphoma/myeloma die more probably in acute hospital beds instead of at home or in a hospice, due to the lack of network around families and caregivers while they have to face alone high symptom burden and/or severe complications. Home care has achieved a relevant role in the global management of unfit and frail patients with blood malignancies improving quality of life and reducing healthcare costs. When entrusted to a full-time specialist team through a careful selection of patients, home care seems promising in terms of feasibility, sustainability and safety.

 

Cruciani M is a Nurse Specialist in Palliative Care, Home Care and Pain Management. He is interested in clinical, educational and research issues regarding palliative care. He is President and Founding Member of the non-profit association “Zero K”, based in Carpi (Modena) and involved in promoting, developing and sharing the culture of palliative care though all forms of arts like photography, cinema, music and drama.

According to the current definition of EAPC (European Association for Palliative Care) palliative care is the active, total care of the patients whose disease is not responsive to curative treatment. Control of pain of other symptom and of social, psychological and spiritual problems is paramount. Although, early palliative care has already demonstrated efficacy in the management of physical, psychological and spiritual symptoms among cancer patients, interventions of simultaneous care are not yet routinely provided in hematology units. Since, patients with blood and lymphoid malignancies in advanced phases of disease generally present a significant symptom burden (fatigue, bleeding and infection risks, fever, dyspnea, pain), the role of palliative care is to support patients and families and to cooperate with the specialist care team in the decision making process and in the caregiving, especially during the transition time from active treatment to the end-of-life. Nursing has a central role in the daily assistance and in critical phases: according to the model of primary nursing and relationship based care, nurses - more than doctors - may recognize those needs that are often hidden behind non-physical symptoms (fear of death/fear of suffering) and address emerging problems to the multidisciplinary team. One of the main unmet needs in the setting of terminally ill hematology patients is the appropriateness of the place of death: a large majority of patients die in acute hospital beds. Any concern about the end-of-life care should be faced at the right time – earlier and simultaneously when there is room enough for the patient to make a conscious choice regarding the place of care, the acceptance/refuse of further lines of antineoplastic therapies, the balance between quality of life and life expectancy.

Recent Publications

1. Hochman M J et al., (2018) Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies. J Pain Symptom Manage 55(1):82-88.

2. Howell D A et al., (2011) Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data. Palliative Medicine 25(6):630-641.

3. Howell D A et al., (2013) Place of death in haematological malignancy: variations by disease sub-type and time from diagnosis to death. BMC Palliative Care 12:42.

4. Epstein A S et al., (2012) Palliative care and hematologic oncology: the promise of collaboration. Blood Reviews 26:233-239.

5. Howell D A et al., (2017) Preferred and actual place of death in haematological malignancy. BMJ Supportive and Palliative Care 7:150-157.

Giulia Ciacci, born in Perugia in 1992, is a nurse specialist in Palliative Care and Pain Management. She currently works in a Pediatric Hematology-Oncology Unit. Her interests are mainly focused on research and promotion of palliative care.

Acute lymphoblastic leukemia in pediatric age is analyzed through a clinical overview and then moves on to the physical and psychological needs of the child and his family during the whole treatment process. Then it was wanted to retrace the professional development and growth of the nurse, who over the years has acquired skills, autonomy and responsibility and who, within a multi-professional team, is a point of reference for the assisted and his family. In addition, both the importance of nursing care in a care path in which technical-practical and above all communication-relational skills are required and the importance of a personalized care process through the use of theoretical nursing models for the detection of bio-psycho-social needs are taken into consideration. Taking care and communication/relationship can improve the quality of life of the child affected by acute lymphoblastic leukemia and his family.

Recent Publications

1. Training / information for the oncohematology pediatric nurse: the relationship as a treatment tool. Pediatric Reports 2012; 4: s2. Prencipe A

2. Nursing diagnosis. Definitions and classifications. 2012. Rigon LA