12th Congress of the European Hematology ... - Haematologica

a less favorable prognosis. Interestingly, our findings concerning the
amplification of the AML1 gene in one case and the heterozygous deletion
of the MLL gene in two TEL/AML1 + cases, agree well with recent
reports considering these aberrations as new non-random recurrent
abnormalities in childhood ALL.
1283
THE THROMBOCYTOPENIA DOES NOT EXCLUDE THE INCIDENCE OF DEEP VEIN
THROMBOSIS IN PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES
M. Jamrozek-Jedlinska, 1 A. Grzywacz, 2 J. Dziamska, 2 I. Jedlinski, 3
K. Zawilska4 1 Strus Hospital, POZNAN; 2 Department of Hematology, POZNAN; 3 Department
of Cardiology, POZNAN; 4 University of Medical Sciences, POZNAN,
Poland
The role of platelets is well established in the development of arterial
thrombotic disorders but questioned in venous thrombosis. We present
5 case reports of deep vein thrombosis (DVT) which occurred in
patients (pts) with thrombocytopenia (grade 3/4) in the course of haematological
neoplasms. The patients were admitted to our department
because of : acute myeloid leucaemia (n=3) (M2, M3) , mantle cell lymphoma
(n=1) and lymphocytic lymphoma (n=1). Thrombocytopenia
resulted from marrow infiltration (n=2) or post -chemotherapy marrow
aplasia (n=3). The following thrombotic risk factors were found : immobilization
(n=5), long term central venous catheter (n=2), chemoterapy
(n=3). All pts presented with typical clinical signs of thrombosis and the
diagnosis of DVT was confirmed by duplex Doppler ultrasonography in
all cases. Localisation of thrombosis included deep veins of lower limbs
(n=5) as well as at the site of central venous catheter insertion (n=2).
Patients were not exposed to heparin (icluding intravascular catheter
flushes) before the first thrombotic episode. Standard treatment with i.v.
unfractionated heparin was applied maintaining aPTT within the therapeutical
range, followed by secondary prophylaxis with a medium dose
of enoxaparine s.c. or oral anticoagulant (INR 2.0-3.0). No severe bleeding
complications were observed but in two still thrombocytopenic pts,
DVT relapsed during anticoagulation treatment at other site then their
previous episode. Fortunately, the course of DVT was not fatal but it prolonged
hospitalization and led to delayed treatment of primary haematologic
disease. Conclusions. Thrombocytopenia dose not prevent deep
vein thrombosis in the course of haematological malignancies and standard
secondary prophylaxis is not effective in some cases. Further studies
are needed to evaluate the trigger factors for clot formation in thrombocytopenic
patients.
1284
WHO OVERCOME PVSG DIAGNOSTIC CRITERIA FOR PATIENTS OF THE REGISTRO
ITALIANO TROMBOCITEMIA (RIT)
L. Gugliotta, 1 A. Tieghi, 2 B. Martino, 2 M. Lunghi, 2 F. Ripamonti, 2
V. Martinelli, 3 E. Rumi, 2 P. Scalzulli, 2 P. Carluccio, 2 A. Dragani, 2
C. Santoro, 4 F. Palmieri, 2 A. Candoni, 2 E. Antonioli2 1 Arcispedale S. Maria Nuova, REGGIO EMILIA; 2 Hematology Unit, REGGIO
EMILIA; 3 Hematology University Federico II, NAPOLI; 4 Hematology University
La Sapienza, ROME, Italy
The Registro Italiano Trombocitemia ( RIT), that is a GIMEMA project,
has been activated in order to registry Italian ET patients, to improve
the diagnosis appropriateness (WHO criteria), to promote the acquisition
of biological data, to evaluate the compliance to the therapeutical guidelines
of the Italian Society of Haematology (SIE), to monitor in particular
the ET patients receiving Interferons α and Anagrelide, to evaluate
cases of pregnancy, paediatric age and familiarity, to define the prognostic
value of the biological factors, to create a network for activation of
new clinical and biological studies. The RIT, co-ordinated by the Haematology
Unit of Reggio Emilia, is a web-based registry that, beside a public
area, comprehends a database of Italian ET patients. The data, with
respect of the privacy rules, are object of validation and analysis by various
RIT expert subcommittees. Eighty-six haematological Institutions
adhered to the RIT, 1242 patients have been registered since June 2005
and 1060 of them are object of the present clinical-haematological analysis.
The use of the WHO classification is interestingly increasing (27%
before 2004 and 61% in the year 2006). The patients, 651 females (61%)
and 409 males (39%), F:M ratio 1.6, showed median age 60 years (males
64, females 58), age below 40 yr (16%), 41-60 yr (35%), 61-70 yr (19%),
over 70 yr (30%). At diagnosis the platelet count (109/L) was 400-600
(13%), 601-1000 (66%), 1001-1500 (17%), over 1500 (4%) with a mean
12 th Congress of the European Hematology Association
864±315 and a median value 787 (males 758, females 804). The haematocrit
value (Hct, %) was significantly higher in males (median 44.4, over
48 in 17% of cases) than in females (median 41.8, over 48 in 6% of cases).
The WBC count (1012/L) was 9.1± 2.7 with no difference between
males and females. Thrombosis and haemorrhage were observed
before/at diagnosis in 19% e 5% of cases, respectively. At diagnosis the
patients presented disease related symptoms and general thrombotic
risk factors in 42% and 79% respectively; the splenomegaly according
to physical examination and ultrasound evaluation was reported in 21%
and 44% of cases, respectively. The bcr/abl evaluation was always performed
and the kariotype study documented a random abnormality in
3.4% of the valuable cases. To improve the diagnostic approach, the
RIT has promoted the bone marrow biopsy centralized revision (WHO
criteria) and the acquisition of the new biological parameters (JAK2,
CD34 + peripheral cells). The 115 reported pregnancies are object of a separete
abstract. Antiplatelet drugs were administered in 75% of patients
and cytoreduction was performed in 70% of cases, with use of Hydroxyurea
(51%), Anagrelide (12%), Interferons α (12%), Pipobroman (3%),
Busulfan (2%). A separate analysis for patients treated with Anagrelide
and Iterferons α is in progress. The follow-up data are presently not
reported.
1285
THE TYPE AND SCREEN PROCEDURE: EFFECTIVENESS AND APPLICATION
IN AN EMERGENCY DEPARTMENT
M.A. Molina, 1 J. Peinado, 2 J.A. García, 2 R. Pérez, 2 M.J. Giménez, 3
M.T. Gallego, 2 C.J. Fresneda, 2 R. Criado, 2 M.J. Jiménez, 2 C. Avivar2 1 Empresa Pública Hospital de Poniente, EL EJIDO. ALMERÍA; 2 Hospital de
Poniente, EL EJIDO ALMERÍA; 3 Transfusion Center, ALMERÍA, Spain
Background. The Type and Screen (TS) procedure is a part of the pretransfusional
testing strategy, and is based on the determination of ABO-
Rh type as well as screening for unexpected antibodies. TS strategy was
initially conceived as an alternative to crossmatching in scheduled surgery.
However, literature is scarce concerning its effectiveness in Emergency
Departments, where request forms for crossmatch and hold blood
for patients in situations such as digestive bleeding, multiple trauma,
etc… are common and frequently wasteful of donor blood. Aims. To
evaluate the results obtained following the implementation of a TS strategy
in our hospital’s Emergency Department. We previously organized
continuous educational workshops on the subject, aimed at both medical
and nursing staff. Methods. We revised transfusion requests and effective
transfusion indexes throughout the previous two years (stage 1) as
well as the two years following implementation of the TS strategy in our
hospital’s Emergency Department (stage 2). Results. In stage 1, 870 TS
requests were registered in our hospital. In stage 2, a total of 1,314 were
ordered, 487 of which (37.1%) came from the Emergency Department.
Of these, only 111 (22.7%) cases eventually required blood crossmatching.
If we accept an average of two packed red cell units per transfusion
request, a total of 752 crossmatching tests would be avoided. The transfusion
percentage for this department in stage 1 was 69.3% (1,486 units
were transfused from 2,144 requested), with a crossmatched / transfused
ratio, C:T ratio, of 1:44. In stage 2, 1,695 units were crossmatched,
1,344 of which were transfused, with and transfusion index of 79.3%
and a C:T ratio of 1:26, significantly lower than that in stage 1. If we had
crossmatched all 752 units that were saved, the global hospital transfusion
percentage would have been 67.2% (against the actual 75.1%).
With regards to only the Emergency Department, the index would have
been 54.9% (against the actual 79.3%). The global hospital transfusion
percentage in stage 1 was 70,1% (C:T ratio 1:43, with 7,729 units
requested and 5,414 transfused). In stage 2, the index was 75.1% (C:T
ratio 1:33), with 4,815 units transfused from 6,411 requested. Assuming
a 17€ cost for every unit that is tested, the global saving totals 12,784€,
when considering only these two years in this single department. Conclusions.
1. The Type and Screen procedure has proved to be effective in
a non-surgical area, such as in an Emergency Department, where the
holding of blood is a common practice, even in situations when transfusion
is not finally required. 2. Its implementation has resulted in a
remarkable cost saving, the optimization of human resources in the
Blood Bank, and most importantly, an improvement in the use of donor
blood. 3. The above-mentioned fact, which is difficult to quantify, gives
blood banks higher operational effectiveness in real emergency situations,
with no associated reduction in transfusional safety. 4. The procedure’s
management has been possible thanks to the close cooperation
between members of the hospital’s Transfusion Committee, whose
main aims are in ensuring proper transfusional practice.
haematologica/the hematology journal | 2007; 92(s1) | 465