Songs without words
I am finding it hard to quietly reflect on the year we have endured because the endurance shows little sign of abating. As we wait for the healing and the resolution, we are hearing comments reported in the news that the “third wave will wash up on our shores” and that the success of our vaccine program has been because of “capitalism" and "greed". I also heard from our hospital divisional manager that there has been a significant increase in aggression toward staff on the door of our cancer centre as people assume that rules are relaxing and are increasingly frustrated about the circumstances for visitors. Sometimes, there are no words.
I will focus on what words I can muster to draw the attention of haematology professionals to an important and emerging area of haemostasis and thrombosis practice. An expert team of our peers have recently been involved in diagnosing and managing a rare syndrome of thrombosis associated with low platelets which have been reported in a few cases. At the moment, any causal association with coronavirus vaccination has not been established. However, if you identify patients with this syndrome in proximity to coronavirus vaccination, it is very important that you complete the online yellow card - this will trigger a request from MHRA for further details.
The cases are unusual because, despite the thrombocytopenia, there is progressive thrombosis, primarily venous, with a high preponderance of cerebral venous sinus thrombosis. Some arterial thrombotic events have also been noted. Testing typically reveals low fibrinogen and very raised D-Dimer levels above the level typically expected in venous thromboembolism. Antibodies to platelet factor 4 (PF4) have been identified, hence there are similarities to heparin-induced thrombocytopenia despite the absence of prior exposure to heparin treatment. The anti PF4 antibodies can be detected by the ELISA HIT assay but not always by the AccuStar assay.
It is important that the correct management is applied to prevent the progression of thrombosis. Of critical note, platelet transfusions should be avoided. Interim guidance on diagnosis and management can be found here, as can contact details for advice from the Expert Haematology Panel.
As this is an emerging area of practice, please continue to check back for updates and to monitor the literature for publications.
I am also pleased to let you know about a new BSH Special Interest Group (SIG). which will be a multi-disciplinary group focussed on the areas of laboratory haematology not already represented by national bodies, principally haematological malignancy and red cell disorders diagnostics. Haematological malignancy diagnostics in the UK will continue to be a growth area as genomics and personalised medicine become increasingly embedded in routine clinical practice, so I am pleased that BSH Genomics Working Group can have a permanent and more formalised role within the laboratory haematology SIG. Members who would like to join the lab SIG are warmly invited.