Monday, 17 November 2014

Dr Ri Scarborough writes about going to Perth with an SPHPM Travel Grant

Kylie Venardos, Gemma Crighton, Ri Scarborough,
Gaby Abelskamp & Erica Wood (not pictured) travelled
to Perth for the HAA meeting
Last month Dr Ri Scarborough traveled to Perth on an SPHPM Travel Grant to attend HAA 2014. Have a read of her experience below.

By Dr Ri Scarborough

The HAA meeting is Australasia’s premier haematology conference, comprising the annual meeting of three organisations: ANZSBT (Australia and New Zealand Society of Blood Transfusion); HSANZ (Haematology Society of Australia and New Zealand) and ASTH (Australasian Society of Thrombosis and Haemostasis). Naturally, this is an important meeting for SPHPM’s Transfusion Research Unit, and this year, five of us made the trip to Perth. SPHPM generously supported my travel for this meeting. It was a very productive trip for both of my projects, the NAIT Registry and the Haemoglobinopathy Registry, and I am grateful for the school’s support.


NAIT Registry presentation

Gemma Crighton presents data from the NAIT Registry
One of the most important reasons for me to be at this conference was to be involved in the first public presentation of data from the national NAIT Registry, which I have been managing for the last 18 months. NAIT (or neonatal alloimmune thrombocytopenia) is a rare and serious disorder in which a pregnant woman makes antibodies against her baby’s platelets, due to a platelet antigen mismatch between the father and the mother. Presentation varies from asymptomatic thrombocytopenia to massive intracranial haemorrhage and death. If anticipated or detected during the pregnancy, NAIT can be managed with IVIg (intravenous immunoglobulin) and sometimes corticosteroids, which reduce the production of anti-platelet antibodies as well as reducing transplacental transmission of antibodies. Often this treatment results in a baby with a normal platelet count at birth, but sometimes, despite the best antenatal care, these babies are born with dangerously low platelets and require treatment (IVIg/platelet transfusions). The NAIT Registry has been collecting NAIT data from Australian hospitals since 2009. Dr Gemma Crighton (pictured left) presented the data on the first 58 cases of NAIT submitted to the registry, for which she won the ANZSBT Presidential Award.


Other presentations

I also attended several presentations on topics related to the NAIT (neonatal alloimmune thrombocytopenia) Registry and Haemoglobinopathy Registry. Of particular relevance were the following presentations:
    Heyu Ni discusses impaired angiogenesis in intracranial haemorrhage in NAIT
Heyu Ni from the University of Toronto discussed the possible mechanism of the most-feared sequela of NAIT: intracranial haemorrhage in the foetus or newborn baby. Interestingly, his team found that it is not thrombocytopenia per se that is responsible for intracranial haemorrhage, but impaired blood vessel formation in the foetal brain. The team created two mouse models of NAIT which mirror those that occur in humans – one where the mother mice made antibodies against loci on the platelet β3 integrin (the most common situation in humans) and another with a rarer type, with antibodies directed against the platelet glycoprotein complex GPIbα. Both groups birthed babies with low platelets, but only the anti-β3 integrin group suffered intracranial haemorrhage. Why? The retinas and brains of the mouse pups in the anti-β3 integrin had reduced blood vessel density, impaired angiogenic signalling, and increased endothelial cell apoptosis; in other words, the brain vessels had failed to form normally, leaving them at high risk of bleeding. When the mothers in the anti-β3 integrin group were given intravenous immunoglobulin (IVIg) during pregnancy, the antibodies’ effect on angiogenesis was markedly reduced. My thoughts on the clinical application of these findings were that the risk of intracranial haemorrhage in human pregnancies affected by NAIT could be stratified according to the specific antibody detected in the mother, and the use of IVIg (an expensive plasma product with some adverse effects) could also be stratified in this way.
Mark Yazer from the University of Pittsburgh manages a centralised blood service in the city of Pittsburgh. One of the challenges for this blood service, as for our own in Australia, is meeting the needs of patients who require many red cell transfusions over their lifetimes, such as those with haemoglobinopathies (sickle cell disease and thalassaemias). These patients are exposed to the blood of many different donors, and although donor and patient are routinely matched for ABO group, Rh-D and Kell antigens, there are hundreds of other red cell antigens which are not routinely tested for, and patients often form antibodies to these. Over time, it becomes increasingly difficult to find donor red cells that these patients don’t have antibodies against – and this is bad news for the patient who relies on donor blood to survive. Genotyping is one answer to this problem. The Pittsburgh Central Blood Bank has started genotyping their blood donors and blood recipients to markedly improve the level of antigen matching for each transfused unit, and thereby reduce the production of red cell alloantibodies in patients. Although genotyping is an expensive process, it only needs to be done once per patient/donor and in fact, is cheaper overall and more reliable than the previous processes used to minimise alloimmunisation risk for recipients.
Tanya Powley from the Blood Service Queensland spoke about the changing demographics of blood recipients and blood donors in Australia and the challenges this creates for the provision of blood products. In essence, the population of blood donors is mostly Caucasian, but many blood recipients are non-Caucasian and may react to the common antigens in Caucasian donor blood. There is increasing demand for blood phenotypes that are rare or non-existent in the Australian donor group. This is particularly relevant to the Haemoglobinopathy Registry, as many patients with sickle cell disease are from minority ethnic groups with quite different red cell phenotypes to the Caucasian population and there are real challenges in finding compatible blood for some of them. Tanya talked about some of the strategies the Blood Service is employing to meet the needs of these patients, including actively recruiting patients’ families as blood donors, public campaigns for new donors within specific ethnic groups, maintaining an inventory of frozen blood products from donors with rare blood types and a panel of donors with rare blood types who can be called upon for “directed” donations.
Leo van der Watering from the University of Leiden, The Netherlands, ran an evening masterclass on “Getting more out of your data”. He had many helpful tips on how to analyse and report data to maximise its usefulness, and submitting to journals. 
Ri Scarborough and Jill Finlayson from PathWest (WA)
chair an ANZSBT session


Chairing a session

As a newly-minted member of the ANZSBT, and being very new to the field of transfusion science, I was surprised and delighted to be invited to co-chair an afternoon session of the ANZSBT stream of the conference. This was not as scary as I expected, and I enjoyed the opportunity to meet the speakers and some of the ANZSBT organising committee.



I also participated in a number of important private meetings at the conference:
+ With Tanya Powley, from the Blood Service Queensland, who will play an important role in a project relating to the Haemoglobinopathy Registry
+ With Giselle Kidson-Gerber, a haematologist from NSW, regarding a possible project regarding screening and antenatal issues around haemoglobinopathies
+ With potential industry partners for the Haemoglobinopathy Registry: Haemonetics, Grifols and bioCSL
+ With Haemoglobinopathy Registry steering committee members and stakeholders from around the country, to discuss NHRMC Partnership Grant ideas – chaired by Merrole Cole-Sinclair and attended by Joy Ho, Erica Wood, Cathy Cole, Simon McRae, Jill Finlayson, Reza Ghassemifar, Ray Banh, Giselle Kidson-Gerber, Juliana Teo


Site Visit

Whilst in Perth, I took the opportunity to visit one of the NAIT Registry participating sites, King Edward Memorial Hospital, where I met a local neonatologist, who is a supporter of the NAIT Registry. This was a really worthwhile meeting for the project, but also a great opportunity to view a piece of Art Deco Architecture.

TRU’s Ri Scarborough, Kylie Venardos, 
Gemma Crighton and Gaby Abelskamp 
at the conference Gala Dinner

There was also time for a little bit of relaxation. My Transfusion Research Unit colleagues and I attended the conference Gala Dinner, which was a pleasant change of pace between intense doses of transfusion science!

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