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Acute thrombotic thrombocytopenic purpura (TTP) is a life‐threatening emergency and plasma exchange (PEX) is the initial treatment shown to reduce acute mortality.

Acute thrombotic thrombocytopenic purpura (TTP) is a life‐threatening emergency and plasma exchange (PEX) is the initial treatment shown to reduce acute mortality. 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. The trainee research network HaemSTAR conducted a retrospective nationwide review of adults presenting to UK hospitals with a first episode of acute TTP. 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. 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.

•Ibrutinib ± rituximab was effective and well tolerated as first-line MCL therapy; outcomes were worse in patients with high-risk disease.•Novel approaches are needed for patients with high-risk MCL and those with progressive disease after first-line ibrutinib.

Introduction: Hip fracture remains the biggest single source of morbidity and mortality in the elderly trauma population, and any intervention focused on quality improvement and system efficiency is beneficial for both patients and clinicians. Two of the variables contributory to improving care and efficiency are time to theater and length of stay, with the overall goal being to improve care as reflected within the achievement of best practice tariff. One of the biggest barriers to optimizing these variables is preinjury anticoagulation.Method: Building on our previous work with warfarin in this population, we utilized a regional hip fracture collaborative network collecting prospective data through the National Hip Fracture Database with custom fields pertaining to all agents, including novel oral anticoagulants.Results: In all, 1965 hip fracture patients median age 83 years (1639 not anticoagulated) were admitted to the 5 centers over 12 months. Median length of stay was 20.71 days; time to theater 23.09 hours, and the populations (anticoagulated vs control) were evenly matched for injury. Anticoagulated patients were delayed to theater (P≤ .001), were inpatients for longer (P≤ .001) and gained less best practice tariff (P≤ .05). All variables per agent were noted and the impact of each assessed.Conclusions: Despite the widespread use of newer anticoagulants, popular due to unmonitored reversal and administration, patients stay longer in hospital and wait longer for surgery than nonanticoagulated patients of the same age and injury. Contemporary perioperative practices impact negatively on the ability to perform timely surgery on hip fracture patients. We propose a guideline specific to the management of anticoagulation in the hip fracture population to aid the optimum preparation of patients for theater, achievement of timely surgery, and potentially reduce length of stay.

Maddox: Janssen: Other: Funding to attend ASH 2016 (travel, accommodation, registration); Boehringer-Ingelheim: Other: Funding to attend ASH 2014 (travel, accommodation, registration).

Maddox: Janssen: Other: Funding to attend ASH 2016 (travel, accommodation, registration); Boehringer-Ingelheim: Other: Funding to attend ASH 2014 (travel, accommodation, registration).

It is difficult to find figures for the expected rate of early mortality in diffuse large B-cell non-Hodgkin lymphoma (DLBCL) as many of the patients who are destined to die early do not enter clinical trials. Our own rate of early mortality (death within 100 days of the diagnostic test being performed) was higher than we had anticipated (23%). We undertook a study to look at risk factors for early mortality, and to see if there were any factors which could be improved by altering our investigation and initial management.

We describe the successful administration of ibrutinib via nasogastic (NG) tube & percutaneous endoscopic gastrostomy (PEG)tube. It was not previously known by the manufacturer if this route of administration was possible.

The community anticoagulant service in Tayside, Scotland provides point of care testing for around 5000 patients at 25 sites using 43 analysers. Since December 2004 this service has used the Hemochron Junior Signature (HJS) analyser (International Technidyne Corporation) for INR measurement. Following satisfactory initial laboratory evaluation, we have compared results of capillary samples analysed using the HJS to venous samples collected simultaneously and analysed in Ninewells Hospital using a Sysmex CA1500 analyser. Reagents used were Citrate PT test cuvettes (International Technidyne Corporation) which uses rabbit brain thromboplastin for the HJS and Dade Innovin (Dade Behring) for the CA1500. Samples for comparison were collected randomly from approximately every tenth patient tested in the anticoagulant clinics for a 12 month period. Results of the comparison are given for 3 separate periods within the 12 months of study as ongoing analysis of data during the study period led to the introduction of a correction factor for results obtained using the HJS analyser. The first correction factor was introduced after the first 4 weeks of study and there was a subsequent revision of this correction factor after a further 5 months. Results for these 3 periods are as follows (all results given are INR units). Period 1: Mean INR 2.8 CA 1500 vs. 3.8 HJS, mean difference −1.0, 95% upper limit of agreement 0.5, 95% lower limit of agreement −2.5 (n=145). Period 2: Mean INR 2.6 CA 1500 vs. 2.7 HJS, mean difference −0.1, 95% upper limit of agreement 1.1, 95% lower limit of agreement −1.2 (n=345). Period 3: Mean INR 2.7 CA 1500 vs. 2.8 HJS, mean difference 0.0, 95% upper limit of agreement 1.3, 95% lower limit of agreement −1.3 (n=662). Additionally, local external quality assurance was performed on 13 occasions (683 total tests) during the period of study. Cumulative results demonstrate that 86% of results were within 15% of the median. We have demonstrated an approach to quality assurance for oral anticoagulant point of care testing and conclude that the HJS is a suitable analyser for this purpose.

The community anticoagulant service in Tayside, Scotland provides point of care testing for around 5000 patients at 25 sites using 43 analysers. Since December 2004 this service has used the Hemochron Junior Signature (HJS) analyser (International Technidyne Corporation) for INR measurement.