Events on 27 September 2023
CONGRESS 2023 - Coagulation for Blood Bankers: Help! I’ve lost the clot….
27/09/2023
Coagulation tests can be confusing, but correct interpretation is crucial to guide transfusion of blood products and haemostatic agents. Advantages and limitations of these tests will be discussed, using a variety of examples to demonstrate potential pitfalls.
Learning outcomes:
Understand appropriate use and limitations of coagulation tests
Interpretation of abnormal results
How results can guide transfusion of blood products
Recognise alternatives to blood products for haemostatic support
Learning outcomes:
Understand appropriate use and limitations of coagulation tests
Interpretation of abnormal results
How results can guide transfusion of blood products
Recognise alternatives to blood products for haemostatic support
CONGRESS 2023 - Acute obstetric coagulopathy
27/09/2023
Postpartum haemorrhage is caused by obstetric complications but may be exacerbated by haemostatic impairment. It is a common observation that placental abruption and amniotic fluid embolism are associated with a severe and early coagulopathy characterised by hypofibrinogenaemia and increased fibrinolysis.
In Cardiff, a programme of research has been undertaken investigating the early detection and replacement of fibrinogen based on viscoelastic haemostatic assays. This culminated in the development of a care bundle for postpartum haemorrhage called the Obstetric Bleeding Strategy for Wales (OBS Cymru). Introduction of the OBS Cymru intervention across Wales resulted in fewer women experiencing massive postpartum haemorrhage (defined as >2500 mL) and decreased need for blood transfusion. The intervention is being investigated further in a NIHR supported study.
At term, women have increased levels of procoagulant clotting factors and reduced anticoagulants leading to a prothrombotic state. Our study confirmed these findings and demonstrated significantly raised thrombin generation. We identified two main types of coagulopathy; a dilutional coagulopathy with coagulation factors and platelets falling progressively with bleed size. However, clinically significant reductions in clotting factors were not seen until bleeds of 3000-4000 mL had occurred due to the high starting levels. Despite this, thrombin generation did not decrease due to increased levels of factor VIII during bleeds. Similar dilution-related falls were seen with fibrinogen levels. The exception was factor XIII which falls at term and decreases further with bleed size. The clinical significance of this finding has not been investigated but could suggest a role for cryoprecipitate.
In a subgroup of women we identified an early and severe consumptive coagulopathy caused by hyperfibrinolysis with very high D-dimer and plasmin/antiplasmin complexes which we termed acute obstetric coagulopathy (AOC). In addition, women with AOC had low levels of fibrinogen and evidence of an acquired dysfibrinogenaemia demonstrated by a reduced Clauss/antigenic ratio. The coagulopathy caused depletion of factor V and factor VIII but other clotting factors and thrombin generation was preserved. An increase in activated protein C was observed but no increase in soluble thrombomodulin demonstrating similarities and differences to trauma-induced coagulopathy.
AOC occurred in about 1/1000 deliveries and was associated with a high rate of fetal and neonatal deaths. It was most commonly associated with placental abruption but occurred with all underlying causes of postpartum haemorrhage.
In Cardiff, a programme of research has been undertaken investigating the early detection and replacement of fibrinogen based on viscoelastic haemostatic assays. This culminated in the development of a care bundle for postpartum haemorrhage called the Obstetric Bleeding Strategy for Wales (OBS Cymru). Introduction of the OBS Cymru intervention across Wales resulted in fewer women experiencing massive postpartum haemorrhage (defined as >2500 mL) and decreased need for blood transfusion. The intervention is being investigated further in a NIHR supported study.
At term, women have increased levels of procoagulant clotting factors and reduced anticoagulants leading to a prothrombotic state. Our study confirmed these findings and demonstrated significantly raised thrombin generation. We identified two main types of coagulopathy; a dilutional coagulopathy with coagulation factors and platelets falling progressively with bleed size. However, clinically significant reductions in clotting factors were not seen until bleeds of 3000-4000 mL had occurred due to the high starting levels. Despite this, thrombin generation did not decrease due to increased levels of factor VIII during bleeds. Similar dilution-related falls were seen with fibrinogen levels. The exception was factor XIII which falls at term and decreases further with bleed size. The clinical significance of this finding has not been investigated but could suggest a role for cryoprecipitate.
In a subgroup of women we identified an early and severe consumptive coagulopathy caused by hyperfibrinolysis with very high D-dimer and plasmin/antiplasmin complexes which we termed acute obstetric coagulopathy (AOC). In addition, women with AOC had low levels of fibrinogen and evidence of an acquired dysfibrinogenaemia demonstrated by a reduced Clauss/antigenic ratio. The coagulopathy caused depletion of factor V and factor VIII but other clotting factors and thrombin generation was preserved. An increase in activated protein C was observed but no increase in soluble thrombomodulin demonstrating similarities and differences to trauma-induced coagulopathy.
AOC occurred in about 1/1000 deliveries and was associated with a high rate of fetal and neonatal deaths. It was most commonly associated with placental abruption but occurred with all underlying causes of postpartum haemorrhage.
CONGRESS 2023 - Performance of a new molecular Point-of-Care system for respiratory viruses under field conditions
27/09/2023
The presentation provides an overview on the technology and analytical performance of a new true molecular point of care testing system without need for upfront specimen preparation, and the potential benefits resulting from its use at the point of care. The presentation also discusses key aspects to be considered prior to implementation at the point of care
CONGRESS 2023 - Next-generation molecular diagnostics: Leveraging digital technologies to enhance multiplexing in real-time PCR
27/09/2023
Next-generation molecular diagnostics: Leveraging digital technologies to enhance multiplexing in real-time PCR
CONGRESS 2023 - Career and qualification progression in virology
27/09/2023
The dynamic of virological diagnosis has transformed dramatically over the past few years in light of the Covid-19 pandemic, with significant changes to equipment and technology, workforce, workload and expertise. This presentation looks at those changes and focuses on the challenges observed and how these will continue over the coming years for virology departments across the country.
CONGRESS 2023 - My early career Point-of-Care Testing experience
27/09/2023
This presentation will include how her career progressed to a Point of Care Testing (POCT) role in the Wales Specialist Virology Centre. It will also cover what POCT is; the method of testing, who gets tested and why POCT is crucial in the efforts to achieve the WHO initiative to eliminate Hepatitis C in Wales.
Examples of what a day-in-the-life of a "POCT-er" consists of: mass screening projects, case studies, what has been learnt from testing in prison and in the community (homeless shelters and substance misuse services). The future of POCT: what's on the horizon?
Examples of what a day-in-the-life of a "POCT-er" consists of: mass screening projects, case studies, what has been learnt from testing in prison and in the community (homeless shelters and substance misuse services). The future of POCT: what's on the horizon?
CONGRESS 2023 - Evolution of infectious disease Point-of-Care Testing (POCT) across Wales - National POCT Lead perspective
27/09/2023
Learn how infectious disease POCT services have evolved across Wales. Discover how Louise's role as a Biomedical Scientist has evolved to National infectious disease POCT lead. Discover how POCT projects are contributing towards the World Health Organisations Hepatitis C elimination targets and how we foresee future POCT services expanding.
CONGRESS 2023 - Near-patient testing - (self-collected samples; breath test to bloods)
27/09/2023
The presentation provides an overview on potential benefits and risks of near-patient testing conducted by health care professionals, including testing of self-collected specimens.