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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.

Antimicrobial resistance (AMR) in anaerobic bacteria varies greatly between institutions and countries. It is crucial that we have robust and widely available methods and perform regular surveillance to raise awareness of AMR amongst laboratory and clinical teams.

The UKARU offers a UK-wide service for the identification and antimicrobial susceptibility testing (AST) of anaerobic clinical isolates. Since 2016, this service has included weekly AST by agar dilution. The MIC population distributions for isolates referred are presented in real time via the ARUMIC platform, facilitating continuous monitoring of the development of resistance and valuable data for the review and development of epidemiological cut-offs (ECOFFs) and species-specific breakpoints, alongside the European Committee for Antimicrobial Susceptibility Testing (EUCAST).

During 2017 – 2021 EUCAST and the UKARU reviewed the AST methodology and breakpoints for anaerobes and developed a standardised disk diffusion method. Fastidious Anaerobe Agar with horse blood (FAA-HB) was used to test the most commonly isolated anaerobic bacteria including Bacteroides spp (n=170), Prevotella spp. (n=49), Fusobacterium necrophorum (n=51), Clostridium perfringens (n=58) and Cutibacterium acnes(n=54). The antimicrobials included for the initial phase were benzylpenicillin, piperacillin-tazobactam, meropenem, metronidazole and clindamycin with vancomycin included for the Gram positive organisms. Breakpoints for additional agents have just been published on the EUCAST website.

This lecture will provide insights into the development of AMR in anaerobic bacteria, the available AST methodologies and the importance of surveillance for this important group of pathogens.

Join some of our panel members for our lunchtime session where we will be hosting an antibody workshop. Looking at different types of antibodies and how to positively identify or eliminate any suspected clincially significant antibodies, whilst testing your knowledge and skills.

The aim is to make the session fun and interactive, focusing on some top tips for solving those antibody mysteries.

Many of us have diagnosed, treated or researched Clostridiodes difficile infection (CDI) for many years and probably know the organism and the disease it produces very well indeed. But how well do we really know it? In truth, we only know this from our own perspective. What is it really like to suffer from CDI? How well do the pathways and guidance we contribute to function in the experience patients?

This talk will focus on patient experiences of CDI, what they can teach us as clinicians and researchers and why involving patients and the public in designing our research and clinical services can help everyone.

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.

There are complex regulatory changes taking place across the UK and the EU, which could have a significant impact on laboratory services. This session will cover what you need to know to keep on top of this and know what actions you should be taking for compliance.

Clinical Liaison Role in Wales – an update on the journey so far

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

COVID – current issues

CRYOSTAT 2 trial