From the President

 

 

Dear Friends and Fellow THANZ members

What a frenzy the past few months have been. It is possibility the busiest, we as THANZ a professional society, have ever had in our history. It all started in April with first reports of VIPIT (later rechristened as VITT and now more broadly called TTS) reported in NEJM by Greinacher and colleagues. A flurry of activity followed as Australia had begun its vaccination roll out with the ChAdOx1 (AstraZeneca or AZ vaccine). THANZ instantly recognized the ramifications and two teams - one lead by A/Prof Vivien Chen for clinical investigation as well as management and another led by Dr Emmanuel Favaloro for ELISA testing platforms were formed. These teams met at least weekly (including on the Easter weekend!) on the Thursdays for 2 hours late in the evening discussing the challenges with diagnosis and management of VITT. A testing strategy was agreed upon nationally and a weekly update was posted on the THANZ website. Guidance for haematologists and other doctors was soon developed. Innumerable scenarios, complex clotting cases discussed and diagnostic algorithms rewritten often late into the night. A 'live' guidance statement was published on the website (subsequently published as an opinion piece in the MJA) which continues to be updated on a weekly basis.

 

An effective response to such a challenge was not only making sure the testing pathways were clear and management guidance was prompt but also in making sure the evolving data informed both regulatory authorities and national policy. The THANZ VITT advisory group comprised over 30 members all of whom participated in providing advice to local jurisdictions, pathology services and the respective state advisory bodies. My colleagues Vivien Chen, Huyen Tran and Danny Hsu along with myself were instrumental in advising ATAGI and other regulatory bodies. A result of this effort was the joint ATAGI THANZ statement issued recently. A recent online educational session by Vivien and Danny had an attendance of over a thousand GPs. Many of my colleagues have appeared in innumerable social media, radio and TV shows explaining the complexity of the challenge in exquisitely simple lay language.

 

This experience has not only humbled me but also made me realize the power of a true team spirit where the motivation is better patient outcomes and deeper understanding of the clotting conundrums. The comradery that we all saw and the countless hours as well as effort put in by many on the team was truly inspirational. Of course the joys of discussing complex coagulation is an ethereal experience to those in the field and felt many a times during these THANZ VITT late night group meetings.

 

My heartfelt thanks to everyone who has contributed to this journey - there are too many to name. In my previous letter I wrote about the thromboembolic challenges that COVID-19 infection had brought to us. It is only befitting that in my last letter as President, I end with our achievements with THANZ being recognized as the leader in guiding local as well as national clinical and policy decisions in regards to the thrombotic/ thrombocytopenic complications of COVID-19 vaccine. 

 

Thanks to my friends and fellow THANZ members for your hard work, team spirit, faith and confidence through this unforgettable journey.

 

Take care and stay safe

Best wishes and warm regards

Anoop K Enjeti

 

 

THANZ corporate sponsor

 

                                                   

Our thanks go to Novo Nordisk for their continued support of the Society
 

 

Welcome New Members

 

Please welcome new members Joyce, Alexander, Mark, Dipti, Emma, Valerie, Joleen, Simone, Loudres, Kathleen, Puja, Anthony, Rebekah, Alex and Sam.

 
 

THANZ Workshop

18 September, 2021

 

The THANZ Workshop will be a virtual meeting on Saturday the 18th of September, 9 am til 12 noon AWST (11am-1pm  AEST).


The meeting will go for 3 hrs with a 10 minute break. Most talks will be live, and you will be able to ask questions.


The first half will be on COVID-19 and Vaccine-Induced Thrombocytopenia.
Emmanuel Favaloro will present laboratory testing for VITT and immunoassays.
Following talks will be on:
1.    Functional procoagulant platelets in VITT
2.    SRA in VITT
3.    Multiplate in VITT.
May also include Australian cases.


The second half will be on general coagulation issues.


Information on registration for the meeting, final program and other details will follow soon.

 

Hope you will be able to join us.


Grace Gilmore
THANZ Council

 

 

 

Blood 2021

20-23 September, 2021

 

Abstract Submission has now closed - thank you to everyone who has submitted an abstract.

 

The program will be delivered virtually from Monday 20th September to Thursday 23rd September and will continue to deliver all the items you have come to expect at a Blood Meeting, including International Speakers, local experts, oral abstracts and virtual posters. In addition, all sessions will be recorded and available on demand to registered attendees for 6 months, allowing unprecedented access to educational content.

 

While the content will be delivered virtually, at time of writing the plan is to proceed with a physical hub in Adelaide. The haematology community was unable to meet in 2020 in view of the COVID-19 pandemic. BLOOD 2021 offers the opportunity for colleagues to meet, catch up, network and discuss latest findings and content of the presentations, plus we have something very special planned for the conference dinner for attendees. So everyone is very welcome and do come to visit Adelaide in beautiful spring time in September! Register now to secure your place at the Hub!

 

A provisional program is now available and will be updated over the coming months.

 

Chee Wee Tan

THANZ Vice President and Blood 2021 local organising committee
 
 

Secretary News and AGM 2021

 

There are several THANZ business items that everyone needs to be aware of and are listed below.

 

Firstly, notice of our Annual General Meeting. Like last year it will be held virtually via Zoom. Details will be forwarded soon to members. Save the Date: Friday 17th September at 12pm-1pm AEST.

 

Council congratulates the S&E travel (virtual) and grant award recipients (see below).

 

We are now in the leadup to Blood 2021 in the Virtual and Adelaide Hub world in September. We would like to acknowledge the great effort Chee-Wee Tan is doing organizing the THANZ stream in this new and challenging format and Grace Gilmore for organizing the THANZ workshop. A big thank you to council and other reviewers of the recently submitted abstracts, we look forward to an excellent meeting whether you attend online or face-to-face in the Adelaide Hub.

 

This year ends the 2 year cycle of THANZ council and there are many council members who are stepping down having completed 3 terms (maximum terms) of service. I would like to acknowledge their contribution to their various roles on council – Eileen Merriman, Grace Gilmore, Anoop Enjeti and Natalie Pecheniuk (yes me😊). So, we are about to open the call for nominations to council and would like to seek nominations from the various states/country these outgoing councillors represent (NZ, WA, NSW, QLD). Any existing Councillor wanting to stay on Council must renominate. Nominations will open 12th July and close 2nd August, stay tuned for an email for a link to the nomination forms. If a ballot is required, you will be notified of the dates via email and will be decided upon prior to the AGM in September. Nominees must be ordinary financial members of THANZ and must be proposed and seconded by THANZ ordinary financial members. Below is some information about what council responsibilities entail. I encourage members to nominate for the role.

  • THANZ Councillors have legal responsibilities as company directors. Council is the Society’s board of directors and as such have statutory obligations under the Australian Corporations Act 2001. The roles and responsibilities of councillors as office bearers are described in Chapter 2D: Officers and employees of the Act; which should be read in conjunction with the THANZ Articles of Association.
  • There is provision for 8 members to ensure geographical balance but no more than two (2) councillors can represent one of the stated regions.  Regions are NSW (incl. ACT), NZ, QLD, SA (incl. NT), VIC (incl. TAS), WA.  Councillors are elected for two-year terms and are able to continue in office for a further two terms, up to six years maximum, if elected in subsequent years. There is no obligation to continue for subsequent terms but it is desirable to provide continuity. 
  • Council meetings are regularly spaced throughout the year usually as teleconferences every 2 months (1-2 hrs) and one face to face meeting, usually during Blood. There is an expectation that Councillors attend these meetings.  Much of the Society’s work is managed outside of its regular meetings and in general by email or telephone communication between councillors, for example making decisions on issues that arise, providing comments or advice following requests from external parties and approving membership applications.
  • Specific officers are elected by Council and in addition councillors can participate in other portfolios which council members chair. President – Presides at all meetings of the Society and is Chairperson of all meetings of council. At the completion of their term the President is invited to remain on council for an additional one-year period as an ex officio to support the incoming president. Vice President – Assists the President in the performance of duties and presides at any meeting at which the President is not present. Secretary – Legally is required to be an Australian resident.  Addresses the membership of Society’s general business/correspondence, legal requirements, nominations for Council, and membership applications/resignations. (This position is supported by our wonderful Secretariat). Treasurer – Provides oversight of the Society’s finances including authorisation of expenses, distribution of funds between accounts and investments, oversight of investment portfolio, review of annual auditor’s report and provide a Treasurer’s report for the AGM. 
  • Council members are also expected to contribute to the Blood Annual Scientific meeting, the joint annual meeting of THANZ, HSANZ and ANZSBT. Organisation of the meeting is managed by professional conference organisers and the local organising committee and council maintains oversight and is represented on the LOC either by council member or nominated representative. There are a number of responsibilities associated with Blood: reviewing abstracts, identifying presentations, selecting society awards, providing support and guidance to invited speakers.

Natalie Pecheniuk, THANZ Secretary
 
 

S&E Award Recipients

 

Research
This year THANZ awarded S&E Research Grants to the following members
 
Jessica Maclean - Heart Research Institute
"Towards improved thrombolytic therapy for stroke: A role for GPVI?"

Cardiovascular disease, which includes stroke, is a leading cause of death and disability in Australia and the world. Despite this, there is only one drug available to treat stroke caused by blood clots. This treatment, thrombolysis, has a range of side effects that means less than 15 per cent of stroke sufferers are eligible to receive it – leaving 85 per cent with limited options. Our research aims to address this significant unmet clinical need with a novel model of stroke to investigate the use of current and novel antiplatelet targets in conjunction with existing treatments to safely remove blood clots and restore blood flow in stroke. Investigators of this global project include Professor Shaun Jackson, Associate Professor Simone Schoenwaelder, Mr Ben Hofma and Dr Xuyu Liu at HRI and Professor Pierre Mangin of the University of Strasbourg, France.

More information at this link .

 
Lisa Lincz - Calvary Mater, Newcastle, NSW
"Establishing a screening test for complement mediated lysis to help diagnose atypical haemolytic uremic syndrome"

Investigators:    Lisa Lincz, Fiona Scorgie, Kent Chapman, Ritam Prasad

Atypical haemolytic uremic syndrome (aHUS) is caused by defects in the regulation of the alternative pathway of complement and is one of many different diseases that results in thrombotic microangiopathy. Prompt diagnosis is both crucial and challenging, but without a definite diagnostic test, aHUS is often a delayed diagnosis of exclusion. A novel biological assay to detect complement activation, known as the ‘Modified Ham Test’, has been developed and described by Gavriilaki et al. (Blood, 2015. 125(23):3637-46). With the help of funding from THANZ, we aim to recreate, ameliorate, and validate this in vitro test in our laboratory for use as a screening tool for aHUS and other complementopathies.

 

Travel

This year THANZ awarded S&E Travel Grants to the following members
 
Aster Pijning, who is attending ISTH and FASEB
 
Mark Screuder, who is attending ISTH

 

Congratulations to the recipients!
 

 
  APSTH Conference Recap

 

 

Earlier this year, the ASPTH kindly provided us with some complimentary virtual registrations to their Congress. Here, two of the registration recipients give a recap of their conference highlights.

 

 

In March this year I was privileged to be able to attend the virtual Asian-Pacific Society on Thrombosis and Haemostasis 2021 conference thanks to a complimentary registration provided by APSTH and THANZ.

 

First up was a wonderful presentation from Professor Midori Shima on Emicizumab, which I was able to view with some of my specialised coagulation colleagues. Since Emicizumab received PBS approval we have seen an increase in requests for testing for patients on this drug, and it was fantastic to be able to learn the history of development of the drug and mechanisms of action. Of most interest however was being able to hear some of the patient experiences of the drug, and how the lives of patients with haemophilia A have been changed by the development of this treatment. We all gained a greater understanding on how vital this drug is to the treatment of Haemophilia A, despite the challenges it can bring to coagulation testing.

 

I also took the opportunity to view other presentations on a wide range of topics, such as:

“Recent progress in pathophysiology of PNH” by Dr Jun-ichi Nishimura – which discussed how mutations in the PIGT gene also results in clinical PNH, and how C5 polymorphisms, in particular c.2654G>A, predicts poor response to eculizumab.

 

“Some Clinical Questions about Thrombosis and Haemostasis in Pregnancy” by Dr Claire McClintock – which discussed topics such as differentiation of thrombocytopenia in pregnancy and which patients should be offered VTE prophylaxis in pregnancy.

 

“Platelets beyond haemostasis” by Prof. Katsue Suzuki-Inoue – which discussed how tumour cells can facilitate metastasis by activation of platelets, and also how platelet CLEC-2 can facilitate blood/lymphatic vessel separation during organ development.

 

I’d like to thank APSTH for preparing such a wonderful conference, and also thank APSTH and THANZ for the opportunity to attend APSTH 2021.

 

Dianne Lovelock
 

I was given the opportunity of attending the Asian-Pacific Society on Thrombosis and Haemostasis (APSTH) virtual scientific congress in March this year. Hosted from Korea, this was a comprehensive meeting discussing issues in thrombosis and haemostasis relevant to our local region. As I have begun practicing in a Haemophilia Treatment Centre this year, I decided to focus on upskilling in haemophilia and predominantly attended the bleeding disorders stream.

The sessions on haemophilia management were fascinating and varied. Talks from illustrious international speakers such as Flora Peyvandi and Steven Wesley Pipe focused on cutting-edge technologies such as gene therapy. The successful trials for haemophilia B were discussed at length, with 98% of recipients able to successfully discontinue prophylaxis. The challenges of gene therapy for haemophilia A were canvassed, particularly the difficulties encountered due to the larger gene size and higher immunogenicity. Overall, gene therapy appears to be a promising future treatment for both haemophilia A and B, although some unanswered questions remain about liver toxicity, duration and variability of response.

 

Novel non-factor treatments for haemophilia A and B were discussed in a dedicated symposium. The use of the bispecific monoclonal antibody emicizumab was discussed in detail, including the challenges of using standard coagulation tests to assess response. The evidence for emerging treatments such as fitusiran, a novel investigational siRNA, was also canvassed. This monthly subcutaneous injection lowers antithrombin levels by engaging the RNA induced silencing complex, and is being studied in the treatment of patients with both haemophilia A and B, with and without inhibitors.

 

The session on congenital haemophilia with inhibitors gave a thought-provoking overview of the management of this difficult clinical problem within the Asia-Pacific. Speakers from Japan, Korea, Taiwan and China discussed the striking differences in the incidence and management of inhibitors in their own countries. Many countries continue to favour immune tolerance induction (ITI) in the majority of patients. The emerging use of costly emicizumab therapy throughout the region was discussed, with different patient prioritisation and availability between countries.

 

Overall, the APSTH congress provided me with an invaluable oversight into the management of haemophilia in our local region. I am grateful to have been given the opportunity to attend.

 

Renee Eslick
 

Public Pathology - Community First, Always

 

Despite the recent lockdown in four States, Australia’s response to the COVID-19 pandemic is still one of the best in the OECD – with only 30,832 cases and 910 deaths. Australia’s exemplary response to the COVID-19 global pandemic has been driven by Public Pathology Services. We outline the remarkable contribution that Public Pathology including THANZ members have made to managing the COVID-19 pandemic in Australia.

 

Since January 2020, there have been 21,450,495 SARS-CoV-2 tests performed in Australia (to 6 July). Public Pathology Services have conducted around half of all these COVID-19 tests. In some States and Territories, Public Pathology Services have tested over 95% of all COVID-19 samples. Public Pathology was the first to develop SARS-CoV-2 assays before commercial test kits became available. Public Pathology conducts genomic sequencing of COVID-19 positive specimens to identify new outbreaks and clusters. Public Pathology/THANZ members also developed confirmatory testing to identify rare COVID-19 vaccine induced blood clots.  

 

The President of Public Pathology Australia Dr Petra Derrington recently stated “The impact of COVID-19 has been far-reaching and unpredictable. It has profoundly affected all of us – personally, professionally, physically and psychologically. Never before have we been so isolated yet connected; united by fear of a virus yet resolved to saving lives.

 

Here in Australia, the swift and effective efforts of Public Pathology Services have been critical to keeping our community safe. Public Pathology experts have been central to the national response since the devastating virus first arrived on our shores. From testing for the virus to working with Government in COVID-19 control centres and committees across the country – Public Pathology has demonstrated how it puts our community first.”

 

The COVID-19 vaccination program in Australia has been lagging behind other countries, with around 7 per cent of the population fully vaccinated (at 5 July, see here also). The principal vaccine at the commencement of the program in February 2021 was the AstraZeneca vaccine (ChAdOx1-nCno-19, AZ). Thrombosis following AZ inoculation was identified in Germany earlier this year.  

 

The expertise of THANZ members has been greatly appreciated within the public sector. Public Hospital Haematologists developed and been following the THANZ Advisory Statement for suspected Vaccine Induced Immune Thrombotic Thrombocytopenia (VITT) since the roll out of the COVID-19 vaccination program. (https://www.thanz.org.au/news/vitt-multidisciplinary-guideline-for-doctors)

 

Screening for VITT involves common tests for FBC, D-dimers and fibrinogen levels. While confirmatory testing for VIIT is by antigen-based VITT immune assay and functional antibody testing which has been worked up by Public Haematologists.  

 

While cases of VIIT are expected to increase as AZ vaccinations increase, figures are also contingent upon reportable case definitions. At this stage, the Therapeutic Goods Association’s (TGA) VITT figures are 41 confirmed cases and 28 probable cases from 4.6 million AZ doses. However, the case numbers do not reflect the heavy workload on the Haematology Departments across Australia and THANZ VITT Committee members.

 

Dr Greg Corboy, Director of Haematology for Pathology Queensland stated “The response to VITT has been an excellent example of the enormous value offered by national professional organisations such as THANZ. This network of highly skilled Public Sector Scientists, Laboratory and Clinical Haematologists has enabled the rapid coordinated collaboration across state boundaries required to deal with a rapidly evolving challenge. This pooling of expertise to develop clear and consistent management guidelines, in parallel with essential testing capacity in the public sector, has been to the benefit of all Australians. I have been impressed by the collegiality and hard work of all those involved in the response across the Public Sector and sincerely thank them for their efforts.”

 

We are fortunate in Australia that we have Public Pathology who put the Community First, Always. See and share Public Pathology Australia videos:

Public Pathology Australia is the national peak body for public pathology services in Australia. For more, go to www.publicpathology.org.au.

 

 

                                                                                                

 

 

Dr Petra Derrington                                                                                      Dr Greg Corboy

President                                                                                                        Director of Haematology

Public Pathology Australia                                                                        Pathology Queensland