Beverley J Hunt^1
1Kings Healthcare Partners

Despite the increasing sophistication of our lives in high income countries, it is sobering to consider that bleeding to death -exsanguination- remains a major cause of death in the modern world. Globally 9% of all deaths are due to trauma (which ranges from blunt such as road-traffic accidents, to penetrating – knife and bullet wounds etc) of which the major cause of death in 24% is haemorrhage. Indeed, in the USA the major cause of death in pregnancy and paediatrics is gunshot wounds. One in two hundred deaths globally occur in pregnancy where once again the major cause of death is post-partum haemorrhage, with the bulk of deaths occurring in low and middle countries where there is a fragile infrastructure in medical care. Lastly there are over 500 million operations annually and one of the major causes of mortality is bleeding. What can we do as Haematologists to improve this situation?

I will discuss the modern understanding of the haemostatic changes in bleeding in trauma, obstetric haemorrhage and surgical bleeding and the current guidance. The benefits of tranexamic acid in these situation will be emphasized.

Neal MD, Hunt BJ. Precision in Transfusion Medicine. JAMA. 2023 Nov 21;330(19):1847-1848. 

Rossaint R, Afshari A, Bouillon B, Cerny V, Cimpoesu D, Curry N, Duranteau J, Filipescu D, Grottke O, Grønlykke L, Harrois A, Hunt BJ, Kaserer A, Komadina R, Madsen MH, Maegele M, Mora L, Riddez L, Romero CS, Samama CM, Vincent JL, Wiberg S, Spahn DR. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023 Mar 1;27(1):80. 

Stanworth SJ, Dowling K, Curry N, Doughty H, Hunt BJ, Fraser L, Narayan S, Smith J, Sullivan I, Green L; Transfusion Task Force of the British Society for Haematology. Haematological management of major haemorrhage: a British Society for Haematology Guideline. Br J Haematol. 2022 Aug;198(4):654-667. 

de Lloyd L, Jenkins PV, Bell SF, Mutch NJ, Martins Pereira JF, Badenes PM, James D, Ridgeway A, Cohen L, Roberts T, Field V, Collis RE, Collins PW. Acute obstetric coagulopathy during postpartum hemorrhage is caused by hyperfibrinolysis and dysfibrinogenemia: an observational cohort study. J Thromb Haemost. 2023 Apr;21(4):862-879. 

Bell SF, de Lloyd L, Preston N, Collins PW. Managing the coagulopathy of postpartum hemorrhage: an evolving role for viscoelastic hemostatic assays. J Thromb Haemost. 2023 Aug;21(8):2064-2077. Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, Schöchl H, Hunt BJ, Sauaia A. Trauma-induced coagulopathy. Nat Rev Dis Primers. 2021 Apr 29;7(1):30. 

Jane Thompson¹

¹South Australian Health and Medical Research Institute, The University of Adelaide, Australian Clinical Laboratories, Adelaide, Australia

Diagnostic testing paradigms for B/T cell-acute lymphoblastic leukaemia have undergone phenomenal recent advances, with approaches personalised in a manner analogous to precision therapeutics. This presentation will concentrate on diagnostic advances in the contexts of real-world cohorts, the ICC of Acute Lymphoblastic Leukaemia and the 5^th Edition of the WHO Classification of Hematolymphoid Tumors. The judicious recognition of clinically relevant subclasses will be discussed. 

Diagnosis of acute lymphoblastic leukaemia (ALL) has more recently focused on defining detailed genomic landscapes. For example, the detailed subclassification of B-ALL has improved prognostication, precision therapy and measurable residual disease monitoring. Diagnostic techniques such as whole transcriptome RNA sequencing and DNA-based whole genome and whole exome sequencing have become mainstream in many centres. Early integration of fluorescence in situ hybridisation (FISH) panels is common. However, in real-world cohorts, economic impacts and testing complexity may present challenges. 

Focusing on B-ALL, and in particular B-ALL with BCR::ABL1-like features (Ph-like ALL) as a model, the application of FISH panels to rationalise diagnosis and treatment will be discussed.  World-wide literature reporting algorithms that account for applicability to geographic locations, population ethnicities, economic situations and laboratory characteristics has provided valuable lessons to guide future directions.