Kacey O'Rourke^1
1Sullivan Nicholaides Pathology

Cellavision is a digital haematology platform that allows digital review of blood films. This technology has been in use in Sullivan Nicholaides for several years for scientist blood film review. In more recent times this technology has been applied for haematologist blood film review. 

Cellavision for haematologist review has several potential scientific and efficiency savings for the haematology laboratory. This talk will outline the local procedures undertaken in rolling out Cellavision for haematologist film review.  This technology allows several benefits including the capacity to review films remotely,  create image databases for later review and teaching, and improve accuracy of reporting as well as significant time savings. The regulatory requirements and limitations of the technology will be discussed and our approach to managing these will be outlined.

Loriza Khan^1
1Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP), St Leonards, Sydney

The examination of a bone marrow aspirate and biopsy is a critical component in the diagnosis and management of blood and bone marrow disorders. Combined with peripheral blood, the aspirated liquid marrow (aspirate) and core biopsy of bone (trephine) containing marrow tissue is used to evaluate the cell count, morphology and cellularity. Methods for extraction, preparation and interpretation may be prone to variances and inconsistencies. To avoid the impact of these differences in the diagnosis of haematological diseases, a number of guidelines are available to assist pathologists. Ubiquitously known guidelines in Australasia are the ICSH guidelines for the standardization of bone marrow specimens and reports (2008) and the RCPA Bone Marrow (Aspirate and Trephine) Structured Reporting Protocol (2014).

Despite the availability of these guidelines for several years, inconsistencies in reporting of the granulopoiesis quantitation and myeloid to erythroid (M:E) ratio from the cell differential count were noted in an external quality assessment program. In the case of an adult with acute leukaemia, WCC of 189.5 x10⁹/L, and 90% blasts, the participants reported M:E ratios ranging from 0 to 99, with a median of 30. This EQA case highlighted the differences in the appropriate quantitation of cells and subsequent reporting of the M:E ratio.  

Pratheepan Puvanakumar^1,2

 

¹Department of Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia

²Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia

 

Relapsed refractory immune thrombotic thrombocytopenic purpura (R/R iTTP) is a life-threatening primary thrombotic microangiopathy (TMA) associated with significantly increased morbidity and mortality.¹ The treatment paradigm in this difficult clinical scenario has been historically limited to increased volume/frequency of therapeutic plasma exchange (TPE), high dose corticosteroids, rituximab, splenectomy, cytotoxic therapies and, more recently, plasma cell directed therapies (e.g. bortezomib, daratumumab). 

 

Recent clinical advances such as the von-Willebrand factor (vWF) targeted nanobody (caplacizumab)² and recombinant form of a disintegrin and metalloprotease with thrombospondin type motif 13 (ADAMTS13)³ have been observed to show reduced rates of disease exacerbations and treatment refractoriness. However, neither of these medications are readily accessible in the current Australian therapeutic landscape for R/R iTTP.  

 

Furthermore, the other crucial therapeutic aspect of R/R iTTP is re-evaluation for previously unrecognised pathologies and/or management of concurrent co-morbidities (e.g. autoimmune disease, malignancies) or relevant physiological states (e.g. pregnancy). The following case studies will illustrate the clinical heterogeneity and spectral overlap of R/R iTTP, practical complexities of therapeutic management and recognition as immune-mediated phenomena associated with other pathological disorders and physiological states. 

 

1.     Farzana A. Sayani, Charles S. Abrams; How I treat refractory thrombotic thrombocytopenic purpura. Blood 2015; 125 (25): 3860–3867. doi: https://doi.org/10.1182/blood-2014-11-551580

2.     Scully, M., Cataland, S. R., Peyvandi, F., Coppo, P., Knöbl, P., Kremer Hovinga, J. A., Metjian, A., de la Rubia, J., Pavenski, K., Callewaert, F., Biswas, D., De Winter, H., Zeldin, R. K., & HERCULES Investigators (2019). Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura. The New England journal of medicine, 380(4), 335–346. https://doi.org/10.1056/NEJMoa1806311

3.     Scully M, Baptista J, Bhattacharya I, Cataland S, Coppo P, Cuccia L, Dutt T, Huang SH, Izquierdo CP, Mingot-Castellano ME, Parnes A. S305: Phase 2 randomized, placebo-controlled, double-blind, multicenter study of recombinant ADAMTS13 in patients with immune-mediated thrombotic thrombocytopenic purpura. HemaSphere. 2023 Aug 1;7(S3):e8651306.