rare blood disorder initiative, blood surveillance sept 30, 2006 bruce ritchie hematology,...
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Rare Blood Disorder Initiative, Blood Surveillance Sept 30, 2006
Bruce Ritchie Hematology, University of Alberta, Edmonton, Alberta
Disclosure
Honoraria:
Bayer, Baxter, Sanofi, Astra-Zeneca, Novo-Nordisk, Aventis-Behring, ZLB, Pharmacia, Pfizer - all go towards studentships
Studentships:
Pharmacia, Baxter, Sanofi, Novo-Nordisk, Bayer
Travel Support:
Bayer, Baxter, Astra-Zeneca, Novo-Nordisk, Pharmacia, Canadian Hemophilia Society, Canadian Hereditary AngioEdema Society, Canadian Immunodeficiency Patient Organization, Alberta Association of Radiologists,
Research Funding: Bayer, Baxter, Novartis, NovoNordisk, CHS, Health Canada/Public Health Agency of Canada.
Outline of my presentation
Rare Blood Disorder Initiative
What is it?
What is needed?
How do we get it?
Treatment surveillance
Networks in place in Canada
Sample collection/testing
Inhibitors, HIV
BBPSP
Rare Blood Disorders Initiative
What is it?
It is: specialized care for rare disorders including:
specialized diagnostics
specialized management - immunizations, …
specialized tracking of outcomes
surveillance
Rare Blood Disorders InitiativeHemophilia
Untreated Hemophilia - median survival of 25
Optimal management - near normal life span
Currently we have close to optimal management
Available:
Clinic for early diagnosis, treatment, tracking, surveillance
Rare Blood Disorders InitiativeSickle Cell Anemia
Untreated Sickle cell anemia - median survival of 25
Optimal management - near normal life span
Currently we have something in between.
Needs:
Better and earlier diagnosis, treatment
Better tracking
Better transfusion management
Better chelation management
Exchange transfusionSickle Cell Anemia
Exchange TransfusionMore effective to lower % of sickle cells (<30%)Less iron overloadRequires specialized equipment and staff
Rare Blood Disorders InitiativeHereditary AngioEdema
Undiagnosed HAE common
Mistreated HAE common - antihistamines, steroids, adrenalin don’t work
Optimal management - near normal life span
Currently we have something in between.
Needs:
Better and earlier diagnosis, treatment
Better tracking
Home management
Home RxHemophilia, HAE, PID
Rare Blood Disorders InitiativePrimary Immnodeficiency
Undiagnosed PID common
Mistreated PID common
Optimal management - near normal life span
Currently we have something in between.
Needs:
Better and earlier diagnosis, treatment
Better tracking
Home management - IgSC
Kazatchkine, M. D. et al. N Engl J Med 2001;345:747-755
The IgG MoleculeHypogqammaglobulinemias
IgIV OutcomesHeadache, Aseptic Meningitis
Allergy, anaphylaxis
Acute Renal Failure in the elderly, diabetes
Blood Borne Pathogens - hepatitis C in mid 1990s
IgSC Immunoglobulin
16% IgSC solutions licensed in Europe (ZLB, CSL), IgIm preparation licensed here (Talecris)
Unlicensed (SAP) vs “Off-label” use of IgIM or IGIV for SC
Subgam - Patient Subgam - Patient Satisfaction SurveySatisfaction Survey After 6 months:
All patients(n=43)
P rior SCIG(n=14)
P rior IVIG(n=29)
Adults (>19 y)(n=23)
Children (<12y) (n=15)
Teenagers(12-19 y) (n=5)
0
10
20
30
40
50
60
70
Perc
enta
ge o
f patients
Much more More Same Not as much
IVIG/SCIG Cost Comparison IVIG/SCIG Cost Comparison ((£)£)
Year 1
•Adult Drug Cost•Routine
Consultations and Tests
•Patient Training•Syringe Drivers•Maintenance
•Total Year 1
SCIG Home Based
10,752
673365
1,762804
14,356
IVIG Hospital Based
10,752
673n/an/a
4,812
16,237
Rare Blood Disorders InitiativeBone Marrow Failure
Undiagnosed mild disease common, but there is associated morbidity
Specific treatment not readily available except in trials
Currently we have something in between.
Needs:
Better and earlier diagnosis, treatment
Better tracking
Better transfusion management
Better chelation therapy - ?Exjade
Rare Blood Disorders Initiative
What is needed?
A clinic with dedicated staff consisting of:
1. nurse, admin assistant, data entry person, physician
2. space - offices, stuff, storage, computers
3. Oversight - Multidisciplinary group (patients)
Rare Blood Disorders Initiative
How do we get it?
Lobbying - governments don’t listen to phsycians, so patients must lobby on their own behalf
Organize
meet, talk, argue, reach consensus
establish policy - Rx, safety, …
Network of Rare Blood Disorder Organizations,
FVIII Concentrates purified from up to 100,000 donors
Hemophilia & HIV
QuickTime™ and aTIFF (LZW) decompressor
are needed to see this picture.
http://www.hc-sc.gc.ca/english/protection/krever/
Transmissible Spongiform Encephalopathies (TSEs)
Rodent TSEHamster, Mouse
Sheep TSEScrapie
Bovine TSEBSE
Cat TSEFSE
Mink TSETME
Deer, Elk TSECWD
Human TSEClassical CJD, GSS, FFI, SPKuru, New Variant CJD
� Normal host protein
� Proteinase K sensitivity
� 33–35 kD MW
PrPC PrPSC
� Associated with infectivity
� Proteinase K partial resistance
� 33–35 kD MW
Treatment surveillance
Networks in place in Canada
Quebec Blood Surveillance Network
Health Canada
AHCDC - BBPSP
Sample collection/testing
Inhibitors, HIV
BBPSP - Blood Borne Pathogens Surveillance Project
QuickTime™ and aTIFF (Uncompressed) decompressor
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Canadian Hemophilia Assessment and Resource Management information System (CHARMS) & NACHC
Product distribution(CBS)
Clinical outcomes(clinic)
CBS, HQ
CenterPoint server, Hamilton
Genotyping(AHCDC)Sample archive
Health CanadaManufacturersCBS, QBS
Provincial Governments
Drug CompanyPalm Pilot systems
Adverseevents
Productuse/outcomes
PDA systemsViews- Messages
Q ui ckTi me™ and a TI FF (LZW) decompressor are needed to see thi s pi cture.
Dialog - Bayer (formerly HemaScan) • Began as a PDA based inventory system• Barcodes generated by system• Now includes internet module• Currently in trial in Hamilton, Ste. Justine, Edmonton• Data management Arrowhead
Advoy - Baxter
• Began as a web based management system• Will use consensus barcodes• Now includes PDAs• Currently in trial in Toronto, Edmonton• Data management 3rd party
Machine Readable Labels
Freezer Map
Freezer Map
The Inventory Database
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Bruce Ritchie
Bruce Ritchie
QuickTime™ and aMotion JPEG OpenDML decompressor
are needed to see this picture.
QuickTime™ and aMotion JPEG OpenDML decompressor
are needed to see this picture.
Bruce Ritchie
Bruce Ritchie
Gene Therapy for point mutations
• Genotyping• Chimeroplasty
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