PURPOSE: Patients with a history of a bone marrow transplant (BMT) have a higher risk of infectious complications because of an immunocompromised state. It has been shown that giving timely antibiotics in 1 hour or less from presentation to the emergency department (ED) decreases morbidity and mortality in this patient population. We hypothesize that a quality improvement (QI) process, termed BMT Fever, will improve timely administration of antibiotics for this population presenting to the ED. METHODS: This is a QI process designed to improve the administration of antibiotics to BMT patients with a subjective or objective fever presenting to the ED. The percent of patients receiving antibiotics within 1 hour or less was compared pre- and post-intervention. RESULTS: Upon implementation of the BMT Fever QI process, the percentage of patients with febrile BMT receiving antibiotics within 1 hour or less per fiscal quarter significantly improved from six out of 28 patients (21%) to 147 out of 173 patients (85%), P value < .05. CONCLUSION: By implementing a QI process that addresses five structural obstacles, we were able to improve our timely administration of antibiotics to patients with febrile BMT presenting to the ED.
Thrombocytopenia is a common lab finding. The two fundamental groups are lack of production versus overconsumption of platelets. When common causes of thrombocytopenia have been ruled out and less common causes, such as thrombotic microangiopathic conditions, have been considered, it is important to keep in mind that patients undergoing dialysis may develop thrombocytopenia from the dialyzer itself.
This case is of a 51-year-old male who presented originally with celiac artery dissection and acute kidney injury requiring emergent dialysis. He ultimately developed thrombocytopenia during his hospitalization. It was initially presumed to be from thrombocytopenic purpura without improvement after plasmapheresis. No clear etiology was identified until it was suspected that the dialyzer was the source of thrombocytopenia. After changing the dialyzer type, the patient’s thrombocytopenia resolved.
Dialyzer-associated thrombocytopenia is a rare but reversible complication of hemodialysis. It is important to keep this differential in mind for patients undergoing hemodialysis.
7055 Background: We analyzed CML mortality from 1999 to 2020 in the US in relation to FDA approval of tyrosine kinase inhibitors (TKIs). These agents were introduced in the 2000s, revolutionizing the treatment of CML and providing a paradigm for targeted therapy in oncology. Starting with imatinib in 2001, followed by dasatinib (2006), nilotinib (2007), and bosutinib (2012). TKIs have increased tolerability and efficacy for the treatment of CML as compared to previous treatment modalities. We investigated age-adjusted mortality rates (AAMR) and annual percent change (APC) in this population in relation to TKI approval. Methods: Using the CDC WONDER database, we examined mortality trends from 1999 to 2020 for CML in the US. AAMRs were calculated per 100,000 people and stratified by sex, race/ethnicity, and census region. AAMR groups were listed as pre-TKI era and 1 year post-FDA approval of different TKI agents. We computed the APC trends for the respective stratification with Joinpoint, a regression analysis program. Results: Between 1999 and 2020 there were 35,268 deaths from CML. In 1999, overall AAMR initially was 0.8, which improved to 0.5 by 2020 with a respective APC of -2.5%. In our subgroup analysis there was a consistent and significant decrease in AAMR since the introduction of Imatinib in 2001. With additional TKI releases, AAMR continued to decline in all subgroups. APC for mortality rates was similar between all subgroups [-2.0 to -2.8%] indicating a similar benefit regardless of subgroup. Male AAMR was consistently higher than female AAMR. Black and white patients (0.5, 2020) have a 2.5x higher AAMR (0.2, 2020) compared to Asian patients. Census region did not show a significant difference between each other. Conclusions: Since the FDA approval of imatinib in 2001 and the subsequent release of TKIs there has been a significant impact on reducing AAMR for patients with CML. The decline was seen in sex, race, and census region. The APCs were similar between all subgroups indicating a consistent improvement in survival. Possible etiologies of disparities in AARM for males in comparison to females and for black and white patients in comparison to Asian patients include gender and race-associated gene polymorphisms possibly inducing differences in drug metabolism. Further gender and race specific pharmacokinetic studies would be useful to further elucidate etiology of the disparity and may lead to changes in TKI dosing strategies. [Table: see text]
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