PROGRAM MENU
Educational Program

THSNA programming is focused on presenting the most current issues in Hemostasis and Thrombosis. The THSNA 2020 program will include on demand access to recorded talks covering four educational tracks as well as live panel discussion sessions, a nursing workshop, digital posters, corporate symposia, and a virtual exhibit hall with commercial booths.

Note that all timea are listed in Eastern Daylight Time (EDT) and any aspect of this program is subject to change.

  Tue - Oct 27      Wed - Oct 28      Thu - Oct 29      Fri - Oct 30   

TUESDAY, OCTOBER 27

10:00 - 11:35 AM
PLENARY SESSION
PLENARY 1: EMBRACING CHANGE: FROM NEW DISCOVERIES TO NEW TREATMENTS TO IMPROVED PRACTICES
Chair/Organizer: Peter Kouides, Cathy Hayward

The opening Plenary of THSNA will showcase discoveries and advances in the fields of thrombosis and hemostasis, with broad perspectives and examples of exciting changes. The expert presenters will cover important basic discoveries and advances that have been enabled by translating discoveries to improve the understanding, diagnosis and care of people with bleeding and thrombotic problems.



OPENING REMARKS
Peter Kouides. THSNA President


ANTICOAGULANT STEWARDSHIP IN THE ERA OF NOVEL THERAPEUTICS
Allison Burnett. University of New Mexico United States


BUILDING FROM BASIC BIOLOGY TO IMPROVE DIAGNOSIS AND CARE.
David Ginsburg. Howard Hughes Medical Institute, University of Michigan


ADAPTING TO NEW THERAPEUTIC OPTIONS: IMPLICATIONS FOR CLINICAL SERVICES AND COAGULATION LABORATORIES
Rajiv Pruthi. Mayo Clinic

12:15 - 1:15 PM
SATELLITE SYMPOSIUM
CORPORATE LUNCH SYMPOSIUM: ASK THE EXPERTS: MANAGING YOUR PATIENTS WITH HEMOPHILIA A IN A VIRTUAL WORLD

Sponsored By: Genentech, Inc.

Join the experts in hemophilia A as they discuss their experiences of managing patients in a virtual setting. They'll share clinical efficacy and safety data, along with any strategies they used to introduce patients to or manage patients on a subcutaneous prophylaxis. A live Q&A session will be held after to answer any questions. Don't miss out on this opportunity to learn more about a different kind of prophylaxis that may be right for your hemophilia A patients.

The discussion will be led by Shannon Meeks, MD, and feature Michael Callaghan, MD, and Jennifer Maahs, NP.



CORPORATE LUNCH SYMPOSIUM: CO-MORBIDITIES AND PHARMACOKINETICS IN PATIENTS WITH HEMOPHILIA; A CASE-BASED DISCUSSION

Sponsored By: Bayer

An overview of co-morbidities affecting aging in hemophilia, treatment considerations, and the importance of adapting and individualizing therapy with pharmacokinetic management. Discussion of interactive, practical case studies. This program is hosted and presented by Dr. Stacy Croteau and Dr. Craig Kessler.


2:00 - 3:30 PM
HEMOSTASIS / BASIC SCIENCE
HEPARIN-INDUCED THROMBOCYTOPENIA
Chair/Organizer: Gow Arepally


NEW APPROACHES TO THE LABORATORY DIAGNOSIS OF HIT
Anand Padmanabhan. Mayo Clinic


ROLE OF THE ENDOTHELIUM IN HIT PATHOGENESIS
Lubica Rauova. The Children's Hospital of Philadelphia/University of Pennsylvania


SPONTANEOUS HIT: PATHOGENESIS AND CLINICAL FEATURES
Ted Warkentin. McMaster University

2:00 - 3:30 PM
HEMOSTASIS
NOT YOUR EVERYDAY BLEEDING
Chair/Organizer: Stephanie Cloutier, Stacy Croteau


BLEEDING OF UNKNOWN CAUSE
Julie Jaffray. Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine


BEYOND THE BLOOD VESSEL, CONNECTIVE TISSUE DISORDERS
Pamela Trapane. University of Florida College of Medicine - Jacksonville


GENDER DIFFERENCES IN BLEEDING & UNDERSTANDING THE BLEEDING TENDENCY IN HEMOPHILIA CARRIERS
Jill Johnsen. Bloodworks and University of Washington

2:00 - 3:30 PM
LABORATORY
UPDATES ON THE NEW GUIDELINES FOR THROMBOPHILIA TESTING
Chair/Organizer: Kristi Smock, Betsy Van Cott


GUIDELINES ON TESTING FOR ACTIVATED PROTEIN C RESISTANCE
Dot Adcock. Laboratory Corporation of America


GUIDELINES ON TESTING FOR PROTEIN C AND PROTEIN S
Richard Marlar. University of New Mexico


GUIDELINES ON TESTING FOR ANTITHROMBIN DEFICIENCY
Betsy Van Cott. Massachusetts General Hospital

4:15 - 6:15 PM
MEMBER EVENT
AC FORUM WORKSHOP: ANTICOAGULATION FORUM MINI BOOT CAMP
Chair/Organizer: Nathan Clark

Join world experts Dr. Scott Kaatz & Dr. Geoffrey Barnes in a rare opportunity to hear talks from the AC Forum Boot Camp curriculum. In addition, they will be joined by Dr. Nathan Clark for an engaging Q&A panel discussion during the "chalk talk". You can help to shape and drive cutting edge topics about caring for patients on anticoagulants and get your questions answered or cases discussed. Target Audience Description: This activity has been designed to meet the educational needs of physicians, pharmacists, registered nurses, and associated health professionals who work in the field of anticoagulation.



4:15

INTRODUCTION
Nathan Clark.


4:20

TOP ARTICLES FROM 2019 YOU NEED TO KNOW
Scott Kaatz.


5:00

BREAK.


5:15

COVID 19 & THROMBOSIS: A CASE-BASED DISCUSSION
Geoffrey Barnes.


5:45

LIVE CHALK TALK (FULL PANEL).


NASCOLA/ISLH WORKSHOP: INTERESTING CASES IN LABORATORY HEMOSTASIS AND THROMBOSIS
Chair/Organizer: Cathy Hayward, Kristi Smock

This joint ISLH/NASCOLA workshop will use a case-based format to highlight important and practical issues in coagulation testing such as strategies, methodologies, interpretation and reporting, and clinical application. The session will be interactive and participant questions and interactive discussion will be encouraged. Target Audience Description: physicians, nurses, laboratory professionals, pharmacists and others.



NURSING WORKSHOP: IMPACT OF ADVANCES IN HEMOSTASIS AND THROMBOSIS ON THE ROLE OF THE NURSE IN THE COORDINATION OF CARE


4:15

WELCOME
TBD .


4:56

MIS-C; THROMBOSIS RISK AND THE ROLE OF THE APP
Jennifer Meldau.


5:08

Q&A/PANEL DISCUSSION.


5:56

Q&A/PANEL DISCUSSION.


4:20

ADOLESCENT TRAUMA, IVC FILTERS AND ANTICOAGULATION
Christine Guelcher.


5:32

ADULT ADHERENCE IN THE ERA OF EMICIZUMAB PROPHYLAXIS
Laurel McKernan.


5:44

TYPE 3 VWD WITH AN INHIBITOR - TREATMENT CHALLENGES
James Munn. Michigan Medicine


4:32

TRANSITION TO DOACS, SURGERY AND TRAUMA
Lynn Oertel.


5:20

DIAGNOSTIC WORK-UP AND LABORATORY CHALLENGES
Kim Schafer.


4:44

CATASTROPHIC ANTIPHOSPHOLIPID ANTIBODY SYNDROME (CAPS): DOES IT EXIST?
Terri Schnurr.


PLATELET DISORDER SUPPORT ASSOCIATION (PDSA) WORKSHOP: ITP JOURNAL CLUB

Four leading international adult and pediatric specialists in Immune Thrombocytopenia (ITP) will hold an ITP journal club with moderator James Bussel, MD. Each of the four experts will select a recent article of interest, whether clinical or laboratory based, and present it live over approximately 10-15 minutes. This will be followed by discussion of each article, including questions from attendees. Speakers: James Bussel, MD, Cornell University, NY, NY Craig Kessler, MD, Georgetown University, Washington, DC Michele Lambert, MD, Childrens Hospital of Philadelphia, Philadelphia, PA John Semple, PhD, Lund University, Lund, Sweden Michael Tarantino, MD, The Bleeding and Clotting Institute, Peoria, IL


7:00 - 7:45 PM
POSTER SESSION
POSTER SESSION 2


A6. DISORDERS OF COAGULATION OR FIBRINOLYSIS


0

ICH IN FVII DEFICIENCY: DURATION OF PROPHYLAXIS?
Alyaa Al Mughairy1, 2, Vanessa Bouskil1, Melanie Jackson1, Caroline Malcolmson1, Ahmad Al Hunaiti1, Manuel Carcao1. 1Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 2The Royal Hospital, Muscat, Oman


0

UTILIZATION OF TELEMEDICINE FOR COMPREHENSIVE VISITS IN PATIENTS WITH INHERITED BLEEDING DISORDERS DURING THE COVID-19 PANDEMIC
Cassandra P Wang1, Kelly A Bush2, Rosalie Brooks2, Katharine Farrow2, Lizandra Gilsdorf2, Fernanda Cortez2, Courtney D Thornburg2. 1Department of Pediatrics, University of California-San Diego School of Medicine, La Jolla, CA, USA. 2Division of Pediatric Hematology/Oncology, Rady Children's Hospital, San Diego, San Diego, CA, USA


116

ANTIHEMOPHILIC FACTOR (HUMAN) CHARACTERIZATION: FOCUS ON TTP TREATMENT
Benedetta Bonito1, Cristina Genuardo1, 2, Ilaria Nardini1, Andrea Caricasole1, Claudio Farina1, Novinyo S. Amega3, Filippo Mori1. 1Department of Research a Innovation, Kedrion SpA, Via di Fondovalle, Loc. Bolognana, Italy. 2Department of Pharmacy, Pisa, Italy. 3Department of Medical Affairs, Fort Lee, NJ, USA


117

QUALITY OF LIFE AND CLINICAL OUTCOMES FROM CHESS US+: A PATIENT-CENTRIC STUDY OF SEVERE HEMOPHILIA B IN THE US
Tom Burke1, Sohaib Asghar1, Jamie O'Hara1, 2, Eileen K. Sawyer3, Nanxin (Nick) Li3. 1HCD Economics, Daresbury, United Kingdom. 2Faculty of Health and Social Care, University of Chester, Chester, United Kingdom. 3uniQure Inc, Lexington, MA, USA


118

SUBDURAL HEMORRHAGE AND CEREBRAL SINOVENOUS THROMBOSIS: FREQUENCY AND ASSOCIATIONS WITH CLINICAL AND HISTORICAL FACTORS.
Shannon L Carpenter1, Mukta Sharma1, Terra Frazier1, Lauren Beslow2, Guillaume Sebire3, Michael Noetzel4, Brian Appavu5, James D Anderst1. 1Children's Mercy Hospital, Kansas City, MO, USA. 2Children's Hospital of Philadelphia, Philadelphia, PA, USA. 3Montreal Children Hospital, Montreal, QC, Canada. 4Washington University, St. Louis, MO, USA. 5Phoenix Children's Hospital, Phoenix, AZ, USA


120

IDENTIFICATION AND CHARACTERIZATION OF A NOVEL THROMBOMODULIN LECTIN-LIKE DOMAIN VARIANT IN A PATIENT WITH VENOUS THROMBOSIS
Sean X. Gu1, Lauren M. Shevell2, Christopher A. Tormey1, Henry M. Rinder1, Noffar Bar2, 3, Alfred I. Lee2, 3. 1Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA. 2Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. 3Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA


122

HIGH-PURITY PLASMA-DERIVED FACTOR X IS EFFECTIVE FOR SHORT-TERM PREVENTATIVE USE AND PERI-SURGICAL HEMOSTATIC COVER: RESULTS FROM A RETROSPECTIVE, OPEN-LABEL, COMPASSIONATE-USE STUDY OF PATIENTS WITH HEREDITARY FACTOR X DEFICIENCY
Martina Buehrlen1, Tiraje Celkan2, James N Huang3, Chioma Akanezi4, Sarale Russ4. 1Klinikum Bremen-Mitte, Prof-Hess-Kinderklinik, Bremen, Germany. 2Istanbul University Cerrahpasa School of Medicine, Fatih, Istanbul, Turkey. 3University of California San Francisco, Benioff Children, San Francisco, CA, USA. 4Bio Products Laboratory Ltd, Elstree, United Kingdom


123

AN IDENTIFIED MUTATIONAL HOTSPOT IN TWO DIFFERENT EXONS OF FIBRINOGEN ALPHA GENE OF CONGENITAL FIBRINOGEN DEFICIENT PATIENTS. BACKGROUND: INHERITED FIBRINOGEN DEFICIENCY IS TRANSMITTED AS AN AUTOSOMAL RECESSIVE DISEASE WITH AN ABSENT LEVEL OF ACTIVATED FIBRINOGEN PROTEIN IN PLASMA. THIS DISORDER HAS MANIFESTED ITS STRONG ASSOCIATION WITH COUSIN MARRIAGE IN OUR SET OF POPULATION WITH SWIFTLY INCREASING NO. OF NEW CASES EACH YEAR. AIM: TO SEARCH OUT FOR SPECTRUM OF MUTATION IN PREVIOUSLY IDENTIFIED MUTATIONS DETECTED IN ALL THREE GENES OF FIBRINOGEN (FGA ALPHA, BETA AND GAMMA) METHODS: THIS DESCRIPTIVE CROSS SECTIONAL STUDY IN CONCORDANCE WITH DECLARATION OF HELSINKI 2000 WAS CONDUCTED IN KARACHI, PAKISTAN. ALL DIAGNOSED CASES OF INHERITED FACTOR 1 DEFICIENCY WERE INCLUDED. RESULTS: TOTAL 14 PATIENTS WERE INCLUDED IN THIS STUDY. OUT OF 14 PATIENTS, 5 WERE SHOWN TO HAVE SIMILAR NONSENSE MUTATION IN EXON 4 AND SIX SAME MISSENSE MUTATION IN EXON 5 OF FIBRINOGEN ALPHA GENE. THIS GENE IS ALSO REPORTED AS THE MOSTLY FREQUENTLY AFFECTED GENE WITH LARGER NO. OF IDENTIFIED MUTATIONS IN GLOBAL RESEARCH DATA. CONCLUSION: RARITY OF INHERITED FACTOR 1 ABSENCE IS DEBATABLE NOW DUE TO ITS SWIFTLY INCREASING INCIDENCE ESPECIALLY IN OUR REGION WHERE COUSIN MARRIAGES ARE ACCUSTOMED. ALTHOUGH FIBRINOGEN GAMMA GENE IS THE LARGEST AMONGST ALL THREE GENES OF FIBRINOGEN PROTEIN WITH 10 EXONS BUT SPECTRUM OF MUTATIONS IN FIBRINOGEN ALPHA GENE HAS PROVEN ITS FREQUENT INVOLVEMENT AND RECOGNIZED AS A MAJOR CONTRIBUTOR IN CAUSING AND EXHIBITING MANIFESTATION OF DISEASE. DISCLOSURE OF INTEREST: NONE DECLARED. KEY WORDS: SPECTRUM OF MUTATION, INHERITED BLEEDING DIATHESIS, CONSANGUINITY, FACTOR 1 DEFICIENCY, FIBRINOGEN PROTEIN
Tehmina Khan1, Arshi Naz1, Anne Goodeve2, Shariq Ahmed1, Tahir Shamsi1, johannes Oldenburg3. 1NIBD, Karachi, Pakistan. 2University of Sheffield, sheffield, United Kingdom. 3Institute of experimental transfusions Medicine, Bonn, Germany


124

ACQUIRED HEMOPHILIA: CLINICAL CHARACTERISTICS AND BLEEDING OUTCOMES
Rohit Kumar1, Shruti Bhandari1, Sunny Singh2, Sindhu Malapati3. 1University of Louisville, Louisville, KY, USA. 2Henry Ford Cancer Institute, Detroit, MI, USA. 3Ascension St. John Hospital and Medical Center, Detroit, MI


125

POPULATION PHARMACOKINETICS OF RECOMBINANT VON WILLEBRAND FACTOR IN PATIENTS WITH VON WILLEBRAND DISEASE OR SEVERE HEMOPHILIA A
Alexander Bauer1, Bettina Ploder1, Zhaoyang Li2, Bjorn Mellgard3, Sofia Friberg-Hietala4, Martin Wolfsegger1. 1Baxalta Innovations GmbH, a Takeda company, Vienna, Austria. 2Shire US Inc, a Takeda company, Cambridge, MA, USA. 3Baxalta US Inc, a Takeda company, Cambridge, MA, USA. 4Pharmetheus AB, Uppsala, Sweden


126

NOVEL PRENATAL DIAGNOSIS OF PROTEIN C DEFICIENCY AND PRIMARY PROPHYLAXIS WITH PROTEIN C CONCENTRATE: A CASE SERIES.
Alexandra Prosser, Lauren Amos, Mukta Sharma. Children's Mercy Hospital, Kansas City, MO, USA


127

LONG-TERM BLEEDING AND CONSUMPTION RATES OF PROPHYLAXIS WITH BAY 94-9027 IN ADOLESCENTS AND YOUNG ADULTS WITH HEMOPHILIA A IN THE PROTECT VIII STUDY
Sanjay Ahuja1, Mindy L. Simpson2, Jonathan M. Ducore3, Olubunmi Afonja4, Inga Bayh5, Mark T. Reding6. 1Rainbow Babies a Children, Cleveland, OH, USA. 2Rush University Medical Center, Chicago, IL, USA. 3University of California Davis Medical Center, Sacramento, CA, USA. 4Bayer, Whippany, NJ, USA. 5Bayer, Wuppertal, Germany. 6University of Minnesota Medical Center, Minneapolis, MN, USA


A7. PATHOPHYSIOLOGY OF THROMBOSIS


0

HEMODYNAMIC AND VENTILATORY RESPONSES DURING EXERCISE IN PEDIATRIC PATIENTS WITH PULMONARY EMBOLISM
Mackenzie Parker, Tony Babb, Michael D Nelson, Ayesha Zia. University of Texas Southwestern Medical Center, Dallas, TX, USA


A8. ANTITHROMBOTIC THERAPY


128

DESCRIBING THE USE OF COAGULATION FACTOR XA (RECOMBINANT), INACTIVATED-ZHZO (ANDEXANET ALFA) AT A MULTICENTER HEALTH SYSTEM
Krishna Modi, Dana Attar, Philip Kuriakose , Jona Lekura, Gerald Koenig, Long To, Michael Hudson, Panayiotis Mitsias , Abdul-Nasser Charara, James Kalus, Norm Buss, Mohammed Rehman, Scott Kaatz. Henry Ford Health System, Detroit, MI, USA


129

TITLE: FIXED-DOSE 1500 UNIT 4F-PCC FOR APIXABAN OR RIVAROXABAN REVERSAL IN MAJOR BLEEDING
Jamie Kooiman, Sean Lujan, Lisa Anselmo, Mindy Mason, Chelsea Rodriguez, Allison Burnett. University of New Mexico Hospital, Albuquerque, NM, USA


130

SHORT-TERM OUTCOMES OF CATHETER-RELATED ARTERIAL THROMBOSIS IN NEONATES AND CHILDREN
Clay T Cohen1, 2, Viia Anderson1, 2, Kristen A Staggers1, Rosa Diaz1, 2. 1Baylor College of Medicine, Houston, TX, USA. 2Texas Children's Hematology and Cancer Centers, Houston, TX, USA


131

BUNDLE APPROACH IN VENOUS THROMBOEMBOLISM PROPHYLAXIS IN PATIENTS WITH NON-TRAUMATIC SUBARACHNOID HEMORRHAGE
Brian V. Phan1, Lolita Fagaragan2, Ali Alaraj2, Keri S. Kim2. 1Riverside University Health System, Moreno Valley, CA, USA. 2University of Illinois Health, Chicago, IL, USA


132

UTILIZATION OF APIXABAN AND RIVAROXABAN LEVELS IN CLINICAL PRACTICE
Anne E Rose1, Erin N Robinson1, Cameron J Patterson1, Katherine A Cinnamon1, David J Ciske2. 1UW Health, Madison, WI, USA. 2University of Wisconsin Medical Foundation, Madison, WI, USA


133

DEVELOPMENT AND IMPLEMENTATION OF A SYSTEM BASED INTERVENTION FOR HEALTHCARE-ASSOCIATED VENOUS THROMBOEMBOLISM PROPHYLAXIS AT A SAFETY NET ACADEMIC MEDICAL CENTER
Alyssa E. Utz1, Michael Knauss1, Palak K. Patel1, Mikhail Y. Akbashev2. 1Grady Health System, Atlanta, GA, USA. 2Emory University School of Medicine, Atlanta, GA, USA


134

THE OVERUSE OF UNFRACTIONATED HEPARIN (UFH) VERSUS LOW MOLECULAR WEIGHT HEPARIN (LMWH) IN HOSPITALIZED PATIENT WITH ACUTE DEEP VEIN THROMBOSIS (DVT) AND PULMONARY EMBOLISM (PE)
Steven J. Jubelirer1, Saranya Dinesan1, Christine A. Welch2, Talia E. Alexander1, Mitchell L. Stanley1. 1Charleston Area Medical Center/West Virginia University, Charleston, WV, USA. 2Charleston Area Medical Center/ Outcomes Research, Charleston, WV, USA


135

SEROPREVALENCE OF PRE-EXISTING NABS AGAINST AAV1, 2, 5, 6 AND 8 IN A SOUTH AFRICAN HEMOPHILIA PATIENT POPULATION
Anna Majowicz1, Nolukholo Ncete2, Floris van Waes1, Nikki Timmer1, Sander J van Deventer1, Johnny N Mahlangu2, Valerie Ferreira1. 1uniQure B. V, Amsterdam, Netherlands. 2Hemophilia Comprehensive Care Center, Johannesburg, South Africa


136

PREVALENCE AND AFFINITY/AVIDITY ASSESSMENT OF PRE-EXISTING NABS AGAINST AAV1, 2, 5, AND 8, ANALYZED IN THE SERUM OF 300 HEALTHY DONORS
Anna Majowicz, Floris van Waes, Nikki Timmer, Sander J van Deventer, Valerie Ferreira. uniQure B. V, Amsterdam, Netherlands


137

RECENT PROGRESS IN THE DEVELOPMENT PROGRAM OF AMT-061 (ETRANACOGENE DEZAPARVOVEC) FOR PERSONS WITH SEVERE OR MODERATELY SEVERE HEMOPHILIA B
Steven W Pipe1, Wolfgang Miesbach2, Annette Von Drygalski3, Adam Giermasz4, Karina Meijer5, Michiel Coppens6, Peter Kampmann7, Robert Klamroth8, Roger Schutgens9, Nigel S Key10, Susan Lattimore11, Michael Recht11, Esteban Gomez13, Giancarlo Castaman14, Eileen K Sawyer12, Robert Gut12. 1University of Michigan, Ann Arbor, MI, USA. 2University Hospital Frankfurt, Frankfurt, Germany. 3University of California San Diego, San Diego, CA, USA. 4University of California Davis, Sacramento, CA, USA. 5University Medical Center Groningen, Groningen, Netherlands. 6Academic Medical Center, Amsterdam, Netherlands. 7Rigshospitalet, Copenhagen, Denmark. 8Vivantes Klinikum, Berlin, Germany. 9University Medical Center, Utrecht, Netherlands. 10University of North Carolina, Chapel Hill, NC, USA. 11Oregon Health a Science University, Portland, OR, USA. 12uniQure biopharma B. V, Lexington, MA, USA. 13Phoenix Children's Hospital, Phoenix, AZ, USA. 14Azienda Ospedaliera Universitaria Careggi, Florence, Italy. 15Erasmus University Medical Center, Rotterdam, Netherlands


A9. INFORMATIONAL ABSTRACT (POSTER ONLY)


0

A MACHINE LEARNING APPROACH TO PREDICT DEEP VENOUS THROMBOSIS AMONG HOSPITALIZED PATIENTS
Logan Ryan, Anna Lynn-Palevsky, Samson Mataraso, Emily Pellegrini, Gina Barnes, Abigail Green-Saxena, Jana Hoffman, Jacob Calvert, Ritankar Das. Dascena, Inc, San Francisco, CA, USA


138

PATIENT SATISFACTION WITH HEMOPHILIA TREATMENT CENTERS: DIFFERENCES BETWEEN MILDS AND SEVERES FROM THE 2ND NATIONAL US HTC PATIENT SATISFACTION SURVEY
Judith Baker1, 2, Rick Shearer3, Merilee Ashton3, Susan Lattimore4. 1Center for Inherited Blood Disorders, Orange, CA, USA. 2UCLA, Los Angeles, CA, USA. 3University of Colorado, Aurora, CO, USA. 4Oregon Health a Science University, Portlant, OR, USA

7:00 - 8:00 PM
SHORT TALKS
BASIC SCIENCE OF HEMOSTASIS


EVALUATING THE ROLE OF SINGLE SITE GLYCAN MODIFICATION OF B-DOMAIN DELETED FACTOR VIII ON ANTI-FACTOR VIII EXPRESSION AND ANTIBODY BINDING
Jasmine C. Ito, John F. Healey, Hunter W. Baldwin, Ernest T. Parker, Shannon L. Meeks , Glaivy Batsuli. Aflac Cancer and Blood Disorders Center of Children, Atlanta, GA, USA


ANGIOGENIC ALTERATIONS IN VON WILLEBRAND DISEASE (VWD) AS A POSSIBLE CAUSE OF OCCULT BLEEDING IN THE STOMACH
Katharina Kaiser1, 2, Stefanie Lehner1, Hanna Allerkamp1, 2, Carsten Detering1, Mahnaz Ekhlasi-Hundrieser1, Christiane Pfarrer2, Mario von Depka1. 1Werlhof Institute, Hannover Germany. 2Institute of Anatomy, University of Veterinary Medicine, Hannover Germany


THE ROLE OF IGM REACTIVE TO THE C1 DOMAIN IN THE HUMORAL IMMUNE RESPONSE TO FACTOR VIII
Seema R Patel, Jasmine C Ito, Hunter W Baldwin, Courtney Cox, John Healey, Ernest Parker, Shannon L Meeks, Glaivy Batsuli. Aflac Cancer and Blood Disorders Center, Children, Atlanta, GA, USA


BLEEDING DISORDER THERAPY


WHAT TO DO WITH PATIENTS WITH TYPE 3 VWD AND VWF INHIBITORS? IS ITI ENOUGH?
Ahmad Al-Huniti, Vanessa Bouskill, Melanie Jackson, Caroline Malcolmson, Alyaa Al Mughairy, Manuel Carcao. The Hospital for Sick Children, Toronto, ON, Canada


AN INTERNATIONAL MULTICENTER STUDY OF BEVACIZUMAB FOR BLEEDING IN HEREDITARY HEMORRHAGIC TELANGIECTASIA: THE INHIBIT-BLEED STUDY
Hanny Al-Samkari1, 2, Raj S. Kasthuri3, Joseph G. Parambil4, Hasan A. Albitar5, Carolina Vazquez6, Marcelo M. Serra6, Sophie Dupuis-Girod7, Craig B. Wilsen8, Justin P. McWilliams8, Evan H. Fountain9, James R. Gossage9, Clifford R. Weiss10, Assaf Issachar11, Mary E. Meek12, Miles Conrad13, Vivek N. Iyer5. 1Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA, USA. 2Harvard Medical School, Boston, MA, USA. 3Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 4Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. 5Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. 6Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 7Centre de Reference pour la maladie de Rendu-Osler, Hospices Civils de Lyon, Lyon, France. 8Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 9Division of Pulmonary, Critical Care, and Sleep Medicine, Augusta University, Augusta, GA, Augusta, GA, USA. 10Russel H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 11Schneider Children, Tel Aviv, Israel. 12Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 13Department of Radiology, University of California San Francisco Medical Center, San Francisco, CA, USA


TREATMENT OF IMMUNE THROMBOCYTOPENIA WITH THE SPLEEN TYROSINE KINASE INHIBITOR FOSTAMATINIB: RESTORING HEMOSTATIC BALANCE WHILEAVOIDING A PROTHROMBOTIC STATE
Ivy Altomare1, Vadim Markovtsov2, Leslie Todd2, Dheepika Weerasinghe2, Robert P Numerof2, Sandra Tong2, Esteban Masuda2, James B Bussel3. 1Duke University School of Medicine, Durham, NC, USA. 2Rigel Pharmaceuticals, Inc, South SanFrancisco, CA, USA. 3New York Presbyterian Hosp. Weill Cornell Medical Center, New York, NY, USA


EFFICACY AND SAFETY OF SIMOCTOCOG ALFA IN PREVIOUSLY UNTREATED PATIENTS WITH SEVERE HAEMOPHILIA A: FINAL RESULTS FROM THE NUPROTECT STUDY
Ellis J Neufeld1, Ri J Liesner2, on behalf of the NuProtect Study Group2. 1St. Jude Children, Memphis, TN, USA. 2Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom


USE OF EMICIZUMAB PROPHYLAXIS IN ADULT AND PEDIATRIC HEMOPHILIA A PATIENTS WITH AND WITHOUT INHIBITORS. SINGLE CENTER EXPERIENCE.
Natalie A. Montanez, Donna Oldfield, Stephanie Gustafson, Joanna Larson, Nidra I. Rodriguez, Neethu Menon, Deborah Brown, Miguel A. Escobar. University of Texas Health Science Center and Gulf States Hemophilia and Thrombophilia Center, Houston, TX, USA


LABORATORY 1


CHILDREN AND YOUNG ADULTS MANIFEST SEVERE COVID-19 COAGULOPATHY
William B Mitchell1, Jennifer Davila1, Janine Keenan1, Jenai Jackson1, Adit Tal1, Kerry A Morrone1, Ellen J Silver1, Sarah O'Brien2, Deepa Mawani1. 1Albert Einstein College of Medicine, Bronx, NY, USA. 2Nationwide Children, Cincinnati, OH, USA


COAGULATION AND CIRCULATING HEPARIN PROFILE IN PATIENTS WITH END-STAGE RENAL DISEASE UNDERGOING MAINTENANCE HEMODIALYSIS
Emily Bontekoe, Arjun Grewal, Jasdeep Bajwa, Nausheen Baig, Melissa Mazariegos, Vinod Bansal, Fakiha Siddiqui, Omer Iqbal, Debra Hoppensteadt, Jawed Fareed. Loyola University Medical Center, Maywood, IL, USA


ASSESSMENT OF A NEW CHROMOGENIC FVIII ASSAY IN SEVERE HAEMOPHILIA A PLASMA CONTAINING EMICIZUMAB
Annette Bowyer, Steve Kitchen, Richard Wardle, Rhona Maclean. Sheffield Haemophilia and Thrombosis Centre, Sheffield, United Kingdom


THE UTILIZATION OF DOAC-STOP IN LABORATORY INVESTIGATION OF LUPUS ANTICOAGULANT FOR PATIENTS ON DIRECT ORAL ANTICOAGULANTS
Jing Jin1, Chris Pfaffroth1, Trang Vu1, Steven Baker2, James Zehnder2, 3. 1Department of Special Coagulation Clinical laboratory, Stanford Health Care, Palo Alto, CA, USA. 2Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA. 3Division of Hematology, School of Medicine, Stanford University, Stanford, CA, USA


THE INFLUENCE OF EMICIZUMAB (EMI) ON GLOBAL HEMOSTASIS IS BETTER MEASURED BY THROMBIN GENERATION ASSAY (TGA) THAN THROMBOELASTOGRAPHY
Erika J Martin1, Gita V Massey2, Janice G Kuhn1. 1Virginia Commonwealth University, Richmond, VA, USA. 2Children, Richmond, VA, USA

7:00 - 7:45 PM
POSTER SESSION
POSTER SESSION 1


A1. ANTICOAGULATION CLINICS


0

REMOTE WARFARIN MANGEMENT USING EKITE; AN INNOVATIVE LEARNING EXPEREINCE WITH HOME INR MONITORING
MARY BAUMAN1, 2, CHRISTINA VANDERPLUYM3, RUKHMI BHAT4, EWURABENA SIMPSON6, MARY MEHEGAN5, PATRICIA MASSICOTTE1, 2. 1Stollery childrens hospital, Edmonton, AB, Canada. 2university of Alberta, Edmonton, AB, Canada. 3boston childrens hospital, Boston, MA, USA. 4lurie childrens hospital, Chicago, IL, USA. 5St louis childrens hospital, St Louis, WA, USA. 6childrens hospital of eastern ontario, Ottawa, ON, Canada


A2. PLATELET ACTIVATION AND BIOCHEMISTRY


0

ENHANCING TRANSFUSABLE PLATELETS USING MRNA THERAPY TO PRODUCE EXOGENOUS PROTEINS
Jerry Leung, Andrew Hagner, Dominik Witzigmann, Peter Zandstra, Pieter Cullis, Christian Kastrup. University of British Columbia, Vancouver, BC, Canada


A5. BLOOD COAGULATION AND FIBRINOLYTIC FACTORS


47

RECOGNIZING REASONS OF UNWARRANTED COAGULATION TESTING IN MEDICALLY ILL PATIENTS - A SNEAK PEEK
Sidra Asad Ali, Amir Khan, Naila Noor. Patel Hospital, Karachi, Pakistan


48

LEVERAGING TURBIDIMETRY AND THROMBOELASTOGRAPHY TO CHARACTERIZE FIBRIN FORMATION UNDER DIVERSE CLOTTING CONDITIONS
Ziqian Zeng1, 2, Mahussi Fagnon1, Tanmaye Nallan Chakravarthula1, 2, Nathan / J Alves1, 2. 1Indiana University School of Medicine: Emergency Medicine, Indianapolis, IN, USA. 2Purdue University: Weldon School of Biomedical Engineering, West Lafayette, IN, USA


49

IDENTIFY THE KNOWLEDGE, ATTITUDE AND PRACTICE OF HEALTHCARE PROVIDERS TOWARD PRESCRIBING FACTOR REPLACEMENT AT FEDERALLY FUNDED HEMOPHILIA TREATMENT CENTERS IN THE UNITED STATES.
Maya Bloomberg1, Krysten Sargenton1, Karina Gattamorta2, Debbie Anglade2. 1University of Miami Hemophilia Treatment Center, Miami, FL, USA. 2University of Miami School of Nursing a Health Studies, Miami, FL, USA


50

PROFILE OF INFLAMMATORY BIOMARKERS AND COAGULATION FACTORS IN END-STAGE RENAL DISEASE
Emily Bontekoe, Arjun Grewal, Vinod Bansal, Debra Hoppensteadt, Melissa Mazariegos, Jawed Fareed. Loyola University Chicago, Maywood, IL, USA


51

COAGULATION PROFILE DERANGEMENT AND DISEASE SEVERITY/SPECTRUM IN PEDIATRIC POPULATION
Asma N Cheema1, Syeda Saima Irshad2, Muhammad Aamer Sujjad1, Muhammad Gulsher1. 1Department of Pathology, Children's Hospital a The Institute of Child Health, Multan, Pakistan. 2Department of Pediatric medicine Children's Hospital a The Institute of Child Health, Multan, Pakistan


52

PERFORMANCE CHARACTERISTICS OF A CHROMOGENIC FACTOR VIII METHOD ON THE STA-R EVOLUTION XP
Ronda A Crist1, Daniel A Stephens1, George M Rodgers1, 2, 3, Jessica Corean1, 2, Karen A Moser1, 2, Kristi J Smock1, 2. 1ARUP Institute for Clinical and Experimental Pathologyr, Salt Lake City, UT, USA. 2Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA. 3Division of Hematology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA


53

THE DEVELOPMENT AND IMPACT OF A HEMOSTATIC STEWARDSHIP PROGRAM AT TWO LARGE ACADEMIC MEDICAL CENTERS
Kathryn Dane, John Lindsley, Satish Shanbhag, Michael Streiff. The Johns Hopkins Hospital, Baltmore, MD, USA


54

ASSOCIATION OF HYPERCOAGULABLE STATE WITH CLINICAL SEVERITY OF SICKLE CELL DISEASE IN SUDANESE PATIENTS
Alaaeddin M. Elzubeir1, 2, Shima H. Elsheikh2, Tayseer A. Alabid2. 1University of Colorado Denver, Aurora, CO, USA. 2University of Khartoum, Khartoum, Sudan


55

EVALUATION OF A RAPID AUTOMATED CHEMILUMINESCENT ADAMTS13 ACTIVITY ASSAY FOR THE ACL ACUSTAR
R Fretwell, T Pitchford, SM Cooper, S Kitchen. Sheffield Teaching Hospitals, Sheffield, United Kingdom


56

EFFECTS OF TAI CHI ON BALANCE IN INDIVIDUALS LIVING WITH HEMOPHILIA
Mark Krimmel1, Rebecca Kruse-Jarres2, Bruno Steiner3. 1Washington Center for Bleeding Disorders, Seattle, WA, USA. 2University of Washington, Seattle, WA, USA. 3Washington Center for Bleeding Disorders, Seattle, WA, USA


57

EFFECT OF HUMAN PLASMA ON EVALUATION OF COAGULATION FACTOR VIII PRODUCT PURITY BY WESTERN BLOT
Yideng Liang, Mohammad B Uddin, Alexey V Khrenov, Sergey S Akimov, Timothy K Lee, Mikhail V Ovanesov. U. S. Food and Drug Administration, Silver Spring, MD, USA


58

KNOCKDOWN OF HEPATIC TAFI OR A2AP BY GALNAC-SIRNA STRATEGY EXPEDITED THROMBOLYSIS IN A RODENT LARGE-VEIN ELECTROLYTIC INJURY MODEL
Jingxuan Liu1, Brian Cooley2, Akin Akinc1, Anna Borodovsky1, Patrick Haslett1. 1Alnylam Pharmaceuticals, Cambridge, MA, USA. 2University of North Carolina, Chapel Hill, NC, USA


59

INFLUENCE OF DOAC REMOVE ON COAGULATION ASSAYS IN SAMPLES FROM PATIENTS ON ANTICOAGULATION
Zahra Al-Qawzai1, Nada Yartey2, Chris Dale2, Minal Dave2, Sean Platton2. 1Clinical Biochemistry Laboratory, Royal London Hospital, London, United Kingdom. 2Haemostasis Laboratory, Royal London Hospital, London, United Kingdom


60

CRYOCHECK™ CHROMOGENIC FACTOR VIII: A NEW KIT FOR THE DETERMINATION OF FACTOR VIII:C ACTIVITY
Tara Quinton, Karen M. Black, Ali Sadeghi-Khomami. Precision BioLogic Inc, Dartmouth, NS, Canada


61

PERFORMANCE OF CRYOCHECK™ CHROMOGENIC FACTOR VIII IN THE RECOVERY OF FACTOR VIII REPLACEMENT THERAPIES
Tara Quinton, Karen M. Black, Ali Sadeghi-Khomami. Precision BioLogic Inc, Dartmouth, NS, Canada


62

DEVELOPMENT AND PERFORMANCE CHARACTERIZATION OF AN AUTOMATED CHROMOGENIC ASSAY FOR HUMAN FACTOR IX ACTIVITY
Narayanan Ramamurthy, Sean Duffin, Cheryl Kucharshi, Zach Vandertuin, Michael Morris. r2 Diagnostics Inc, Suoth Bend, IN, USA


63

MATHEMATICAL MODELING OF IMPACTS OF VARIABLE HEMATOCRIT AND BLOOD COLLECTION FILL VOLUME ON CITRATED PLASMA FOR COAGULATION TESTING
Jay S. Raval, Marian A. Rollins-Raval, Richard A. Marlar. University of New Mexico, Albuquerque, NM, USA


64

EFFICACY AND SAFETY OF N8-GP FOR PROPHYLAXIS AND BLEED CONTROL IN US VS GLOBAL PATIENTS WITH HEMOPHILIA A: RESULTS FROM THE PATHFINDER CLINICAL PROGRAM
Allison P. Wheeler1, Miguel Escobar2, Susan Kearney3, Leslie Raffini4, Janice M. Staber5, Suchitra Acharya6, David L. Cooper7, Steven Lentz8. 1Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA. 2University of Texas Health Science Center, Houston, TX, USA. 3Children, Minneapolis, MN, USA. 4Children, Philadelphia, PA, USA. 5University of Iowa Stead Family Children, Iowa City, IA, USA. 6Cohen Children, New Hyde Park, NY, USA. 7Novo Nordisk Inc, Plainsboro, NJ, USA. 8University of Iowa, Iowa City, IA, USA


65

PHARMACOVIGILANCE OF VON WILLEBRAND FACTOR/COAGULATION FVIII COMPLEX (HUMAN)- 10 YEARS' EXPERIENCE
Claudio Sandoval, Azim Saifee, Dipen Patel, Huub Kreuwel. Octapharma USA, Hoboken, NJ, USA


66

VON WILLEBRAND DISEASE IN PREGNANCY AND THE USE OF EPIDURAL ANALGESIA
Maissaa Janbain, MD, Radia Ksayer, MD, Anna Swigert, BS. Tulane University School of Medicine, New Orleans, LA, USA


A7. PATHOPHYSIOLOGY OF THROMBOSIS


0

PEDIATRIC RENAL RHABDOID CELLS CONSTITUTIVELY EXPRESS HEMOSTATIC SYSTEM FACTORS AND THE PROTEIN EXPRESSION IS AFFECTED BY CHEMOTHERAPY
Hanjie Zhu, Ghada Aborkhees, Kevin Dietrich , Lesley Mitchell. Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada


A9. INFORMATIONAL ABSTRACT (POSTER ONLY)


67

A ROLE FOR NURSES: HOSPITAL-WIDE ROLL OUT OF EXTREMITY PRECAUTIONS FOR NEW FINDING OF EXTREMITY THROMBOSIS PROCEDURE AT A PEDIATRIC TERTIARY CARE SETTING - A QUALITY IMPROVEMENT INITIATIVE
Marilyn Blumenstein, Emily Roberto. The Children's Hospital of Philadelphia, Philadelphia, PA, USA


68

PHARMACOKINETICS OF RECOMBINANT VON WILLEBRAND FACTOR IN PERIPARTUM MANAGEMENT OF AN ADOLESCENT WITH TYPE 2M VON WILLEBRAND DISEASE
Caitlin Montcrieff1, 2. 1Rhode Island Hemostasis a Thrombosis Center, Providence, RI, USA. 2Hasbro Children's Hospital, Providence, RI, USA


69

RETROSPECTIVE ANALYSIS OF TEN YEARS OF PT AND APTT VALIDATION DATA IN A REFERENCE LAB
Dan A Stephens, Ronda A Crist, George M Rogers, Kristi J Smock, Karen Moser. ARUP Institute for Clinical and Experimental Pathologyr, Salt Lake City, UT, USA

7:00 - 8:00 PM
SHORT TALKS
THROMBOSIS: DIAGNOSIS AND MANAGEMENT


OPTIMIZING THROMBOPROPHYLAXIS USE IN PEDIATRIC ORTHOPEDIC SURGERY THROUGH IMPLEMENTATION OF A VENOUS THROMBOEMBOLISM RISK SCREENING TOOL
Wyatt MacNevin1, Kedar Padhye2, Yasser Alkhalife2, Victoria Price1, Ron El-Hawary2, Brian R. Branchford3, Sarah Stevens4, Ketan Kulkarni1. 1Division of Pediatric Hematology Oncology, Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada. 2Division of Orthopaedics, IWK Health Centre, Halifax, NS, Canada. 3Division of Pediatric Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. 4Department of Anesthesiology, IWK Health Centre, Halifax, NS, Canada


RESULTS OF THE PEGASUS PHASE 3 RANDOMIZED TRIAL DEMONSTRATING SUPERIORITY OF THE C3 INHIBITOR, PEGCETACOPLAN, COMPARED TO ECULIZUMAB IN PATIENTS WITH PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
Ilene Weitz1, Hillmen Peter2, Szer Jeff3, Alexander Roth4, Britta Hochsmann5, Jens Panse6, Kensuke Usuki7, Morag Griffin2, Jean-Jacques Kiladjian8, Carlos de Castro9, Hisakazu Nishimori10, Mohamed Hamdani11, Temitayo Ajayi11, Antonio Risitano12, Regis Peffault de Latour13, on behalf of PEGASUS investigators . 1Jane Anne Nohl Division of Hematology, Keck-USC School of Medicine, Los Angeles, CA, USA. 2Department of Haematology, St James's University Hospital, Leeds United Kingdom. 3Department of Clinical Haematology, Peter MacCallum Cancer Center a Royal Melbourne Hospital, Melbourne Australia. 4Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen Germany. 5Institute of Transfusion Medicine, University of Ulm and Institute of Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Transfusion Service and University Hospital Ulm, Ulm Germany. 6Department of Oncology, Hematologiy, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen Germany. 7NTT Medical Center Tokyo, Tokyo Japan. 8Centre d'Investigations Cliniques, Hopital Saint-Louis Assistance Publique, Paris France. 9Duke University School of Medicine, Durham, NC, USA. 10Department of Hematology and Oncology, Okayama University Hospital, Okayama Japan. 11Apellis Pharmaceuticals, Waltham, MA, USA. 12Hematology and BMT Unit, AORN San Giuseppe Moscati, Avellino Italy. 13French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Assistance Publique, Paris France


ANALYSIS OF MANAGEMENT STRATEGIES FOLLOWING SLIGHTLY OUT OF RANGE INRS: WATCHFUL WAITING VS. ANY DOSE CHANGES
Hallie B. Remer1, Xiaokui Gu1, Brian Haymart1, Geoffrey D. Barnes1, Mona Ali2, Eva Kline-Rogers1, Tina Alexandris-Souphis1, Jay Kozlowski3, James B. Froehlich1, Vinay Shah4, Greg Krol4, Scott Kaatz4. 1University of Michigan, Ann Arbor, MI, USA. 2Beaumont Hospital, Royal Oak, MI, USA. 3Detroit Medical Center, Detroit, MI, USA. 4Henry Ford Health System, Detroit, MI, USA


OVERUTILIZATION OF VENOUS DOPPLER ULTRASONOGRAPHY TO DETECT DEEP VEIN THROMBOSIS IN INTENSIVE CARE UNITS
Sophie Samuel1, Thuy Nguyen1, James Beeson1, Thanh Dao1, Liang Zhu2, Louise D McCullough2. 1Memorial Hermann Medical Center, Houston, TX, USA. 2Univeristiy of Texas. McGovern Medical School, Houston, TX, USA


PREVALENCE, TRENDS, PREDICTORS AND OUTCOMES OF PORTAL VEIN THROMBOSIS IN HOSPITALIZED PANCREATIC CANCER PATIENTS: A NATIONWIDE INPATIENT SAMPLE DATABASE ANALYSIS FROM 1998-2016
Yu Zhao1, Hussam Alhasson1, Peng Cai2, Anas Saad3, Muneer Al-Husseini4. 1Department of Internal Medicine, Rochester Regional Health- Unity Hospital, Rochester, NY, USA. 2Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA. 3Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA. 4Department of Internal Medicine, Ascension St John Hospital, Detroit, MI, USA