UKPS members present their data at the EBMT 50th Annual Meeting
We are delighted to share the contributions of UKPS member Ms Carmel Ann Galligan at this year’s upcoming EBMT annual meeting. EBMT is taking place 14-17th April in Glasgow, where Carmel Ann is presenting two posters during the session ‘Nurses Posters Adult’ on Sunday 14thApril.
In Abstract NP058: ‘Iron Deficiency in Patients Undergoing Extracorporeal Photopheresis (ECP)’, Carmel Ann will discuss Iron deficiency noted in an ECP cohort of patients in an Irish context, while in Abstract NP046: ‘Haematology Crib Cards’ Carmel Ann will describe the ‘Crib Cards’ project – initiated and designed to support end to end learning in the CAR T Nursing Education pathway and the Transplant pathway.
Carmel Ann’s full abstracts can be found below, and we hope her poster presentations stimulate much interest and discussion.
NP058: Iron Deficiency in Patients Undergoing Extracorporeal Photopheresis (ECP)
Carmel Ann Galligan1
1HOPe Directorate, St James’s Hospital, Dublin, Ireland
Background: Iron deficiency was noted in the Extracorporeal Photopheresis (ECP) cohort of patients in an Irish context. ECP is an immune modulating treatment using leukapheresis procedure in the treatment of steroid refectory acute and chronic Graft versus Host Disease (GvHD) (Drexler et al.,2020). This process involves three steps, firstly the cells are collected through an apheresis procedure called leukapheresis to collect the mononuclear cells. Secondly, a photosensitizing drug called 8- methoxypsoralen (UVADEXTM) is injected to the collected mononuclear cells. These mononuclear cells are then exposed to a UVA light and finally reinfused back to the patient (Owsianowski et al.,2020; Knobler et al.,2014). These mononuclear cells treated with the photosensitizing drug (8-methoxysoralen) with UVA light undergo lymphocyte apoptosis causing an increased in pro inflammatory regulation. This reduces the donor T cell, therefore, reducing the GvHD effect to the patient.
Graft versus Host Disease occurs because transplanted cells see the patient (host) as foreign and attack the patient, manifesting initially in three areas, skin, liver, and gut. However, GvHD can affect all organs in a cytokine attack of T cells between the donor and the host’s immune system (Holler, Greinix, and Zeiser, 2018). Approximately 20-80% of HSCT patients will manifest GvHD in the post-transplantation phase (Harris et al.,2016) and as many as 40%- 50% of HSCT patients are refectory to the first line GvHD treatment (Mac Millan et al. 2015; Zeiser and Blazar, 2017; Pidala and Anasetti, 2010). As ECP is a complex process, effective, efficient, and competent nursing management is required, It was observed Iron Deficiency is common in patient undergoing ECP treatment for GvHD.
Methods: A Retrospective chart review was completed of patients on active ECP treatment for acute or chronic GvHD from January to December 2023, who underwent ECP treatments. Current ferritin level was recorded regardless of length of time on ECP. Single centre, Irish review.
Results: Fourteen patients were included in this analysis. Normal ferritin range used 23-393 ng/ml. Four patients were iron deficient (ferritin <23 ng/ml), three patient borderline <150 ng/ml and the seven patient all had normal ferritin serum levels.
Conclusions: Iron deficiency can occur with ECP treatment. Therefore, this risk factor should be monitored. Moosavi et al. (2020) stated iron deficiency anemia is a risk with chronic ECP treatment, and it is stated that it is possible due to maintained blood components in the instrument (Moosavi et al. 2020).
Disclosure: Paid speaker and consultation for ABBVIE
NP046: Haematology ‘Crib Cards’
Carmel Ann Galligan1, Deirdre Byrne1, Maria Gillespie1, Fidelma Dowdall1, Sinead Impey2
1HOPe Directorate, St James’s Hospital, Dublin, Ireland, 2School of Nursing and Midwifery, Trinity College, Dublin, Ireland.
Background: The ‘Crib Cards’ project was initiated and designed to support end to end learning pathways designed and planned by the development teams in the CAR T Nursing Education pathway and on the Transplant pathway. This project was designed following an extensive gap analysis of current training and documentation review across the Haematopoietic Stem Cell Transplantation (HSCT) setting in St James.
The need was to provide evidence based education to support staff and the underpinning standards were the JACIE 8th standards. JACIE applicable standards were B3.6.2 which states that nurses shall have received specific training and maintain competence in the transplant and cellular therapy related skills that they practice.
Methods: An action research methodology was used to achieve the goal of providing evidence based education and ensuring the programme content supported other elements of bespoke education pathways designed by the development team.
The project roles included clinical, technical, education and quality components. Development meetings were planned to design the programme content as required. The materials were combined by four haematology expert nurses in the field of HSCT. The evidence was compiled independently to gather current evidence based practice. This represented a consensus agreement from a nursing perspective in HSCT and Haematology nursing. Healthcare professionals are required to update their skills regularly and engage in continuous professional development (CPD). Mlambo, Silén and McGrath (2021) published a meta synthesis which looked into nurses’ experiences of CPD and how one could propose to provide CPD successfully, as every day in the nursing environment requires new skill sets and knowledge within the dynamic healthcare service we are all working in. Evidence in CPD research concluded that is peer to peer, for example nurse to nurse, education is most beneficial and effective (Clarke, 2005, and Zaleska and De Menezes, 2007).
Results: ‘Crib Card’ content was reviewed on an ongoing basis throughout the project from a clinical, education and quality perspective to ensure content was relevant and evidence based. Technical skills and the support of a skilled designer was key in achieving our project outcome in the form of well designed, referenced, document controlled electronic ‘Crib Cards’ that were uploaded to the hospital intranet system to allow staff to access key ‘Crib Card’ information on a 24 hour basis. A designer was involved in the publishing of the “Crib Cards’,this addition ensured that the content was visible and effective to the reader. Funds for this quality improvement project were sourced locally through HOPe Directorate grant funds. All ‘Crib Card’ documents were also included in the local QPulse quality management system to ensure regular review and updates of documents are completed as required.
Conclusions: Haematology Crib Cards were compiled to provide information on each different topic which is required for the nursing management of the haematology patient. CPD is an effective benefit for the patient, the individual nurse and the institute (Balls, 2010).
Disclosure: Carmel Ann Galligan -Paid speaker and consultation for ABBVIE
The UK Photopheresis Society 