***NEW PODCAST - ANNEXA-I***.Pleased to release the latest episode of "Don't Just Read the Abstract" podcast with @PipNicolson. In this episode, we discuss ANNEXA-I - andexanet alfa vs usual care for intracerebral haemorrhage. It's a lively discussion! .On all podcast platforms.

#SickleCell #inequalities #GeneTherapy.

Among other points, we stress the importance of good communications from leaders, advocacy groups, and institutions. We also reflect on the importance of investing in familiar therapies such as hydroxycarbamide, transfusion, and good all round preventative management.

This approach is a dilemma in the context of historical underinvestment. Can lowering approval thresholds and allowing earlier access to novel therapies be a route towards health equity? Or does this remove vital protections and compound inequalities for people living with SCD?.

NICE initially rejected all three of the above therapies, then subsequently approved them, at least in part in a bid to tackle health inequalities. In so doing, NICE stated that they accept more uncertainty about efficacy and safety than they would normally.

Our figure shows the wild west of approvals and reversals in SCD over the past few years. Voxeletor was available in the UK for only 4 months and crizanliuzmab for only just over 12! .This erodes trust.

In the past few years, three new therapies for sickle cell disease have been approved for use in the UK NHS. These are: crizanlizumab, voxeletor, and exa-cel (gene therapy).

1/ Out now in @Hemasphere_EHA. Interesting authorship this - consisting of some academic physicians, Chair of @SickleCellUK and a fantastic patient advocate. We discuss the impact of recent approvals and reversals in sickle on the community. A short🧵.#OpenAccess

We need an RCT to work out whether there is any benefit at all to venesection or whether we can simply see once in clinic and discharge the vast majority of patients who do not have JAK2 mutation. Well done to @PipNicolson and supported by @HaemSTAR_UK.

Obviously, this is a heterogenous group but there is absolutely not strong evidence for venesection in idiopathic and secondary polycythaemia. Our recent UK-wide survey shows that ~40% physicians regularly venesect patients.

Over median 6.2 y follow-up, rate of new VTE: 2.9% and new arterial thrombosis: 7.3%. Mortality rate: 15%.The only predictor of thrombosis was prior VTE. Neither venesection nor persistence of polycythaemia affected either thrombosis or mortality

Importantly, we found that by the time these patients were seen in clinic, the haematocrit was already falling and had often reduced below diagnostic threshold by 12 months from first clinic assessment.

Interestingly, we found only a weak correlation between haematocrit measurement and red cell mass (where measured).

We studied 266 patients with non-JAK2 mutated polycythaemia and audited against BSH guidelines. 60% patients had at least one venesection - 40% were never venesected - demonstrating variable practice across our two centres.

1/ Pleased to have been involved in this study in @BrJHaem that looks at secondary & idiopathic polycythaemia. This is not a fashionable area but a big deal that takes up a lot of time in the clinic. We looked at management and thrombosis rates in two large centres in England.

Looking for a review into a fascinating group of diseases embedded in evolutionary biology? . This review from Megan Preece, Deepa Arachchillage and team should do it for you.

I have done three DBS checks in the space of 6 months for rotating training jobs in the NHS. Surely there is a more efficient way!?.

An SHO once called me as the on-call haematologist. He didn't know the patient's name, the background history, or why he was calling. I went to the ward!. A reminder that one can arrive at competence by many routes. Similarly, one can arrive at incompetence by many routes.

Trump claimed he could quickly resolve crises in Gaza, Ukraine, Iran, and North Korea, without any plan, or knowledge of complex geopolitics and history. The world is learning the true cost of populism - chaos, war, and destruction.

Impressive results here. Really interesting - ven-ibr better than ibr alone or FCR in CLL. Great work from the UK trials team.

🎧What's it like to be one of two haematologists in an entire West African country? 🌍.On the latest episode of Don't Just Read the Abstract, @PipNicolson and I discuss with Dr Megan Kell, Chair of the @BritSocHaem Global Specialist Interest Group about her time in the Gambia. 🩸