One Week in Bangkok – Thoughts on ISTH 2024
Posted on: July 10, 2024
Jennifer J. Kiblinger
Scientific Director
First, I need to comment how amazing the people of Thailand were. This introvert was a bit worried about going to such a crowded city, but everyone was so hospitable. At the hotel, at the convention center, on the public transit. Those of you who stayed to the end perhaps heard Dr. Guy Young state how amazed he was at how organized the lines were to get on the trains. I must second that. They really made things so much more pleasant. The congress venue, Queen Sirikit National Convention Center, was about the most beautiful I’ve seen, clean with plentiful seating and places to grab a coffee.
A story that demonstrates the character of the people I met: The first morning there, I realized after I got out of the shower that one of my diamond earrings fell out. I searched and couldn’t find it so thought it must have gone down the drain. Then two days later, I came back to the hotel at night to find my diamond earring sitting on the vanity. Housekeeping found it and returned it! I am so grateful for everyone’s honesty and hospitality.
The exhibit hall offered many delights, from chair Thai Massage to the sought-after yearly t-shirts from our partner, Technoclone. The line for the shirts snaked throughout the hall!
On Monday evening, I had the pleasure of attending a private seminar at KHAO, hosted by Zacros on the T-TAS® 01 PL Chip in the clinical laboratory. The food was delicious and the atmosphere was authentic. (Thank you to my colleague for explaining that the white peppermint-scented thing was a hand towel and not a palette cleanser!). We learned how the T-TAS® 01 can detect platelet function defects that conventional tests may miss, independent of platelet count.
The science was as top-notch as ever, highlighting the latest breakthroughs in thrombosing and bleeding disorders.
The first day began with a lively discussion of ISTH guidelines. This set of 13 recommendations address clinical care of hemophilia A and B patients. These guidelines for hemophilia sparked passionate commentary. For example, questions regarding physicians’ liability were raised, but the guidelines allow for physician expertise and care and emphasize patient involvement and shared decision-making. With so many options and questions in hemophilia care, with more coming, I’m sure the discussions will continue as the field evolves. An intriguing thought when discussing future directions is how AI might be incorporated into guidelines and diagnoses.
On the topic of hemophilia, laboratory testing was addressed during multiple sessions. We know that there is a discrepancy between one stage clotting assays (OSA) and chromogenic substrate assays (CSA), and that it matters what therapy the patient is on to determine the appropriate test. An interesting and concerning fact I learned is that, despite CSA being more accurate in most (certainly not all!) situations, providers ordered CSA in 35% for women vs. 61% for men. More providers ordered OSA only in women vs. men. Thank you to the leaders of the WHAssay Project who seek to remedy this by understanding the current practices and perspectives of hemophilia provides in diagnosing women and girls with Hemophilia A (WGwHA) with OSA vs. CSA.
Another valuable session was the Hemophilia Laboratory Testing Workshop. The room was full, illustrating the desire for diagnostics-focused panels. Each therapy has its own characteristics which complicates assay choice for monitoring. The speakers provided a helpful breakdown of treatments and appropriate assay methodologies. In an ideal world, we would know what each patient is on, but unfortunately that is still a roadblock in many cases. It’s therefore important for laboratories to report what method/reagents they are using.
Here is a table of current and upcoming therapies and whether it is recommended to use a Chromogenic Substrate Assay with Human or Bovine Factor Reagent:
| Therapeutic | CSA with Human Factor Reagents | CSA with Bovine Factor Reagents |
| Advate | Yes | Yes |
| Adynovate/Adynovi | Yes | Yes |
| Jivi | Yes | Yes |
| Esperoct | Yes | Yes |
| Afstyla | Yes | Yes |
| Elocta / Eloctate | Yes | Yes |
| Obizur | No | No |
| Altuviiio / Altuvoct – Efanesoctocog alfa | No | No |
| Plasma-Derived FVIII | Yes | Yes |
| Hemlibra (Emicizumab) | Yes – to detect presence of Emi, or quantitated with calibrated assay | No, not to detect presence of Emi, or quantitated with calibrated assay |
| FVIII in presence of emicizumab | No | Yes |
| Mim8 | Likely No, similar to Emi | Likely Yes, similar to Emi |
Source: Nongnuch Sirachainan, Steve Kitchen, Geoffrey Kershaw. Hemophilia testing diagnostics laboratory workshop. ISTH 2024, 06/25/2024; 4137958; DL 02.
Thrombin Generation Testing was mentioned frequently for its utility as a global test over PT or APTT. Data suggest thrombin generation assays can be useful in many situations, from pediatrics, anticoagulation, hemophilia. It was discussed as a potential tool for measuring hemostatic efficacy, but it needs to be standardized. My immediate thought was that automated methodologies like the Ceveron TGA, for research use only, not for use in diagnostic procedures, could be of use in these studies.
Finally, I was reminded how appropriate it is to discuss antithrombotics vs. anticoagulants. New classes of antithrombotics like those that target FXI and FXIa may be safer than current therapeutics, if they can prevent clotting without increased risk of bleeding. The Gus Born Memorial Plenary Lecture was given by Professor Martine Jandrot-Perrus, MD PhD, and looked at Glycoprotein VI (GPVI) as a target in antithrombotic therapy development. This collagen receptor belongs to the immunoglobulin family and is restricted to platelets and megakaryocytes. This limits unwanted effects, making it an appealing drug target. GPVI deficiency is not associated with significant bleeding risk and hence introduces a new class of antithrombotics. The therapeutic GPVI antagonist, glenzocimab is being evaluated in various clinical trials, particularly in ischemic stroke.
All around, the ISTH 2024 Congress was a great success. Thank you to the Congress organizers and thank you to DiaPharma for this unique opportunity and experience. And importantly, a huge thank you to my colleague, Gloria Sukes, Director of Commercial Operations, for being a fabulous travel companion who made learning, discussing, and navigating the conference and city a delight.
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