Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Leung KH, Tam KW, Lei WS, Pang CK, Fan TC, Lin SY
Affiliation :
Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Introduction: Hepatitis B infection, either carriers or recovered from past infection, are common in HongKong Chinese. Patients with haematological malignancy often require intensive chemotherapy, B-cell depleting agents such as rituximab or myeloablative conditioning regimen for hematopoietic stem cell transplantation. Hepatitis B reactivation is potentially fatal and largely preventable with close monitoring and appropriate antiviral drugs. Failure to offer treatment is tragic and has serious medical-legal consequences
Objectives :
Objectives: To audit the compliance of haematology patients undergoing chemotherapy to the recommended guidelines for prevention of hepatitis B reactivation
Methodology :
Methodology: All haematology inpatients from July to December 2023 were screened and those received at least one cycle of chemotherapy were included. Baseline testing of hepatitis B status, appropriate prescription of prophylactic antiviral drugs, checking of hepatitis B virus deoxyribonucleic acid (HBV-DNA) level and clinical outcome were reviewed. Two international guidelines were used as reference standards.
Result & Outcome :
Results: 115 patients (52% male) fulfilled the inclusion criteria. 49.5% patients had lymphoma; 23.5% had multiple myeloma; 19.1% had acute myeloid leukaemia; others had myelodysplastic syndrome, acute lymphoblastic leukaemia or chronic lymphocytic leukaemia. All patients (115 patients) had appropriate pre-chemotherapy hepatitis B status checked. 13% of patients were hepatitis B carriers while 53% had past hepatitis B infections and totally 66% (76 patients) of our patients were susceptible to hepatitis B reactivation. 100% of patients at risk were on appropriate prophylactic antiviral treatment. All patients had regular monitoring of liver function but only 66 out of 76 patients (87%) had HBV-DNA checked. No patients had hepatitis B reactivation during the study period.
Conclusion: The compliance rates on pre-chemotherapy hepatitis B status checking, initiation of prophylactic antiviral treatment and monitoring of liver function were 100% and no patient having hepatitis B reactivation. However, the checking of HBV-DNA is only 87% which needs reinforcement measures and promulgation. Even though hepatitis B reactivation is rare for patients on antiviral treatment regularly, monitoring of HBV-DNA is required in most of the international guidelines and reactivation is still possible, especially in patients with poor drug compliance. Possible reason for suboptimal HBV-DNA testing may be the long turnaround time for HBV-DNA processing which is currently 7-14 days and might require further improvement.
