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Background: Anemia in pregnancy increases the need for blood transfusion during and after delivery and is associated with an increased risk of maternal and fetal mortality, therefore preventing maternal anemia may improve outcomes. Iron deficiency is the most common pathologic cause of anemia in pregnancy and is estimated to affect about 30% of pregnant women in the third trimester in the US. The baseline peripartum blood transfusion rate at our institution is 3.2%. Historically, patients who may have benefited from intravenous (IV) iron were continued on oral iron and subsequently delivered with persistent iron deficiency anemia. If identified to need IV iron, these patients were usually referred to a hematologist. However, in the absence of a structured protocol, referral was provider-dependent. Objective: We formed a multidisciplinary work group consisting of members from the departments of Hematology, Obstetrics, Pharmacy, Nursing, and Blood Bank to reduce peripartum blood transfusions by developing a process to manage pregnant patients with iron deficiency anemia. The treatment algorithm utilized at our institution was adapted from "How I treat anemia in pregnancy: iron, cobalamin, and folate" (Achebe & Gafter-Gvili, 2017), which recommends IV iron for hemoglobin less than 11 g/dL and ferritin less than 30 µg/dL in the third trimester and for hemoglobin less than 10.5 g/dL and ferritin less than 30 µg/dL in the second trimester along with recommendations for iron repletion in the first trimester. The primary endpoint was the utilization of blood transfusion. Secondary endpoints included an increase in maternal hemoglobin after treatment and evaluating the safety of IV ferric carboxymaltose as measured by side effects and frequency of hypophosphatemia. Five months after initiation of the IV iron recommendations, we performed an audit to assess its use. Methods: A retrospective IRB-approved chart review of anemic, iron-deficient pregnant women who received IV ferric carboxymaltose from 1/30/19 - 6/30/19 was performed. Thirty-six patients were identified and their charts were reviewed to determine the hemoglobin and ferritin levels prior to IV iron, the number of IV iron infusions received with any side effects, phosphorus levels on days of IV iron, hemoglobin level after IV iron, and need for peripartum blood transfusion. Results: Of the 36 patients who received IV iron for anemia in pregnancy, post-IV iron hemoglobin and blood transfusion information was only available for 26 patients. The remaining 10 patients had not delivered as yet or had delivered at another institution so data were not available. Of these 26 patients, the median age was 26.0 years and all received IV iron during their third trimester. No patients required a blood transfusion peripartum. The average hemoglobin prior to IV iron was 9.3 g/dL and the average hemoglobin after 1-2 IV iron infusions was 11.3 g/dL, an increase of 2.0 g/dL across the total group (Figure 1) (p<0.0001). Of these 26 patients, 7 patients received 1 dose of IV iron and 2 patients experienced heartburn or nausea during or soon after the IV iron infusion. Phosphorus levels were checked in 24 patients and 6 experienced hypophosphatemia with no attributable side effects. No patient experienced a serious adverse effect or reaction requiring discontinuation of IV iron therapy. Conclusion: Results from the first 5 months of this project suggest using a standardized iron deficiency anemia treatment protocol including IV iron to reduce the need for peripartum blood transfusion and increase hemoglobin levels. Additionally, our data suggest IV ferric carboxymaltose is well-tolerated in these patients. These results also support using multi-professional teams to improve the quality of healthcare delivery to pregnant patients with iron deficiency anemia. We have created an IRB-approved database to study more patient-centered postpartum outcomes such as quality of life among IV iron recipients as well as lactation rates and fetal outcomes. We plan to expand this strategy to other patients who have a predictable and likely preventable need for intermittent blood transfusion, such as patients with chronic gynecologic blood loss. Reference: Achebe, M. M., & Gafter-Gvili, A. (2017). How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood, 129(8), 940-949. https://doi.org/10.1182/blood-2016-08-672246. Disclosures Davidson: ABIM: Other: American Board of Internal Medicine.

Albumin-bound paclitaxel (nab-paclitaxel), in combination with gemcitabine, is used for first-or second-line treatment of advanced pancreatic cancer (APC). The objectives of this retrospective single institution study are to report the rates of hematologic toxicity, febrile neutropenia (FN), growth factor utilization, progression-free and overall survival of nab-paclitaxel-gemcitabine in a real-world, non-clinical trial setting. Patients with APC treated with nab-paclitaxel-gemcitabine between January 1, 2012 and December 31, 2014 were identified. Data were retrospectively collected from the electronic medical record under an institutional IRB-approved protocol. A total of 29 patients treated with nab-paclitaxel-gemcitabine were included in the analyses. Half of the patients (52%) had received previous therapy for advanced disease, with the majority of those patients (80%) receiving FOLFIRINOX. Grade ≥3 neutropenia and thrombocytopenia were reported in 31% and 21% of patients. FN was observed in 1 patient (3%), and growth factor was utilized in 10% of patients. Most patients (86%) required at least one dose modification, with 76% of patients having dose omission due to toxicity. Median progression-free survival was 3.9 months and median overall survival was 5.4 months. Our results suggest that the rates of hematologic toxicity in the real-world setting are similar to those seen in clinical trial population, despite variances in clinical practice. It remains unclear whether the underutilization of growth factor support affects the incidence of neutropenia outside of clinical trials. The short overall and progression-free survival observed in this study population are not unexpected, as the majority of patients received nab-paclitaxel-gemcitabine as second-line therapy.

knowledge of CP and master in pharmacy students (ST) related to pediatric HSCT/oncology and to evaluate their expectations in terms of training and education. Methodology: An online questionnaire was set up (Qual-tricsÓ) to evaluate knowledge and need for training. It consisted of a general part, a part evaluating theoretical knowledge on HSCT/pediatric oncology and some examples to gain insight in the way they give pharmaceutical advice. The final part involved issues on past/present education. Results: In total, 223 responses from 156 CP and 67 ST were obtained. Of them, 26.3% (CP) and 11.9% (ST) were involved in providing medication to this population. Only 34.0% (CP) and 44.0% (ST) gave correct answers to general questions. In total, 39.3% (CP and ST) had no idea how to handle this question or to give advice (47.5%). In total, 98.7% (CP) and 97.0% (ST) found the knowledge they gained at the university insufficient for their professional practice. None of CP and 4.5% (ST) had lessons on this issue during their basic curriculum. Nevertheless, 68.6% (CP) and 79.1% (ST) found it necessary to implement this subject in the university curriculum. Finally, 91.0% (CP) and 89.6% (ST) were voluntary to follow post-university education on this subject (evening session or e-learning module). Conclusion: Although the role of CP in pediatric HSCT/ oncology has been established, the results of this study show a lack of knowledge and need for training. Both CP and ST are interested in this subject and, apart from implementation in the basic curriculum, they prefer evening sessions or elearning training to optimize their pharmaceutical care.

Background Venous thromboembolism (VTE) is a common and often fatal medical event. VTE management often includes inferior vena cava filter (IVCF) placement when anticoagulation fails or is contraindicated. Controversial indications for IVCF placement include adjunctive treatment for deep vein thrombosis (DVT) without pulmonary embolism (PE) and VTE prophylaxis for high-risk patients (Deyoung and Minocha, 2016; Ho et al., 2019). Numerous device-associated mechanical and medical complications have been described (Ayad et al., 2019) and guidelines recommend early retrieval (Morales et al., 2013). There is limited evidence, however, to guide anticoagulation practices while IVCFs are retained. We aimed to characterize IVCF placement, retrieval, and interim medical management at our institution. Methods Retrospective chart review was performed for all patients who underwent IVCF placement at the University of Virginia Medical Center from January to December 2016. Data were collected from time of IVCF placement until either IVCF removal or 18 months post-placement, whichever occurred first. Indication for IVCF placement, baseline patient characteristics, IVCF complications, anticoagulation regimens, and bleeding and clotting events were identified. Baseline characteristics were recorded for all patients. Patients who did not survive the admission during which the IVCF was placed, underwent IVCF removal prior to discharge, or lacked adequate outpatient records during the period of IVCF retention were excluded from the event analysis cohort. Results IVCFs were placed in 140 patients during the study period (Table 1). A majority of patients were admitted to a surgical service, frequently following trauma (49 patients, 35%). IVCFs were placed for several indications, most commonly diagnosed VTE with a contraindication to anticoagulation (70 patients, 50%) and prophylaxis for high risk of VTE (44 patients, 31%). By the end of the study period, 88 patients (63%) had confirmed IVCF removal while 35 patients (25%) retained the IVCF for a clinical consideration. 33 patients (24%) lacking an adequately documented period of outpatient IVCF retention were excluded from the event analysis. Of the 107 patients included in the event analysis cohort, 76 patients (71%) underwent IVCF removal. Removal occurred >60 days after placement in 82% of these cases and median time to removal was 95 days (Table 2). Outpatient follow up and anticoagulation management varied widely, though 75 patients (70%) received a therapeutic dose anticoagulant during the period of IVCF retention and only 15 patients (14%) were not exposed to either a prophylactic or therapeutic dose anticoagulant. 50 patients (47%) had at least one regimen change. Bleeding and/or clotting events occurred for 15 patients (14%, Table 3). All 8 bleeding events occurred during anticoagulant exposure. Patients were exposed to a therapeutic dose anticoagulant during 4 of the 6 observed major or clinically relevant non-major bleeding events. Of the 12 observed clotting events, 8 occurred in the absence of anticoagulation. Isolated DVT was the most common clotting event (8 events in 7 patients, 7%) and IVCF thrombus was observed in 2 patients (2%). Bleeding and clotting events were observed in patients with a wide range of indications for IVCF placement, including patients whose IVCFs were placed prophylactically. Conclusions The optimal medical management of retained IVCFs is uncertain. This retrospective study characterizes IVCF placement, removal, and interim medical management for a diverse patient population at a single institution. Outpatient follow up varied widely and anticoagulant exposure during IVCF retention was inconsistent. Despite considerable anticoagulant exposure across the cohort, major bleeding events were infrequent. Thrombotic events, often in the absence of anticoagulation and potentially preventable, were more common. Standardization of medical management during IVCF retention would likely benefit this heterogeneous patient population at high risk of both bleeding and thrombotic complications. Ongoing statistical modeling for the study cohort will seek to inform anticoagulant decision making by assessing for associations between anticoagulant exposure and these clinical events. Disclosures No relevant conflicts of interest to declare.