Folic Acid Deficiency

A team of international researchers has demonstrated, for the first time in a field study, that using folic acid-fortified iodized table salt can prevent multiple severe birth defects. A team of international researchers -- including experts from the University of Central Florida and Emory University -- has demonstrated, for the first time in a field study, that using folic acid-fortified iodized table salt can prevent multiple severe birth defects. The importance of women having enough folic acid in their bodies before and during pregnancy to prevent permanent and life-threatening birth defects, such as spina bifida and anencephaly, has been known for decades. The World Health Organization recommends that all women should take supplement pills with 400 micrograms of folic acid daily, from the moment they begin attempting to conceive through the first three months of pregnancy. Mandatory staple food fortification with folic acid is a cost-effective, safe, and an equitable way to address the issue. In May 2023, the World Health Assembly adopted a resolution promoting food fortification with folic acid to accelerate the slow pace of prevention of spina bifida and other birth defects associated with low maternal folate levels at the time of early pregnancy. Yet approximately 260,000 births worldwide -- about 20 per every 10,000 births -- are still affected by spina bifida and anencephaly, contributing to a high number of stillbirths, elective pregnancy terminations, and deaths of infants and young children. The problem While folic acid has been added through mandatory staple grain food fortification in about 65 countries, including the United States, more than 100 countries have yet to implement fortification due to challenges that include limited capacity for large-scale fortification of staple grains in these regions or lack of political will. A solution A new study published Friday by JAMA Network Open showed that a solution is not only possible, many people already have it on their kitchen tables. The clinical trial showed that mixing folic acid to commercially available iodized table salt, based on the existing average daily consumption of salt, increased serum folate levels among participants to levels needed for prevention of spina bifida and anencephaly. The increase was significant, a 3.7-fold improvement before and after a four-month period of using the study salt with iodine and folic acid. "We proved that folic acid can get into the blood through salt. Hopefully countries that have not already implemented fortification programs can now look at their infrastructures and realize that salt fortification is cheap and it's really easy to add in the amount of folic acid needed to save lives," says Jogi Pattisapu, MD, the study's lead author and a neurosurgeon from UCF's College of Medicine. "It might just turn the salt a little yellow, but the participants did not mind and we know it works. What we need now is action." Why it matters Pattisapu credits the study's successful outcome to the collaborative nature of the research team, specifically the efforts and expertise of researchers from Emory University's Rollins School of Public Health and the colleagues from multiple institutions in India, who co-led the study and recruited and monitored the 83 non-pregnant women -- who were between the ages of 18-45, from four different villages in southern India -- who consumed the folic acid-fortified salt as part of their regular diet during a four-month period in 2022. India has a high prevalence of spina bifida and anencephaly. "Work was done there, by the Indian team, for their cause," Pattisapu says. "That was very important, and it is a powerful message." Even though food fortification is mandatory in the United States, the researchers say the impact of this new study could be felt globally in countries with successful salt iodization programs. "This is a global goodwill involving the health of mothers and babies. We are making sure we apply the knowledge we have," says Vijaya Kancherla, an associate professor in the Department of Epidemiology at Rollins. "These are preventable birth defects and once it happens, you cannot cure it. Surgeries and clinical care are expensive and largely not available in low- and middle-income countries. Due to that, most babies with spina bifida die globally. So, it is a human rights issue that everyone should be worried about and should strive to find alternate solutions that prevent these conditions from occurring in the first place, no matter where one is born. We show that salt has the potential to close the prevention gap now." The researchers also made it clear the study does not promote salt intake, but rather adding the necessary amount of folic acid to the table salt that residents of these regions are already consuming. If the average daily salt consumption is reduced in these regions, the concentration of folic acid would simply be increased, to meet the need. This approach is already used in grain fortification program. The researchers said at least 50 percent of the current global spina bifida cases would be prevented if the major, already existing iodized salt programs took the simple step of adding folic acid. "We now know folic acid fortification of iodized salt can prevent folate deficiency that causes spina bifida," says Godfrey Oakley Jr., MD, director of the Center for Spina Bifida Prevention at Rollins. "The stage is now set for a rapid acceleration of prevention of these birth defects in many countries"

A new study has found high rates of anemia among patients in the Irish health system, while screening for common causes was found to be low. A new study by researchers at University of Limerick in Ireland has found high rates of anaemia among patients in the Irish health system, while screening for common causes was found to be low. The research study carried out by a team at University of Limerick School of Medicine found that substantial numbers of men and women in the health system had anaemia, the presence of which is strongly associated with high rates of hospitalisation, death, and poor quality of life. Anaemia (a low level of haemoglobin in the body) is a common but treatable condition that predicts adverse clinical outcomes. It affects nearly two billion people across the globe and is the third-leading cause of years with lived disability in the world. While the study revealed a high burden of patients with the condition, it found that there were relatively low rates of screening for treatable causes of anaemia, including deficiencies in vitamin B12, folate, and iron, which highlights an important gap in care delivery programs and emphasises the need for quality improvement initiatives. Prior to the large population-based study, the prevalence of anaemia and information on its underlying causes was largely unknown as data at the national or regional level was limited. The research, published in the journal BJGP Open, is the largest study ever to explore the burden of anaemia and the extent of investigation for underlying common causes in Ireland. The study found that 12% of Irish patients had anaemia with 1 in 8 women (13.2%) affected and 1 in 10 men (10.5%). Most of these patients were found to have had mild anaemia (9.1% of total), with moderate to severe anaemia present in the remaining 2.9%. The percentage of patients with anaemia was particularly high in elderly patients, and in patients with underlying medical conditions such as kidney disease, diabetes and for patients undergoing treatment in specific clinical settings. Despite the high burden of anaemia, less than 20% of anaemic patients were tested for deficiencies of vitamin B12 and folic acid, and only one third of all patients were screened for iron deficiency during follow-up. Although there was some improvement in screening rates with increasing severity of anaemia, approximately 50% of patients with severe anaemia did not undergo screening. "This is the largest study to address the magnitude of anaemia and the extent to which it is investigated in the Irish health system," according to senior investigator Professor Austin Stack, Foundation Chair of Medicine at UL's School of Medicine and Consultant Nephrologist, University Hospital Limerick. "Our study reveals a significant burden of anaemia that was present in several high-risk groups, including patients with diabetes, chronic kidney disease, and the elderly. The prevalence of anaemia increased exponentially in older men and women, highlighting their increased vulnerability. "Patients with advanced kidney disease had nearly eight-fold higher prevalence compared to patients with normal kidney function. Patients who attended the emergency room, outpatient departments or admitted to hospital were found to be particularly affected, with prevalence ranging from 18 % to 29 %," Professor Stack explained. Anaemia is a condition in which the body does not have enough healthy red blood cells or haemoglobin (an iron-rich protein) to carry oxygen to the cells around the body. Haemoglobin is essential for red blood cells to carry oxygen from the lungs to the rest of the body. When someone suffers from anaemia, the body does not get enough oxygen in the blood, and this can cause tiredness, shortness of breath, and dizziness. The researchers assembled a cohort of 112,181 patients using data from the National Kidney Disease Surveillance System to assess for anaemia and followed them for up to one year to explore the use of screening tests that check for iron deficiency, B12, and folate deficiency. Co-author Dr Leonard Browne, Senior Research Fellow in Biostatistics at the UL School of Medicine, highlighted the low level of screening for treatable causes of anaemia. "What is remarkable is that less than 20% of anaemic patients were screened for vitamin B12 and folate deficiency, and only one third were screened for iron deficiency at three-months follow-up," he explained. "Despite some improvement with increasing severity of anaemia, approximately 50% of patients with severe anaemia did not undergo screening. Indeed, when we followed patients for up to 12 months, screening rates did increase although modestly for B12 and folate deficiency -- 30% -- and doubled for iron deficiency -- 46%. These findings reveal that common causes of anaemia are inadequately tested for in the wider health system especially among high-risk groups." Professor Stack emphasised the importance of screening for and identifying the underlying cause of anaemia. "We found that one in three patients had evidence of absolute iron deficiency, 6.3% had B12 deficiency, and a further 5.8% were folate deficient. All these deficiencies are easily treated in modern day clinical practice leading to significant improvement in the degree of anaemia. This study provides a valuable starting point from which we can begin to understand practice patterns in care delivery and the development of quality improvement programmes in the health system. "Iron deficiency is the main cause of anaemia affecting women more than men. The findings from our study correlate well with the international body of evidence, which shows that investigation of anaemia subtype is uncommon and that the standards of anaemia management vary considerably," Professor Stack added. The research was funded by the Health Research Board (HRB) and Dr Mairéad O'Driscoll, Chief Executive of the HRB said: "Professor Stack's research is a really nice example of how intelligent and targeted secondary-data analysis can make important contributions to our knowledge base. The data-driven insights from his work have obvious potential to inform and improve health service delivery. "The HRB is committed to working with all of our partners to advance the use of primary and secondary data to enhance health policy, to improve healthcare delivery and to drive innovation in our health services."

Studies point to preventive measures and therapies that can set children on a healthier course with lifelong benefits SAN DIEGO, Dec. 9, 2023 /PRNewswire/ -- Researchers report significant progress toward improving access to effective interventions to address blood disorders and promote healthy blood cell functioning in four studies presented during the 65th American Society of Hematology (ASH) Annual Meeting and Exposition. The studies suggest new opportunities to act early in life to achieve lifelong benefits, including in children born with challenging disorders such as sickle cell disease (SCD) and hemophilia. "This research really highlights the importance of early action and prevention," said Sarah O'Brien, MD, of Nationwide Children's Hospital. "From prenatal supplements to optimizing therapies, these findings show ways we can help our young patients be as healthy as possible, which can also improve outcomes with more complex therapies." The first two studies examine life-changing therapies for people living with SCD, an inherited blood disorder that affects the blood's ability to carry oxygen, leading to organ damage and episodes of severe pain called vaso-occlusive crises. One provides new evidence that hydroxyurea, an oral medication widely available in the U.S. and other high-resource countries, is feasible, safe, and effective to administer at optimal doses in Africa, where many people with sickle cell currently lack access to treatment. The other study reports substantial and long-lasting benefits of a gene therapy for SCD, reflected not only in laboratory markers but in significant improvements in quality of life for people living with the disorder. The third study sheds light on how the amount of folic acid, or folate, a developing fetus is exposed to in the womb can affect the system that maintains blood and immune cells in adulthood, with important implications for lifelong health. The fourth study shows that a drug injected subcutaneously can help protect infants born with the bleeding disorder hemophilia from serious complications such as intracranial bleeds. Avoiding such events at an early age can reduce children's chances of permanent brain and tissue damage and potentially set them up to receive the greatest possible benefit from other therapies later in life. Lovo-cel gene therapy shows enduring results in preventing sickle cell pain crises 1051: Efficacy, Safety, and Health-Related Quality of Life (HRQOL) in Patients with Sickle Cell Disease (SCD) Who Have Received Lovotibeglogene Autotemcel (Lovo-cel) Gene Therapy: Up to 60 Months of Follow-up In the longest-running gene therapy trial for SCD to date, researchers report that a vast majority of patients have seen long-lasting, nearly complete resolution of vaso-occlusive events. With up to five years of follow-up and a median follow-up of three years, the new findings bolster evidence that lovo-cel is a safe and effective treatment for SCD. "It is a truly transformative therapy," said Julie Kanter, MD, director of the Adult Sickle Cell Disease Program and professor of Medicine and Pediatrics at University of Alabama, Birmingham, and the study's lead author. "Using gene therapy through lovo-cel, we've been able to essentially rid individuals with SCD of vaso-occlusive events. It results in normal hemoglobin levels and people just feeling amazing." SCD is caused by a gene that results in the production of abnormal hemoglobin, a protein in the red blood cells that carries oxygen. For lovo-cel therapy, stem cells are removed from a patient's bone marrow and a viral vector is used to add a gene to the stem cells that equips them to produce healthy hemoglobin. The modified stem cells are then returned to the bone marrow, where they manufacture blood cells with healthy hemoglobin. Several other gene therapies for SCD are being tested in separate clinical trials. Lovo-cel is the longest running gene therapy trial for SCD to date and the only current trial to use a gene addition therapy rather than gene editing techniques to alter the stem cell genome. The new findings include results from 34 pediatric and adult patients who completed lovo-cel therapy within the past 16 months to five years. Between six and 18 months following their lovo-cel infusion, 88.2% of the patients experienced no vaso-occlusive events at all and 94.1% experienced no severe vaso-occlusive events. By contrast, these patients suffered a median of three severe vaso-occlusive events per year for the two years before they enrolled in the trial. A vast majority of patients showed significant amounts of new, non-sickle hemoglobin (HbAt87Q) induced by the gene therapy, resulting in marked improvements in total hemoglobin, Dr. Kanter reported. "Even more exciting than the laboratory findings, many individuals have also reported significant improvements in terms of pain intensity, fatigue, and the degree to which pain interfered with daily life," said Dr. Kanter. The process of administering lovo-cel requires patients to undergo an autologous stem cell transplant (a transplant that uses a patient's own stem cells instead of those from a donor) and uses conditioning chemotherapy to remove the old bone marrow and prepare the space for the new, modified stem cells. Side effects were common and consistent with conditioning chemotherapy including mouth sores and low blood counts. One patient was diagnosed with a blood cancer known as myelodysplastic syndrome. Scientists determined that the viral vector used for lovo-cel therapy did not cause the disorder; the patient also has not required any blood transfusions or experienced any vaso-occlusive events and continues to receive close monitoring. Overall, the study provides strong evidence that lovo-cel is effective at the genetic level to produce healthy (non-sickled) hemoglobin, reduce hemolysis (cell breakage), improve total hemoglobin, and prevent vaso-occlusive events over an extended period while also improving patient quality of life; however, Dr. Kanter and team cautioned that longer-term data will be needed to determine whether it also helps to prevent stroke, kidney disease, and other longer-term complications of SCD. To reduce health disparities commonly faced by people with SCD, Dr. Kanter added that it will also be important to work to address cost barriers and ensure equitable access to the therapy — as well as continuing care after patients receive it — if the therapy receives approval from the U.S. Food and Drug Administration. "We don't know the long-term effects yet, so we need to make sure that the patients who get this gene therapy also receive ongoing care," said Dr. Kanter. "We also want to make sure that the centers that are performing these therapies really understand SCD and are equipped to take care of people with SCD for the best possible outcomes." Dr. Kanter noted that the study has a relatively small sample size, was not randomized, and did not include people with severe renal disease, heart disease, or severe central nervous system vascular disease. The trial was funded by bluebird bio, developer of lovo-cel. This abstract will be presented by Julie Kanter of the University of Alabama, Birmingham in an oral presentation on Monday, December 11, 2023, at 4:30 p.m. Pacific time in Hall A (San Diego Convention Center). Extended use of hydroxyurea with optimal dosing found to be safe and effective in children with sickle cell anemia in Africa 6: Hydroxyurea Dose Optimization Is Safe and Improves Outcomes for Children with Sickle Cell Anemia Living in Sub-Saharan Africa: The Reach Experience Hydroxyurea is safe, well tolerated, and effective in Africa, according to the latest data from the Realizing Effectiveness Across Continents with Hydroxyurea (REACH) trial. REACH is the largest trial to test hydroxyurea in children anywhere in the world and among the first to test its feasibility in real-world settings in Africa, where children with sickle cell anemia face additional health risks such as malnutrition and malaria that are less prevalent elsewhere. The new data align with findings reported earlier in the study and, now with an average follow-up of over seven years, increase confidence that hydroxyurea treatment can be feasibly maintained in African settings with good safety and efficacy in the long term. In addition, the study underscores the importance of achieving the optimal dose of hydroxyurea, as higher doses lead to the best clinical responses. "It's really exciting to see that the optimal dose is safe and effective," said Banu Aygun, MD, Cohen Children's Medical Center of New York, and the study's lead author. "It suggests that we should advocate for giving the best dose to children living in Africa just like we are doing here in the United States." Newborns are routinely screened for SCD in the United States, where there are currently about 100,000 affected individuals, most of whom have access to treatments such as hydroxyurea, which reduces SCD complications by increasing the production of fetal hemoglobin. In Africa, where it is estimated that over 300,000 babies are born with sickle cell each year, newborn screening programs are just beginning to be established and the vast majority of children do not have access to hydroxyurea treatment. For the REACH trial, researchers worked with local partners in Angola, the Democratic Republic of Congo, Kenya, and Uganda to administer hydroxyurea to a total of 606 children with a genetic subtype of SCD known as sickle cell anemia, 86% of whom still remain on treatment an average of over seven years later. Participants received a low fixed dose of 15 to 20 mg/kg/day initially to ensure safety. Once safety was established, the dosing was raised and then further optimized to allow each patient to receive the highest dose they could tolerate safely. After this optimization process, the average dose reached about 27.5 mg/kg/day, which is similar to the optimal dosage of 25 to 30 mg/kg/day that is standard in the United States. These extended REACH results show both safety and strong efficacy, especially when comparing the optimized dose with the lower initial fixed dose. Laboratory responses including various measures of hemoglobin content in the blood improved with increasing dosage, while the rate of events including vaso-occlusive episodes, acute chest syndrome, enlargement of the spleen, stroke, transfusions, malaria, non-malarial infections, and deaths decreased. There were few safety concerns and a low overall rate of dose-related toxicities. Researchers say hydroxyurea is well suited for use in Africa because it is a daily pill that does not require refrigeration, is relatively inexpensive, and has a long track record of benefits. However, the feasibility of its implementation in Africa was uncertain until this study because of concerns about cost, how well the treatment would work in populations facing risks that have not been previously studied such as malnutrition and high rates of malaria, and whether issues such as lack of transportation, language barriers, and political instability would hinder families' ability to access clinics. Based on the results, researchers say there is now good evidence that hydroxyurea treatment at optimal dosing is feasible and beneficial for children living with sickle cell anemia in Africa. "Many newborn screening programs are coming out [now], and we know for newborn screening programs, it's not enough to diagnose a condition if you can't tie it to a treatment," said Dr. Aygun. "If we are diagnosing children with sickle cell anemia, we have to be able to offer hydroxyurea to them." Banu Aygun of Cohen Children's Medical Center will present this study in the Plenary Scientific Session on Sunday, December 10, 2023, at 2:00 p.m. Pacific time in Hall A (San Diego Convention Center). Researchers trace lifelong impacts of folate deficiency during early development 5: Metabolic Programming of Hematopoietic Stem Cell Function By Prenatal Folate For decades, pregnant women have been advised to consume enough of the B-vitamin folic acid, or folate, to prevent neural tube defects in their babies, and many foods in the U.S. are fortified with folate for this reason. However, there has been little understanding of how folic acid might affect prenatal development in other ways. Now, a new study conducted in mice has uncovered some of the mechanisms by which exposure to too little — or too much — folate in the womb can affect a person's health and susceptibility to disease into adulthood. The study examines the relationship between prenatal folate availability and metabolic programming of hematopoietic, or blood, stem cells (HSCs), the stem cells that give rise to all blood and immune cells in the adult body. When functioning properly, HSCs ensure the body has the right types and amounts of blood and immune cells. "Our study shows how manipulation of nutrients during early development can shape the function of the adult blood system by programming blood stem cells during development," said Brian Krum, MSc, a PhD student at the University of Utah, and the study's lead author. "These changes persist into adulthood where they have permanent effects on the hematopoietic system and also potentially affect immune function and disease risk." Previous studies have shown that folate helps regulate red blood cell production; in adults, low-circulating folate can cause anemia. The new study is the first to examine how folate levels in a pregnant mother affect HSCs in her children. The results reveal that prenatal folate exposure can affect HSCs and their function into adulthood. The researchers assessed HSC function in the offspring of mice that were fed diets that were folate deficient, folate sufficient, or folate supplemented during pregnancy. The results showed that HSCs from adult mice that were exposed to folate deficiency during fetal development had poorer performance in producing all types of blood and immune cells, while those that were exposed to excess folate during development overproduced all the same blood and immune cells. Tracing the metabolic pathways involved, the researchers found evidence that mitochondrial dysfunction was instrumental in driving the effects of folate deficiency on HSCs. Dysregulation of mitochondrial metabolism was evident in HSCs during fetal development and persisted into adult HSCs, suggesting that sustained metabolic defects are a key driver of the underlying dysfunction. For pregnant women, researchers said the findings underscore the need to address folate deficiency, which is common in lower-resourced countries where people may not have access to enough folate-rich foods. While folate deficiency is rare in countries like the U.S. where food is fortified with folate and folic acid supplements are often taken during pregnancy, Krum noted that consuming excess folate may also have implications for blood and immune function. The study findings are also relevant to understanding the interactions between nutrition and anti-folate chemotherapy drugs. Researchers suggested future studies illustrating the metabolic aspects of HSC programming by folate might help identify novel pathways and targets to more selectively target folate metabolism in blood cancers, particularly pediatric leukemias, in order to achieve the best therapeutic benefit while minimizing toxicities. Brian Krum of the University of Utah will present this study during the Plenary Scientific Session on Sunday, December 10, 2023, at 2:00 p.m. Pacific time in Hall A (San Diego Convention Center). Emicizumab found safe and effective for preventing bleeding in infants with Hemophilia A 505: Emicizumab Prophylaxis in Infants with Severe Hemophilia A without Factor VIII Inhibitors: Results from the Primary Analysis of the HAVEN 7 Study In a new study, infants with severe hemophilia A who started receiving emicizumab in the first few months of life experienced few bleeding events, no other serious hemophilia complications, and no serious treatment-related adverse events. Researchers say the results offer reassurance that this hemophilia drug, which was previously tested mostly in older children and adults, is safe and effective for use in infants too. The drug could fill a significant gap for babies born with hemophilia A, who generally cannot receive factor VIII infusions to replace the clotting agent that their bodies do not make naturally, due to challenges with administering regular intravenous infusions in young infants (including challenges with venous access and the need for central venous access devices). Without factor VIII infusions or other therapies, these babies can be vulnerable to uncontrolled bleeding and damage to joints and organs, including bleeding in the brain. "Emicizumab proved to be highly efficacious in these infants in preventing all bleeds, traumatic bleeds, and spontaneous bleeding, and it was well tolerated," said Steven Pipe, MD, of the University of Michigan, the study's lead author. "I think this is going to be adopted broadly [as a prophylactic agent in infants]." Factor VIII infusions are a mainstay of hemophilia A treatment, particularly for stemming severe bleeding or controlling bleeding during surgery. However, these infusions can become less effective if patients develop antibodies that inhibit factor VIII, something that grows more likely with increased exposure to factor VIII. Emicizumab is an effective prophylactic therapy even in the presence of factor VIII inhibitors, Dr. Pipe explained. Since its approval as a first-line hemophilia therapy in 2017, emicizumab has been increasingly adopted as a prophylactic drug to prevent bleeding and reduce the number of factor VIII infusions patients require. Until now, there has been little data on the use of emicizumab in young babies. For the study, researchers administered the drug to 55 infants with hemophilia A starting at a median age of four months and continuing for a median of just under two years and a minimum of one year. After an initial loading period of four weekly injections, parents administered the drug at home via subcutaneous injection every two weeks. Throughout the study, over half of the study participants (54.5%) had no bleeds requiring treatment. All treated bleeding events were related to trauma such as scrapes and falls; no participants had bleeding in the brain or spontaneous bleeds requiring treatment. Laboratory tests showed that most participants were able to maintain therapeutic concentrations of the study drug in their bodies and none developed antidrug antibodies. Adverse events such as fevers and infections were common, which was expected given that infants frequently experience minor illnesses. The only adverse events that were considered treatment-related were low-grade reactions (localized redness of the skin) at the injection site, which occurred in 16.4% of participants and were temporary, said Dr. Pipe. Researchers noted that more research will be needed to gauge any long-term effects of emicizumab use in babies, including whether it helps reduce the use of factor VIII and consequently the development of factor VIII inhibitors. In the meantime, Dr. Pipe suggested that emicizumab represents a good prophylactic option for babies, especially during the first year when administering factor VIII as a prophylactic therapy is often not feasible. "Many people would call this a game-changer as far as clinical practice is concerned," said Dr. Pipe. "If you're a parent of an infant with hemophilia, to have a therapeutic option that you can get your baby started on as soon as possible just provides such reassurance for the family." Steven Pipe, University of Michigan, will present this study in an oral presentation on Sunday, Dec. 10, 2023, at 12:00 noon in room 29 (San Diego Convention Center). ### The American Society of Hematology (ASH) (hematology.org) is the world's largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. For more than 60 years, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology. ASH's flagship journal, Blood (bloodjournal.org) is the most cited peer-reviewed publication in the field, and Blood Advances (bloodadvances.org) is an open-access, online journal that publishes more peer-reviewed hematology research than any other academic journal worldwide. Two new journals will be joining the Blood Journals portfolio in 2024, Blood Neoplasia (bloodneoplasia.org) and Blood Vessels, Thrombosis & Hemostasis (bloodvth.org). Contact: Melissa McGue, ASH, [email protected] Kira Sampson, ASH, [email protected] Brianne Cannon, FleishmanHillard, [email protected] SOURCE American Society of Hematology