RT Journal Article SR Electronic T1 Establishment of a thalassaemia major quality improvement collaborative in Pakistan JF Archives of Disease in Childhood JO Arch Dis Child FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP archdischild-2018-315743 DO 10.1136/archdischild-2018-315743 A1 Zahra Hoodbhoy A1 Lubaina Ehsan A1 Najveen Alvi A1 Fatimah Sajjad A1 Aleezay Asghar A1 Omair Nadeem A1 Asim Qidwai A1 Shabneez Hussain A1 Erum Hasan A1 Sadaf Altaf A1 Salman Kirmani A1 Babar S Hasan YR 2019 UL http://adc.bmj.com/content/early/2019/06/29/archdischild-2018-315743.abstract AB Objectives The aim of this study was to establish multidisciplinary care for patients with transfusion-dependent thalassaemia (TDT) by creating a TDT quality improvement (QI) collaborative in a resource-constrained setting. This study presents our initial experience of creating this collaborative, the baseline characteristics of the participants, the proposed QI interventions and the outcome metrics of the collaborative.Design and setting TDT QI collaborative is a database comprising patients with TDT from four centres in Karachi, Pakistan. Study variables included symptoms of cardiac or endocrine dysfunction, physical examination including anthropometry and Tanner staging, chelation therapy, results of echocardiography, T2* cardiac MRI (CMR) and serum ferritin. The main outcome of this collaborative was improvement in TDT-related morbidity and mortality. Interventions addressing the key drivers of outcome were designed and implemented.Results At the time of reporting, the total number of patients in this database was 295. Most patients reported cardiac symptoms corresponding to New York Heart Association class 2. Approximately half (52%, n=153) of the patients demonstrated severe myocardial iron overload (T2* <10 ms). Majority of the patients (58%, n=175) were not on adequate chelation therapy. There was no difference in echocardiographic measures of systolic and diastolic left ventricle among the different spectrums of iron overloaded myocardium.Conclusion Using T2* CMR and endocrine testing, we have identified significant burden of iron siderosis in our patients with TDT. Lack of adequate iron load assessment and standardised management was observed. Interventions designed to target these key drivers of outcome are the unique part of this QI-based TDT registry.