As Montefiore Einstein’s chief of hematology, director of the Thrombosis Prevention and Treatment Program, co-director of the Hemophilia Treatment Center, and co-director of the Women’s Blood Disorders Clinic, Dr. Henny Billett has seen a lot of changes in the way blood disorders are treated from when she was a T32 research fellow in hematology at Montefiore. And she has also been a part of those changes.
“In the early stage of my career, there was little we could do beyond what was standard at the time for thrombosis, hemophilia, and sickle cell disease. Now we have major treatment advances that are life changing when for so long these blood disorders were life limiting,” says Billett.
Ten years ago, Billett’s Thrombosis Program was among the first in the country to manage bridging parenteral anticoagulation as an outpatient therapy for patients with thrombosis, decreasing hospital stays and improving quality of life. Now, with newer, more effective oral anticoagulants that have fewer bleeding complications and require minimal monitoring with little or no need for parenteral therapy, the Thrombosis Program is mostly outpatient staffed by NPs with expertise and experience. Similarly, for patients with hemophilia, innovative research has led to bispecific antibody therapy, small interfering RNA therapies as well as recombinant clotting factor therapies that can be used preventatively. While not a cure for hemophilia, these offer many patients peace of mind, more freedom, and longer lifespans. And because these therapies do not rely on human blood plasma, patients are not at risk of contracting bloodborne infections, such as hepatitis and HIV, which only a few decades ago was responsible for the deaths of over 90% of the New York hemophilia community. In 2015, Billett and Jennifer Davila, M.D., her pediatric co-director, received federal designation as a Comprehensive Hemophilia Treatment Center, Montefiore’s first. The HTC@Montefiore has more than tripled its patient population in five years.
The growing recognition that hematologic disorders, particularly hemorrhage and thrombosis, are responsible for over half the deaths in pregnant women led Billett to start the Women’s Blood Disorders Clinic. This clinic anticipates problems and sets up treatment and delivery plans for the Bronx’s underserved women at all stages of the process, from preconception to postpartum management. To increase awareness, Billett has led seminars and workshops in hematology and pregnancy with the American Society of Hematology and the Hemophilia Association of New York.
Sickle cell research, in general, has been traditionally underfunded, but that is changing, especially at Montefiore Einstein, due in part to Billett’s leadership. There has been a mini explosion of potential therapies for patients with sickle cell disease. Clinicians now understand, for example, the role of white blood cells in sickle cell disease and the process of sickle vaso-occlusion. New targeted treatments, including the use of anti-selectins, oxygen-affinity modifiers, stem cell transplants, and gene therapy have mitigated at least some of the complications of sickle cell disease. One of the first things Billett did as chief of the division of hematology was recruit foremost sickle cell researchers to rebuild Montefiore’s sickle cell program, which had ended in 2008 when National Institutes of Health (NIH) funding for all comprehensive sickle cell programs terminated. Currently at Montefiore, more than 1,000 adult patients with sickle cell disease receive care from a team of physicians, nurse practitioners, social workers, and clinical researchers. Now, as is true for the Thrombosis and Hemophilia Programs, the Sickle Cell Program has several ongoing NIH/CDC, industry, and investigator-initiated studies.
COVID’s Curious Blood Problem
At the beginning of the pandemic little was known about COVID’s effects on the hematologic system. But patients were developing thromboses and life-threatening clots at increasingly alarming rates.
“We could see that clots were forming everywhere – in their lungs, hearts, and brains, in dialysis lines, and in catheters. Patients were hypercoagulable but we didn’t understand why,” says Billett. We observed this happening in so many of our COVID patients, and they were getting sicker because of it. Many of the deaths during this time were due to clotting.”
There were no prior data about the effectiveness of giving anticoagulation to COVID patients even prophylactically. However, Billett and her colleagues were seeing a significant reduction in deaths in patients who received blood thinners compared to those who didn’t. Since patients were also receiving a lot of other medications, it couldn’t be solely attributable to the use of preemptive anticoagulants. Still, the reductions in deaths aligned with the administration of giving anticoagulants to patients at the start.
This was exciting and hopeful news. Dr. Billett discussed the results with Yaron Tomer, M.D., chair of the department of medicine at Montefiore Einstein, who urged her to create a protocol to guide hospital staff on the use of anticoagulation for all COVID patients entering the hospital. “It is a credit to Dr. Tomer that, realizing we had to act swiftly in those horrific times, he promoted this idea, which was based on strong, but subjective and not yet published, data,” says Billett. “There was no time to wait for the results of a formal study. People were dying. We needed to do whatever we could using the information we had at the time. It was the right thing to do, and many lives were saved.”
Working with Eran Bellin, M.D., Montefiore Einstein’s vice president of clinical IT research and development and professor of clinical epidemiology and population health and medicine, they used Montefiore Einstein’s “Clinical Looking Glass,” software program, which Bellin helped create, to crunch data on clots, mortality, anticoagulation, D-dimers (biomarkers), thrombosis, and hemostasis – based on laboratory data gleaned from 4,000 hospitalized patients. What they found proved what they already knew – that the anticoagulation protocol was beneficial!
Since then and continuing until today, Billett, working closely with department of medicine hospitalists Benjamin Galen, M.D. and Sweta Chekuri, M.B.B.S, is part of the NIH’s ACTIV-4 trials on anticoagulation in COVID.
Says Tomer, “Dr. Billett is a gift to the field of hematology, her patients, and colleagues. She has contributed immensely to building the Montefiore division of hematology and to making it one of the premier hematology divisions in the US.”
Posted on: Friday, June 10, 2022