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Male C, Ay C, Crevenna R, Eichinger S, Feistritzer C, Füller R, Haushofer A, Kurringer A, Neumeister P, Puchner S, Rettl T, Schindl T, Schuster G, Schwarz R, Sohm M, Streif W, Thom K, Wagner B, Wissmann E, Zwiauer K, Pabinger I. [Treatment of haemophilia in Austria]. Wien Klin Wochenschr 2024; 136:75-102. [PMID: 38743098 DOI: 10.1007/s00508-024-02370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
This guideline is intended to provide practical guidance for the diagnosis and treatment of haemophilia in Austria. Few randomized controlled interventional trials are available addressing the treatment of haemophilia, therefore recommendations are usually based on low level of evidence and represent expert consensus.This guideline is based on the WFH guideline, published in 2020, and adapted according to the national circumstances and experience.It includes recommendations and suggestions for diagnosis and follow-up visits and pharmacological therapies for treatment and prophylaxis. Further topics comprise special aspects in children and adults with severe haemophilia, outcome measurement, and management of trauma, special bleedings and interventions, including dental procedures, inhibitors, management of haemophilia carriers, and psychosocial aspects.
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Affiliation(s)
- Christoph Male
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Cihan Ay
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Richard Crevenna
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Sabine Eichinger
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Clemens Feistritzer
- Abteilung für Innere Medizin V - Hämatologie und Onkologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Robert Füller
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | - Alexander Haushofer
- Institut für Medizinische und Chemische Labordiagnostik, Klinikum Wels-Grieskirchen, Wels-Grieskirchen, Österreich
| | - Andreas Kurringer
- Abteilung für Kinder- und Jugendheilkunde, Landeskrankenhaus Bregenz, Bregenz, Österreich
| | - Peter Neumeister
- Klinische Abteilung für Hämatologie, Medizinische Universität Graz, Graz, Österreich
| | - Stephan Puchner
- Klinische Abteilung für Orthopädie, Universitätsklinik für Orthopädie und Unfallchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Rettl
- Abteilung für Innere Medizin und Hämatologie und internistische Onkologie, Klinikum Klagenfurt, Klagenfurt, Österreich
| | - Thomas Schindl
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | | | - Rudolf Schwarz
- Abteilung für Kinder- und Jugendheilkunde, Landesklinikum Amstetten, Universität Wien, Wien, Österreich
| | - Michael Sohm
- Universitätsklinik für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| | - Werner Streif
- Department Kinder- und Jugendheilkunde, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Katharina Thom
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Barbara Wagner
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Eva Wissmann
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Karl Zwiauer
- Universitätsklinik für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| | - Ingrid Pabinger
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
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Ndai AM, Allen BR, Wynn TT, Rajasekhar A, Saqr Z, Sandeli I, Vouri SM, Reise R. Rapid recognition and optimal management of hemophilia in the emergency department: A quality improvement project. J Am Coll Emerg Physicians Open 2024; 5:e13168. [PMID: 38699223 PMCID: PMC11065154 DOI: 10.1002/emp2.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/05/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives This study aimed to assess the effectiveness of a continuous quality improvement initiative at the University of Florida Health Physicians practice in reducing the time to administer factor replacement therapy (FRT) for hemophilia patients presenting with bleeding in the emergency department (ED). Methods The study, a quasi-experimental, interventional design, was conducted between January 2020 and January 2023. The intervention, implemented in September 2021, involved training ED physicians, creating a specialized medication order set within the electronic health record (EHR), and a rapid triage system. The effectiveness was measured by comparing the time from ED arrival to factor administration before and after the intervention and benchmarking it against the National Bleeding Disorders Foundation's Medical and Scientific Advisory Council (MASAC)-recommended 1-hour timeline for factor administration. An interrupted time series (ITS) analysis with a generalized least squares model assessed the intervention's impact. Results A total of 43 ED visits (22 pre-intervention and 21 post-intervention) were recorded. Post-intervention, the average time from ED arrival to factor administration decreased from 5.63 to 3.15 hours. There was no significant increase (27% vs. 29%) in the patients receiving factor within 1-hour of ED arrival. The ITS analysis predicted a 20-hour reduction in the average quarterly time to administer factor by the end of the study, an 84% decrease. Conclusions The quality improvement program decreased the time to administer FRT for patients with hemophilia in the ED. However, the majority of patients did not achieve the 1-hour MASAC-recommended timeline for factor administration after ED arrival.
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Affiliation(s)
- Asinamai M. Ndai
- Department of Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- University of Florida Health PhysiciansGainesvilleFloridaUSA
| | - Brandon R. Allen
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Tung T. Wynn
- Division of Pediatric Hematology/OncologyDepartment of PediatricsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Anita Rajasekhar
- Division of Hematology/OncologyDepartment of MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Ziad Saqr
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Ina Sandeli
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Scott M. Vouri
- Department of Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- University of Florida Health PhysiciansGainesvilleFloridaUSA
| | - Rachel Reise
- Department of Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- University of Florida Health PhysiciansGainesvilleFloridaUSA
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Kendel NE, Abdelghani E, Stanek JR, Mitchell B, Dunn MW, Rodriguez V, Dunn AL. Increasing optimal coagulation factor dosing in the paediatric emergency department: Update to a quality improvement study. Haemophilia 2024; 30:367-374. [PMID: 38146254 DOI: 10.1111/hae.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Prompt, appropriate coagulation factor replacement according to injury and bleeding severity in persons with haemophilia is required to prevent acute and long-term complications. AIMS Increase proportion of persons with haemophilia A (HA) and B (HB) treated appropriately for an acute injury and bleeding episode at a tertiary children's emergency department (ED) from 65% to 85% and sustain for one year. Secondary aim: increase time interval between patient ED encounters with out-of-range factor dosing. METHODS Utilizing quality improvement methodology and plan-do-study-analyze cycles, ED encounters for individuals with HA/HB receiving coagulation factor replacement for injuries were audited for in-range coagulation factor dosing. Goal factor dose defined as 50% correction for minor bleeds and 100% correction for major bleeds. Optimal dosing range defined as 90%-120% of the calculated goal dose to account for vial size variability. Interventions targeted communication via the EMR problem list and optimization of physician education. RESULTS Our previous publication demonstrated 33.3% of ED encounters with out-of-range factor replacement. Following several interventions, the cumulative rate of encounters with out-of-range dosing decreased to 18%. Overall, there was an increase in the mean percent of encounters receiving optimal factor dosing for both HA/HB compared to baseline (82.2% vs. 71.1%), though this was not a statistically significant difference. CONCLUSION Despite implementation of multiple interventions, out-of-range factor dosing continues to occur. Our team plans to reinstate simulation center education for ED staff and continue education efforts of pharmacists and hematology trainees with the goal of further reducing out-of-range dosing in our ED.
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Affiliation(s)
- Nicole E Kendel
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatric Hematology/Oncology, Akron Children's Hospital, Akron, Ohio, USA
| | - Eman Abdelghani
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph R Stanek
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brockton Mitchell
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Quality Improvement Resource at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michael W Dunn
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amy L Dunn
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Alblaihed L, Dubbs SB, Koyfman A, Long B. High risk and low prevalence diseases: Hemophilia emergencies. Am J Emerg Med 2022; 56:21-27. [DOI: 10.1016/j.ajem.2022.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022] Open
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Hart DP, Branchford BR, Hendry S, Ledniczky R, Sidonio RF, Négrier C, Kim M, Rice M, Minshall M, Arcé C, Prince S, Kelleher M, Lee S. Optimizing language for effective communication of gene therapy concepts with hemophilia patients: a qualitative study. Orphanet J Rare Dis 2021; 16:189. [PMID: 33910590 PMCID: PMC8082836 DOI: 10.1186/s13023-020-01555-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/23/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND For communities of people living with hemophilia and other genetic conditions, gene therapy could represent a paradigm shift in treatment strategies. As investigational therapeutic modalities such as gene therapy become more widely used and discussed, there is a critical need for all stakeholders to communicate using a lexicon that is intelligible, accurate, consistent, and representative of novel treatments. In doing so, expectations can be more carefully managed and potential risks, benefits, and limitations better understood. In recognition of this need, a first-ever study of gene therapy lexicon was conducted using established methods of market research and linguistic analysis. METHODS Ninety-four participants representing hematologists, nurses, caregivers, and people with hemophilia A, in six countries (US, UK, Spain, Germany, France, Italy) took part in a series of in-depth interviews, face-to-face focus groups, an advisory board meeting, and online group interviews to develop, refine, and test verbal, written, and pictorial language concepts through a three-phase iterative process. Sessions were conducted in local languages using detailed discussion guides. Feedback from participants was captured using real-time instant-response dial testing to measure moment-by-moment emotional responses to language stimuli. Semiquantitative analysis of the responses informed selection of preferred language concepts for final testing, and qualitative discussion explored preference rationale. Participants also completed polling and forced rank and choice written exercises. RESULTS Study feedback showed that the hemophilia community has preferences around consistent lexicon to describe hemophilia and its management. Expert linguistic analysis of feedback from the three phases enabled agreement of a consensus lexicon of vocabulary and an optimized summary narrative for talking about gene therapy amongst people affected by hemophilia A. Preferences were largely consistent across audiences and countries, although some country-specific recommendations were made. A representative summary phrase was agreed: "Gene therapy is being studied in clinical trials with the aim to allow the body to produce factor VIII protein on its own". CONCLUSIONS The use of preferred language across different stakeholders increases understanding and comfort during discussions of novel and complex therapeutic modalities such as gene therapy. Consistent use of community-informed lexicon minimizes miscommunication and facilitates informed decision-making regarding potential future treatment opportunities.
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Affiliation(s)
- Daniel P Hart
- Royal London Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, E1 1BB, UK.
| | - Brian R Branchford
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah Hendry
- Maslansky + Partners, 200 Varick Street, Suite 601, New York, NY, 10014, USA
| | - Robert Ledniczky
- Maslansky + Partners, 200 Varick Street, Suite 601, New York, NY, 10014, USA
| | | | - Claude Négrier
- Hemophilia and Thrombosis Center, Hôpital Cardiologique, Université Lyon 1, Lyon, France
| | - Michelle Kim
- Hemophilia Foundation of Southern California, Pasadena, CA, USA
| | | | | | - Claire Arcé
- Association française des hémophiles, Paris, France
| | | | | | - Sharon Lee
- BioMarin Pharmaceutical Inc., Novato, CA, USA
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Mahdavi A, Mohammadi H, Foshati S, Shokri‐Mashhadi N, Clark CCT, Moafi A, Rouhani MH. Effects of the dietary approach to stop hypertension (DASH) diet on blood pressure, blood glucose, and lipid profile in adolescents with hemophilia: A randomized clinical trial. Food Sci Nutr 2021; 9:145-153. [PMID: 33473278 PMCID: PMC7802541 DOI: 10.1002/fsn3.1972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/04/2023] Open
Abstract
Children with hemophilia are an enhanced risk of modifiable cardiovascular and metabolic abnormalities. There is currently no nutritional guideline to prevent or manage cardiometabolic risk factors in these patients. Therefore, the present study sought to investigate the effect of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiovascular and metabolic risk factors among children with hemophilia. In this parallel randomized clinical trial, 40 children (all male) with hemophilia were randomly allocated to the DASH group (n = 20) or control group (n = 20) for 10 weeks. The intervention group received the DASH diet (50%-55% of energy from carbohydrate, 27%-30% of energy from fat and 16%-18% energy from protein), and the control group received nutritional recommendations based on healthy eating practices. Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were measured at the beginning and end of the study. Serum vitamin C was measured as a biomarker of compliance with the DASH diet. Study was registered at IRCT.ir (IRCT20130903014551N6). A significant increase in serum vitamin C in the DASH diet group was observed compared to the control group (p = .001), indicating good compliance with the DASH diet. There was a significant reduction in SBP (-0.48 mmHg), DBP (-0.48 mmHg), FBS (-5.86 mg/dl), TC (-16.07 mg/dl), TG (-17.21 mg/dl), and LDL-C (-9.79 mg/dl), and a significant increase in HDL-C (3.39 mg/dl), in the DASH diet group compared with the control group. Adherence to the DASH diet in children with hemophilia yielded beneficial effects in blood pressure, lipid profiles, and FBS.
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Affiliation(s)
- Atena Mahdavi
- Food Security Research Center and Department of Community NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Hamed Mohammadi
- Food Security Research Center and Department of Clinical NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Sahar Foshati
- Food Security Research Center and Department of Clinical NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Nafiseh Shokri‐Mashhadi
- Food Security Research Center and Department of Clinical NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | | | - Alireza Moafi
- Pediatric Hematology and OncologyIsfahan University of Medical SciencesIsfahanIran
| | - Mohammad Hossein Rouhani
- Food Security Research Center and Department of Community NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
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Teitel J, Sholzberg M. Emergency Management of Hemophilia. J Emerg Med 2020; 59:607-608. [PMID: 33183681 DOI: 10.1016/j.jemermed.2020.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jerome Teitel
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Banchev A, Stoyanova D, Avramova B, Mladenov B, Moutafchieva P, Konstantinov D. Successful intraosseous factor VIII application in a haemophilic emergency. J Clin Pharm Ther 2020; 46:212-214. [PMID: 32860636 DOI: 10.1111/jcpt.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Intravenous (IV) replacement therapy with plasma derived or recombinant factor VIII (FVIII) and factor IX concentrates is the mainstay for treatment of patients with haemophilia A and B. Therefore, the current therapy is particularly dependent on the presence of a secure IV access especially in case of emergency. CASE DESCRIPTION A life-threatening bleeding event in an 8-month-old boy is managed by intraosseous (IO) infusion of recombinant FVIII concentrate. No adverse events have been observed 6 months after the application, and complete heeling has been reported. WHAT IS NEW AND CONCLUSION Venous application of factor concentrate remains inevitable in any haemophilic emergency. In case IV access is lacking, an IO institution of factor might be considered. To our knowledge, this represents the first reported case of IO application of recombinant FVIII concentrate in a patient with haemophilia.
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Affiliation(s)
- Atanas Banchev
- Department of Paediatric Haematology and Oncology, University Hospital "Tzaritza Giovanna - ISUL", Sofia, Bulgaria
| | - Denka Stoyanova
- Department of Paediatric Haematology and Oncology, University Hospital "Tzaritza Giovanna - ISUL", Sofia, Bulgaria
| | - Boryana Avramova
- Department of Paediatric Haematology and Oncology, University Hospital "Tzaritza Giovanna - ISUL", Sofia, Bulgaria
| | - Bogdan Mladenov
- Paediatric Intensive Care Unit, University Hospital "Pirogov", Sofia, Bulgaria
| | - Petya Moutafchieva
- Department of Paediatric Surgery, University Hospital "Pirogov", Sofia, Bulgaria
| | - Dobrin Konstantinov
- Department of Paediatric Haematology and Oncology, University Hospital "Tzaritza Giovanna - ISUL", Sofia, Bulgaria
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Song JC, Liu SY, Zhu F, Wen AQ, Ma LH, Li WQ, Wu J. Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China. Mil Med Res 2020; 7:15. [PMID: 32241296 PMCID: PMC7118900 DOI: 10.1186/s40779-020-00244-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 01/14/2023] Open
Abstract
Thrombocytopenia is a common complication of critical care patients. The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia. Therefore, the Critical Care Medicine Committee of Chinese People's Liberation Army (PLA) worked with Chinese Society of Laboratory Medicine, Chinese Medical Association to develop this consensus to provide guidance for clinical practice. The consensus includes five sections and 27 items: the definition of thrombocytopenia, etiology and pathophysiology, diagnosis and differential diagnosis, treatment and prevention.
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Affiliation(s)
- Jing-Chun Song
- Department of Critical Care Medicine, the 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang, 360104, China.
| | - Shu-Yuan Liu
- Emergency Department, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Feng Zhu
- Burns and Trauma ICU, Changhai Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ai-Qing Wen
- Department of Blood Transfusion, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Lin-Hao Ma
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Wei-Qin Li
- Surgery Intensive Care Unit, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
| | - Jun Wu
- Department of Clinical Laboratory, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, 100035, China.
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Tebo C, Gibson C, Mazer-Amirshahi M. Hemophilia and von Willebrand Disease: A Review of Emergency Department Management. J Emerg Med 2020; 58:756-766. [PMID: 32249010 DOI: 10.1016/j.jemermed.2020.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 01/19/2020] [Accepted: 02/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemophilia and von Willebrand disease (VWD) are the most common congenital coagulation factor deficiencies. Patients with these disorders who experience bleeding complications are often initially managed in the emergency department (ED). OBJECTIVE OF THE REVIEW This review will focus on the emergency department management of patients with these disorders and provide an update on current treatment options. DISCUSSION The mainstay of management is initial stabilization, control of bleeding when possible, and administration of specific factors. Early coordination of care with hematology is critical. CONCLUSIONS Emergency medicine providers must have an understanding of the pathophysiology, clinical presentation, and management strategies in order to optimally care for these complex patients.
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Affiliation(s)
- Collin Tebo
- Georgetown University School of Medicine, Washington, DC
| | - Colin Gibson
- Georgetown University School of Medicine, Washington, DC
| | - Maryann Mazer-Amirshahi
- Georgetown University School of Medicine, Washington, DC; Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC
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García Sánchez P, Martín Sánchez J, Rivas Pollmar MI, Álvarez Román MT, Jiménez Yuste V. Haemophilia: Reasons for visits to the paediatric emergency department. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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García Sánchez P, Martín Sánchez J, Rivas Pollmar MI, Álvarez Román MT, Jiménez Yuste V. Hemofilia: naturaleza de las visitas a urgencias pediátricas. An Pediatr (Barc) 2019; 91:394-400. [DOI: 10.1016/j.anpedi.2019.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/20/2019] [Accepted: 04/26/2019] [Indexed: 11/26/2022] Open
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Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:98. [PMID: 30917843 PMCID: PMC6436241 DOI: 10.1186/s13054-019-2347-3] [Citation(s) in RCA: 663] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/06/2019] [Indexed: 12/24/2022]
Abstract
Background Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient- or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group’s belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient. Electronic supplementary material The online version of this article (10.1186/s13054-019-2347-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Donat R Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Vladimir Cerny
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Socialni pece 3316/12A, CZ-40113, Usti nad Labem, Czech Republic.,Centre for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic, Sokolska 581, CZ-50005, Hradec Kralove, Czech Republic.,Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, CZ-50003, Hradec Kralove, Czech Republic.,Department of Anaesthesia, Pain Management and Perioperative Medicine, QE II Health Sciences Centre, Dalhousie University, Halifax, 10 West Victoria, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, University of Paris XI, Faculté de Médecine Paris-Sud, 78 rue du Général Leclerc, F-94275, Le Kremlin-Bicêtre Cedex, France
| | - Daniela Filipescu
- Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Sos Fundeni 256-258, RO-022328, Bucharest, Romania
| | - Beverley J Hunt
- King's College and Departments of Haematology and Pathology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, SI-3000, Celje, Slovenia
| | - Marc Maegele
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Giuseppe Nardi
- Department of Anaesthesia and ICU, AUSL della Romagna, Infermi Hospital Rimini, Viale Settembrini, 2, I-47924, Rimini, Italy
| | - Louis Riddez
- Department of Surgery and Trauma, Karolinska University Hospital, S-171 76, Solna, Sweden
| | - Charles-Marc Samama
- Hotel-Dieu University Hospital, 1, place du Parvis de Notre-Dame, F-75181, Paris Cedex 04, France
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, D-52074, Aachen, Germany.
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Drayton Jackson M, Dunn MW, Storey MA, Dunn AL. Increasing optimal coagulation factor dosing in the paediatric emergency department: A quality improvement study. Haemophilia 2019; 25:258-263. [PMID: 30748062 DOI: 10.1111/hae.13693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/29/2018] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Haemophilia is a disorder complicated by bleeding episodes that require emergent medical evaluation. Factor replacement dosing can present challenges for emergency department (ED) care. AIMS We aimed to reduce out-of-range factor dosing in the ED. Specifically, we sought to increase the number of haemophilia ED patient visits between encounters where sub-optimal factor dosing was administered from a baseline of 4-15 encounters. METHODS A chart review was completed on all patients with haemophilia A (HA) or B (HB) seen in the ED for injuries requiring factor concentrate from September 2015 to August 2016. Injuries were classified as minor-requiring a 50% factor correction or major-requiring a 100% factor correction. Optimal dosing range was defined as 90%-120% of the institutional guideline goal for the degree of injury. The predicted optimal dose range for each patient was compared to the actual dose administered. RESULTS Baseline data demonstrated optimal dosing range in 70% of encounters. There was no difference between patients with HA or HB in frequency of out-of-range dosing (P = 0.15). There was no difference in frequency of out-of-range dosing between types of clotting factor concentrate used. After initiation of quality improvement (QI) interventions, we achieved 16 encounters between out-of-range dosing, exceeding our goal of 15. However, this success was not sustained. CONCLUSION Optimal coagulation factor dosing is important for patient care and resource management. QI interventions promoted increased accuracy of factor dosing for patients with haemophilia seen in the ED.
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Affiliation(s)
| | - Michael W Dunn
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Michael A Storey
- Pharmacy Administration, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy L Dunn
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
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Diagnostic and therapeutic approach in adult patients with traumatic brain injury receiving oral anticoagulant therapy: an Austrian interdisciplinary consensus statement. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:62. [PMID: 30795779 PMCID: PMC6387521 DOI: 10.1186/s13054-019-2352-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/10/2019] [Indexed: 12/11/2022]
Abstract
There is a high degree of uncertainty regarding optimum care of patients with potential or known intake of oral anticoagulants and traumatic brain injury (TBI). Anticoagulation therapy aggravates the risk of intracerebral hemorrhage but, on the other hand, patients take anticoagulants because of an underlying prothrombotic risk, and this could be increased following trauma. Treatment decisions must be taken with due consideration of both these risks. An interdisciplinary group of Austrian experts was convened to develop recommendations for best clinical practice. The aim was to provide pragmatic, clear, and easy-to-follow clinical guidance for coagulation management in adult patients with TBI and potential or known intake of platelet inhibitors, vitamin K antagonists, or non-vitamin K antagonist oral anticoagulants. Diagnosis, coagulation testing, and reversal of anticoagulation were considered as key steps upon presentation. Post-trauma management (prophylaxis for thromboembolism and resumption of long-term anticoagulation therapy) was also explored. The lack of robust evidence on which to base treatment recommendations highlights the need for randomized controlled trials in this setting.
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García Sánchez P, Molina Gutiérrez MÁ, Martín Sánchez J, Inisterra Viu L, García García S, Rivas Pollmar MI, Martín Salces M, Álvarez Román MT, Jiménez Yuste V. Head trauma in the haemophilic child and management in a paediatric emergency department: Descriptive study. Haemophilia 2018; 24:e187-e193. [PMID: 29873151 DOI: 10.1111/hae.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Haemophilia is one of the most common inherited bleeding disorders in the Emergency Department (ED). The most dangerous site of bleeding is the central nervous system. AIMS To describe the characteristics of haemophiliacs arrived to our ED following a head trauma and to analyse the incidence of intracranial haemorrhage (ICH). MATERIALS AND METHODS Retrospective, analytical, observational study, conducted in a Paediatric ED. We included haemophilic patients aged from birth to 16 years who consulted after a head trauma over a 6-year period. Data collected included age, type of haemophilia and head trauma, symptoms, prophylaxis status, CT imaging, treatment and number of visits to the ED. RESULTS About 46 males and 85 episodes were analysed. The median age was 2.38 years. Severe haemophilia A was the most frequent type of disease (50%). All head injuries were mild, and the most frequent mechanism was a collision with an object (38.8%). In 62 episodes (72.9%) the patients were asymptomatic. The rest 23 events had symptomatology, being the most common headache (26%), emesis (21.7%) and drowsiness (17.4%). Head CT was obtained in 31 episodes, founding altered results in 10 (6 of them corresponding to ICH). All the patients with ICH had symptomatology. About 37 episodes required admission. CONCLUSION Intracranial haemorrhage is one of the most dangerous events in haemophiliacs and it may occur after a head trauma. Our study suggests that, in case of head trauma, CT must be obtained in symptomatic patients and in those with additional risk factors. Asymptomatic patients must have prolonged observation.
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Affiliation(s)
- P García Sánchez
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - M Á Molina Gutiérrez
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - J Martín Sánchez
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - L Inisterra Viu
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - S García García
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - M I Rivas Pollmar
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - M Martín Salces
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - M T Álvarez Román
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - V Jiménez Yuste
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
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18
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Park BY, Park YS. Surgery in Patients with Von Willebrand Disease : A Single Center Experience. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2017. [DOI: 10.15264/cpho.2017.24.1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bo Young Park
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Shil Park
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
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Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer EAM, Ozier Y, Riddez L, Schultz A, Vincent JL, Spahn DR. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 2016; 20:100. [PMID: 27072503 PMCID: PMC4828865 DOI: 10.1186/s13054-016-1265-x] [Citation(s) in RCA: 594] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/11/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution. METHODS The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013. RESULTS The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome. CONCLUSIONS A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.
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Affiliation(s)
- Rolf Rossaint
- />Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Bertil Bouillon
- />Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne-Merheim Medical Centre, Ostmerheimer Strasse 200, 51109 Cologne, Germany
| | - Vladimir Cerny
- />Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Socialni pece 3316/12A, 40113 Usti nad Labem, Czech Republic
- />Department of Research and Development, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
- />Department of Anaesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
- />Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, QE II Health Sciences Centre, 10 West Victoria, 1276 South Park St., Halifax, NS B3H 2Y9 Canada
| | - Timothy J. Coats
- />Emergency Medicine Academic Group, University of Leicester, University Road, Leicester, LE1 7RH UK
| | - Jacques Duranteau
- />Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, University of Paris XI, Faculté de Médecine Paris-Sud, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, Cedex France
| | - Enrique Fernández-Mondéjar
- />Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, ctra de Jaén s/n, 18013 Granada, Spain
| | - Daniela Filipescu
- />Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Sos Fundeni 256-258, 022328 Bucharest, Romania
| | - Beverley J. Hunt
- />King’s College, Departments of Haematology, Pathology and Lupus, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Radko Komadina
- />Department of Traumatology, General and Teaching Hospital Celje, Oblakova 5, 3000 Celje, Slovenia
| | - Giuseppe Nardi
- />Shock and Trauma Centre, S. Camillo Hospital, Viale Gianicolense 87, 00152 Rome, Italy
| | - Edmund A. M. Neugebauer
- />Faculty of Health - School of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, Building 38, 51109 Cologne, Germany
| | - Yves Ozier
- />Division of Anaesthesia, Intensive Care and Emergency Medicine, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Louis Riddez
- />Department of Surgery and Trauma, Karolinska University Hospital, 171 76 Solna, Sweden
| | - Arthur Schultz
- />Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Lorenz Boehler Trauma Centre, Donaueschingenstrasse 13, 1200 Vienna, Austria
| | - Jean-Louis Vincent
- />Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Donat R. Spahn
- />Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Pabinger I, Heistinger M, Muntean W, Reitter-Pfoertner SE, Rosenlechner S, Schindl T, Schuster G, Streif W, Thom K, Male C. [Treatment of haemophilia in Austria]. Wien Klin Wochenschr 2015; 127 Suppl 3:S115-30. [PMID: 26525378 DOI: 10.1007/s00508-015-0872-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
This guideline which is endorsed by the Austrian Society of Haemophilia, the Austrian Society of Paediatrics, and the Austrian Society of Haematology & Medical Oncology is intended to give a clear and practical guidance for diagnosing and treating haemophilia in Austria. In the treatment of haemophilia there are few controlled interventional trials, and recommendations usually have a rather low level of evidence.The main basis for this paper are the new international guidelines by the World Federation of Hemophilia, published in 2013. These were adapted according to the local situation and experience.Covered topics are diagnostics, control visits, pharmacological treatment options, prophylaxis and treatment in children and adults, possible problems arising in haemophilia carriers and special aspects like home therapy, options for venous catheters, management of various traumas, bleedings and interventions, including dental procedures, and last not least inhibitors and their treatment.
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Affiliation(s)
- Ingrid Pabinger
- Klinische Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Max Heistinger
- 1. Medizinische Abteilung, LKH Klagenfurt, Klagenfurt, Österreich
| | - Wolfgang Muntean
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Sylvia-Elisabeth Reitter-Pfoertner
- Klinische Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | | | - Thomas Schindl
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | | | - Werner Streif
- Department für Kinder- und Jugendheilkunde, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Katharina Thom
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Christoph Male
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
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El Dakhakhny AM, Hesham MA, Hassan TH, El Awady S, Hanfy MM. Impact of health instructions on improving knowledge and practices of haemophilia A adolescents: a single centre experience. Haemophilia 2014; 20:e260-6. [PMID: 24697953 DOI: 10.1111/hae.12431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Nowadays, health education has been elevated to a higher standing in healthcare systems in managing chronic illness; yet, this approach has not received sufficient support in developing countries as these societies still tend to the traditional stage of 'treatment after disease'. Adolescence is a critical period and voyage into adulthood can be more challenging for haemophilia teens. For teens with haemophilia, learning to care for their own disorder is a giant step forward in asserting their independence and preparation for adult life. AIM We aimed to determine impact of health instructions on improving knowledge and practices of haemophilia A adolescents. METHODS An interventional study was conducted on 50 haemophilia A adolescents at outpatient clinic of Pediatric Hematology Unit of Zagazig University Hospitals. Three tools were used. The first was a structured interview sheet to evaluate patients' knowledge. The second was a clinical checklist to evaluate patients' practices. The third was health instructions program. Tools were developed by the researchers based on a thorough review of related literature and a full understanding of the needs of haemophilic adolescents. Evaluation of health instructions success was based on comparing scores of tool I and tool II before health instructions (pretest) and after health instructions immediately (posttest) and after 2 months (follow-up test). RESULTS There was a significant improvement in knowledge and practices of haemophilia A adolescents in posttest and follow-up test compared to pretest. CONCLUSION Health instructions have an impact on improving knowledge and practices of haemophilia A adolescents.
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Affiliation(s)
- A M El Dakhakhny
- Department of Pediatric Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt
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22
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Özgönenel B, Zia A, Callaghan MU, Chitlur M, Rajpurkar M, Lusher JM. Emergency department visits in children with hemophilia. Pediatr Blood Cancer 2013. [PMID: 23192828 DOI: 10.1002/pbc.24401] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The pediatric emergency department (ED) management of bleeding and other complications of hemophilia constitutes an increasingly important component of hemophilia therapy. This retrospective study examined the overall ED use by children with hemophilia in a single center, with a particular aim to investigate visits related to injury or bleeding, and those related to blood stream infection in patients with a central venous catheter (CVC). METHODS Electronic medical records of patients with hemophilia presenting to Children's Hospital of Michigan ED were reviewed. Different categories of ED visits over a 5-year period (January 2006-December 2010) were examined. RESULTS There were 536 ED visits from 84 male patients (median age 4 years, range 0-21) with hemophilia over the 5-year period. The reasons for ED visits were: injury or bleeding (61.2%); suspected CVC-related infection (11.8%); causes unrelated to hemophilia (19.2%); and routine clotting factor infusion (7.8%). Eighteen visits from six patients were secondary to injury or bleeding in a patient not yet diagnosed with hemophilia. An intracranial hemorrhage was detected in five visits. Overall, 5.4% of all visits represented distinct episodes of bloodstream infection. CONCLUSION The pediatric ED is an indispensable component of the overall hemophilia care, because: (1) patients with potentially lethal problems such as ICH or CVC-related infection may present to the ED for their initial management; (2) previously undiagnosed patients with hemophilia may also present to the ED for their first bleeding episodes, initiating the diagnostic investigations; (3) the ED provides after-hours treatment service for many episodes of injury or bleeding, and also for clotting factor infusion.
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Affiliation(s)
- Bülent Özgönenel
- Division of Hematology/Oncology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA.
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[Separation of coagulation factor VIII with high activity using gigaporous anion exchange chromatography]. Se Pu 2012; 30:618-23. [PMID: 23016297 DOI: 10.3724/sp.j.1123.2012.01036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A purification process to obtain coagulation factor VIII (F VIII) with high activity from human plasma was established. Based on the analysis of the size ratio between F VIII and matrix porous medium and its effect on the protein activity, a novel purification process designed was superporous ion exchange chromatography (IEC). The operating conditions of gigaporous and traditional anion exchange chromatography were optimized separately. The chromogenic substrate, gel filtration and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) were used to monitor the bioactivity and purity of the chromatographic products. The results showed that the superporous medium could not only protect structure of macro-protein but also enhance its mass transfer, finally giving FVIII product with high activity. The yield of F VIII in superporous chromatography was about five times of commercially agarose chromatography and the specific activity was up to 154 IU/mg protein. Furthermore, we studied the regeneration process of the superporous medium, washing the column with 5 column volumes of 1 mol/L NaOH at a low flow rate, to ensure the chromatographic stability. This purification process is simple, reproducible and suitable for large-scale production.
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Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A. Guidelines for the management of hemophilia. Haemophilia 2012; 19:e1-47. [PMID: 22776238 DOI: 10.1111/j.1365-2516.2012.02909.x] [Citation(s) in RCA: 1265] [Impact Index Per Article: 105.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 01/23/2023]
Affiliation(s)
- A. Srivastava
- Department of Hematology; Christian Medical College; Vellore; India
| | - A. K. Brewer
- Department of Oral Surgery; The Royal Infirmary; Glasgow; Scotland
| | - E. P. Mauser-Bunschoten
- Van Creveldkliniek and Department of Hematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - N. S. Key
- Department of Medicine; University of North Carolina; Chapel Hill; NC; USA
| | - S. Kitchen
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield; UK
| | - A. Llinas
- Department of Orthopaedics and Traumatology; Fundación Santa Fe University Hospital Fundación Cosme y Damián and Universidad de los Andes and Universidad del Rosario; Bogotá; Colombia
| | - C. A. Ludlam
- Comprehensive Care Haemophilia and Thrombosis Centre; Royal Infirmary; Edinburgh; UK
| | - J. N. Mahlangu
- Haemophilia Comprehensive Care Centre; Johannesburg Hospital and Department of Molecular Medicine and Haematology; Faculty of Health Sciences; National Health Laboratory Services and University of the Witwatersrand; Johannesburg; South Africa
| | - K. Mulder
- Bleeding Disorders Clinic; Health Sciences Center; Winnipeg; Canada
| | - M. C. Poon
- Departments of Medicine; Pediatrics and Oncology, and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; University of Calgary, Foothills Hospital and Calgary Health Region; Calgary; Canada
| | - A. Street
- Haematology; Alfred Hospital; Melbourne; Victoria; Australia
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Prise en charge de l’hémophilie en salle d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2012. [DOI: 10.1007/s13341-012-0189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Simpson ML, Thompson AA. Recognition and Management of Hemophilia Emergencies. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2011. [DOI: 10.1016/j.cpem.2011.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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