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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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Pezeshkpoor B, Berkemeier AC, Herbst K, Albert T, Müller J, Oldenburg J. Comprehensive domain-specific analysis and immunoglobulin G profiling of anti-factor VIII antibodies using a bead-based multiplex immunoassay. J Thromb Haemost 2024; 22:1591-1604. [PMID: 38453023 DOI: 10.1016/j.jtha.2024.02.016] [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] [Received: 11/14/2023] [Revised: 01/27/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Antibodies against factor (F)VIII are a major complication in the treatment of patients with severe hemophilia A. The Nijmegen-Bethesda assay (NBA) is the gold standard for detection of neutralizing antibodies (inhibitors), whereas both inhibitors and nonneutralizing antibodies can be detected by immunoassays such as enzyme-linked immunosorbent assay (ELISA) and multiplex bead-based assays. OBJECTIVES Evaluation of an in-house Luminex bead-based assay (LumiTope) compared with a commercially available ELISA and NBA. METHODS The LumiTope method comprised full-length and B-domain-deleted FVIII as well as 9 purified FVIII single or multidomains. The respective proteins were coupled to magnetic beads to detect domain-specific immunoglobulin (IgG; IgG1-4) anti-FVIII antibodies in a large cohort of patients with hemophilia A with and without inhibitors. RESULTS Overall, LumiTope assay had a high sensitivity (94.9%) and specificity (91.2%), particularly in patients with low-titer inhibitors compared with ELISA (sensitivity of 72.2% vs 27.7%). IgG4 was the most abundant IgG subclass in NBA-positive patients. NBA-positive and -negative patients showed different domain profiles. Patients with genetic variants in the heavy chain predominantly exhibited antibodies specific to this chain, while those with a light-chain variant showed a more diverse distribution of antibody specificities. Patients with an intron 22 inversion resembled those with a light-chain defect, with a majority of antibodies targeting the light chain. CONCLUSION LumiTope assay provides a sensitive and specific method for not only detection but also domain specification of anti-FVIII-antibodies. Implementation of bead-based assays could improve antibody detection, profiling, and comparability of results and complement NBA.
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Affiliation(s)
- Behnaz Pezeshkpoor
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany.
| | - Ann-Cristin Berkemeier
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Kerstin Herbst
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Thilo Albert
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Jens Müller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany; Center for Rare Diseases Bonn (ZSEB), University Clinic Bonn, Bonn, Germany.
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Abdulla Alzahrani H, Warsi A, Mullah-Ali A, Alotaibi G, Abu-Riash M, Alshahrani M, Siddiqui M, Owaidah T, Hashmi S. Consensus-Based Expert Recommendations on the Management of Hemophilia A in the Gulf Region. Acta Haematol 2024:1-14. [PMID: 38565097 DOI: 10.1159/000538400] [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: 12/13/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hemophilia A presents a significant health challenge in the Gulf region, where it has an especially high prevalence. There are several unmet needs associated with the management of hemophilia A in the region. The aim of this manuscript was to contextualize unmet management needs, provide recommendations to optimize care, and specify requirements for the establishment of gene therapy centers in the region. SUMMARY An expert panel was assembled comprising ten clinical hematologists from Kuwait, Oman, Saudi Arabia, and the UAE. The Delphi methodology was used to obtain a consensus on statements relating to several aspects of hemophilia A. A consensus was reached for all statements by means of an online, anonymized voting system. The consensus statements pertain to screening and diagnosis, treatment approaches, and requirements for the implementation of gene therapy. KEY MESSAGES There are significant challenges that hinder the optimal management of hemophilia A in the Gulf region. The consensus statements presented provide specific recommendations to improve diagnostic and treatment approaches, promote multidisciplinary care, and optimize regional data generation and reporting. These statements also delineate the requirements for the establishment of gene therapy centers for hemophilia A in the region.
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Affiliation(s)
- Hazzaa Abdulla Alzahrani
- Consultant Hematology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Warsi
- Department of Oncology, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ali Mullah-Ali
- Consultant Pediatric Hematology, National Bank of Kuwait Specialized Hospital for Children, Shuwaikh Industrial, Kuwait
| | - Ghazi Alotaibi
- Department of Medicine (Oncology Center), King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud Abu-Riash
- Senior Clinical Specialist Hematology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammad Alshahrani
- Consultant Pediatric Hematology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mustaqeem Siddiqui
- Consultant Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Tarek Owaidah
- Consultant Hemato-Pathology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shahrukh Hashmi
- Consultant Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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Cho S, Perry AM, Cheng AM, Wang C, Rico JF. Advances in Hemophilia A Management. Adv Pediatr 2022; 69:133-147. [PMID: 35985706 DOI: 10.1016/j.yapd.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hemophilia A is an inherited insufficiency of Factor VIII (FVIII), one of the critical clotting factors. The gold standard for the management of moderate-to-severe hemophilia A is prophylaxis using regular replacement therapy with clotting factor concentrates. Compared with conventional treatment, extended half-life products reduce the burden of frequent factor replacement injections. Of note, up to 30% of patients with hemophilia A receiving prophylactic factor infusions develop "inhibitors," neutralizing anti-FVIII autoantibodies. Therapeutic options for patients with hemophilia A and inhibitors include the immune tolerance induction (ie, eradication of inhibitors) and the management of acute bleeds with bypassing agents and/or emicizumab. Emicizumab is a biphasic monoclonal antibody mimicking activated FVIII, approved for patients with hemophilia A with/without inhibitors. Gene therapy is an emerging therapy for hemophilia A, essentially curing patients with hemophilia A or transforming them to a milder phenotype by establishing continuous endogenous expression of FVIII after one-time treatment.
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Affiliation(s)
- Sukjoo Cho
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
| | - Ashley M Perry
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
| | - Anna M Cheng
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Carrie Wang
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Juan Felipe Rico
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA.
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Montalvão SADL, Lowe A, Kitchen S. Advantages of external quality assessment-EQA programs. Haemophilia 2022; 28:679-686. [PMID: 35415926 DOI: 10.1111/hae.14562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The first external quality assessment (EQA) in Thrombosis and Haemostasis was elaborated over 20 years ago, and since then, several national and international EQA institutions have been established. AIM Display the benefits of EQA programs. METHODS The spectrum of EQA action was evaluated ranges from improving the performance of the local laboratory to highlighting inadequate diagnostic tests that need to be replaced by new technologies. RESULTS The first result approach is related to a national management of quality in laboratories. In recent years, Brazil has invested in an EQA program to aid public policy in the laboratory area. During this period, a group of haemostasis laboratory specialists were invited to manage the results and help the Ministry of Health with applying these results as a strategy to improve laboratories. Thus, in collaboration with NEQAS-BC, the University of Campinas - UNICAMP, established a Brazilian EQA program for Blood Coagulation. The second result approach is related to FVIII inhibitor assay performance evaluation, which is another type of EQA program benefit. Despite the assay being considered the gold standard to measure neutralised immunoglobulins for FVIII since 1975, over 40 years ago, the test still has a high coefficient of variation. Results from NEQAS-BC and WFH IEQAS program demonstrate the inter-laboratory variation across the United Kingdom over the last years and among emergent countries. CONCLUSION The EQA programs have an important educational role in helping countries manage their public policy and in the international inquiry regarding the necessity of new technologies in haemostasis.
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Affiliation(s)
| | - Anna Lowe
- UK NEQAS Blood Coagulation, Sheffield, UK
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Castaman G, Borchiellini A, Santagostino E, Radossi P, Aksu S, Yilmaz M, Serban M, Uscatescu V, Truica C, Fasulo MR, Mancuso ME, Paladino E, Valpreda A, Guarnieri C, Macchia R, Scarpellini M, Mathew P, Morfini M. Non-Compartment and compartmental pharmacokinetics, efficacy, and safety of Kedrion FIX concentrate. Eur J Pharm Sci 2020; 153:105485. [PMID: 32712218 DOI: 10.1016/j.ejps.2020.105485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND An open-label phase II, multicenter clinical trial was conducted at 11 Haemophilia Centres in Italy, Romania, and Turkey, to evaluate the pharmacokinetics (PK), efficacy, and safety of high purity, plasma-derived, double virus inactivated and double nano-filtered factor IX (pd-FIX) concentrate (Kedrion FIX), EudraCT Number: 2005-006186-14. MATERIAL AND METHODS 16 previously treated patients (PTPs) with severe or moderately severe haemophilia B were enrolled in the study. At enrolment, 14 underwent the first PK assessment (PK I), and the second PK (PK II) assessment was performed after six months of treatment (5 on-demand and nine prophylaxis) at the end of the study. PK parameters were evaluated by Non-Compartmental Analysis (NCA), One-Compartment model (OCM), and Two-Compartment Model (TCM). Efficacy of Kedrion FIX in all 16 patients was evaluated by the number of bleeding events, and clinical response following the infusions. Periodic FIX inhibitor assays and thrombogenicity tests were scheduled throughout the study to assess the safety of the drug. RESULTS As compared to the published data on PK of pdFIX, Kedrion FIX displayed a longer half-life (22.37-55.73 hrs), reduced clearance, and regular volume of distribution at PK I by both NCA and OCM. The comparison of outcomes of PK II with those of PK I by OCM, also showed significant changes, particularly in patients on prophylaxis, who showed some improved parameters of PK. Due to two outlier values at the end of the trial, the NCA parameters of PK I were not compared to those of PK II. Breakthrough bleeds were successfully treated with 1 or 2 infusions. No significant adverse events were observed during the study. DISCUSSION During the six-month clinical study period, the use of Kedrion FIX resulted in a safe and effective pd-FIX concentrate with excellent PK characteristics.
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Affiliation(s)
- G Castaman
- Azienda Ospedaliero-Universitaria Careggi, Malattie Emorragiche e della Coagulazione, Largo Brambilla 3, 50134 Firenze, Italy
| | - A Borchiellini
- Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza, CRR Malattie emorragiche e Trombotiche dell'adulto Ematologia, Corso Bramante, Torino, Italy
| | - E Santagostino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Via Pace 9, 20122 Milano, Italy
| | - P Radossi
- Regional Hospital and Haemophilia Hospital, Castelfranco Veneto, Italy
| | - S Aksu
- Hacettepe University Medical Faculty, Department of Internal Medicine, Sihhiye/Ankara, Turkey
| | - M Yilmaz
- SANKO University, School of Medicine Sani Konukoglu Application and Research Hospital, Department of Hematology, Gaziantep, Turkey
| | - M Serban
- "Louis Turcanu" Children Clinical Emergency Hospital, 21 Nemoianu str., Timisoara, Romania
| | - V Uscatescu
- Clinical Institute Fundeni, Bucharest 2nd district, Romania
| | - C Truica
- "Dr. Constantin Opris" Country Emergency Hospital, Hematology Department, Baia Mare, Romania
| | - M R Fasulo
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Via Pace 9, Milano, Italy
| | - M E Mancuso
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Via Pace 9, Milano, Italy
| | - E Paladino
- Azienda Ospedaliero-Universitaria Careggi, Malattie Emorragiche e della Coagulazione Largo Brambilla 3, Firenze, Italy
| | - A Valpreda
- Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza, CRR Malattie emorragiche e Trombotiche dell'adulto Ematologia. Corso Bramante, Torino, Italy
| | - C Guarnieri
- Kedrion Biopharma, Global Medical Affairs, Castelvecchio Pascoli, Lucca, Italy
| | - R Macchia
- Kedrion Biopharma, Global Medical Affairs, Castelvecchio Pascoli, Lucca, Italy
| | - M Scarpellini
- Kedrion Biopharma, Global Medical Affairs, Castelvecchio Pascoli, Lucca, Italy
| | - P Mathew
- Prasad has a account Presbyterian Hospital, Albuquerque, NM, USA; Kedrion Biopharma, TA Lead Haematology, Global Medical Affairs, Fort Lee, NJ, USA
| | - M Morfini
- Italian Association of Haemophilia Centres (AICE), Milan, Italy.
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Tiede A, Alberio L. The Art of Detecting Antibodies against Factor VIII. Hamostaseologie 2020; 40:485-490. [DOI: 10.1055/a-1223-3353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractAntibodies against factor VIII (FVIII) can be detected based on their ability to neutralize the procoagulant activity of FVIII (neutralizing antibodies, inhibitors), or based on their specific binding capacity to FVIII protein. This article reviews the available assays and their clinical interpretation in patients with congenital and acquired hemophilia.
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Affiliation(s)
- Andreas Tiede
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Lorenzo Alberio
- Service et Laboratoire Central d'Hématologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Gandhi T, Lawler P, Foxton E, Chowdary P, Riddell A. Clinical utility of sample preheat treatment in a modified Nijmegen-Bethesda assay (mNBA) for inhibitor monitoring in congenital and acquired haemophilia A: A single-centre four-year experience. Haemophilia 2020; 26:e300-e307. [PMID: 32892451 DOI: 10.1111/hae.14090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laboratory monitoring for factor VIII inhibitors ideally requires samples with the lowest possible factor VIII (FVIII) level, potentially challenging in patients with congenital haemophilia A (CHA) receiving regular prophylaxis and acquired haemophilia A (AHA) patients with endogenous FVIII. Inactivation of FVIII by preheating (preheat treatment, PHT) of patient plasma has been suggested to facilitate monitoring. AIM To evaluate the clinical utility of PHT prior to inhibitor analysis by modified Nijmegen-Bethesda assay (mNBA) in patients with CHA and AHA. METHODS Inhibitor screening by mNBA under standard conditions and with PHT at 56°C for 30, 60 and 90 minutes was evaluated. FVIII inhibitor results between 2007 and 2010 without PHT (720 results from 222 CHA and AHA patients), and between 2011 and 2014 post-PHT (1102 results from 302 patients) were available for analysis. RESULTS Of total 1822 results available, 61% were from severe HA patients, 22% from mild and moderate HA and 16% from AHA. Pre-PHT, 74% of samples were analysed by the mNBA, and the remaining 26% were not tested as FVIII levels were >20 IU/dL as per local protocol. Postintroduction of PHT (90 and 60 minutes), 96% of samples received were analysed for an inhibitor. Post-PHT in patients with AHA (n = 26), 69% of samples tested with factor VIII levels >20 IU/dL were found to have detectable inhibitor. CONCLUSION FVIII inhibitor testing using PHT at 56°C for 60 minutes facilitates inhibitor surveillance of CHA on prophylaxis. Potentially, 30 minutes at 56°C might be equally efficacious. In AHA receiving immunosuppression, monitoring of inhibitor titre after initial factor VIII response might enable personalized immunosuppression.
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Affiliation(s)
- Tejas Gandhi
- Haemophilia & Thrombosis Laboratory (Health Services Laboratories), Royal Free Hospital, London, UK
| | - Pura Lawler
- Haemophilia & Thrombosis Laboratory (Health Services Laboratories), Royal Free Hospital, London, UK
| | - Eleanor Foxton
- Haemophilia & Thrombosis Laboratory (Health Services Laboratories), Royal Free Hospital, London, UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia & Thrombosis Centre, Royal Free Hospital, London, UK
| | - Anne Riddell
- Haemophilia & Thrombosis Laboratory (Health Services Laboratories), Royal Free Hospital, London, UK
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Krzowski B, Balsam P, Peller M, Lodziński P, Grabowski M, Drozd-Sokołowska J, Basak G, Gawałko M, Opolski G, Kosiuk J. Electrophysiological Procedures in Patients With Coagulation Disorders - A Systemic Review. Circ J 2020; 84:875-882. [PMID: 32350233 DOI: 10.1253/circj.cj-20-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Catheter ablation (CA) is considered first-line treatment for many patients with symptomatic arrhythmias. Indications for CA are constantly increasing, as is the number of procedures. Although CA is nowadays regarded a safe procedure, there is a risk of complications, including both bleeding- and thrombosis-related events. Several factors contribute to periprocedural risk; of these, patient coagulation status is of considerable clinical relevance. In this context, even a simple procedure poses a considerable challenge in a patient with coagulation disorder. However, the level of evidence regarding CA in patients with coagulation disorders is very low. Neither experts' recommendations nor clinical guidelines have been presented so far. The aim of this article is to analyze potential procedure-related risks and provide clinicians with useful information and practical suggestions regarding optimization of procedural safety in patients with coagulation disorders.
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Affiliation(s)
- Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Michał Peller
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Piotr Lodziński
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | | | - Grzegorz Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw
| | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Jedrzej Kosiuk
- 1st Chair and Department of Cardiology, Medical University of Warsaw.,Department of Electrophysiology, Helios Klinikum Koethen
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Evaluation of nonneutralizing antibodies against factor VIII in severe haemophilia A patients from India. Blood Coagul Fibrinolysis 2019; 30:337-340. [DOI: 10.1097/mbc.0000000000000843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Compartment syndrome of the forearm with life-threatening bleeding after fasciotomy as the presenting sign of postpartum acquired hemophilia A: a case report. Blood Coagul Fibrinolysis 2019; 30:120-126. [PMID: 30864964 DOI: 10.1097/mbc.0000000000000799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
: Acquired hemophilia A (AHA) is a rare bleeding disorder caused by the development of autoantibodies against clotting factor VIII. Although the cause of this disorder remains obscure, it is often linked to malignancies, drug administration, autoimmune diseases and pregnancy. In pregnancy-associated AHA, hemorrhagic symptoms usually present 1-4 months peripartum, however they may occur up to 1-year postpartum. Compartment syndrome of the forearm is also very uncommon complication of AHA but can have devastating consequences. We report a rare case of a compartment syndrome of the forearm in a 30-year-old woman 2.5 months postpartum as the presentation of pregnancy-associated AHA.
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Morfini M, Rapisarda CAP. Safety of recombinant coagulation factors in treating hemophilia. Expert Opin Drug Saf 2019; 18:75-85. [PMID: 30681006 DOI: 10.1080/14740338.2019.1574743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION During the last decade, new FVIII/IX concentrates have been developed for the treatment of patients affected by hemophilia A/B. Significant progress has been achieved regarding their half-life, but the old issue of immunogenicity and new concerns about safety need to be addressed. AREAS COVERED After the implementation of virucidal methods, both plasma-derived and recombinant clotting factor concentrates achieved a very safe profile. The development of anti-FVIII antibodies is the major adverse event of replacement therapy with both FVIII concentrates. Furthermore, the new extended half-life concentrates, protein fused or pegylated, raised some concerns about their side effects. EXPERT OPINION The treatment of hemophilia A with inhibitors by induction of immunotolerance and using by-passing concentrates, improved the quality of life of patients but did not allow them to have a life expectancy like that of patients without inhibitors. The new humanized monoclonal antibody (MAb) ACE910, mimicking FVIII function, seems to be able to reduce the bleedings of hemophilia A patients with inhibitors. The post-marketing surveillance will clarify if the adverse events observed during the phase III clinical trials and compassionate use were due to the association with a Prothrombin activated complex concentrate or to the prothrombotic effect of the drug itself.
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Affiliation(s)
- Massimo Morfini
- a Italian Association of Haemophilia Centres (AICE) Florence , Italy
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13
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Batsuli G, Ito J, Mercer R, Baldwin WH, Cox C, Parker ET, Healey JF, Lollar P, Meeks SL. Anti-C1 domain antibodies that accelerate factor VIII clearance contribute to antibody pathogenicity in a murine hemophilia A model. J Thromb Haemost 2018; 16:1779-1788. [PMID: 29981270 PMCID: PMC6123829 DOI: 10.1111/jth.14233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Indexed: 01/06/2023]
Abstract
Essentials Inhibitor formation remains a challenging complication of hemophilia A care. The Bethesda assay is the primary method used for determining bleeding risk and management. Antibodies that block factor VIII binding to von Willebrand factor can increase FVIII clearance. Antibodies that increase clearance contribute to antibody pathogenicity. SUMMARY Background The development of neutralizing anti-factor VIII (FVIII) antibodies remains a challenging complication of modern hemophilia A care. In vitro assays are the primary method used for quantifying inhibitor titers, predicting bleeding risk, and determining bleeding management. However, other mechanisms of inhibition are not accounted for in these assays, which may result in discrepancies between the inhibitor titer and clinical bleeding symptoms. Objectives To evaluate FVIII clearance in vivo as a potential mechanism for antibody pathogenicity and to determine whether increased FVIII dosing regimens correct the associated bleeding phenotype. Methods FVIII-/- or FVIII-/- /von Willebrand factor (VWF)-/- mice were infused with anti-FVIII mAbs directed against the FVIII C1, C2 or A2 domains, followed by infusion of FVIII. Blood loss via the tail snip bleeding model, FVIII activity and FVIII antigen levels were subsequently measured. Results Pathogenic anti-C1 mAbs that compete with VWF for FVIII binding increased the clearance of FVIII-mAb complexes in FVIII-/- mice but not in FVIII-/- /VWF-/- mice. Additionally, pathogenic anti-C2 mAbs that inhibit FVIII binding to VWF increased FVIII clearance in FVIII-/- mice. Anti-C1, anti-C2 and anti-A2 mAbs that do not inhibit VWF binding did not accelerate FVIII clearance. Infusion of increased doses of FVIII in the presence of anti-C1 mAbs partially corrected blood loss in FVIII-/- mice. Conclusions A subset of antibodies that inhibit VWF binding to FVIII increase the clearance of FVIII-mAb complexes, which contributes to antibody pathogenicity. This may explain differences in the bleeding phenotype observed despite factor replacement in some patients with hemophilia A and low-titer inhibitors.
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MESH Headings
- Animals
- Antibodies, Heterophile/administration & dosage
- Antibodies, Heterophile/immunology
- Antibodies, Heterophile/toxicity
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/toxicity
- Antibodies, Neutralizing/administration & dosage
- Antibodies, Neutralizing/immunology
- Antibodies, Neutralizing/toxicity
- Epitopes/immunology
- Factor VIII/antagonists & inhibitors
- Factor VIII/immunology
- Factor VIII/pharmacokinetics
- Hemophilia A/drug therapy
- Hemophilia A/immunology
- Hemorrhage/etiology
- Inhibitory Concentration 50
- Mice
- Mice, 129 Strain
- Mice, Inbred C57BL
- Models, Animal
- Phenotype
- Protein Domains
- von Willebrand Diseases
- von Willebrand Factor/metabolism
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Affiliation(s)
- G Batsuli
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - J Ito
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - R Mercer
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - W H Baldwin
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - C Cox
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - E T Parker
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - J F Healey
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - P Lollar
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - S L Meeks
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
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Abolghasemi H, Panahi Y, Ahmadinejad M, Toogeh G, Karimi M, Eghbali A, Mirbehbahani NB, Dehdezi BK, Badiee Z, Hoorfar H, Eshghi P, Maghsoudi N, Sahebkar A, Gholami-Fesharaki M. Comparative evaluation of the safety and efficacy of recombinant FVIII in severe hemophilia A patients. J Pharmacopuncture 2018; 21:76-81. [PMID: 30151307 PMCID: PMC6054092 DOI: 10.3831/kpi.2018.21.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/20/2018] [Accepted: 05/17/2018] [Indexed: 11/09/2022] Open
Abstract
Objective This study compared the safety and efficacy of Safacto® versus xyntha® in patients with severe hemophilia A. Methods Thirty-three male patients with severe hemophilia A were randomly divided into two groups. Seventeen patients received Safacto® and 16 patients received Xyntha® for four consecutive times. The dosage of FVIII was 40-50 IU/kg for each injection. Plasma level of FVIII activity was evaluated before every injection, 15 minutes after the injection and one month after the start of the trial. The rate of factor VIII activity, pain and joint motion were also assessed before and after the treatment. Results Plasma level of FVIII clotting activity in Safacto® and Xyntha® were 1.96±0.5 IU/dl and 1.63±0.5 IU/dl and increased to 88.84±25.2 IU/dl and 100.09±17.8 IU/dl, respectively (P<0.001). Pain score and range of motion improvement were 9.3±0.9 and 8.7±0.1 in Safacto® (P=0.17); and 9.4±0.8 and 8.8±0.3 in Xyntha® (P=0.35), respectively. No allergic or other unfavorable reactions was observed with either of the preparations. Conclusion This study showed that Safacto® has a favorable efficacy and safety profile.
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Affiliation(s)
- Hassan Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yunes Panahi
- Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Minoo Ahmadinejad
- High Institute of Research, Iranian Blood Transfusion Organization, Tehran, Iran
| | - Gholamreza Toogeh
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran.,High Institute of Research, Iranian Blood Transfusion Organization, Tehran, Iran.,Hematology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pediatric Hematology-Oncology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Golestan University of Medical Sciences, Gorgan, Iran.,Department of Thalassemia & Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.,Doctor Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Isfahan University of Medical Sciences, Isfahan, Iran.,Neuroscience Research Center (NRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mehran Karimi
- Hematology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aziz Eghbali
- Department of Pediatric Hematology-Oncology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Bighan Keikhaei Dehdezi
- Department of Thalassemia & Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Zahra Badiee
- Doctor Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Hoorfar
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Maghsoudi
- Neuroscience Research Center (NRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Batty P, Hart DP, Platton S. Optimization of pre-analytical heat treatment for inhibitor detection in haemophilia A. Int J Lab Hematol 2018; 40:561-568. [PMID: 29777571 DOI: 10.1111/ijlh.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Factor VIII (FVIII) antibody formation is the greatest clinical and laboratory challenge within the haemophilia centre. The Nijmegen-Bethesda assay (NBA) is the gold standard for inhibitor quantification, but affected by pre-analytical variables including a patient's FVIII activity (FVIII:C). Pre-analytical heat treatment (PHT) provides a methodology for inhibitor testing when measurable FVIII:C is present. METHODS We evaluated the effect of different PHT conditions (time/temperature) on FVIII:C as well as on potency of inhibitory activity in samples containing FVIII:C (endogenous pooled plasma and exogenous recombinant FVIII (rFL-FVIII) concentrate) or FVIII inhibitor. RESULTS PHT of endogenous FVIII at 37°C, 47°C and 52°C resulted in declining measurable FVIII:C at 120 minutes (69%, 57% and 13% of the original FVIII:C, respectively). Incubation at 56°C resulted in FVIII:C ≤ 1IU/dL after 60 minutes for endogenous FVIII and 120 minutes for rFL-FVIII. Incubation at 58°C resulted in FVIII:C < 1IU/dL at 15-30 minutes for endogenous FVIII and at 30-60 minutes for rFL-FVIII. No difference was seen for inhibitor detection following PHT (56°C or 58°C) by NBA or anti-FVIII IgG ELISA. CONCLUSION PHT at 58°C for 30 minutes demonstrated consistent reduction in FVIII:C < 1IU/dL without appearing to affect inhibitor detection. Laboratory awareness of differences in thermostability of different sources of FVIII is important when choosing PHT conditions.
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Affiliation(s)
- P Batty
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK.,The Royal London Hospital Haemophilia Centre, Barts Health, The Royal London Hospital, London, UK
| | - D P Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK.,The Royal London Hospital Haemophilia Centre, Barts Health, The Royal London Hospital, London, UK
| | - S Platton
- The Royal London Hospital Haemophilia Centre, Barts Health, The Royal London Hospital, London, UK
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16
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Messori A, Peyvandi F, Mengato D, Mannucci PM. Incidence of low-titre factor VIII inhibitors in patients with haemophilia A: meta-analysis of observational studies. Haemophilia 2017; 23:e87-e92. [PMID: 28220685 DOI: 10.1111/hae.13193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2016] [Indexed: 01/02/2023]
Abstract
INTRODUCTION A few studies have been focused on low-titre inhibitors in patients with haemophilia A. Although several putative factors have been implicated in the development of these inhibitors, solid data are still lacking. AIM The aim of this study was to perform a proportion meta-analysis on the incidence of low-titre inhibitors in haemophilia A. METHODS We surveyed the PubMed database to identify studies on de novo development of low-titre inhibitors in haemophilia A patients. On the basis of these data, we carried out a proportion meta-analysis to summarize information on incidence and between-study variability. Furthermore, the following three covariates were assessed by meta-regression: (i) mild disease vs. severe haemophilia; (ii) status of previously untreated patient (PUP) as opposed to multi-transfused and (iii) type of factor VIII. RESULTS Our literature search on PubMed extracted 340 eligible articles. From these, we selected 33 patient cohorts that were included in our meta-analysis (19 cohorts for PUPs and 14 cohorts for multi-transfused or unselected patients). The pooled incidence of low-titre inhibitors was 10.3% (95%CI: 8.3-12.5%) for studies including PUPs and 5.8% (95%CI: 2.5-10.4%) for the other studies; the difference was statistically significant (P = 0.003). Meta-regression of 31 patient cohorts found that mild disease and type of factor VIII were not associated with an increased incidence of low-titre inhibitors. CONCLUSIONS Our results confirmed that PUPs show a higher incidence of low-titre inhibitors than the other patients. Furthermore, our data showed that mild haemophilia was not associated with an increased incidence of low-titre inhibitors.
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Affiliation(s)
- A Messori
- Health Technology Assessment Unit, ESTAR Regional Health Service, Florence, Italy
| | - F Peyvandi
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - D Mengato
- Pharmaceutical Chemistry and Pharmacology Department, University of Padua, Padua, Italy
| | - P M Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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17
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Millner AH, Tiefenbacher S, Robinson M, Boesen HT. A variation of the Nijmegen-Bethesda assay using heat or a novel heat/cold pretreatment for the detection of FIX inhibitors in the presence of residual FIX activity. Int J Lab Hematol 2016; 38:639-647. [DOI: 10.1111/ijlh.12552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/02/2016] [Indexed: 12/01/2022]
Affiliation(s)
- A. H. Millner
- Immunogenicity Assessment; Novo Nordisk A/S; Måløv Denmark
| | - S. Tiefenbacher
- Colorado Coagulation; Laboratory Corporation of America Holdings; Englewood CO USA
| | - M. Robinson
- Colorado Coagulation; Laboratory Corporation of America Holdings; Englewood CO USA
| | - H. T. Boesen
- Immunogenicity Assessment; Novo Nordisk A/S; Måløv Denmark
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18
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Tabriznia-Tabrizi S, Gholampour M, Mansouritorghabeh H. A close insight to factor VIII inhibitor in the congenital hemophilia A. Expert Rev Hematol 2016; 9:903-13. [PMID: 27367203 DOI: 10.1080/17474086.2016.1208554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Hemophilia A (HA) has an X-linked pattern of inheritance and is the most common of the hemorrhagic disorders. HA is caused by a decreased or deficiency of the functional clotting factor VIII (FVIII) and effects 1 in 5000-10,000 male births. The common treatment for hemophilia is replacement therapy by plasma-derived or recombinant FVIII. Approximately 20-30% of people with a severe type of HA develop an inhibitor and this phenomenon is the main challenge in the management of these patients. Genetic factors and environmental determinants contribute to inhibitor development. Here, the roles of various genetic and environmental factors such as the type of FVIII concentrate used, the number of exposure days, and peak treatment time will be discussed in detail. It seems this information is helpful for hematologists. AREAS COVERED A literature review was done in January 2016 on PubMed and Scopus using the following keywords:' h(a)emophilia A & factor VIII inhibitor', 'h(a)emophilia A & factor VIII alloantibody', 'h(a)emophilia A & inhibitor'. There was no time limitation; however, there was an English language limitation placed on the articles selected. Expert commentary: Influential genetic and environmental factors in developing inhibitors have been discussed. Most of the risk factors are related to previously untreated patients with hemophili.
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Affiliation(s)
| | - Marzie Gholampour
- a Haematology , Mashhad University of Medical sciences (MUMS) , Mashhad , Iran
| | - Hassan Mansouritorghabeh
- b Allergy Research Center, Ghaem hospital, School of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
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19
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Adcock DM, Mammen J, Nair SC, de Lima Montalvão SA. Quality laboratory issues in bleeding disorders. Haemophilia 2016; 22 Suppl 5:84-9. [DOI: 10.1111/hae.12991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/19/2022]
Affiliation(s)
- D. M. Adcock
- Colorado Coagulation, Laboratory Corporation of America Holdings; Englewood CO USA
| | - J. Mammen
- Department of Transfusion Medicine and Immunohaematology; Christian Medical College; Vellore Tamil Nadu India
| | - S. C. Nair
- Department of Transfusion Medicine and Immunohaematology; Christian Medical College; Vellore Tamil Nadu India
| | - S. A. de Lima Montalvão
- IHTC Hemophilia Unit “Cláudio L. P. Corrêa”; Instituto Nacional de Ciência e Tecnologia do Sangue; Hemocentro Unicamp; University of Campinas; São Paulo Brazil
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20
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Barnbrock A, Heller C, Königs C, Budde U, Schwabe D. Lupus anticoagulants associated inhibitor against factor IX in a young patient with haemophilia B. Haemophilia 2016; 22:e437-9. [PMID: 27353656 DOI: 10.1111/hae.12956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 01/13/2023]
Affiliation(s)
- A Barnbrock
- Comprehensive Care Centre for Thrombosis and Hemostasis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
| | - C Heller
- Comprehensive Care Centre for Thrombosis and Hemostasis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - C Königs
- Comprehensive Care Centre for Thrombosis and Hemostasis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - U Budde
- Medylis Laborgesellschaft mbH, Hamburg, Germany
| | - D Schwabe
- Comprehensive Care Centre for Thrombosis and Hemostasis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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21
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Anti–factor VIII IgA as a potential marker of poor prognosis in acquired hemophilia A: results from the GTH-AH 01/2010 study. Blood 2016; 127:2289-97. [DOI: 10.1182/blood-2015-09-672774] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/08/2016] [Indexed: 01/12/2023] Open
Abstract
Key Points
This study is the first to assess the prognostic value of FVIII-specific antibody data in patients with AHA. Anti-FVIII IgA, but not immunoglobulin G, autoantibodies at baseline are potential predictors of recurrence and poor outcome of AHA.
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van den Berg HM, Hashemi SM, Fischer K, Petrini P, Ljung R, Rafowicz A, Carcao M, Auerswald G, Kurnik K, Kenet G, Santagostino E. Increased inhibitor incidence in severe haemophilia A since 1990 attributable to more low titre inhibitors. Thromb Haemost 2015; 115:729-37. [PMID: 26632988 DOI: 10.1160/th15-08-0692] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/05/2015] [Indexed: 01/13/2023]
Abstract
Many studies have reported an increased incidence of inhibitors in previously untreated patients (PUPs) with severe haemophilia A after the introduction of recombinant products. It was the objective of this study to investigate whether the inhibitor incidence has increased between 1990 and 2009 in an unselected cohort of PUPs with severe haemophilia A (FVIII< 1 %). Patients were consecutively recruited from 31 haemophilia treatment centres in 16 countries and followed until 50 exposure days or until inhibitor development. Inhibitor development was studied in five-year birth cohorts comparing cumulative incidences. Furthermore the risk for inhibitor development per five-year birth cohort was studied using multivariable Cox regression, adjusting for potential genetic and treatment-related confounders. A total of 926 PUPs were included with a total cumulative inhibitor incidence of 27.5 %. The inhibitor incidence increased from 19.5 % in 1990-1994 (lowest) to 30.9 % in 2000-2004 (highest; p-value 0.011). Low titre inhibitor incidence increased from 3.1 % in 1990-1994 to 10.5 % in 2005-2009 (p-value 0.009). High titre inhibitor incidences remained stable over time. After 2000, risk of all inhibitor development was increased with adjusted hazard ratios 1.96 (95 % CI 1.06-2.83) in 2000-2004 and 2.34 (1.42-4.92) in 2005-2009. Screening for inhibitors was intensified over this 20-year study period from a median of 1.9 to 2.9 tests/year before 2000 to 2.7 to 4.3 tests/year after 2000. In conclusion, the cumulative inhibitor incidence has significantly increased between 1990 and 2009. The high titre inhibitor incidence has remained stable.
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Affiliation(s)
- H Marijke van den Berg
- H. Marijke van den Berg, MD, PhD, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA Utrecht, The Netherlands, Tel.: +31 88 7568189, Fax: +31 88 7568099, E-mail:
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23
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Heat treatment of samples improve the performance of the Nijmegen–Bethesda assay in hemophilia A patients undergoing immune tolerance induction. Thromb Res 2015; 136:1280-4. [DOI: 10.1016/j.thromres.2015.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/24/2015] [Accepted: 08/22/2015] [Indexed: 11/18/2022]
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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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Zhao H, Yang L, Long C, Guo Y, Wu R, Liu X, Qin X, Liang H, Duan Z. Hemophilia care in China: review of care for 417 hemophilia patients from 11 treatment centers in Shanxi Province. Expert Rev Hematol 2015; 8:543-50. [DOI: 10.1586/17474086.2015.1043263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Montalvão SAL, Tucunduva AC, Siqueira LH, Sambo ALA, Medina SS, Ozelo MC. A longitudinal evaluation of anti-FVIII antibodies demonstrated IgG4 subclass is mainly correlated with high-titre inhibitor in haemophilia A patients. Haemophilia 2015; 21:686-92. [PMID: 25708525 DOI: 10.1111/hae.12646] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 12/24/2022]
Abstract
The development of inhibitory antibodies against factor VIII (FVIII) (inhibitor) is the major complication in haemophilia A patients. The FVIII-binding antibodies development comprises a polyclonal immunoglobulin (Ig) G response. Recent studies showed strong correlation between the presence of neutralizing anti-FVIII antibodies (inhibitors) and IgG4 subclass. The aim of this study was to evaluate anti-FVIII IgG subclasses in haemophilia A patients with inhibitor both in a cross-sectional and in a longitudinal analysis. Inhibitors were determined by Nijmegen-Bethesda assay. Anti-FVIII IgG subclasses were performed by ELISA, and samples from 20 healthy individuals were used to validate the test. We studied 25 haemophilia A patients with inhibitor, previously treated exclusively with plasma-derived FVIII concentrates or bypassing agents. The IgG subclasses distributions were evaluated in two groups of patients classified according to inhibitor response. IgG1 and IgG4 antibodies were most prominent in haemophilia A patients with inhibitors when compared with IgG2 and IgG3. This study reports for the first time the behaviour of FVIII-binding IgG1 and IgG4 subclasses in a longitudinal analysis, in a clinical setting, of high-response inhibitor haemophilia A patients, showing the correlation of IgG4 and the inhibitor titres. In spite of being considered a non-pathologic antibody subclass with anti-inflammatory properties in other situations, IgG4 is correlated with the presence of high-titre inhibitor in the haemophilia setting. The comprehension of the IgG4 role in immune response may be crucial to establish the process for designing specific tolerance to FVIII.
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Affiliation(s)
- S A L Montalvão
- Hemophilia Unit 'Cláudio L. P. Corrêa', Centro de Hematologia e Hemoterapia da Unicamp, Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas, Campinas, São Paulo, Brazil
| | - A C Tucunduva
- Hemophilia Unit 'Cláudio L. P. Corrêa', Centro de Hematologia e Hemoterapia da Unicamp, Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas, Campinas, São Paulo, Brazil
| | - L H Siqueira
- Hemophilia Unit 'Cláudio L. P. Corrêa', Centro de Hematologia e Hemoterapia da Unicamp, Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas, Campinas, São Paulo, Brazil
| | - A L A Sambo
- Hemophilia Unit 'Cláudio L. P. Corrêa', Centro de Hematologia e Hemoterapia da Unicamp, Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas, Campinas, São Paulo, Brazil
| | - S S Medina
- Hemophilia Unit 'Cláudio L. P. Corrêa', Centro de Hematologia e Hemoterapia da Unicamp, Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas, Campinas, São Paulo, Brazil
| | - M C Ozelo
- Hemophilia Unit 'Cláudio L. P. Corrêa', Centro de Hematologia e Hemoterapia da Unicamp, Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas, Campinas, São Paulo, Brazil
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Abstract
Abstract
The development of neutralizing antibodies against factor VIII (FVIII inhibitors) and factor IX (FIX inhibitors) is the major complication in hemophilia care today. The antibodies neutralize the biological activity of FVIII and FIX and render replacement therapies ineffective. Antibodies are generated as a result of a cascade of tightly regulated interactions between different cells of the innate and the adaptive immune system located in distinct compartments. Any event that modulates the repertoire of specific B or T cells, the activation state of the innate and adaptive immune system, or the migration pattern of immune cells will therefore potentially influence the risk for patients to develop inhibitors. This chapter reviews our current understanding of different pathways of antibody development that result in different qualities of antibodies. Potential differences in differentiation pathways leading to high-affinity neutralizing or low-affinity non-neutralizing antibodies and the potential influence of gene polymorphisms such as HLA haplotype, FVIII haplotype, and polymorphisms of immunoregulatory genes are discussed.
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Reipert BM. Risky business of inhibitors: HLA haplotypes, gene polymorphisms, and immune responses. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:372-378. [PMID: 25696881 DOI: 10.1182/asheducation-2014.1.372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The development of neutralizing antibodies against factor VIII (FVIII inhibitors) and factor IX (FIX inhibitors) is the major complication in hemophilia care today. The antibodies neutralize the biological activity of FVIII and FIX and render replacement therapies ineffective. Antibodies are generated as a result of a cascade of tightly regulated interactions between different cells of the innate and the adaptive immune system located in distinct compartments. Any event that modulates the repertoire of specific B or T cells, the activation state of the innate and adaptive immune system, or the migration pattern of immune cells will therefore potentially influence the risk for patients to develop inhibitors. This chapter reviews our current understanding of different pathways of antibody development that result in different qualities of antibodies. Potential differences in differentiation pathways leading to high-affinity neutralizing or low-affinity non-neutralizing antibodies and the potential influence of gene polymorphisms such as HLA haplotype, FVIII haplotype, and polymorphisms of immunoregulatory genes are discussed.
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Mulliez SMN, Vantilborgh A, Devreese KMJ. Acquired hemophilia: a case report and review of the literature. Int J Lab Hematol 2014; 36:398-407. [PMID: 24750687 DOI: 10.1111/ijlh.12210] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/24/2014] [Indexed: 11/27/2022]
Abstract
Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies against clotting factor VIII (FVIII). FVIII autoantibody is characterized as polyclonal immunoglobulin G directed against the FVIII procoagulant activity. This disease occurs most commonly in the elderly population and with preponderance of men in nonpregnancy-related AHA. There are well-established clinical associations with AHA such as malignancy, other autoimmune diseases and pregnancy. However, up to 50% of reported cases remain idiopathic. The clinical manifestation of AHA includes mostly spontaneous hemorrhages into skin, muscles and soft tissues, or mucous membranes. AHA should be suspected when a patient with no previous history of bleeding presents with bleeding and an unexplained prolonged activated partial thromboplastin time. The diagnosis is confirmed in the laboratory by the subsequent identification of reduced FVIII levels and FVIII inhibitor titration. There is a high mortality, making prompt diagnosis and treatment vitally important. The principles of treatment consist in controlling the bleeding and eradicating the inhibitor. Because of the overall high relapse rate (15-33%), it is also recommended to follow up these patients. The review summarizes what is currently known about the epidemiology, pathogenesis, clinical features, diagnosis, treatment and prognosis of AHA and starts with a case report.
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Affiliation(s)
- S M N Mulliez
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
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30
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van den Berg HM. Epidemiological aspects of inhibitor development redefine the clinical importance of inhibitors. Haemophilia 2014; 20 Suppl 4:76-9. [DOI: 10.1111/hae.12404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 12/25/2022]
Affiliation(s)
- H. M. van den Berg
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
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Abstract
Pregnancy induces a number of physiologic changes that affect the hematologic indices, either directly or indirectly. Recognizing and treating hematologic disorders that occur during pregnancy is difficult owing to the paucity of evidence available to guide consultants. This review discusses specifically the diagnosis and management of benign hematologic disorders occurring during pregnancy. Anemia secondary to iron deficiency is the most frequent hematologic complication and is easily treated with oral iron formulations; however, care must be taken not to miss other causes of anemia, such as sickle cell disease. Thrombocytopenia is also a common reason for consulting the hematologist, and distinguishing gestational thrombocytopenia from immune thrombocytopenia (ITP), preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), or thrombotic thrombocytopenic purpura (TTP) is essential since the treatment differs widely. Occasionally the management of mother and infant involves the expeditious recognition of neonatal alloimmune thrombocytopenia (NAIT), a condition that is responsible for severe life-threatening bleeding of the newborn. Additionally, inherited and acquired bleeding disorders affect pregnant women disproportionately and often require careful monitoring of coagulation parameters to prevent bleeding in the puerperium. Finally, venous thromboembolism (VTE) during pregnancy is still largely responsible for mortality during pregnancy, and the diagnosis, treatment options and guidelines for prevention of VTE during pregnancy are explored.
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Affiliation(s)
- Danielle M Townsley
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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32
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Sborov DW, Rodgers GM. How I manage patients with acquired haemophilia A. Br J Haematol 2013; 161:157-65. [DOI: 10.1111/bjh.12228] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Douglas W. Sborov
- Division of Hematology and Oncology; Ohio State University Medical Center; The Arthur G. James Comprehensive Cancer Center; Columbus; OH; USA
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2013 revised edition : hemostatic treatment guidelines for hemophilia patients without inhibitors. ACTA ACUST UNITED AC 2013. [DOI: 10.2491/jjsth.24.619] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Distinct characteristics of antibody responses against factor VIII in healthy individuals and in different cohorts of hemophilia A patients. Blood 2012; 121:1039-48. [PMID: 23243272 DOI: 10.1182/blood-2012-07-444877] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Neutralizing antibodies against factor VIII (FVIII) remain the major complication in the replacement therapy of hemophilia A patients. To better understand the evolution of these antibodies it is important to generate comprehensive datasets which include both neutralizing and nonneutralizing antibodies, their isotypes, and IgG subclasses. We developed sensitive ELISAs to analyze FVIII-binding antibodies in different cohorts of hemophilia A patients and in healthy individuals. Our data reveal the prevalence of FVIII-binding antibodies among healthy individuals (n = 600) to be as high as 19%, with a prevalence of antibody titers > or =1:80 of 2%. The prevalence of FVIII-binding antibodies was 34% (5% for titers > or =1:80) in patients without FVIII inhibitors (n = 77), 39% (4% for titers > 1:80) in patients after successful immune tolerance induction therapy (n = 23), and 100% (n = 20, all titers > or =1:80) in patients with FVIII inhibitors. We found significant differences for IgG subclasses of FVIII-binding antibodies between the different study cohorts. IgG4 and IgG1 were the most abundant IgG subclasses in patients with FVIII inhibitors. Strikingly, IgG4 was completely absent in patients without FVIII inhibitors and in healthy subjects. These findings point toward a distinct immune regulatory pathway responsible for the development of FVIII-specific IgG4 associated with FVIII inhibitors.
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35
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Laboratory identification of factor inhibitors: an update. Pathology 2012; 44:293-302. [PMID: 22531341 DOI: 10.1097/pat.0b013e328353254d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 01/19/2012] [Accepted: 01/29/2012] [Indexed: 11/26/2022]
Abstract
Coagulation factor inhibitors comprise antibodies that bind to and then neutralise specific pro-coagulant plasma proteins. Coagulation factor inhibitors can develop against any coagulation factor, although the most common are against factor VIII (FVIII). These can develop in individuals with inherited haemophilia A (HA) as an immune response to factor replacement therapy, or as auto-antibodies leading to the condition of acquired HA. Clinical suspicion for inhibitors may arise when individuals present with bleeding symptoms without any prior bleeding diathesis, or when a patient with known mild haemophilia presents with a bleeding diathesis more extreme to their usual presentation, or when there is failure of factor replacement therapy to arrest bleeding in a known haemophiliac. The laboratory identification of factor inhibitors requires a careful and systematic approach that excludes other possible causes of prolonged screening tests, most commonly the activated partial thromboplastin time (APTT), and sometimes prothrombin time (PT). Coagulation factor inhibitor studies, including the Bethesda assay, are then undertaken to measure inhibitor titre, which guides treatment. This paper overviews the laboratory investigation of factor inhibitors, and also briefly reviews recent cross-laboratory inhibitor studies and the most recent evidence related to differential inhibitor formation according to type of therapy.
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36
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Abstract
Hemostasis is traditionally defined as a physiological response to blood vessel injury and bleeding, which entails a co-ordinated process involving the blood vessel, platelets, and blood clotting proteins (i.e. coagulation factors). Hemostasis can be divided into primary and secondary components. The former rapidly initiates after endothelial damage and is characterized by vascular contraction, platelet adhesion, and formation of a soft aggregate plug. The latter is initiated following the release of tissue factor and involves a complex sequence of events known as the blood coagulation cascade, encompassing serial steps where each coagulation factor activates another in a chain reaction that culminates in the conversion of fibrinogen to fibrin. Patients carrying abnormalities of the coagulation cascade (i.e. deficiencies of coagulation factors) have an increased bleeding tendency, where the clinical severity is mostly dependent upon the type and the plasma level of the factor affected. These disorders also impose a heavy medical and economic burden on individual patients and society in general. The aim of this article is to provide a general overview on the pathophysiology, clinics, diagnostics, and therapy of inherited disorders of coagulation factors.
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Affiliation(s)
- Giuseppe Lippi
- U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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37
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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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Miller CH, Platt SJ, Rice AS, Kelly F, Soucie JM. Validation of Nijmegen-Bethesda assay modifications to allow inhibitor measurement during replacement therapy and facilitate inhibitor surveillance. J Thromb Haemost 2012; 10:1055-61. [PMID: 22435927 PMCID: PMC4477703 DOI: 10.1111/j.1538-7836.2012.04705.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND As part of a pilot U.S. inhibitor surveillance project initiated at the Centers for Disease Control and Prevention (CDC) in 2006, a centralized inhibitor measurement was instituted. OBJECTIVE To validate a modified method for inhibitor measurement suitable for surveillance of treated and untreated patients. METHODS/RESULTS In all, 710 subjects with hemophilia A were enrolled; 122 had a history of inhibitor (HI). Nijmegen-Bethesda assay (NBA) results on 50 split specimens shipped on cold packs and frozen were equivalent (r=0.998). Because 55% of 228 initial specimens had factor (F)VIII activity (VIII:C) present, a heat treatment step was added. Heating specimens to 56°C for 30 min and centrifuging removed FVIII, as demonstrated by a reduction of VIII:C and FVIII antigen to <1 U dL(-1) in recently treated patients. Among specimens inhibitor-negative before heating, one of 159 with negative HI and five of 30 with positive HI rose to ≥ 0.5 Nijmegen-Bethesda units (NBU) after heating. Correlation of heated and unheated inhibitor-positive specimens was 0.94 (P=0.0001). The modified method had a coefficient of variation (CV) for a 1 NBU positive control of 10.3% and for the negative control of 9.8%. Based on results on 710 enrollment specimens, a positive CDC inhibitor was defined as ≥ 0.5 NBU. Results were similar when 643 post-enrollment specimens were included. Of 160 enrolled hemophilia B patients, two had HI. All others had NBU ≤ 0.2 at enrollment. CONCLUSION The CDC experience demonstrates that this modified NBA can be standardized to be within acceptable limits for clinical tests and can be used for national surveillance.
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Affiliation(s)
- C H Miller
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Pisal DS, Kosloski MP, Middaugh CR, Bankert RB, Balu-Iyer SV. Native-like aggregates of factor VIII are immunogenic in von Willebrand factor deficient and hemophilia a mice. J Pharm Sci 2012; 101:2055-65. [PMID: 22388918 DOI: 10.1002/jps.23091] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 02/01/2012] [Accepted: 02/03/2012] [Indexed: 01/13/2023]
Abstract
The administration of recombinant factor VIII (FVIII) is the first-line therapy for hemophilia A (HA), but 25%-35% of patients develop an inhibitory antibody response. In general, the presence of aggregates contributes to unwanted immunogenic responses against therapeutic proteins. FVIII has been shown to form both native-like and nonnative aggregates. Previously, we showed that nonnative aggregates of FVIII are less immunogenic than the native protein. Here, we investigated the effect of native-like aggregates of FVIII on immunogenicity in HA and von Willebrand factor knockout (vWF(-/-)) mice. Mice immunized with native-like aggregates showed significantly higher inhibitory antibody titers than animals that received native FVIII. Following restimulation in vitro with native FVIII, the activation of CD4+ T-cells isolated from mice immunized with native-like aggregates is approximately fourfold higher than mice immunized with the native protein. Furthermore, this is associated with increases in the secretion of proinflammatory cytokines IL-6 and IL-17 in the native-like aggregate treatment group. The results indicate that the native-like aggregates of FVIII are more immunogenic than native FVIII for both the B-cell and the T-cell responses.
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Affiliation(s)
- Dipak S Pisal
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Amherst, New York 14260, USA
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40
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Craig TJ, Bewtra AK, Bahna SL, Hurewitz D, Schneider LC, Levy RJ, Moy JN, Offenberger J, Jacobson KW, Yang WH, Eidelman F, Janss G, Packer FR, Rojavin MA, Machnig T, Keinecke HO, Wasserman RL. C1 esterase inhibitor concentrate in 1085 Hereditary Angioedema attacks--final results of the I.M.P.A.C.T.2 study. Allergy 2011; 66:1604-11. [PMID: 21884533 DOI: 10.1111/j.1398-9995.2011.02702.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The placebo-controlled study International Multicentre Prospective Angioedema C1-INH Trial 1 (I.M.P.A.C.T.1) demonstrated that 20 U/kg C1 esterase inhibitor (C1-INH) concentrate (Berinert®; CSL Behring, Marburg, Germany) is effective in treating acute abdominal and facial Hereditary Angioedema (HAE) attacks. METHODS I.M.P.A.C.T.2 was an open-label extension study of I.M.P.A.C.T.1 to evaluate the safety and efficacy of long-term treatment with 20 U/kg C1-INH for successive HAE attacks at any body location. Efficacy outcomes included patient-reported time to onset of symptom relief (primary) and time to complete resolution of all symptoms (secondary), analysed on a per-patient and per-attack basis. Safety assessments included adverse events, vital signs, viral safety and anti-C1-INH antibodies. RESULTS During a median study duration of 24 months, 1085 attacks were treated in 57 patients (10-53 years of age). In the per-patient analysis, the median time to onset of symptom relief was 0.46 h and was similar for all types of attacks (0.39-0.48 h); the median time to complete resolution of symptoms was 15.5 h (shortest for laryngeal attacks: 5.8 h; 12.8-26.6 h for abdominal, peripheral and facial attacks). Demographic factors, type of HAE, intensity of attacks, time to treatment, use of androgens and presence of anti-C1-INH antibodies had no clinically relevant effect on the efficacy outcomes. There were no treatment-related safety concerns. No inhibitory anti-C1-INH antibodies were detected in any patient. CONCLUSIONS A single dose of 20 U/kg C1-INH concentrate is safe and provides reliable efficacy in the long-term treatment of successive HAE attacks at any body location.
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Affiliation(s)
- T J Craig
- Penn State University College of Medicine, Hershey, PA 17033, USA.
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Phadke S. Hemophilia care in India: a review and experience from a tertiary care centre in uttar pradesh. Indian J Hematol Blood Transfus 2011; 27:121-6. [PMID: 22942560 DOI: 10.1007/s12288-011-0084-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 05/27/2011] [Indexed: 10/18/2022] Open
Abstract
Approximately 14,000 people with hemophilia are registered at the Hemophilia Federation of India; however, hemophilia remains under-diagnosed and many cases are not registered. In June 2009, the Government of Uttar Pradesh made anti-hemophilic factors available at a few centers, including the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. Consequently, the level of hemophilia care has improved considerably in recent times. Amongst the many challenges facing people with hemophilia, the development of inhibitors, which neutralize clotting factors provided by replacement therapy, is the most feared one. Healthcare professionals who treat people with hemophilia should not only be knowledgeable about the condition and committed to bettering the management of hemophilia, but also take responsibility for the judicious allocation of resources for various aspects of managing hemophilia. This manuscript aims to raise awareness regarding the detection and management of inhibitors in hemophilia based on the experience of a tertiary care hemophilia treatment centre in Uttar Pradesh, India.
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Affiliation(s)
- Shubha Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
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42
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Pisal DS, Balu-Iyer SV. Phospholipid binding lowers immunogenicity of human recombinant factor VIII in von Willebrand factor knockout mice. Thromb Haemost 2011; 105:1115-8. [PMID: 21475771 DOI: 10.1160/th10-09-0628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 02/25/2011] [Indexed: 11/05/2022]
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