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Al-Huniti A, Marshall L, Rusk D, Pruthi RK, Rodriguez V, Ferdjallah A, Kuhn A. Use of crushed tranexamic acid tablets in water for paediatric patients with bleeding disorders. Haemophilia 2024; 30:648-657. [PMID: 38507239 DOI: 10.1111/hae.14996] [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: 11/27/2023] [Revised: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Ε-Aminocaproic acid oral solution (EACA OS) is the only commercially available antifibrinolytic for patients who cannot swallow tablets. Insurance denials and high costs remain barriers to its use. OBJECTIVES To determine the safety and efficacy of crushed tranexamic acid tablets in water (cTXAw) for children with bleeding disorders. METHODS We retrospectively reviewed records of children (<10 years) with bleeding disorders who received cTXAw or EACA OS from 1 December 2018, through 31 July 2022, at Mayo Clinic (Rochester, Minnesota). Bleeding outcomes were defined according to ISTH criteria. RESULTS Thirty-two patients were included (median age, 3 years; male, n = 23). Diagnoses were VWD (n = 17), haemophilia (n = 5), FVII deficiency (n = 3), inherited platelet disorder (n = 4), ITP (n = 2), and combined FV and FVII deficiencies (n = 1). Thirty-two courses of cTXAw (monotherapy 24/32; mean duration 6 days) and fifteen courses of EACA (monotherapy 12/15; mean duration 5 days) were administered. No surgical procedures (n = 28) were complicated by bleeding. Of the 19 bleeding events, 16 had effective haemostasis, two had no reported outcome, and one had no response. cTXAw and EACA were equally effective in preventing and treating bleeding (p value > .1). No patients had adverse effects. Eight of 19 patients (42%) who were initially prescribed EACA OS did not receive it because of cost or insurance denial. The estimated average wholesale price of one treatment was $94 for cTXAw and $905 for EACA OS. CONCLUSIONS CTXAw appears to be an effective, safe, and low-cost alternative option to EACA OS for young children with bleeding disorders.
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Affiliation(s)
- Ahmad Al-Huniti
- Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda Marshall
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn Rusk
- Department of Nursing, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv K Pruthi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vilmarie Rodriguez
- Division of Hematology/Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Asmaa Ferdjallah
- Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexis Kuhn
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
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Iacob SI, Feinn RS, Sardi L. Systematic review of complications arising from male circumcision. BJUI COMPASS 2021; 3:99-123. [PMID: 35474726 PMCID: PMC8988744 DOI: 10.1002/bco2.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background Neonatal male circumcision is the most common procedure performed on paediatric patients (Simpson et al., 2014) and one of the most common surgical procedures in the world (American Academy of Pediatrics, 2012). Methods A search was conducted for articles about complications arising from male circumcision surgeries by entering the term ‘male circumcision’ into PubMed on June 16, 2020. Six thousand six hundred forty‐one articles published from 1945 to 2020 were found. Seventy‐eight articles were ultimately selected for the systematic review. Results The 78 articles selected from the literature search were entered into one of three tables. The first table includes 15 articles pertaining to chart reviews and cohort studies and report complication rates. The second table reports specific complications from 51 case reports and case series, and the third table is a summary from 12 articles regarding physician questionnaires and society recommendations. Additionally, the 78 articles were used to compile a list of 47 specific complications arising from male circumcision surgeries. Conclusions Complications from neonatal male circumcisions are common and healthcare providers need to be better informed of the potential complications of the surgery so that they can more effectively counsel their patients about potential risks, likelihood of complications and what can be done to prevent them. While experienced providers who practice in sterile settings have better outcomes with fewer complications, encouraging parents to take into account who is performing their son's circumcision, what was their training, how clean is their practice and how much experience they have and reminding them they have the option to decline the procedure entirely allow the parents to get a more complete picture and play an essential role in the decision‐making process.
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Affiliation(s)
- Stanca Iris Iacob
- Frank H. Netter MD School of Medicine Quinnipiac University North Haven Connecticut USA
| | - Richard S. Feinn
- Frank H. Netter MD School of Medicine Quinnipiac University North Haven Connecticut USA
| | - Lauren Sardi
- Department of Sociology Quinnipiac University Hamden Connecticut USA
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Elalfy MS, Mostafa S, Elalfy OM, Ghamry IRE, Meabed M, Zafar T, Tarawah A, Elekiaby M. A survey on practice of circumcision in children with severe haemophilia in Eastern Mediterranean Region. Haemophilia 2021; 27:e617-e619. [PMID: 34110651 DOI: 10.1111/hae.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Mohsen Saleh Elalfy
- Children's Hospitals, Pediatric Hematology Oncology Ain Shams University, Cairo, Egypt
| | - Salwa Mostafa
- Children's Hospitals, Pediatric Hematology Oncology Ain Shams University, Cairo, Egypt
| | - Omar Mohsen Elalfy
- Child Health in Complementary Medicine, National Research Center, cairo, Egypt
| | - Islam Reda El Ghamry
- Children's Hospitals, Pediatric Hematology Oncology Ain Shams University, Cairo, Egypt
| | - Mohamed Meabed
- Pediatric Hematology, Pediatric Hematology Bani-Suif University, Bani-Suif, Egypt
| | - Tahira Zafar
- Haemophilia treatment centre, Haemophilia treatment Centre Rawalpindi, Rawalpindi, Pakistan.,Frontier Medical college, Frontier Medical College Abbotabad, Abbotabad, Pakistan
| | - Ahmad Tarawah
- Hereditary Blood Disorders Center, King Abdullah Medical City, AlMadinah, Saudi Arabia
| | - Magdy Elekiaby
- Hematology unit, Shabrawishi Hospital Blood Bank, Giza, Egypt
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El Ekiaby M, Haffar A. Low-dose surgical prophylaxis: Optimization of use of World Federation of Hemophilia Humanitarian Aid donated clotting factor concentrates to developing countries. Haemophilia 2021; 26 Suppl 3:11-15. [PMID: 32356350 DOI: 10.1111/hae.13921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with hemophilia (PWH) might need surgical interventions during the course of their lives. Such medical interventions pose hemostatic challenges and requests infusion of clotting factor concentrates (CFCs) during peri and postoperative for variable periods to prevent bleeding and until complete wound healing. Access to CFCs to PWH living in resource limited settings is usually a challenge which makes surgical interventions either risky or not practical. Recently World Federation of Hemophilia (WFH) started a humanitarian aid program to channel CFCs into resource limited countries and which allowed the possibility to perform surgical interventions for PWH in these countries. AIM OF WORK To study safety and efficacy of using lower doses of CFCs for surgical prophylaxis. METHODS Review of literature and our center experience to demonstrate safety and efficacy of low dose surgical prophylaxis using CFCs RESULTS: Several elements can help using lower doses of CFCs for surgical prophylaxis in resource limited setting. These elements include severity of hemophilia, type of surgical procedure, the use of hemostatic surgical techniques, the type of CFCs, the mode of infusion of CFCs and finally the use of adjunctive therapies CONCLUSION: Management of surgical procedures for PWH in a multidisciplinary specialized hemophilia treatment centers with proper understanding of hemostatic and surgical challenges of the procedure can allow for safe and effective use of lower doses of CFCs for surgical prophylaxis.
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Affiliation(s)
- Magdy El Ekiaby
- Shabrawishi Hospital Blood Transfusion and Hemophilia Treatment Center, Giza, Egypt
| | - Assad Haffar
- World Federation of Hemophilia, Montreal, QC, Canada
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Swaminathan N, Thatcher C, Staber JM. Haemostatic efficacy of single-dose factor administration in neonates with severe haemophilia undergoing circumcision. Haemophilia 2020; 26:786-792. [PMID: 32746496 DOI: 10.1111/hae.14122] [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: 04/24/2020] [Revised: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Perioperative management of children with haemophilia undergoing surgery is a complex and understudied topic. Circumcision is the most common procedure performed in the neonatal period, and guidelines to prevent bleeding complications from circumcision are lacking. Treatment protocols vary widely, and many centres treat patients with factor products for up to two weeks after circumcision. There is an unmet need for studies evaluating optimal factor replacement therapy around the time of circumcision in neonates with severe haemophilia. AIM To determine the efficacy of a single dose of factor replacement before circumcision to prevent bleeding complications in neonates with severe haemophilia. METHODS We conducted a retrospective chart review of male infants born between January 2000 and June 2019. Male neonates with severe haemophilia diagnosed at the Iowa Hemophilia and Thrombosis Center (n = 22) and healthy newborn controls who underwent circumcision at the University of Iowa Hospitals were included. Data were collected from the electronic medical record. Neonates with severe haemophilia were separated into two groups-those pretreated with one dose of factor replacement before circumcision and those without pretreatment. RESULTS We observed that neonates with severe haemophilia pretreated with a single dose of factor VIII or factor IX replacement had significantly reduced bleeding complications, shorter hospital stay and required less therapeutic intervention compared with untreated patients. Importantly, pretreated patients had outcomes similar to healthy controls. CONCLUSIONS Our results demonstrate that a single dose of factor replacement before circumcision is effective to prevent bleeding in neonates with severe haemophilia.
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Affiliation(s)
- Neeraja Swaminathan
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Collin Thatcher
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Janice M Staber
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Moorehead PC, Chan AKC, Lemyre B, Winikoff R, Scott H, Hawes SA, Shroff M, Thomas A, Price VE. A Practical Guide to the Management of the Fetus and Newborn With Hemophilia. Clin Appl Thromb Hemost 2018; 24:29S-41S. [PMID: 30373387 PMCID: PMC6714852 DOI: 10.1177/1076029618807583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Newborns with hemophilia are at risk of intracranial hemorrhage, extracranial hemorrhage,
and other bleeding complications. The safe delivery of a healthy newborn with hemophilia
is a complex process that can begin even before conception, and continues throughout
pregnancy, birth, and the newborn period. This process involves the expectant parents and
a wide variety of health-care professionals: genetic counselors, obstetricians,
neonatologists, pediatricians, radiologists, adult and pediatric hematologists, and nurses
with expertise in hemophilia. Because of this multidisciplinary complexity, the relative
rarity of births of newborns with hemophilia, and the lack of high-quality evidence to
inform decisions, there is considerable variation in practice in this area. We present a
comprehensive multidisciplinary approach, from preconception counseling to discharge
planning after birth, and describe available options for management decisions. We
highlight a number of areas of important uncertainty and controversy, including the
preferred mode of delivery, the appropriate use and timing of neuroimaging tests, and the
appropriate use of clotting factor concentrates in the newborn period. While the approach
presented here will aid clinicians in planning and providing care, further research is
required to optimize the care of newborns with hemophilia.
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Affiliation(s)
- Paul C Moorehead
- Section of Pediatric Hematology/Oncology, Janeway Children's Health and Rehabilitation Centre, St. John's, Canada.,Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Canada
| | - Anthony K C Chan
- McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, University of Ottawa, Ottawa, Canada
| | - Rochelle Winikoff
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Ste-Justine University Health Center, University of Montreal, Montreal, Canada
| | - Heather Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Canada
| | - Sue Ann Hawes
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Manohar Shroff
- Department of Radiology, Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Aidan Thomas
- Maritime Medical Genetics Service, IWK Health Centre, Halifax, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Canada
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8
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Seck M, Sagna A, Guéye MS, Faye BF, Sy D, Touré SA, Sall A, Touré AO, Diop S. Circumcision in hemophilia using low quantity of factor concentrates: experience from Dakar, Senegal. BMC HEMATOLOGY 2017; 17:8. [PMID: 28451435 PMCID: PMC5402675 DOI: 10.1186/s12878-017-0080-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Abstract
Background Circumcision in hemophiliacs is a delicate surgery because of bleeding risks that could be avoided by adequate substitution of coagulation factor. This practice is very challenging in countries where anti hemophilic treatment is inaccessible. The study aimed to evaluate a circumcision protocol in hemophilia A using low quantities of factor concentrates. Methods This prospective study included 26 hemophiliacs A who underwent circumcision in 2014. Medical treatment protocol using low quantity of factor concentrates was drafted by physicians of the Hemophilia Treatment Center and the surgical protocol by experienced surgeons. Assessment criteria were: number of hospitalization days, number of exposure days to factor concentrates, delay to healing and occurrence of bleeding events. Results Mean age was 9.6 years (1–30). Hemophiliacs patients were classified as severe (n = 8), moderate (n = 9) and mild form (n = 9). Mean number of exposure days to factor VIII concentrates was 6.9 days (5–12) in children and 10.75 days (7–16) in adults (p = 0.0049); mean number of hospitalization days was 3.68 days (2–10) in children and 13.5 days (13–15) in adults (p = 0.0000); delay to healing was 26.47 days (20–35) in children and 25.25 days (22–30) in adults (p = 0.697); five haemophiliacs (19.2%) presented bleeding events after the circumcision. The mean amount of FIII concentrates used per patient was 1743 IU (810–2340). Conclusion The study shows treatment protocol using low quantity of factor concentrates is efficient in hemophilia patients who underwent circumcision.
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Affiliation(s)
- Moussa Seck
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Aloïse Sagna
- Pediatric Surgical Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Mame Sokhna Guéye
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Blaise Félix Faye
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Diariétou Sy
- Hematology Service, National Blood Transfusion Center, Dakar, BP 5005 Senegal
| | | | - Abibatou Sall
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Awa Oumar Touré
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Saliou Diop
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
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Kisseih E, Yerrapotu N, Yadav D, February M. A Case of Hemophilia A Presenting in a Neonate and a Review of the Literature. Glob Pediatr Health 2017; 4:2333794X17693110. [PMID: 28321438 PMCID: PMC5347409 DOI: 10.1177/2333794x17693110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/27/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Deepak Yadav
- Children's Hospital of Michigan, Detroit, MI, USA
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