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Sidonio RF, Lu A, Hale S, Caicedo J, Bullano M, Xing S. Early diagnosis of persons with von Willebrand disease using a machine learning algorithm and real-world data. Expert Rev Hematol 2024; 17:261-268. [PMID: 38779711 DOI: 10.1080/17474086.2024.2354925] [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: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Von Willebrand disease (VWD) is underdiagnosed, often delaying treatment. VWD claims coding is limited and includes no severity qualifiers; improved identification methods for VWD are needed. The aim of this study is to identify and characterize undiagnosed symptomatic persons with VWD in the US from medical insurance claims using predictive machine learning (ML) models. RESEARCH DESIGN AND METHODS Diagnosed and potentially undiagnosed VWD cohorts were defined using Komodo longitudinal US claims data (January 2015-March 2020). ML models were built using key characteristics predictive of VWD diagnosis from the diagnosed cohort. Two ML models predicted VWD diagnosis with the highest accuracy in females (random forest; 84%) and males (gradient boosting machine; 85%). Undiagnosed persons suspected to have VWD were identified using an 80% cutoff probability; profiles of key characteristics were constructed. RESULTS The trained ML models were applied to the undiagnosed cohort (28,463 females; 20,439 males) with suspected VWD. Fifty-two percent of undiagnosed females had heavy menstrual bleeding, a key pre-diagnosis symptom. Undiagnosed males tended to have more frequent medical procedures, hospitalizations, and emergency room visits compared with undiagnosed females. CONCLUSIONS ML algorithms successfully identified potentially undiagnosed symptomatic people with VWD, although many may remain undiagnosed and undertreated. External validation of the algorithms is recommended.
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Affiliation(s)
- Robert F Sidonio
- Aflac Cancer and Blood Disorders Center, Egleston Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Anan Lu
- Life Sciences Practice, Charles River Associates, Boston, MA, USA
| | - Sarah Hale
- US Medical, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | - Jorge Caicedo
- US Medical, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | - Mike Bullano
- US Medical, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | - Shan Xing
- US Medical, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
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van Tienhoven XA, Pishko AM, Chiang E, Cuker A, Marshall AL. Documentation of Menstrual Concerns in Women with Inherited Bleeding Disorders: A Single Center Retrospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:637-641. [PMID: 37209785 DOI: 10.1016/j.jogc.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Affiliation(s)
| | - Allyson M Pishko
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - Elaine Chiang
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - Adam Cuker
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - Ariela L Marshall
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
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Corrales-Medina FF, Federici AB, Srivastava A, Dougall A, Millar CM, Roberts JC, Jaffray J, Berntorp E. A need to increase von Willebrand disease awareness: vwdtest.com - A global initiative to help address this gap. Blood Rev 2023; 58:101018. [PMID: 36210240 DOI: 10.1016/j.blre.2022.101018] [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: 07/22/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 11/02/2022]
Abstract
Von Willebrand disease (VWD) is an inherited bleeding disorder caused by quantitative or qualitative deficiencies in von Willebrand factor (VWF). People with VWD may experience excessive, recurrent or prolonged bleeding, particularly during menstruation, childbirth, surgery or following trauma. However, many VWD patients are undiagnosed, and therefore inadequately treated. Reasons for the underdiagnosis of VWD include its relatively mild symptoms, complex diagnosis, lack of awareness among non-specialist healthcare providers and the general population, and a lack of prioritisation of disorders disproportionately affecting females. The vwdtest.com platform was launched as part of a global initiative to raise awareness and improve diagnosis of VWD. Besides providing VWD-specific educational resources, the website includes an online bleeding self-assessment tool and offers diagnostic support for individuals, and their providers, who have a score suggestive of a bleeding disorder. vwdtest.com helps to address these unmet needs, especially in regions with limited access to educational and diagnostic resources.
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Affiliation(s)
- Fernando F Corrales-Medina
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami-Miller School of Medicine, Miami, FL, USA; University of Miami-Hemophilia Treatment Center, Miami, FL, USA.
| | - Augusto B Federici
- University of Milan, School of Medicine, Department of Oncology and Haematology Oncology, Milan, Italy; Division of Haematology and Transfusion Medicine of Luigi Sacco University Hospital, Milan, Italy
| | - Alok Srivastava
- Christian Medical College, Department of Haematology, Vellore, India
| | - Alison Dougall
- School of Dental Science, Trinity College Dublin, Ireland; Dublin Dental University Hospital, Dublin, Ireland
| | - Carolyn M Millar
- Imperial College London, Department of Immunology and Inflammation, Centre for Haematology, London, UK
| | - Jonathan C Roberts
- Bleeding & Clotting Disorders Institute, Peoria, IL, USA; University of Illinois College of Medicine at Peoria, Department of Pediatrics and Medicine, Peoria, IL, USA
| | - Julie Jaffray
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Erik Berntorp
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden
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Owaidah T, Alharbi M, Mandourah M, Saleh M, Almusa A, Alnounou R, Alzahrani H, Khogeer H. Clinical and laboratory presentation of von Willebrand disease: Experience from a single center in KSA. J Taibah Univ Med Sci 2022; 18:413-419. [PMID: 37102076 PMCID: PMC10124135 DOI: 10.1016/j.jtumed.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives This study was aimed at assessing the clinical presentations and laboratory findings among patients diagnosed with vWD at a Saudi tertiary care unit. Methods This retrospective study included 189 patients with vWD who were followed up in our unit over 4 years. Clinical and laboratory data were collected and analyzed in SPSS. Results The median age of the study cohort was 30 years (range 11 months-56 years). The cohort had a female preponderance, with 32.30% males and 66.70% females. Bleeding from different sites was observed, mostly from the joints and muscles (23.90%), followed by the mucus membranes (14.60%), genitourinary areas (7.70%), ecchymoses (2.80%), and gastrointestinal areas (2.80%). A total of 48% of participants presented with more than one type of bleeding. A total of 105 (58.01%) participants had type 1; 29 (16.02%) had type 2; and 47 (25.96%) had type 3 vWD. Blood tests indicated the following mean value: hemoglobin, 116 ± 25.60 gm/L; ferritin, 75.80 ± 166.80 μg/L (median 28.5); vWAg, 0.40 ± 0.27IU/ml; and vWD:RCo, 0.32 ± 0.20IU/dL. The partial thromboplastin time was prolonged in 49.20% and normal in 50.80% of participants. Platelet function analysis values were prolonged in 92.90% and normal in 7.10% of participants. Comparative analysis of the O-type and non-O blood type showed that blood type O was significantly correlated with factor VIII (p-value = 0.013), vWF:RCo (p-value = 0.004), and vWF:Ag (p-value = 0.019). Conclusion Joint and muscle bleeds were the most common clinical presentations in our cohort. Although type 1 vWD was most prevalent in our cohort, we observed a comparatively higher prevalence of type 3, possibly because of ethnic differences or referral bias. We found a significant difference between O and non-O blood type regarding FVIII and vWF:Ag, and observed a more pronounced difference for vWD activity measuresd by vWF:RCo with blood type O being the systematic factor.
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Affiliation(s)
- Tarek Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA
- Department of Haematology and Transfusion Medicine, Alfaisal University, Riyadh, KSA
- Corresponding address: Consultant Hematology and Transfusion Medicine, Alfaisal University, Riyadh 11211, KSA.
| | - Muhammed Alharbi
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA
| | - Mohammed Mandourah
- Department of Haematology and Transfusion Medicine, Alfaisal University, Riyadh, KSA
| | - Mahasen Saleh
- Department of Paediatric Haematology Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA
| | - Abdulrahman Almusa
- Department of Paediatric Haematology Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA
| | - Randa Alnounou
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA
| | - Hazza Alzahrani
- Adult Hematology/HSCT, Oncology Centre, King Faisal Specialist Hospital and Research Center Riyadh, KSA
| | - Haithm Khogeer
- Adult Hematology/HSCT, Oncology Centre, King Faisal Specialist Hospital and Research Center Riyadh, KSA
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Rauch A, Valentino LA, Mills K, Witkop ML, Santaella ME, DiMichele D, Recht M, Susen S. Big picture initiatives in bleeding disorders. Haemophilia 2022; 28 Suppl 4:53-60. [PMID: 35521733 DOI: 10.1111/hae.14532] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The inherited bleeding disorders (IBD) community has witnessed significant therapeutic advances recently, yet important gaps persist, particularly for those with rare disorders and historically underserved populations. AIMS -To create a national research blueprint agenda, led by the National Hemophilia Foundation (NHF), enhancing patient-centric principles, accelerate research progress and address important gaps in care. -To review critical gaps that remain to be addressed in women with IBDs, who face specific bleeding challenges. METHODS The NHF research blueprint research agenda was defined by input from across the community, including caregivers and patients who are considered subject matter experts of their IBD, research leaders, allied health professionals and specialists, and representatives of the biopharmaceutical industry. In addition, two medical experts in the field of IBDs performed a comprehensive review to address the knowledge gaps in women with IBDs. RESULTS Two foundational principles of the NHF blueprint are: (1) it must deliver on key issues that significantly impact the lives of those affected by IBDs, and (2) the priorities defined are relevant and actionable aimed to achieve health equity among all those affected by IBDs. A multidisciplinary approach is necessary for an optimal management of puberty, transition to adulthood and pregnancy. Even if strict guidelines are followed, recent studies show that women with IBDs are still facing a high burden. CONCLUSION NHF blueprint will be issued in 2022. A specific research agenda is needed in women with IBDs to further improve their management and quality of life.
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Affiliation(s)
| | - Leonard A Valentino
- National Hemophilia Foundation, New York, New York, USA.,Rush University, Chicago, Illinois, USA
| | - Kevin Mills
- National Hemophilia Foundation, New York, New York, USA
| | | | | | | | - Michael Recht
- American Thrombosis and Hemostasis Network, Rochester, New York, USA
| | - Sophie Susen
- CHU Lille, Hematology Transfusion, LILLE, France
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