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Badescu MC, Badulescu OV, Butnariu LI, Floria M, Ciocoiu M, Costache II, Popescu D, Bratoiu I, Buliga-Finis ON, Rezus C. Current Therapeutic Approach to Atrial Fibrillation in Patients with Congenital Hemophilia. J Pers Med 2022; 12:519. [PMID: 35455634 PMCID: PMC9029474 DOI: 10.3390/jpm12040519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Cardiovascular disease in hemophiliacs has an increasing prevalence due to the aging of this population. Hemophiliacs are perceived as having a high bleeding risk due to the coagulation factor VIII/IX deficiency, but it is currently acknowledged that they also have an important ischemic risk. The treatment of atrial fibrillation (AF) is particularly challenging since it usually requires anticoagulant treatment. The CHA2DS2-VASc score is used to estimate the risk of stroke and peripheral embolism, and along with the severity of hemophilia, guide the therapeutic strategy. Our work provides the most complete, structured, and updated analysis of the current therapeutic approach of AF in hemophiliacs, emphasizing that there is a growing interest in therapeutic strategies that allow for short-term anticoagulant therapy. Catheter ablation and left atrial appendage occlusion have proven to be efficient and safe procedures in hemophiliacs, if appropriate replacement therapy can be provided.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.V.B.); (M.C.)
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
- Internal Medicine Clinic, “Dr. Iacob Czihac” Emergency Military Clinical Hospital Iasi, 700483 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.V.B.); (M.C.)
| | - Irina-Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
| | - Ioana Bratoiu
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Oana Nicoleta Buliga-Finis
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.B.); (I.-I.C.); (D.P.); (O.N.B.-F.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
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Touré SA, Seck M, Sy D, Bousso ES, Faye BF, Diop S. Life-threatening bleeding in patients with hemophilia (PWH): a 10-year cohort study in Dakar, Senegal. Hematology 2022; 27:379-383. [DOI: 10.1080/16078454.2022.2047286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sokhna Aïssatou Touré
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Moussa Seck
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Diariatou Sy
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Elimane Seydi Bousso
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Blaise Felix Faye
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Saliou Diop
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
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Gardner A, McLean TW, Winslow JE. Computed Tomography Scans in Children With Hemophilia After Minor Head Trauma. Pediatr Emerg Care 2022; 38:e27-e28. [PMID: 34986584 DOI: 10.1097/pec.0000000000002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children with hemophilia have the usual childhood risk of falls and head trauma. Head computed tomographies (HCTs) are fast, detailed, and readily available, but increased radiation exposure in the pediatric population is now recognized as causing increased brain malignancy. By examining the incidence of intracranial cerebral hemorrhage in this population, we will be able to weigh risks and benefits of HCT use more accurately. METHODS Using a retrospective chart review, we examined past medical records of pediatric patients, aged 0 to 15 years, with hemophilia presenting to 1 academic medical center. Primary outcomes included number of head CTs ordered, total and per patient over the years studied, and the incidence of positive findings, as defined by presence of blood products as documented by radiologist final read/interpretation. RESULTS The mean number of head CTs per child was 2.5 (range, 1-10). None of the HCT scans were read as intracranial cerebral hemorrhage, and none of the patients had findings that lead to neurosurgical intervention. In a sensitivity analysis, applying Pediatric Emergency Care Applied Research Network head injury criteria, 11 HCT scans would be ordered for a reduction of 80 HCTs, or a decrease of 2 HCT scans per child. No incidence of intracranial cerebral hemorrhage would have been missed. CONCLUSIONS Our findings suggest that in the child with hemophilia and a history of minor head trauma, exposure to the radiation of a HCT based on the diagnosis of hemophilia alone may not be necessary but that imaging decisions need to be made in conjunction with clinical examination findings and neurologic status.
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Affiliation(s)
- Alison Gardner
- From the Departments of Pediatrics and Emergency Medicine
| | | | - James E Winslow
- Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC
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4
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Incidence and mortality rates of intracranial hemorrhage in hemophilia: a systematic review and meta-analysis. Blood 2021; 138:2853-2873. [PMID: 34411236 DOI: 10.1182/blood.2021011849] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
Intracranial hemorrhage (ICH) is a severe complication that is relatively common among hemophilia patients. This systematic review aimed to obtain more precise estimates of ICH incidence and mortality in hemophilia, which may be important for patients, caregivers, researchers and health policy-makers. PubMed and EMBASE were systematically searched using terms related to "hemophilia" and "intracranial hemorrhage" or "mortality". Studies that allowed calculation of ICH incidence or mortality rates in a hemophilia population of at least 50 patients were included. We summarized evidence on ICH incidence and calculated pooled ICH incidence and mortality in three age groups: (1) persons of all ages with hemophilia, (2) children and young adults below 25 years of age with hemophilia and (3) neonates with hemophilia. Incidence and mortality were pooled with a Poisson-Normal model or a Binomial-Normal model. We included 45 studies that represented 54 470 patients, 809 151 person-years and 5326 live births of hemophilia patients. In persons of all ages, the pooled ICH incidence and mortality rates were 2.3 (95% CI 1.2-4.8) and 0.8 (95% CI 0.5-1.2) per 1000 person-years, respectively. In children and young adults, the pooled ICH incidence and mortality rates were 7.4 (95% CI 4.9-11.1) and 0.5 (95% CI 0.3-0.9) per 1000 person-years, respectively. In neonates, the pooled cumulative ICH incidence was 2.1% (95% CI 1.5-2.8) per 100 live births. ICH was classified as spontaneous in 35-58% of cases. Our findings suggest that ICH is an important problem in hemophilia that occurs among all ages, requiring adequate preventive strategies.
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Bressan S, Monagle P, Dalziel SR, Borland ML, Phillips N, Kochar A, Lyttle MD, Cheek JA, Neutze J, Oakley E, Dalton S, Gilhotra Y, Hearps S, Furyk J, Babl FE. Risk of traumatic intracranial haemorrhage in children with bleeding disorders. J Paediatr Child Health 2020; 56:1891-1897. [PMID: 32810331 DOI: 10.1111/jpc.15073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022]
Abstract
AIM To assess computerised tomography (CT) use and the risk of intracranial haemorrhage (ICH) in children with bleeding disorders following a head trauma. METHODS Design: Multicentre prospective observational study. SETTING 10 paediatric emergency departments (ED) in Australia and New Zealand. PATIENTS Children <18 years with and without bleeding disorders assessed in ED following head trauma between April 2011 and November 2014. INTERVENTIONS Data collection of patient characteristics, management and outcomes. MAIN OUTCOME MEASURES Rate of CT use and frequency of ICH on CT. RESULTS Of 20 137 patients overall, 103 (0.5%) had a congenital or acquired bleeding disorder. CT use was higher in these patients compared with children without bleeding disorders (30.1 vs. 10.4%; rate ratio 2.91 95% CI 2.16-3.91). Only one of 31 (3.2%) children who underwent CT in the ED had an ICH. This patient rapidly deteriorated in the ED on arrival and required neurosurgery. None of the patients with bleeding disorders who did not have a CT obtained in the ED or had an initial negative CT had evidence of ICH on follow up. CONCLUSIONS Although children with a bleeding disorder and a head trauma more often received a CT scan in the ED, their risk of ICH seemed low and appeared associated with post-traumatic clinical findings. Selective CT use combined with observation may be cautiously considered in these children based on clinical presentation and severity of bleeding disorder.
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Affiliation(s)
- Silvia Bressan
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Paul Monagle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Natalie Phillips
- Emergency Department, Children's Hospital Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, University of Queensland, Centre for Children's Health Research, Brisbane, Queensland, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Mark D Lyttle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Bristol Children's Hospital, Bristol, UK.,Academic Department of Emergency Care, University of the West of England, Bristol, UK
| | - John A Cheek
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Dalton
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yuri Gilhotra
- Emergency Department, Children's Hospital Queensland, Brisbane, Queensland, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jeremy Furyk
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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6
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García Sánchez P, Martín Sánchez J, Rivas Pollmar MI, Álvarez Román MT, Jiménez Yuste V. Haemophilia: Reasons for visits to the paediatric emergency department. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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García Sánchez P, Martín Sánchez J, Rivas Pollmar MI, Álvarez Román MT, Jiménez Yuste V. Hemofilia: naturaleza de las visitas a urgencias pediátricas. An Pediatr (Barc) 2019; 91:394-400. [DOI: 10.1016/j.anpedi.2019.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/20/2019] [Accepted: 04/26/2019] [Indexed: 11/26/2022] Open
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Intracranial Hemorrhage in Children With Inherited Bleeding Disorders: A Single Center Study in China. J Pediatr Hematol Oncol 2019; 41:207-209. [PMID: 30557169 DOI: 10.1097/mph.0000000000001358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intracranial hemorrhage (ICH) is a life-threatening condition in children. Inherited bleeding disorders (IBD) have high risk of ICH. AIM This single center study aims to identify the incidence, risk factors, and neurological outcome of ICH in children who suffer from IBD. METHODS From 2005 to 2017, 241 children with IBDs from Nanfang hospital, Department of Pediatrics, were evaluated. The ICH episodes were identified by medical history, general physical examination, detailed neurological examination, and computed tomographic or magnetic resonance imaging examination. The risk factors, location of ICH, management strategies, and outcome were noted. RESULTS ICH was confirmed in 54/241 (22.4%) children with IBD among them 52/54 (96.2%) (95% confidence interval [CI], 91.1%-99.9%) were hemophilia A and hemophilia B patients. The overall risk of ICH among children with IBD was 22.4% (95% CI, 17.2%-27.8%). The median age of ICH was 30 months (0 to 204) and 18/54 (33.3%) (95% CI, 20.3%-46.3%) children had an ICH in the first year of life. Twenty-eight of 52 (53.8%) hemophilic children with ICH were assessed for inhibitor of FVIII and FIX. Nine of 28 (32%) hemophilic children with inhibitor developed the ICH. Six of 52 (11.5%) (95% CI, 2.6%-20.5%) hemophilic children had multiple episodes of ICH in which 4 were inhibitor positive. Thirteen of 54 (24%) (95% CI, 12.3%-35.9%) had positive family history of IBD. Twenty-two (36%) (95% CI, 23.7%-48.5%) of 61 ICH episodes were caused by trauma and 39 (63.9%) (95% CI, 51.5%-76.3%) were nontrauma related. Subdural hematoma was most frequently observed. Mortality risk from ICH in children with IBD was 5/54 (9.2%) (95% CI, 1.3%-17.2%). Eleven (22.4%) (95% CI, 10.3%-34.6%) of 49 survivors had known neurological squeal, whereas 38 (77.5%) (95% CI, 65.4%-89.7%) had no documented evidence of neurological impairment. CONCLUSIONS Hemophilia is the most common IBD and most frequently associated with ICH. Risk and consequences of ICH in IBD were high during the first year of life while in older children better outcome may be expected. The optimal management of ICH depends on immediate recognition and prompt replacement therapy.
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9
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Mahlangu JN. Bispecific Antibody Emicizumab for Haemophilia A: A Breakthrough for Patients with Inhibitors. BioDrugs 2018; 32:561-570. [DOI: 10.1007/s40259-018-0315-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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García Sánchez P, Molina Gutiérrez MÁ, Martín Sánchez J, Inisterra Viu L, García García S, Rivas Pollmar MI, Martín Salces M, Álvarez Román MT, Jiménez Yuste V. Head trauma in the haemophilic child and management in a paediatric emergency department: Descriptive study. Haemophilia 2018; 24:e187-e193. [PMID: 29873151 DOI: 10.1111/hae.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Haemophilia is one of the most common inherited bleeding disorders in the Emergency Department (ED). The most dangerous site of bleeding is the central nervous system. AIMS To describe the characteristics of haemophiliacs arrived to our ED following a head trauma and to analyse the incidence of intracranial haemorrhage (ICH). MATERIALS AND METHODS Retrospective, analytical, observational study, conducted in a Paediatric ED. We included haemophilic patients aged from birth to 16 years who consulted after a head trauma over a 6-year period. Data collected included age, type of haemophilia and head trauma, symptoms, prophylaxis status, CT imaging, treatment and number of visits to the ED. RESULTS About 46 males and 85 episodes were analysed. The median age was 2.38 years. Severe haemophilia A was the most frequent type of disease (50%). All head injuries were mild, and the most frequent mechanism was a collision with an object (38.8%). In 62 episodes (72.9%) the patients were asymptomatic. The rest 23 events had symptomatology, being the most common headache (26%), emesis (21.7%) and drowsiness (17.4%). Head CT was obtained in 31 episodes, founding altered results in 10 (6 of them corresponding to ICH). All the patients with ICH had symptomatology. About 37 episodes required admission. CONCLUSION Intracranial haemorrhage is one of the most dangerous events in haemophiliacs and it may occur after a head trauma. Our study suggests that, in case of head trauma, CT must be obtained in symptomatic patients and in those with additional risk factors. Asymptomatic patients must have prolonged observation.
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Affiliation(s)
- P García Sánchez
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - M Á Molina Gutiérrez
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - J Martín Sánchez
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - L Inisterra Viu
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - S García García
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - M I Rivas Pollmar
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - M Martín Salces
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - M T Álvarez Román
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
| | - V Jiménez Yuste
- Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain
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11
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Chalmers EA, Alamelu J, Collins PW, Mathias M, Payne J, Richards M, Tunstall O, Williams M, Palmer B, Mumford A. Intracranial haemorrhage in children with inherited bleeding disorders in the UK 2003-2015: A national cohort study. Haemophilia 2018; 24:641-647. [PMID: 29635852 DOI: 10.1111/hae.13461] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Intracranial haemorrhage in children with inherited bleeding disorders is a potentially life-threatening complication and presents a significant therapeutic challenge. AIM To define the characteristics, management and outcomes of intracranial haemorrhage presenting in UK children ≤16 years of age with inherited bleeding disorders from 2003 to 2015. METHOD Retrospective analysis of children treated at UK haemophilia centres. RESULTS Of 66 children presenting with Intracranial haemorrhage (ICH), 82% had haemophilia A or B, 3% VWD and 15% a rare IBD. The IBD was a severe phenotype in 91%. The rates of ICH were 6.4 and 4.2 per 1000 patient years for haemophilia A and B, respectively. Median age at presentation was 4 months (33% neonates; 91% children <2 years of age). In neonates, delivery was spontaneous vaginal (SV) in 11, instrumental in 6, caesarean in 4 and unknown in 1. In children with haemophilia, the risk of ICH after instrumental delivery was 10.6 times greater than after SV delivery. Trauma was more common in children >2 years (67%) than in children 1 month to 2 years (18%; P = .027). Prior to ICH, only 4.5% of children were on prophylaxis. 6% of haemophiliacs had an inhibitor. The median duration of initial replacement therapy was 15 days. Mortality was 13.5%. Neurological sequelae occurred in 39% of survivors, being more common following intracerebral bleeding. In haemophilia survivors, 52% subsequently developed a FVIII inhibitor. CONCLUSION Intracranial haemorrhage occurs most frequently in children with severe IBDs, during the first 2 years of life and in children not receiving prophylaxis. Intracranial haemorrhage often occurs without documented trauma.
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Affiliation(s)
- E A Chalmers
- Department of Haematology, Royal Hospital for Children, Glasgow, UK
| | - J Alamelu
- Department of Paediatric Haematology, Evelina Children's Hospital, London, UK
| | - P W Collins
- School of Medicine, Cardiff University, Cardiff, UK
| | - M Mathias
- Department of Haematology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - J Payne
- Department of Haematology, Sheffield Children's Hospital, Sheffield, UK
| | - M Richards
- Department of Haematology, Leeds Children's Hospital, Leeds, UK
| | - O Tunstall
- Bristol Haemophilia Comprehensive Care Centre, Bristol Royal Hospital for Children, Bristol, UK
| | - M Williams
- Haemophilia Centre, Birmingham Childrens' Hospital, Birmingham, UK
| | - B Palmer
- The National Haemophilia Database, Manchester, UK
| | - A Mumford
- Department of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
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12
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Husseinzadeh H, Chiasakul T, Gimotty PA, Pukenas B, Wolf R, Kelty M, Chiang E, Fogarty PF, Cuker A. Prevalence of and risk factors for cerebral microbleeds among adult patients with haemophilia A or B. Haemophilia 2017; 24:271-277. [DOI: 10.1111/hae.13398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 12/11/2022]
Affiliation(s)
- H. Husseinzadeh
- Division of Hematology/Oncology; Department of Medicine; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - T. Chiasakul
- Division of Hematology; Department of Medicine; Faculty of Medicine; Chulalongkorn University and King Chulalongkorn Memorial Hospital; Thai Red Cross Society; Bangkok Thailand
| | - P. A. Gimotty
- Department of Biostatistics, Epidemiology and Informatics; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - B. Pukenas
- Section of Neuroradiology; Department of Radiology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - R. Wolf
- Section of Neuroradiology; Department of Radiology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - M. Kelty
- Division of Hematology/Oncology; Department of Medicine; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - E. Chiang
- Division of Hematology/Oncology; Department of Medicine; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - P. F. Fogarty
- Division of Hematology/Oncology; Department of Medicine; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - A. Cuker
- Division of Hematology/Oncology; Department of Medicine; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
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13
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Abstract
Retrospective and prospective studies unambiguously show that prophylactic treatment of severe hemophilia A or B should be started as primary prophylaxis at 1–2 years’ of age and ideally before the first joint bleed. The dose and dose frequency should be individually tailored depending on the goal of treatment, venous access and the bleeding phenotype. The circumstances during the first exposures of factor VIII concentrates in hemophilia A may have an impact on the risk of developing inhibitors. Enhanced half-life products, in particular in hemophilia B, will facilitate treatment in patients with difficult venous access but also in achieving a higher trough level. Evidence accumulate that prophylactic treatment is beneficial also in adults and in patients with inhibitors.
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Affiliation(s)
- Rolf Ljung
- Department of Clinical Sciences Lund-Paediatrics, Lund University, Lund, Sweden ; Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
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14
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Bladen M, Main E, Khair K, Hubert N, Koutoumanou E, Liesner R. The incidence, risk and functional outcomes of intracranial haemorrhage in children with inherited bleeding disorders at one haemophilia center. Haemophilia 2016; 22:556-63. [DOI: 10.1111/hae.12938] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M. Bladen
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - E. Main
- Institute of Child Health; University College London; London UK
| | - K. Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - N. Hubert
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - E. Koutoumanou
- Institute of Child Health; University College London; London UK
| | - R. Liesner
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
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15
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Carcao M, Srivastava A. Factor VIII/factor IX prophylaxis for severe hemophilia. Semin Hematol 2016; 53:3-9. [DOI: 10.1053/j.seminhematol.2015.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Revised: 11/05/2004] [Accepted: 12/01/2005] [Indexed: 11/11/2022]
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Karaman K, Akbayram S, Garipardıç M, Öner AF. Diagnostic evaluation of our patients with hemophilia A: 17-year experience. Turk Arch Pediatr 2015; 50:96-101. [PMID: 26265893 DOI: 10.5152/tpa.2015.2516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
AIM Hemophilia A is a rare inherited bleeding disorder resulting from factor VIII deficiency and is a group of diseases characterized by intra-articular and intramuscular bleeding. In this study, we aimed to retrospectively evaluate the treatment outcomes, demographic and clinical characteristics of our patients who were treated and followed up for last 17 years in our pediatric hematology unit with a diagnosis of Hemophilia A. MATERIAL AND METHODS The medical records of 83 patients who were diagnosed with Hemophilia A and followed up between 1997 and 2014 in our hospital's pediatric hematology clinic were reviewed retrospectively. The demographic data, prophylaxis state, development of inhibitors and clinical characteristics of the patients were evaluated. RESULTS When the complaints at presentation were examined, it was found that 27 (32%) patients had hemarthrosis, 24 (29%) patients had ecchymosis and hematoma, 13 (16%) patients had prolonged bleeding after trauma or cut, 10 (12%) patients had gingival, mouth or nose bleeding, 4 (5%) patients had prolonged bleeding after circumcision, 4 (5%) patients had gastrointestinal bleeding, 1 (1%) patient had hematuria. Fifty (60%) patients were considered severe hemophilia A, 20 (24%) patients were considered moderate hemophilia A and 13 (16%) patients were considered mild hemophilia A according to factor activity. Among severe hemophilia A patients, primary prophylaxis was being administered in 2 (2%) patients and secondary prophylaxis was being administered in 40 (48%) patients. Inhibitor positivity was found in 8 (10%) of these patients. It is found that hemophilic artropathy developed in 17 patients and 8 of these 17 patients had undergone radioisotope synovectomy. CONCLUSIONS Treatment of severe bleeding in hemophilia A patients should be performed in hospital and the presence of inhibitor must be investigated in cases of uncontrolled bleeding where adequate doses of factor concentrates have been administered for treatment. In order to decrease the development of inhibitor, prophlaxis should be suggested to patients rather than repetetive treatment when bleeding occurs. The radioactive synovectomy should not be overlooked in countries like ours in which factors can not be used adequately.
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Affiliation(s)
- Kamuran Karaman
- Department of Peiatrics, Division of Pediatric Hematology and Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Sinan Akbayram
- Department of Peiatrics, Division of Pediatric Hematology and Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Mesut Garipardıç
- Department of Peiatrics, Division of Pediatric Hematology and Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Ahmet Fayik Öner
- Department of Peiatrics, Division of Pediatric Hematology and Oncology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
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Witmer CM. Low mortality from intracranial haemorrhage in paediatric patients with haemophilia. Haemophilia 2015; 21:e359-63. [DOI: 10.1111/hae.12716] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
- C. M. Witmer
- Division of Hematology; Departments of Pediatrics; Children's Hospital of Philadelphia; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
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18
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Ljung R, Gretenkort Andersson N. The current status of prophylactic replacement therapy in children and adults with haemophilia. Br J Haematol 2015; 169:777-86. [DOI: 10.1111/bjh.13365] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rolf Ljung
- Department of Clinical Sciences Lund-Paediatrics; Lund University; Lund Sweden
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
| | - Nadine Gretenkort Andersson
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
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19
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Naderi M, Younesi MR, Dorgalaleh A, Alizadeh S, Kazemi A, Tabibian S. Association between expression of MMP-2 and MMP-9 genes and pathogenesis of intracranial hemorrhage in severe coagulation factor XIII deficiency. Hematology 2014; 20:487-492. [PMID: 25544259 DOI: 10.1179/1607845414y.0000000226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background Matrix metalloproteinases (MMPs) play a key role in the degradation of basement membrane and extracellular matrix in tissue remodeling, and are involved in pathogenesis of intracranial hemorrhage (ICH). Despite replacement therapy, ICH is by far the main cause of bleeding-related death among patients with severe factor XIII deficiency (FXIIID). The aim of this study is to evaluate the association between MMP-2 and MMP-9 genes expression and ICH in these patients. Materials and methods Quantitative real-time reverse transcription (RT)-PCR assay was used to quantify MMP-2 and MMP-9 mRNAs in 42 specimens of patients with FXIIID including 18 case and 24 control groups. The comparative method of relative quantification (2-Delta-Delta-cCt) was utilized to analyze the expression level of each target gene. The expression level of glyceraldehyde-3-phosphate dehydrogenase was used to standardize the expression levels of MMPs. Results Umbilical bleeding was the most common clinical manifestation among all patients. We found expression upregulation of MMP-9 gene in 13 patients (72.2%) in case and 3 patients (12.5%) in control group, indicating a significant difference between cases and controls for MMP-9 gene expression level (P = 0.001%)(CI 2.8-95.3). Conclusions Our patients present with a wide spectrum of clinical symptoms, which are important in screening and diagnosis of patients with FXIIID. We hypothesized that the overexpression of MMP-9 due to polymorphisms or inflammation was associated with pathogenesis of ICH in FXIIID. This effect can be attenuated by nonspecific MMP inhibition to reduce hospitalization and death rates in these patients.
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Affiliation(s)
- Majid Naderi
- a Genetics of Non-Communicable Disease Research Center Zahedan University of Medical Sciences, Zahedan , Iran
| | - Mohammad Reza Younesi
- b Department of Hematology Allied Medical School, Tehran University of Medical Sciences, Tehran , Iran
| | - Akbar Dorgalaleh
- c Department of Hematology and Blood Transfusion , Iran University of Medical Sciences , Tehran , Iran
| | - Shaban Alizadeh
- b Department of Hematology Allied Medical School, Tehran University of Medical Sciences, Tehran , Iran
| | - Ahmad Kazemi
- c Department of Hematology and Blood Transfusion , Iran University of Medical Sciences , Tehran , Iran
| | - Shadi Tabibian
- b Department of Hematology Allied Medical School, Tehran University of Medical Sciences, Tehran , Iran
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20
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Valentino LA. Considerations in individualizing prophylaxis in patients with haemophilia A. Haemophilia 2014; 20:607-15. [PMID: 24712891 DOI: 10.1111/hae.12438] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
Abstract
Prophylaxis is considered optimal care for children and adults with severe haemophilia A because of its proven ability to reduce joint and other bleeding episodes. However, a 'one size fits all' approach to prophylaxis is not ideal, potentially leading to over-treatment in some individuals and under-treatment in others. Moreover, a generic plan fails to take into account a patient's lifestyle and personal preferences. This article reviews the factors contributing to bleeding risk and joint damage and uses case studies to illustrate how these contributors can be weighed to individualize the prophylactic regimen, thereby increasing the likelihood of therapeutic success.
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Affiliation(s)
- L A Valentino
- Rush Hemophilia and Thrombophilia Center, Department of Pediatrics, Rush Children's Hospital and Rush University Medical Center, Chicago, IL, USA
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21
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Abstract
Patients with hemophilia and other congenital bleeding disorders are at risk for development of central nervous system (CNS) hemorrhage and can present with acute or chronic neurologic symptoms. These disorders are generally caused by qualitative or quantitative deficiency of components of hemostasis such as coagulation proteins, von Willebrand factor, or platelets. Rapid diagnosis and specific medical management such as coagulation factor replacement therapy are mandatory to minimize the morbidity and mortality of CNS bleeding. Therefore, the objective of this chapter is to introduce neurologists to the physiology of hemostasis and to provide an overview of the clinical presentation, and management of inherited bleeding disorders that can potentially present with CNS bleeding. Since hemophilia is the most common bleeding disorder encountered in clinical practice, more emphasis is placed on management of hemophilia. Additionally, neurologic manifestations related to the bleeding diathesis in patients with hemophilia are elaborated.
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22
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Özgönenel B, Zia A, Callaghan MU, Chitlur M, Rajpurkar M, Lusher JM. Emergency department visits in children with hemophilia. Pediatr Blood Cancer 2013. [PMID: 23192828 DOI: 10.1002/pbc.24401] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The pediatric emergency department (ED) management of bleeding and other complications of hemophilia constitutes an increasingly important component of hemophilia therapy. This retrospective study examined the overall ED use by children with hemophilia in a single center, with a particular aim to investigate visits related to injury or bleeding, and those related to blood stream infection in patients with a central venous catheter (CVC). METHODS Electronic medical records of patients with hemophilia presenting to Children's Hospital of Michigan ED were reviewed. Different categories of ED visits over a 5-year period (January 2006-December 2010) were examined. RESULTS There were 536 ED visits from 84 male patients (median age 4 years, range 0-21) with hemophilia over the 5-year period. The reasons for ED visits were: injury or bleeding (61.2%); suspected CVC-related infection (11.8%); causes unrelated to hemophilia (19.2%); and routine clotting factor infusion (7.8%). Eighteen visits from six patients were secondary to injury or bleeding in a patient not yet diagnosed with hemophilia. An intracranial hemorrhage was detected in five visits. Overall, 5.4% of all visits represented distinct episodes of bloodstream infection. CONCLUSION The pediatric ED is an indispensable component of the overall hemophilia care, because: (1) patients with potentially lethal problems such as ICH or CVC-related infection may present to the ED for their initial management; (2) previously undiagnosed patients with hemophilia may also present to the ED for their first bleeding episodes, initiating the diagnostic investigations; (3) the ED provides after-hours treatment service for many episodes of injury or bleeding, and also for clotting factor infusion.
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Affiliation(s)
- Bülent Özgönenel
- Division of Hematology/Oncology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA.
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23
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Farrugia A, Cassar J, Kimber MC, Bansal M, Fischer K, Auserswald G, O'Mahony B, Tolley K, Noone D, Balboni S. Treatment for life for severe haemophilia A- A cost-utility model for prophylaxis vs. on-demand treatment. Haemophilia 2013; 19:e228-38. [DOI: 10.1111/hae.12121] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 02/06/2023]
Affiliation(s)
| | - J. Cassar
- Faculty of Health; University of Canberra; Canberra; Australia
| | - M. C. Kimber
- Plasma Protein Therapeutics Association; Annapolis; MD; USA
| | - M. Bansal
- Plasma Protein Therapeutics Association; Annapolis; MD; USA
| | - K. Fischer
- Van Creveldkliniek, University Medical Center Utrecht; Utrecht; The Netherlands
| | - G. Auserswald
- Ambulanz fuer Thrombose und Haemostasestoerungen Prof.- Hess Kinderklink; Klinikum Bremen-Mitte; Germany
| | | | - K. Tolley
- Tolley Health Economics Ltd; Derbyshire; UK
| | - D. Noone
- Irish Haemophilia Society; Dublin; Ireland
| | - S. Balboni
- Plasma Protein Therapeutics Association; Annapolis; MD; USA
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24
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Ljung R. Hemophilia and prophylaxis. Pediatr Blood Cancer 2013; 60 Suppl 1:S23-6. [PMID: 23109472 DOI: 10.1002/pbc.24340] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 08/30/2012] [Indexed: 11/06/2022]
Abstract
Clinical experience over decades and numerous retrospective and, recently, also prospective studies clearly demonstrate that prophylactic treatment, albeit much more expensive, is superior to on-demand treatment regardless of whether the outcome is number of joint- or life-threatening bleeds or arthropathy optimal prophylactic treatment should be started early (primary prophylaxis) but various opinions exist on the model. The optimal model should be to individualize prophylaxis taking into account the bleeding phenotype and the individual susceptibility to arthropathy and further develop monitoring by global coagulation assays and pharmacokinetic parameters. This review covers proof of concept of primary prophylaxis in children, comparisons between prophylaxis and on demand treatment, and future trends of prophylactic treatment of hemophilia.
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Affiliation(s)
- Rolf Ljung
- Departments of Pediatrics, Malmö & Lund and Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.
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25
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Diagnosis and treatment of intracranial hemorrhage in children with hemophilia. Blood Coagul Fibrinolysis 2013; 24:23-7. [DOI: 10.1097/mbc.0b013e32835975d6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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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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27
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Leissinger C, Gringeri A, Antmen B, Berntorp E, Biasoli C, Carpenter S, Cortesi P, Jo H, Kavakli K, Lassila R, Morfini M, Négrier C, Rocino A, Schramm W, Serban M, Uscatescu MV, Windyga J, Zülfikar B, Mantovani L. Anti-inhibitor coagulant complex prophylaxis in hemophilia with inhibitors. N Engl J Med 2011; 365:1684-92. [PMID: 22047559 DOI: 10.1056/nejmoa1104435] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with severe hemophilia A and factor VIII inhibitors are at increased risk for serious bleeding complications and progression to end-stage joint disease. Effective strategies to prevent bleeding in such patients have not yet been established. METHODS We enrolled patients with hemophilia A who were older than 2 years of age, had high-titer inhibitors, and used concentrates known as bypassing agents for bleeding in a prospective, randomized, crossover study comparing 6 months of anti-inhibitor coagulant complex (AICC), infused prophylactically at a target dose of 85 U per kilogram of body weight (±15%) on 3 nonconsecutive days per week, with 6 months of on-demand therapy (AICC at a target dose of 85 U per kilogram [±15%] used for bleeding episodes). The two treatment periods were separated by a 3-month washout period, during which patients received on-demand therapy for bleeding. The primary outcome was the number of bleeding episodes during each 6-month treatment period. RESULTS Thirty-four patients underwent randomization; 26 patients completed both treatment periods and could be evaluated per protocol for the efficacy analysis. As compared with on-demand therapy, prophylaxis was associated with a 62% reduction in all bleeding episodes (P<0.001), a 61% reduction in hemarthroses (P<0.001), and a 72% reduction in target-joint bleeding (≥3 hemarthroses in a single joint during a 6-month treatment period) (P<0.001). Thirty-three randomly assigned patients received at least one infusion of the study drug and were evaluated for safety. One patient had an allergic reaction to the study drug. CONCLUSIONS AICC prophylaxis at the dosage evaluated significantly and safely decreased the frequency of joint and other bleeding events in patients with severe hemophilia A and factor VIII inhibitors. (Funded by Baxter BioScience; Pro-FEIBA ClinicalTrials.gov number, NCT00221195.).
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Affiliation(s)
- Cindy Leissinger
- Louisiana Center for Bleeding and Clotting Disorders, Tulane University, New Orleans, LA, USA.
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SAKATA K, MATSUMOTO T, WADA H, KUMAMOTO T, IWAMOTO S, OHISHI K, TAKAHASHI J, KATAYAMA N, KOMADA Y. A case of three-year-old boy with severe haemophilia A on prophylaxis identified with a chronic subdural haematoma 2 years after the first episode of acute subdural bleeding. Haemophilia 2011; 18:e1-2. [DOI: 10.1111/j.1365-2516.2011.02641.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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ZANON E, IORIO A, ROCINO A, ARTONI A, SANTORO R, TAGLIAFERRI A, COPPOLA A, CASTAMAN G, MANNUCCI PM. Intracranial haemorrhage in the Italian population of haemophilia patients with and without inhibitors. Haemophilia 2011; 18:39-45. [DOI: 10.1111/j.1365-2516.2011.02611.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Witmer C, Presley R, Kulkarni R, Michael Soucie J, Manno CS, Raffini L. Associations between intracranial haemorrhage and prescribed prophylaxis in a large cohort of haemophilia patients in the United States. Br J Haematol 2010; 152:211-6. [DOI: 10.1111/j.1365-2141.2010.08469.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Valentino LA. Controversies regarding the prophylactic management of adults with severe haemophilia A. Haemophilia 2010; 15 Suppl 2:5-18, quiz 19-22. [PMID: 20041959 DOI: 10.1111/j.1365-2516.2009.02159.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L A Valentino
- Department of Pediatrics and Internal Medicine, Rush University Medical Center, Chicago, IL 60612-3833, USA.
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33
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NAKAR C, COOPER DL, DiMICHELE D. Recombinant activated factor VII safety and efficacy in the treatment of cranial haemorrhage in patients with congenital haemophilia with inhibitors: an analysis of the Hemophilia and Thrombosis Research Society Registry (2004-2008). Haemophilia 2010; 16:625-31. [DOI: 10.1111/j.1365-2516.2010.02208.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maclachlan J, Gough-Palmer A, Hargunani R, Farrant J, Holloway B. Haemophilia imaging: a review. Skeletal Radiol 2009; 38:949-57. [PMID: 18807029 DOI: 10.1007/s00256-008-0586-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 08/16/2008] [Accepted: 08/18/2008] [Indexed: 02/02/2023]
Abstract
Haemophilia disorders are characterised by a blood coagulation anomaly leading to prolonged and excessive bleeding. Imaging provides an essential role in the investigation of both the musculoskeletal and the non-musculoskeletal complications of haemophilia. Our institution is home to a large tertiary referral centre for haemophilia treatment. Using our broad experience, we present a multi-modality pictorial review of the musculoskeletal manifestations of haemophilia, including haemophilic arthropathy, intra-muscular haemorrhage and haemophilic pseudotumour. The main imaging features of haemophilic arthropathy are described, including synovial hypertrophy, haemosiderin deposition, sub-chondral cyst formation and loss of joint space.
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Powell JS. Recombinant factor VIII in the management of hemophilia A: current use and future promise. Ther Clin Risk Manag 2009; 5:391-402. [PMID: 19536318 PMCID: PMC2697540 DOI: 10.2147/tcrm.s4412] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hemophilia A is a rare inherited bleeding disorder due to mutation of the gene that encodes the coagulation protein factor VIII. Historically, prior to the availability of treatment with factor VIII preparations, most boys died from uncontrolled bleeding, either spontaneous bleeding or after injury, before reaching 20 years of age. One of the most impressive triumphs of modern medicine is that with current recombinant factor VIII replacement therapy, a boy born in the 21st century with severe hemophilia A can anticipate a normal life expectancy with essentially no permanent complications from bleeding. For severe hemophilia A, current optimal treatment should have two goals: first, to provide sufficient factor VIII to prevent spontaneous bleeding, and second, to provide sufficient factor VIII to have normal coagulation function after any trauma. However, the replacement therapy requires tremendous resources for effective use, and remains extraordinarily expensive. Thus there are opportunities for further advances in therapy for hemophilia A. Two major concerns continue to trouble current optimal treatment approaches: some patients will develop neutralizing antibodies during the first 50 infusions of therapeutic factor VIII, and second, to administer therapeutic factor VIII every other day in young boys often requires placement of a central venous access device, and such use carries the life-threatening risks of infection and thrombosis. Because of the effectiveness of current therapy, any new developments in treatment will require significant concerns for safety, both immediate and in the long term. A number of research groups seek to prolong the biological efficacy of infused recombinant factor VIII. Currently, one such promising development is in the advanced stages of clinical trial. The goals will be to improve further the quality of life of an individual with severe hemophilia A, and to reduce the burden of current treatment strategies on families and medical resources. Hopefully, the hemophilia community will continue to participate actively in the clinical trials needed to address these new challenges.
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Affiliation(s)
- Jerry S Powell
- Division of Hematology and Oncology, University of California Davis Cancer Center, Sacramento, CA, USA
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