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Abdul‐Kadir R, Gomez K. Reproductive health and hemostatic issues in women and girls with congenital factor VII deficiency: A systematic review. J Thromb Haemost 2022; 20:2758-2772. [PMID: 36073900 PMCID: PMC9828586 DOI: 10.1111/jth.15872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Congenital factor VII (FVII) deficiency is an inherited bleeding disorder, with heterogenous bleeding symptoms. Women with FVII deficiency face hemostatic challenges during menstruation, ovulation, and childbirth. This systematic review evaluated prevalence and management of bleeding symptoms associated with gynecological and obstetric issues in women with FVII deficiency. METHODS Databases (BIOSIS Previews, Current Contents Search, Embase, and MEDLINE) were searched for studies reporting FVII deficiency and gynecological or obstetric issues in women. Articles were screened using Joanna Briggs Institute checklists and relevant data extracted. RESULTS One hundred fourteen women were identified from 62 publications. Forty-six women had severe deficiency (FVII:C < 5% or <5 IU/dl). Heavy menstrual bleeding (HMB) was the most common bleeding symptom (n = 94; 82%); hospitalization and urgent medical/surgical interventions for acute HMB episodes were required in 16 women (14%). Seven women reported ovarian bleeding (6%); other bleeding symptoms varied. Patient management was inconsistent and included hemostatic and hormonal treatments. Only four women (7%) reporting vaginal bleeding during pregnancy. Postpartum hemorrhage (PPH) occurred following 12/45 deliveries (27%; 5 [42%] requiring blood transfusion) and was not necessarily prevented by prophylaxis (8 women). CONCLUSION Women with congenital FVII deficiency have an increased risk of HMB, ovarian bleeding, and PPH, impacting quality of life. Recognition of a bleeding disorder as the cause is often delayed. Management of bleeding complications is heterogeneous due to lack of treatment guidelines. Harmonizing severity classification of FVII deficiency may help standardize treatment strategies and development of specific guidelines for these women.
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Affiliation(s)
- Rezan Abdul‐Kadir
- Katharine Dormandy Haemophilia Centre and Department of Obstetrics & GynaecologyRoyal Free HospitalLondonUK
| | - Keith Gomez
- Haemophilia Centre and Thrombosis UnitRoyal Free London NHS Foundation TrustLondonUK
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Akdeniz A, Ünüvar A, Ar MC, Pekpak E, Akyay A, Mehtap Ö, Karadağ FK, Acıpayam C, Doğan A, Ekinci Ö, Köker SA, Albayrak C, Demirci U, Güney T, Kurt M, Karaman S, Kimyon ÖŞ, Albayrak S, Öncül Y, Ünal S, Şahin F, Tuna R, Zulfikar B, Apak BB, Ümit EG, Demir AM. Results of multicenter registry for patients with inherited factor VII deficiency in Turkey. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 82:28-36. [PMID: 34915774 DOI: 10.1080/00365513.2021.2013524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inherited factor VII (FVII) deficiency (FVIID) is the most common of inherited rare bleeding disorders. Other determinants of clinical severity apart from FVII level (FVIIL) include genetic and environmental factors. We aimed to identify the cut-off FVIILs for general and severe bleedings in patients with FVIID by using an online national registry system including clinical, laboratory, and demographic characteristics of patients. METHODS Demographic, clinical, and laboratory data of patients with FVIID extracted from the national database, constituted by the Turkish Society of Hematology, were examined. Bleeding phenotypes, general characteristics, and laboratory features were assessed in terms of FVIILs. Bleeding rates and prophylaxis during special procedures/interventions were also recorded. RESULTS Data from 197 patients showed that 46.2% of patients had FVIIL< 10%. Most bleeds were of mucosal origin (67.7%), and severe bleeds tended to occur in younger patients (median age: 15 (IQR:6-29)). Cut-off FVIILs for all and severe bleeds were 16.5% and 7.5%, respectively. The major reason for long-term prophylaxis was observed as central nervous system bleeding (80%). CONCLUSION Our data are consistent with most of the published literature in terms of cut-off FVIIL for bleeding, as well as reasons for prophylaxis, showing both an increased severity of bleeding and younger age at diagnosis with decreasing FVIIL. However, in order to offer a classification similar to that in Hemophilia A or B, data of a larger cohort with information about environmental and genetic factors are required.
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Affiliation(s)
- Aydan Akdeniz
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Mersin University, Mersin, Turkey
| | - Ayşegül Ünüvar
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Istanbul University Hospital, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esra Pekpak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Gaziantep Children's Hospital, Gaziantep, Turkey
| | - Arzu Akyay
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Inonu University, Malatya, Turkey
| | - Özgür Mehtap
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Fatma Keklik Karadağ
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Ege University, İzmir, Turkey
| | - Can Acıpayam
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Sutcu Imam University, Kahramanmaras, Turkey
| | - Ali Doğan
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Ömer Ekinci
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Firat University, Elazığ, Turkey
| | - Sultan Aydın Köker
- Department of Pediatric Hematology and Oncology, Antakya State Hospital, Antakya, Turkey
| | - Canan Albayrak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Ufuk Demirci
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Trakya University, Edirne, Turkey
| | - Tekin Güney
- Department of Hematology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Meltem Kurt
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Ankara University, Ankara, Turkey
| | - Serap Karaman
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Istanbul University Hospital, Istanbul, Turkey
| | - Özge Şahin Kimyon
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinan Albayrak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Gaziantep Children's Hospital, Gaziantep, Turkey
| | - Yurday Öncül
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Inonu University, Malatya, Turkey
| | - Serkan Ünal
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Fahri Şahin
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Ege University, İzmir, Turkey
| | - Rumeysa Tuna
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Istanbul University Hospital, Istanbul, Turkey
| | - Bulent Zulfikar
- Division of Pediatric Hematology-Oncology, Istanbul University, Cerrahpasa Medical Faculty & Istanbul University Oncology Institute, Istanbul, Turkey
| | - Burcu Belen Apak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baskent University, Ankara, Turkey
| | - Elif Gülsüm Ümit
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Trakya University, Edirne, Turkey
| | - Ahmet Muzaffer Demir
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Trakya University, Edirne, Turkey
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Function and regulation of corin in physiology and disease. Biochem Soc Trans 2021; 48:1905-1916. [PMID: 33125488 DOI: 10.1042/bst20190760] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
Abstract
Atrial natriuretic peptide (ANP) is of major importance in the maintenance of electrolyte balance and normal blood pressure. Reduced plasma ANP levels are associated with the increased risk of cardiovascular disease. Corin is a type II transmembrane serine protease that converts the ANP precursor to mature ANP. Corin deficiency prevents ANP generation and alters electrolyte and body fluid homeostasis. Corin is synthesized as a zymogen that is proteolytically activated on the cell surface. Factors that disrupt corin folding, intracellular trafficking, cell surface expression, and zymogen activation are expected to impair corin function. To date, CORIN variants that reduce corin activity have been identified in hypertensive patients. In addition to the heart, corin expression has been detected in non-cardiac tissues, where corin and ANP participate in diverse physiological processes. In this review, we summarize the current knowledge in corin biosynthesis and post-translational modifications. We also discuss tissue-specific corin expression and function in physiology and disease.
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N-glycan in the scavenger receptor cysteine-rich domain of hepsin promotes intracellular trafficking and cell surface expression. Int J Biol Macromol 2020; 161:818-827. [DOI: 10.1016/j.ijbiomac.2020.06.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/12/2022]
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Clinical problems and surgical interventions in inherited factor VII deficiency. Turk Arch Pediatr 2020; 55:184-190. [PMID: 32684764 PMCID: PMC7344127 DOI: 10.14744/turkpediatriars.2020.79069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/13/2020] [Indexed: 12/22/2022]
Abstract
Aim: Factor VII deficiency is one of the hereditary coagulation disorders that has autosomal reccessive inheritance and is observed relatively frequently (1/500 000). It is clinically heterogeneous, and may be asymptomatic or lead to life-threatening bleeding. Thus, there is no correlation between FVII activity and clinical findings. Plasma-derived and recombinant FVII concentrates are currently used for treatment. In countries where access to these products is lacking, fresh frozen plasma and prothrombin complex concentrates are also used, though they contain low amounts of factor FVII. In this study, we present the clinical properties, treatments, and surgical interventions used in patients followed up in our clinic with a diagnosis of factor FVII deficiency. Material and Methods: Patients who were diagnosed as FVII deficiency in Division of Pediatric Hematology and Oncology between July 1997 and July 2018, were included in the study. The patients’ demographic characteristics, symptoms at presentation, PT, aPTT, and FVII values, types of bleeding, and treatments and surgical interventions used, were recorded. The bleedings observed in the patients were classified by severity as asymptomatic, minor, and major. Results: A total of 18 patients (7 girls and 11 boys) with a mean age of 9.64±9.63 years were included in the study. The mean follow-up time was found as 78.06±54.4 months. When the bleedings were classified clinically, no bleeding was observed in eight patients (44.4%). The factor FVII level was found as <10% in three of these eight asymptomatic patients and above 20% in the others. Minor bleeding was observed in nine patients (50%) and major bleeding was observed in one patient. When the patients were classified as asymptomatic and symptomatic, there was no significant difference between the two groups in terms of FVII level (p=0.57). A total of 21 surgical interventions were performed in 14 (78%) of 18 patients who were being followed up. Conclusion: FVII deficiency has a very wide spectrum both clinically and in terms of approach to surgical interventions. Therefore, patients with factor FVII deficiency should be followed up and treated by comprehensive care centers with close collaboration of multiple disciplines.
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Khudhair AA, Salih AAM, Kadhum AJ. Congenital factor VII deficiency in Iraqi children (Single Centre Experience). Pak J Med Sci 2020; 36:177-181. [PMID: 32063955 PMCID: PMC6994885 DOI: 10.12669/pjms.36.2.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective Factor VII (FVII) deficiency is probably one of the most common of the rare autosomal recessive coagulation disorders, with an estimated prevalence of l: 500000. All age groups can be affected with FVII deficiency. This study aimed to describe the demographic parameters, symptomatology, hemostatic values and the outcome of FVII deficiency. Methods This is a retrospective descriptive study of patients with congenital FVII deficiency over a period of seven years from (August 2008 to August 2015). The data were collected by reviewing the files for each patient diagnosed with FVII deficiency. Surgical interventions, complications and follow up visits were recorded. Results Twenty-four patients were included in this study, 17 females and seven males, below one year was the most common age at presentation. More than half of patients (58.3%) were diagnosed within six months of symptoms onset. The majority of patients had severe phenotype. The most common symptom was epitaxis (41.7%). Five out of 10 patients with FVII level < 1% have either mild to moderate phenotype of the disease without complications; while six out of 14 patients with FVII > 1% had at least one episode of severe bleeding. Three patients had hepatitis C; all were treated by blood products before the introduction of recombinant FVII in Iraq. The outcome of most patients (75%) was normal without complications at time of study. Conclusion Clinical manifestations of FVII deficiency are variable and they are not necessarily correlated to the FVII level.
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Affiliation(s)
- Ali Ahmed Khudhair
- Dr. Ali Ahmed Khudhair, C.A.B.P, FICMS (PED). Department of Pediatrics, Children Welfare Teaching Hospital, Baghdad, Iraq
| | - Afrah Abdul-Mahdi Salih
- Dr. Afrah Abdul-Mahdi Salih, C.A.B.P, MRCPH. Department of Pediatrics, Children Welfare Teaching Hospital, Baghdad, Iraq
| | - Ausama Jamal Kadhum
- Dr. Ausama Jamal Kadhum, C.A.B.P. Department of Pediatrics, Children Welfare Teaching Hospital, Baghdad, Iraq
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Kashyap R, Alim M, Chandra D, Singh R. Recurrent seizures in a neonate with intracranial hemorrhage and congenital factor VII deficiency: A missed diagnosis. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_67_20] [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
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Wang H, Wang L, Li S, Dong N, Wu Q. N-Glycan-calnexin interactions in human factor VII secretion and deficiency. Int J Biochem Cell Biol 2019; 113:67-74. [PMID: 31185295 DOI: 10.1016/j.biocel.2019.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Factor VII (FVII) is a key serine protease in blood coagulation. N-glycosylation in FVII has been shown to be critical for protein secretion. To date, however, the underlying biochemical mechanism remains unclear. Recently, we found that N-glycans in the transmembrane serine protease corin are critical for calnexin-assisted protein folding and extracellular expression. In this study, we tested the hypothesis that N-glycans in the FVII protease domain mediate calnexin-assisted protein folding and that naturally occurring F7 mutations abolishing N-glycosylation impair FVII secretion. We expressed human FVII wild-type (WT) and mutant proteins lacking one or both N-glycosylation sites in HEK293 and HepG2 cells in the presence or absence of a glucosidase inhibitor. FVII expression, secretion and binding to endoplasmic reticulum chaperones were examined by immune staining, co-immunoprecipitation, Western blotting, and ELISA. We found that N-glycosylation at N360 in the protease domain, but not N183 in the pro-peptide domain, of human FVII is required for protein secretion. Elimination of N-glycosylation at N360 impaired calnexin-assisted FVII folding and secretion. Similar results were observed in WT FVII when N-glycan-calnexin interaction was blocked by glucosidase inhibition. Naturally occurring F7 mutations abolishing N-glycosylation at N360 reduced FVII secretion in HEK293 and HepG2 cells. These results indicate that N-glycans in the FVII protease domain mediate calnexin-assisted protein folding and subsequent extracellular expression. Naturally occurring F7 mutations abolishing N-glycosylation in FVII may impair this mechanism, thereby reducing FVII levels in patients.
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Affiliation(s)
- Hao Wang
- From Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lina Wang
- The Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China
| | - Shuo Li
- From Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ningzheng Dong
- The Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China; MOH Key Laboratory of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qingyu Wu
- From Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; The Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China.
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Şalcıoğlu Z, Bayram C, Şen H, Ersoy G, Aydoğan G, Akçay A, Tuğcu D, Akıcı F, Gökçe M, Demirkaya M, Ayçiçek A, Başlar Z. Congenital Factor Deficiencies in Children: A Report of a Single-Center Experience. Clin Appl Thromb Hemost 2017; 24:901-907. [PMID: 29050499 PMCID: PMC6714728 DOI: 10.1177/1076029617731596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Congenital factor deficiencies (CFDs) refer to inherited deficiency of coagulation factors in the blood. A total of 481 patients with CFDs, who were diagnosed and followed at our Pediatric Hematology and Oncology Clinic between 1990 and 2015, were retrospectively evaluated. Of the 481 cases, 134 (27.8%) were hemophilia A, 38 (7.9%) were hemophilia B, 57 (11.8%) were von Willebrand disease (vWD), and 252 (52.3%) were rare bleeding disorders (RBDs). The median age of the patients at the time of diagnosis and at the time of the study was 4.1 years (range: 2 months to 20.4 years) and 13.4 years (range: 7 months to 31.3 years), respectively. The median duration of the follow-up time was 6.8 years (range: 2.5 months to 24.8 years). One hundred nineteen (47.2%) of 252 patients with RBDs were asymptomatic, 49 (41.1%) of whom diagnosed by family histories, 65 (54.6%) through preoperative laboratory studies, and 5 (4.2%) after prolonged bleeding during surgeries. Consanguinity rate for the RBDs was 47.2%. Prophylactic treatment was initiated in 80 patients, 58 of whom were hemophilia A, 7 were hemophilia B, 13 were RBDs, and 2 were vWD. Significant advances have been achieved during the past 2 decades in the treatment of patients with CFDs, particularly in patients with hemophilias. The rarity and clinical heterogeneity of RBDs lead to significant diagnostic challenges and improper management. In this regard, multinational collaborative efforts are needed with the hope that can improve the management of patients with RBDs.
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Affiliation(s)
- Zafer Şalcıoğlu
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Cengiz Bayram
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Hülya Şen
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Gizem Ersoy
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Gönül Aydoğan
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Arzu Akçay
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Deniz Tuğcu
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Ferhan Akıcı
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Müge Gökçe
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Metin Demirkaya
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Ali Ayçiçek
- 1 Department of Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Zafer Başlar
- 2 Department of Hematology-Internal Medicine, Cerrahpaşa Medical School, İstanbul University, İstanbul, Turkey
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Quintavalle G, Riccardi F, Rivolta GF, Martorana D, Di Perna C, Percesepe A, Tagliaferri A. F7 gene variants modulate protein levels in a large cohort of patients with factor VII deficiency. Results from a genotype-phenotype study. Thromb Haemost 2017; 117:1455-1464. [PMID: 28447100 DOI: 10.1160/th17-02-0085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/10/2017] [Indexed: 12/14/2022]
Abstract
Congenital factor VII (FVII) deficiency is a rare bleeding disorder caused by mutations in F7 gene with autosomal recessive inheritance. A clinical heterogeneity with poor correlation with FVII:C levels has been described. It was the objective of this study to identify genetic defects and to evaluate their relationships with phenotype in a large cohort of patients with FVII:C<50 %. One hundred twenty-three probands were genotyped for F7 mutations and three polymorphic variants and classified according to recently published clinical scores. Forty out of 123 patients (33 %) were symptomatic (43 bleedings). A severe bleeding tendency was observed only in patients with FVII:C<0.10 %. Epistaxis (11 %) and menorrhagia (32 % of females in fertile age) were the most frequent bleedings. Molecular analysis detected 48 mutations, 20 not reported in the F7 international databases. Most mutations (62 %) were missense, large deletions were 6.2 %. Compound heterozygotes/homozygotes for mutations presented lower FVII:C levels compared to the other classes (Chi2=43.709, p<0,001). The polymorphisms distribution was significantly different among the three F7 genotypic groups (Chi2=72.289, p<0,001). The presence of truncating mutations was associated with lowest FVII:C levels (Chi2=21.351, p=0.002). This study confirms the clinical and molecular variability of the disease and the type of symptoms. It shows a good correlation between the type of F7 mutation and/or polymorphisms and FVII:C levels, without a direct link between FVII:C and bleeding tendency. The results suggest that large deletions are underestimated and that they represent a common mechanism of F7 gene inactivation which should always be investigated in the diagnostic testing for FVII deficiency.
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Affiliation(s)
- Gabriele Quintavalle
- Gabriele Quintavalle, Regional Reference Centre for inherited bleeding disorders, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy, Tel.: +39 0521 703971, Fax: +39 0521 704332, E-mail:
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Girolami A, Cosi E, Ferrari S, Girolami B, Lombardi AM. Bleeding manifestations in heterozygotes with congenital FVII deficiency: a comparison with unaffected family members during a long observation period. ACTA ACUST UNITED AC 2017; 22:375-379. [PMID: 28176610 DOI: 10.1080/10245332.2017.1286540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine whether heterozygotes with FVII deficiency have a bleeding tendency or not. PATIENTS AND METHODS Eighty-four patients (OK) heterozygous for FVII deficiency, at the onset of the study, were paired with unaffected family members and followed for a long period of time (mean 22.6 years) for the occurrence of bleeding. Diagnosis of heterozygosis had to be based on family studies, clotting, immunological assays and genetic analysis. RESULTS The mean FVII activity level was 0.51 IU/dl (range 35-65) and 94 IU/dl (range 88-118) in the heterozygotes and in the normal counterparts, respectively. Documented bleeding manifestations occurred in eight heterozygotes and in seven normal subjects. Statistical analysis of the difference was not significant. Bleeding manifestations were easy bruising, bleeding after tooth extractions, menorrhagia, epistaxis with no difference among the two groups. There was no strict correlation between bleeding and FVII activity levels. CONCLUSIONS The study indicates that heterozygotes for FVII deficiency show rare bleeding manifestations which are also present in the unaffected family members with normal FVII levels. This indicates that Factor VII activity levels played no role in the occurrence of the bleeding symptoms. Furthermore, FVII levels of around 0.40 IU/dl are capable of assuring a normal hemostasis.
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Affiliation(s)
- Antonio Girolami
- a Department of Medicine , University of Padua Medical School , Padua , Italy
| | - Elisabetta Cosi
- a Department of Medicine , University of Padua Medical School , Padua , Italy
| | - Silvia Ferrari
- a Department of Medicine , University of Padua Medical School , Padua , Italy
| | - Bruno Girolami
- b Division of Medicine , Padua City Hospital , Padua , Italy
| | - Anna Maria Lombardi
- a Department of Medicine , University of Padua Medical School , Padua , Italy
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How do we encounter rare factor deficiencies in children? Single-centre results from Turkey. Blood Coagul Fibrinolysis 2015; 26:145-51. [PMID: 25390505 DOI: 10.1097/mbc.0000000000000204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rare factor deficiencies (RFDs) are autosomal recessively inherited coagulation factor deficiencies encountered at a frequency of between one in 500, 000 and one in two million. MATERIALS AND METHODS One hundred and ninety-two patients, diagnosed as having RFD, followed and treated in our clinic between 1990 and 2013 were retrospectively evaluated in this study. RESULTS From the 192 patients, 142 had FVII, 15 had FX, 14 had FXI, 10 had fibrinogen, six had FV, two had FXIII, two had FV + FVIII and one had FII deficiency. One hundred and thirty of the cases were boys and 62 were girls. The age range was 2 weeks to 24 years and the ages at the admission were between 2 weeks and 16 years. The rate of consanguinity was 49.4%. Eighty-eight of our patients were asymptomatic (45.8%) and 104 were symptomatic (54.2%). Asymptomatic patients were diagnosed by family histories (39.8%), preoperative laboratory studies (54.6%) and operational bleeding (5.6%). Sixty-eight of our symptomatic patients displayed grade II (65.4%) and 36 displayed grade III bleeding symptoms (34.6%). First bleeding regions were skin (33%), nose (28%), central nervous system (CNS) (15.5%), oral cavity (10.5%), soft tissue (6%), joint (3%), urinary system (2%) and gastrointestinal system (GIS) (2%), respectively. The bleeding prevalence rates of our symptomatic patients are listed as epistaxis 62.5%, skin bleedings 53%, oral cavity bleeding 28.8%, haematomas 18.3%, CNS bleedings 17.3%, haemarthrosis 14.4%, GIS bleedings 3.8%, menorrhagia 2.9%, haematuria 1.9%, bleeding because of operations 1.9% and iliopsoas bleedings 1.9%. CNS bleedings (41%) take the first place among the serious bleedings of our cases, followed by haemarthrosis (36.4%), GIS bleedings (18.1%) and iliopsoas bleedings (4.5%). Prophylaxy was applied to nine patients (five patients with FVII, two patients with fibrinogen and one each with FV and FX deficiency). CONCLUSIONS The characteristics of clinical presentations, first bleeding attacks, bleeding prevalence and severe bleedings as well as prophylactic approaches are discussed in this article.
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da Silva VA, Silva SS, Martins FFM. Acquired deficiency of coagulation factor VII. Rev Bras Hematol Hemoter 2015; 37:269-71. [PMID: 26190433 PMCID: PMC4519705 DOI: 10.1016/j.bjhh.2015.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/25/2015] [Indexed: 11/16/2022] Open
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14
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Siboni SM, Biguzzi E, Mistretta C, Garagiola I, Peyvandi F. Long-term prophylaxis in severe factor VII deficiency. Haemophilia 2015; 21:812-9. [DOI: 10.1111/hae.12702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 12/19/2022]
Affiliation(s)
- S. M. Siboni
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - E. Biguzzi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - C. Mistretta
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - I. Garagiola
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - F. Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
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15
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Punnen A, Loganathan SK, Veetiyil GI, Scott JX, Kumar S. Neonate with orbital bleed. Pediatr Blood Cancer 2015; 62:548. [PMID: 25447027 DOI: 10.1002/pbc.25339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/10/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Anu Punnen
- Department of Pediatrics, Christian Medical College, Vellore, 632004,, India
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16
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Alam MM, Moiz B, Rehman KA, Jethwani P, Fadoo Z. Congenital Factor VII Deficiency in Children at Tertiary Health Care Facility in Pakistan. Clin Appl Thromb Hemost 2013; 21:639-44. [PMID: 24322277 DOI: 10.1177/1076029613515070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This study presents the demographics, clinical spectrum, and outcome of patients with congenital factor VII (FVII) deficiency at a tertiary care center over a period of 12 years. Of the 49 patients, 27 (55%) patients were males. Consanguinity was found in 92% of the patients. The median age of symptom onset was 2.4 (interquartile range [IQR]: 1.1-6.5) years with a median age of 5.8 (IQR: 3.1-10) years at diagnosis. Life-threatening complications like intracranial bleeding (ICB) and intra-abdominal bleeding (IAB) were observed in 8 (16.4%) patients. We found that 11 (55%) of the 20 patients with FVII coagulant activity (FVIIc) <1% were either asymptomatic or showed mild phenotype. In contrast, 9 (53%) of the 17 patients with FVIIc >5% were affected by severe symptoms. Age <1 year was the only identified risk factor associated with development of life-threatening bleeding episodes (P = .042; odds ratio 6.46). Overall, 4 (8.2%) died as a consequence of ICB (3 patients) and IAB (1 patient).
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Affiliation(s)
| | - Bushra Moiz
- Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan
| | | | | | - Zehra Fadoo
- Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
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17
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Surgical interventions in childhood rare factor deficiencies: a single-center experience from Turkey. Blood Coagul Fibrinolysis 2013; 24:854-61. [PMID: 24158119 DOI: 10.1097/mbc.0b013e3283655667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital rare factor deficiencies may present in infancy by life-threatening bleedings or may not show any symptoms until adulthood. It is reported more commonly in countries having consanguineous marriages. Data regarding surgical interventions of rare congenital factor deficiencies are based on case reports and records of guidelines. There are no well documented and separately prepared directories related to pre-surgical and prophylactic approaches of surgical interventions of these deficiencies. Our retrospective study consisted of 171 rare factor deficiencies that were followed up in our clinic, and of whom 61 had 88 surgical interventions between 1990 and 2012. Of these patients, 45 were having factor VII deficiency, and factor V, X, XI, XIII and fibrinogen deficiencies were present in five, four, three, two and two patients, respectively. In 23 patients, factor coagulant activities were under 5% (37.7%), in 15 it was between 5 and 30% (24.6%), and in 23 between 30 and 50% (37.7%). Twenty-eight were symptomatic and 33 were asymptomatic. Information of 51 (83.6%) male and 10 (16.4%) female patients with an age range of 5-25 years (13 ± 5.27), whose age at presentation ranged between 3 weeks and 18 years (7 ± 4.66), were retrieved from patient records and from the records contained in the data-processing environment introduced in 2005. The rate of familial consanguinity was 49.2%. Of the surgical interventions, 24 (27.3%) were major, 24 (27.3%) were minor and 40 (45.4%) were circumcision. We used fresh frozen plasma in 32, recombinant factor (rF)VIIa in 20, prothrombin complex concentrate in five and fibrinogen in three patients during surgical interventions. In 18 patients, antifibrinolytic agents were also used. In 27 patients, surgical interventions were applied without any replacement therapy. No additional doses were required after surgical prophylaxis doses. Thrombotic events were not observed. Antibody occurrence was not detected in these patients. In our study, we evaluated preparation for surgical procedures, factor replacement therapy before surgical intervention and postoperative follow-up in patients with rare coagulation factor deficiency.
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Napolitano M, Giansily-Blaizot M, Dolce A, Schved JF, Auerswald G, Ingerslev J, Bjerre J, Altisent C, Charoenkwan P, Michaels L, Chuansumrit A, Di Minno G, Caliskan U, Mariani G. Prophylaxis in congenital factor VII deficiency: indications, efficacy and safety. Results from the Seven Treatment Evaluation Registry (STER). Haematologica 2013; 98:538-44. [PMID: 23403322 DOI: 10.3324/haematol.2012.074039] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Because of the very short half-life of factor VII, prophylaxis in factor VII deficiency is considered a difficult endeavor. The clinical efficacy and safety of prophylactic regimens, and indications for their use, were evaluated in factor VII-deficient patients in the Seven Treatment Evaluation Registry. Prophylaxis data (38 courses) were analyzed from 34 patients with severe factor VII deficiency (<1-45 years of age, 21 female). Severest phenotypes (central nervous system, gastrointestinal, joint bleeding episodes) were highly prevalent. Twenty-one patients received recombinant activated factor VII (24 courses), four received plasma-derived factor VII, and ten received fresh frozen plasma. Prophylactic schedules clustered into "frequent" courses (three times weekly, n=23) and "infrequent" courses (≤ 2 times weekly, n=15). Excluding courses for menorrhagia, "frequent" and "infrequent" courses produced 18/23 (78%) and 5/12 (41%) "excellent" outcomes, respectively; relative risk, 1.88; 95% confidence interval, 0.93-3.79; P=0.079. Long term prophylaxis lasted from 1 to >10 years. No thrombosis or new inhibitors occurred. In conclusion, a subset of patients with factor VII deficiency needed prophylaxis because of severe bleeding. Recombinant activated factor VII schedules based on "frequent" administrations (three times weekly) and a 90 μg/kg total weekly dose were effective. These data provide a rationale for long-term, safe prophylaxis in factor VII deficiency.
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Affiliation(s)
- Mariasanta Napolitano
- University of L'Aquila, Dipartimento di Medicina Interna e Sanità Pubblica, L'Aquila, Italy.
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