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Hemophilia in the south of Tunisia. Blood Coagul Fibrinolysis 2022; 33:418-421. [PMID: 35867935 DOI: 10.1097/mbc.0000000000001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hemophilia is a rare constitutional hemorrhagic disorder. There is insufficient epidemiological data on hemophilia in Tunisia. To describe the epidemiological, clinical, therapeutic, and outcome of a cohort of patients with hemophilia in southern Tunisia. A retrospective study was conducted on patients with hemophilia at the Hemophilia Treatment Center of Southern Tunisia in Sfax over 38 years (from January 1982 to December 2020). Data were collected in a regional hemophilia registry of the South Tunisian center. We collected 141 cases of hemophilia, 85% of whom had hemophilia A and 15% had hemophilia B. The severe form represented 65%, followed by the moderate form at 25%. The prevalence of hemophilia was 4.4 in 100 000 population. Family history of hemophilia was found in 70%. The mean age of patients at diagnosis was 28 months. Hemophilia was detected in 87% of cases after hemorrhagic syndrome. Bleeding occurred mainly in hemarthrosis (73%), hematoma (70%), and visceral bleeding (28%). Intracranial bleeding occurred in 6% of cases. Thirty-six percent of patients were on prophylactic therapy. Hemophilic arthropathy was the most important orthopedic complication in our patients (38%). Inhibitory antibodies occurred in 16% of PWH. Transfusion-transmitted infections with HIV and hepatitis C were in 2 and 31% of cases, respectively. The prevalence of hemophilia is still underestimated in our center. The severe form of hemophilia is the most frequent. Hemophilic arthropathy was the most important complication in our patients. This showed that hemophilia is still a disabling disease in our country.
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Hassab HM, Saad HR, Abdel Ghany HM. Quality of life and clinical assessment of joint health in children with hemophilic arthropathy. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hemophilic arthropathy results in pain, deformity, and disability with severe impairments, activity limitation, and thus productivity loss. Also patterns of treatment interfere with patients’ life, so the quality of life should be assessed when evaluating treatment. The aim of this work was to assess the quality of life of children with hemophilic arthropathy and its relation to clinical joint health.
Results
The study was carried out on fifty boys with hemophilic arthropathy. All patients were subjected to thorough local clinical assessment of the most affected and/or target joint using Hemophilia Joint Health Score (HJHS 2.1) and assessment of quality of life using Haemo quality of life (Haemo-Qol) questionnaire children and parent versions. Among the fifty hemophilic patients, 36 (72%) patients were hemophilia A and 14 (28 %) patients were hemophilia B. The age at first hemarthrosis ranged from 1 to 8 years with a mean of 2.40±1.78. While the number of joints affected in the studied patients ranged from 2 to 13 joints with a mean of 7±3.25. As regards the severity, 23 patients (46%) had severe, and 27 (54%) had moderate hemophilia. Forty four (88%) patients had different degrees of anemia. There was significant correlation between child Haemo-QoL with degree of anemia (r = 0.291, P = 0.040), mainly with view and school dimensions. There were significant correlations between child and parent Haemo-QoL and HJHS with each of the following: factor activity level, duration of the disease, duration of joint disease, number of bleeding attacks last year, and number of joints affected. Synovectomy was done for 5 (10%) patients. The total child Haemo-QoL score was statistically significantly lower after the intervention (P=0.043), with a significant improvement in physical health, feeling, view, family, school and sports, treatment, and dealing dimensions. In the current study, there were significant positive correlations between child and parent Haemo-QoL and HJHS scores.
Conclusions
The quality of life in patients with hemophilic arthropathy was influenced by the joint health, factor activity level, disease duration, number of bleeding attacks, number of joints affected (during life), duration of joint disease, and presence of hepatitis C virus.
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Lassandro G, Pastore C, Amoruso A, Palladino V, Accettura D, Buzzi A, Tafuri S, Gallone MF, Valente R, Trisciuzzi R, Cassone C, Giordano P. Eligibility for competitive sport medical certification of children with severe hemophilia: Italian observational study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022129. [PMID: 35315416 PMCID: PMC8972861 DOI: 10.23750/abm.v93i1.11531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Abstract
Background ad aim of workː the position of Italian law regarding participation of prophylactically treated hemophiliacs to organized sport trainings and competitions remains unclear and this study focuses on the eligibility of pediatric patients in particular. Methodsː 16 patients age 3 to 15 years old, with severe haemophilia and prophylaxis starting age of 20,2 ± 2,2 months were enrolled. Weight, height, body mass index (BMI) and joint status (Hemophilia Joint Health Score [HJHS] and Haemophilia Early Arthropathy Detection with UltraSound, HEAD-US score) of patients were evaluated at start (T0) and after 12 months (T12) of a HIITS sport activity program. Resultsː All patients qualified for Italian competitive sport medical certification. Their weight and height increased after 12 months, without an increase in BMI (T0= 17,2; T1= 18,7; p>0,05). HJHS score did not change significantly (T0: 1.6 ± 1; T1: 2.1 ± 1.3; p>0.05). All children were right-handed and atrophy for the muscles of the right elbow significantly decreased (no atrophy seen at T0 in 4 of 16 patients and at T1 in 8 of 16 patients; p=0.045). Conclusionsː Hemophilic children, prophylactically treated, are capable to be included in sport groups and physical activity programs.
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Affiliation(s)
- Giuseppe Lassandro
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica Pediatrica, Università degli Studi di Bari Aldo Moro, Bari, Italia, Istituto di medicina dello Sport “Vito Accettura”, Federazione Italiana Medicina dello Sport, Bari, Italia
| | - Carmela Pastore
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica Pediatrica, Università degli Studi di Bari Aldo Moro, Bari, Italia
| | - Anna Amoruso
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica Pediatrica, Università degli Studi di Bari Aldo Moro, Bari, Italia
| | - Valentina Palladino
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica Pediatrica, Università degli Studi di Bari Aldo Moro, Bari, Italia
| | - Domenico Accettura
- Istituto di medicina dello Sport “Vito Accettura”, Federazione Italiana Medicina dello Sport, Bari, Italia
| | | | - Silvio Tafuri
- Sezione di Igiene, Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari “Aldo Moro”, Bari, Italia
| | - Maria F. Gallone
- Sezione di Igiene, Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari “Aldo Moro”, Bari, Italia
| | | | - Rodrigo Trisciuzzi
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Università degli Studi di Bari “Aldo Moro”, Bari, Italia, Corso di Dottorato in Trapianti di Tessuti ed Organi e Terapie Cellulari (DETO, Università degli Studi di Bari “Aldo Moro”, Bari, Italia)
| | | | - Paola Giordano
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica Pediatrica, Università degli Studi di Bari Aldo Moro, Bari, Italia
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Promoting Sports Practice in Persons with Hemophilia: A Survey of Clinicians' Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211841. [PMID: 34831596 PMCID: PMC8625842 DOI: 10.3390/ijerph182211841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022]
Abstract
Historically, people with hemophilia have been warned to avoid physical activities as a possible cause of bleeding; however, currently, sport is considered necessary, especially in the developmental age, for providing a good quality of life. A survey was proposed to a group of hematologists and sports physicians working in Puglia, Italy, to explore their approach to physical activities for their patients with hemophilia and to obtain suggestions about possible interventions to promote the access of patients to sports. The survey was answered by 6 hematologists and 15 sports physicians. In total, 71% (about six patients/year/physician) of patients with hemophilia seen by sports physicians asked for counseling about sports, and 67% (about five patients/year/physician) actually practiced sports. On the other hand, only 31% (about 16 patients/year/hematologist) of patients asked hematologists questions on sports, and only 16% (about seven patients/year/hematologist) of patients with hemophilia and that were followed-up by hematologists practiced sports. The sports most often recommended to patients with hemophilia by physicians included swimming, athletics, tennis, running and gymnastics. According to hematologists, physical activity was very efficient in improving the quality of life of patients; stability of joints; their psychological, social and musculoskeletal wellbeing; and in reducing the risk of bleedings. On the other hand, physical activity was considered less important in all these areas by sport physicians. In conclusion, answers to this survey suggested that sports could be promoted among hemophilic patients by increasing the sports physicians' knowledge about hemophilia and their special role in this area. In addition, interviewed clinicians were of the opinion that increased awareness of specific guidelines and clinical practice protocols among both hematologists and sports physicians could be beneficial. Finally, answers suggested that access to fitness certification should be facilitated.
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Lassandro G, Amoruso A, Palladino V, Palmieri VV, Giordano P. The risk of venipuncture in newborn with severe hemophilia: Case report of a large elbow hemorrhage and literature review of compartment syndrome. Hematol Rep 2021; 13:8967. [PMID: 34221293 PMCID: PMC8215530 DOI: 10.4081/hr.2021.8967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/26/2021] [Indexed: 12/20/2022] Open
Abstract
Hemophilias are hemorrhagic congenital rare diseases. The gold standard of therapy in hemophilics is the intravenously replacement therapy. We can infuse intravenously plasma derived factors (FVIII for Hemophilia A and FIX for Hemophilia B) or recombinant products (i.e. clotting factor synthetically produced). Venipuncture is not a safe procedure in subjects with hemorrhagic diseases. It is considered an invasive technique with potential massive bleeding and it requires standardized procedures to prevent complications. Local pressure after the procedure (with eventually ice rest) must be always done. In case of bleeding a rapid replacement therapy must be conducted. A severe complication in hemophilia is compartment syndrome. We report a case of massive bleeding in a hemophilic newborn after venipuncture and a literature review of compartment syndrome in hemophiliacs. The aim of this paper is to help physicians in the clinical management to prevent the evolution of a massive bleeding in compartment syndrome.
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Affiliation(s)
| | | | | | | | - Paola Giordano
- Pediatric Section, Department of Biomedical Science and Human Oncology, University “Aldo Moro”, Bari, Italy
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Lassandro G, Ciaccia L, Amoruso A, Palladino V, Palmieri VV, Giordano P. Focus on MicroRNAs as Biomarker in Pediatric Diseases. Curr Pharm Des 2021; 27:826-832. [PMID: 33087027 DOI: 10.2174/1381612826666201021125512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND MiRNAs are a class of small non-coding RNAs that are involved in the post-transcriptional regulation of gene expression. MiRNAs are considered a class of epigenetic biomarkers. These biomarkers can investigate disease at different stages: diagnosis, therapy or clinical follow-up. OBJECTIVE The aim of this paper is to highlight the innovative use of miRNAs in several childhood diseases. METHODS We conducted a literature review to search the usage of miRNAs in pediatric clinical routine or experimental trials. RESULTS We found a possible key role of miRNAs in different pediatric illnesses (metabolic alterations, coagulation defects, cancer). CONCLUSION The modest literature production denotes that further investigation is needed to assess and validate the promising role of miRNAs as non-invasive biomarkers in pediatric disorders.
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Affiliation(s)
- Giuseppe Lassandro
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Loredana Ciaccia
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Anna Amoruso
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Valentina Palladino
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Viviana V Palmieri
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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Brown LJ, La HA, Li J, Brunner M, Snoke M, Kerr AM. The societal burden of haemophilia A. I - A snapshot of haemophilia A in Australia and beyond. Haemophilia 2020; 26 Suppl 5:3-10. [PMID: 32935397 DOI: 10.1111/hae.14102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Few studies, both in Australia and overseas, have examined the social impacts of living with haemophilia A (HA) or the economic costs associated with the disorder. The purpose of this paper is to examine the epidemiology and societal burden of people with HA (PwHA) in Australia, with a particular focus on men with this disorder. METHODS The epidemiology and societal burden of HA in Australia, with a particular focus on men with this disorder, were assessed, using data available in the Australian and international literature and publicly available data. RESULTS The mean annual prevalence of HA is approximately 1-2 per 10 000 males. Prophylactic treatment is used in one-quarter (25.1%) of people with moderate HA, and 82.2% of people with severe HA. Within the latter group, 16.1% have inhibitors for Factor VIII, predisposing them to worse morbidity, mortality and quality of life when compared to the non-inhibitor population. Joint pain and joint disease occur commonly in PwHA, with up to 70% of adults with HA experiencing joint problems. HA is associated with poor physical health, and PwHA miss school and work due to bleeding-related events. CONCLUSION HA is associated with substantial economic burden; with large differences in costs reported between countries. Overall, HA imposes a significant burden of disease on PwHA, their families and the community at large.
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Affiliation(s)
- Laurie J Brown
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Hai A La
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Jinjing Li
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | | | - Martin Snoke
- Roche Products Pty Limited, Sydney, NSW, Australia
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Continuous infusion with octocog alfa during cardiac surgery for tetralogy of Fallot in a haemophilic child. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 19:253-256. [PMID: 32530399 DOI: 10.2450/2020.0030-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/31/2020] [Indexed: 12/23/2022]
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Analysis of Sasang Constitutional Medicine as an Optimal Preventive Care Strategy for Hemophilia Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4147803. [PMID: 32090089 PMCID: PMC7015185 DOI: 10.1155/2020/4147803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/25/2019] [Accepted: 12/06/2019] [Indexed: 11/20/2022]
Abstract
Introduction. Medical improvements have allowed hemophilia patients to anticipate an increased quality of life and life expectancy similar to that of the general population. Analysis of the potential disease symptoms of hemophilia patients based on a survey of Sasang Constitutional Medicine (SCM) is important for optimal preventive care and adjunctive therapy to avoid life-threating complications.
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Schiavoni M, Napolitano M, Giuffrida G, Coluccia A, Siragusa S, Calafiore V, Lassandro G, Giordano P. Status of Recombinant Factor VIII Concentrate Treatment for Hemophilia a in Italy: Characteristics and Clinical Benefits. Front Med (Lausanne) 2019; 6:261. [PMID: 31850352 PMCID: PMC6901793 DOI: 10.3389/fmed.2019.00261] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/28/2019] [Indexed: 01/19/2023] Open
Abstract
The current interest in recombinant factor VIII (rFVIII) products stems from the fact that they offer a technological solution to prolonging the half-life of and reducing the risk of formation of alloantibodies (inhibitors) against FVIII in treated patients with hemophilia A (HA). The Italian health care system has authorized the use of a wide range of rFVIII concentrates of the first, second, and third generation, as well as new innovative rFVIII preparates with an extended half-life (EHL) (Kogenate FS®-Bayer, belonging to the second generation and replaced since 2017 by a product consisting of the same modified molecule; because it is only available until the end of the current year, it will not be considered in this review). Some of these products have unique pharmacodynamic and pharmacokinetic (PK) profiles, including an EHL. The first-generation full-length rFVIII (FL-rFVIII), octocog alfa (Recombinate® Baxter/BIOVIIIx), although the oldest rFVIII product, has several desirable features. Third-generation products include two modified octocog alfa molecules (Advate®, Shire; Kovaltry®, Bayer) as well as the B domain-deleted rFVIII (BDD-rFVIII) moroctocog alfa (ReFacto®-Pfizer). The B domain-truncated (BDT-rFVIII) turoctocog alfa (NovoEight®, Novo Nordisk), the BDD-rFVIII simoctocog alfa (Nuwiq®, Kedrion), the single-chain BDT-rVIII lonoctocog alfa (Afstyla®, CSL Behring), and the BDD-rFVIIIFc efmoroctocog alfa (Elocta®, Sobi-Biogen) are new, innovative products. Simoctocog alfa, because its peculiarities, is considered a fourth-generation rFVIII concentrate. Turoctocog alfa, simoctocog alfa, and lonoctocog alfa have a high affinity for von Willebrand factor (vWF) that reduces renal clearance and prolongs the half-life of rFVIII. Efmoroctocog alfa, a first-in-class rFVIII-Fc fusion protein (rFVIIIFc), has a half-life 1.5–1.8 times longer than that of conventional plasma-derived FVIII (pd-rFVIII) and other rFVIII products. Clinical studies have evaluated the efficacy, safety, and inhibitor development of all these innovative concentrates in both previously treated (PTPs) and untreated patients (PUPs). This review considers the rFVIII products that are indicated for the treatment of patients with severe HA, focusing on those that are commercially available in Italy. Their PK characteristics, immunogenicity, and clinical benefits are discussed and compared.
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Affiliation(s)
- Mario Schiavoni
- Associazione per la Lotta alle Malattie Emorragiche e Trombotiche, Maglie, Italy
| | - Mariasanta Napolitano
- Internal Medicine and Medical Specialities, Haematology Unit, Department of Health Promotion, Mother and Child Care, Reference Regional Center for Thrombosis and Haemostasis, University of Palermo, Palermo, Italy
| | - Gaetano Giuffrida
- U.O.C. di Ematologia, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Antonella Coluccia
- U.O.C di Medicina Interna, Centro Emofilia e Coagulopatie Rare-Ospedale "I.Veris delli Ponti", Scorrano-ASL, Lecce, Italy
| | - Sergio Siragusa
- U.O.C. di Ematologia, Università degli Studi, Palermo, Italy
| | - Valeria Calafiore
- U.O.C. di Ematologia, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Giuseppe Lassandro
- Dipartimento di Scienza Biomedica e Oncologia Umana, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Paola Giordano
- Dipartimento di Scienza Biomedica e Oncologia Umana, Università degli Studi di Bari "Aldo Moro", Bari, Italy
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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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Minkowitz B, Lillie E, Ristic JR, Gregory JJ. Unmasking Hemophilia B After Hip Aspiration: A Case Report. JBJS Case Connect 2019; 9:e0275. [PMID: 31167219 DOI: 10.2106/jbjs.cc.18.00275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 7-year-old boy presented with excruciating hip pain for 1 day, unable to bear weight. Magnetic resonance imaging (MRI) revealed small hip joint effusion and synovitis, which was treated by urgent operative aspiration to rule out infection. Subsequently, the postoperative site bled continuously, despite compression. The hip wound and blood cultures showed no growth. He was examined by a hematologist and had normal coagulopathy lab results. He was discharged and went home 4 days after aspiration and was scheduled for outpatient hematology work-up. He was readmitted 11 days after aspiration with continued pain and MRI was repeated, showing large hip hemarthrosis. Lab results at that time showed a prolonged partial thromboplastin time of 43.9 seconds. The patient was given fresh frozen plasma. The hip effusion was stable on ultrasound. He was found to have low factor IX <17% consistent with hemophilia B and was given recombinant factor IX (Benefix) of 2,000 units. The following day, his pain was markedly improved and he was discharged. At the 4-month follow-up, the patient was fully ambulatory. CONCLUSIONS This is a case of unexpected bleeding after hip aspiration which led to the life-changing diagnosis of Hemophilia B in a pediatric patient. Orthopedists should be wary of bleeding dyscrasias and involve consultants as needed.
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Affiliation(s)
- Barbara Minkowitz
- Department of Orthopedics, Morristown Medical Center, Morristown, New Jersey
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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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Klukowska A, Szczepański T, Vdovin V, Knaub S, Bichler J, Jansen M, Dzhunova I, Liesner RJ. Long-term tolerability, immunogenicity and efficacy of Nuwiq ® (human-cl rhFVIII) in children with severe haemophilia A. Haemophilia 2018; 24:595-603. [PMID: 29582516 DOI: 10.1111/hae.13460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Nuwiq® (human-cl rhFVIII, simoctocog alfa) is a 4th generation recombinant human FVIII, without chemical modification or fusion with any other protein, produced in a human cell line. AIM/METHODS This study (GENA-13) was an extension of the GENA-03 study in which previously treated children aged 2-12 years with severe haemophilia A received Nuwiq® prophylaxis for ≥6 months. GENA-13 examined long-term tolerability, immunogenicity and efficacy of Nuwiq® prophylaxis in children. RESULTS Of 59 patients enrolled in GENA-03, 49 continued Nuwiq® prophylaxis in GENA-13 for a median (range) of 30.0 (9.5-52.0) months. No patient withdrew due to drug-related adverse events or developed inhibitors. Only 2 of 20 518 infusions were associated with possibly related adverse events (dyspnoea, fever). The estimated annualized bleeding rate (ABR) was 0.67 (95% CI: 0.44, 1.02) for spontaneous and 2.88 (95% CI: 1.86, 4.46) for all bleeds. Younger children (2-5 years) had lower ABRs than children aged 6-12 years. Annualized bleeding rates were reduced in GENA-13 vs GENA-03, especially for spontaneous bleeds in younger children (71% reduction; ABR ratio 0.29 [95% CI: 0.11, 0.74]). Nuwiq® efficacy was rated as excellent/good in the treatment of 83.0% of 305 evaluated breakthrough bleeds. Surgical prophylaxis with Nuwiq® was rated as excellent for all 17 assessed procedures. CONCLUSION Long-term treatment with Nuwiq® for the prevention of bleeds in children with severe haemophilia A was well tolerated, effective and reduced spontaneous bleeding by up to 70% compared with GENA-03.
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Affiliation(s)
- A Klukowska
- Department of Pediatrics, Hematology and Oncology, Warsaw Medical University, Warsaw, Poland
| | - T Szczepański
- Department of Paediatric Haematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - V Vdovin
- Morozovsky Children's Hospital, Hematology Centre, Moscow, Russia
| | - S Knaub
- Octapharma AG, Lachen, Switzerland
| | | | - M Jansen
- Octapharma Pharmazeutika Produktionsges.mbH, Vienna, Austria
| | | | - R J Liesner
- Great Ormond Street Hospital for Children, NHS Trust Haemophilia Centre, London, UK
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16
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The impact of extended half-life versus conventional factor product on hemophilia caregiver burden. Qual Life Res 2018; 27:1335-1345. [PMID: 29392598 PMCID: PMC5891570 DOI: 10.1007/s11136-018-1792-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Extended half-life factor products have reduced annualized bleeding rates in hemophilia patients. The impact of extended half-life versus conventional factor products on hemophilia caregiver burden has not been investigated. This study aimed to evaluate caregiver burden in extended half-life versus conventional factor products for hemophilia A and B. METHODS This cross-sectional web-based study of caregivers of people with hemophilia A or B was recruited from a panel research company and by word of mouth. Participants completed the Hemophilia Caregiver Impact measure, the PedsQL Family Impact Module (PedsQL), and the Work Productivity and Activity Impairment Questionnaire (WPAI). We also collected demographic, insurance coverage, and medical information related to the hemophilia patient(s). Burden differences were assessed using linear regression and matched cohort analyses. RESULTS The sample (n = 448) included 49 people who were caring for people on extended half-life factor products. Worse caregiver burden was associated with more infusions per week and more bleeds in the past 6 months. Regression analyses suggested that caring for someone who is on a extended half-life factor product is associated with lower emotional impact (β = - 0.11, p < 0.05, Adjusted R2 = 0.06), and shows a trend association with lower practical impact (β = - 0.09, p < 0.10, Adjusted R2 = 0.05). The matched cohort analysis also revealed that people on extended half-life factor product had lower Emotional Impact and Practical Impact scores (t = - 2.95 and - 2.94, respectively, p < 0.05 in both cases). No differences were detected on the PedsQL or the WPAI. CONCLUSION The reduced required frequency of factor product infusions of extended half-life factor products appears to reduce the emotional distress and practical burden of caregiving. Future work should evaluate the longitudinal impact.
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17
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García-Dasí M, Torres-Ortuño A, Cid-Sabatel R, Barbero J. Practical aspects of psychological support to the patient with haemophilia from diagnosis in infancy through childhood and adolescence. Haemophilia 2016; 22:e349-58. [PMID: 27418523 DOI: 10.1111/hae.13018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 12/01/2022]
Abstract
Persons with haemophilia, living with their condition from infancy, require attention from a biopsychosocial approach, in which both the biological and the biographical dimension are addressed. These patients and their environment may benefit greatly from having professionals to help them manage, pre-emptively if possible, to adapt to the disease, cope with the experience of suffering and overcome the difficulties caused by chronicity. The ultimate goal of the interventions was to achieve the best quality of life possible with tailored objectives throughout the patient's life, including disease control, addressing the particular difficulties, and achieving optimal empowerment. This article aims to describe the role of Health Psychology and its professionals in supporting the young patient with haemophilia and provide a brief guide that might be useful for health professionals involved in his care. From the psychological perspective, this paper focuses on communication of diagnosis, the role and support of the family, issues during infancy, childhood and adolescence and how the healthcare team can address them to provide successful support.
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Affiliation(s)
- M García-Dasí
- Instituto de Investigaciones Sanitarias La Fe, Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | | | - J Barbero
- Instituto de Investigaciones Sanitarias La Fe, Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Hospital Universitario La Paz, Madrid, Spain
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18
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Abstract
INTRODUCTION Sports activities are part of multidisciplinary treatments in people with hemophilia. AIM The objective of this study was to assess the incidence of sports activities in the quality of life as perceived by children with hemophilia. METHODS A total of 53 children with hemophilia aged 7 to 13 years and 51 children without hemophilia were evaluated. The perception of quality of life, clinical variables, and the frequency of sports activities were registered. The joint condition of patients with hemophilia was measured with the Spanish version of the Haemophilia Joint Health Score. RESULTS There were no significant differences in the perception of quality of life between children with hemophilia and children without hemophilia. Sports activities in people with hemophilia promoted a greater health satisfaction. CONCLUSIONS Sports activity in children with hemophilia is associated with an improved quality of life and joint health. It is also associated with improved psychosocial wellness.
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19
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Giordano P, Brunetti G, Lassandro G, Notarangelo LD, Luciani M, Mura RM, Lazzareschi I, Santagostino E, Piacente L, Ventura A, Cavallo L, Grano M, Faienza MF. High serum sclerostin levels in children with haemophilia A. Br J Haematol 2015; 172:293-5. [PMID: 25944671 DOI: 10.1111/bjh.13481] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Paola Giordano
- Department of Biomedical Science and Human Oncology, Paediatric Unit University of Bari "A. Moro", Bari, Italy
| | - Giacomina Brunetti
- Department of Basic and Medical Sciences, Neurosciences and Sense Organs, Section of Human Anatomy and Histology, University of Bari "A. Moro", Bari, Italy
| | - Giuseppe Lassandro
- Department of Biomedical Science and Human Oncology, Paediatric Unit University of Bari "A. Moro", Bari, Italy
| | - Lucia D Notarangelo
- Oncohaematology and Bone Marrow Transplantation Unit, Children's Hospital, Brescia, Italy
| | - Matteo Luciani
- Division of Paediatric Haematology, Bambino Gesù Children's and Research Hospital, Rome, Italy
| | - Rosa M Mura
- Paediatric Haematology-Oncology, Cagliari Hospital, Cagliari, Italy
| | - Ilaria Lazzareschi
- Division of Paediatric Oncology, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy
| | - Elena Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Maggiore Hospital, IRCCS Cà Granda Foundation, Milan, Italy
| | - Laura Piacente
- Department of Biomedical Science and Human Oncology, Paediatric Unit University of Bari "A. Moro", Bari, Italy
| | - Annamaria Ventura
- Department of Biomedical Science and Human Oncology, Paediatric Unit University of Bari "A. Moro", Bari, Italy
| | - Luciano Cavallo
- Department of Biomedical Science and Human Oncology, Paediatric Unit University of Bari "A. Moro", Bari, Italy
| | - Maria Grano
- Department of Basic and Medical Sciences, Neurosciences and Sense Organs, Section of Human Anatomy and Histology, University of Bari "A. Moro", Bari, Italy
| | - Maria F Faienza
- Department of Biomedical Science and Human Oncology, Paediatric Unit University of Bari "A. Moro", Bari, Italy.
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20
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Urasinski T, Stasyshyn O, Andreeva T, Rusen L, Perina FG, Oh MS, Chapman M, Pavlova BG, Valenta-Singer B, Abbuehl BE. Recombinant factor IX (BAX326) in previously treated paediatric patients with haemophilia B: a prospective clinical trial. Haemophilia 2014; 21:196-203. [PMID: 25495591 DOI: 10.1111/hae.12548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
A newly developed recombinant factor IX (BAX326(1) ) was investigated for prophylactic use in paediatric patients aged <12 years with severe (FIX level <1%) or moderately severe (FIX level 1-2%) haemophilia B. The aim of this prospective clinical trial was to assess the safety, haemostatic efficacy and pharmacokinetic profile of BAX326 in previously treated paediatric patients. BAX326 was administered as prophylaxis twice a week for a period of 6 months, and on demand for treatment of bleeds. Safety was assessed by the occurrence of related AEs, thrombotic events and immunologic assessments. Efficacy was evaluated by annualized bleeding rate (ABR), and by treatment response rating (excellent, good, fair, none). PK was assessed over 72 h. None of the 23 treated paediatric subjects had treatment-related SAEs or AEs. There were no thrombotic events, inhibitory or specific binding antibodies against FIX, rFurin or CHO protein. Twenty-six bleeds (19 non-joint vs. 7 joint bleeds) occurred (mean ABR 2.7 ± 3.14, median 2.0), of which 23 were injury-related. Twenty subjects (87%) did not experience any bleeds of spontaneous aetiology. Haemostatic efficacy of BAX326 was excellent or good for >96% of bleeds (100% of minor, 88.9% of moderate and 100% of major bleeds); the majority (88.5%) resolved after 1-2 infusions. Longer T1/2 and lower IR were observed in younger children (<6 years) compared to those aged 6 to 12 years. BAX326 administered as prophylactic treatment as well as for controlling bleeds is efficacious and safe in paediatric patients aged <12 years with haemophilia B.
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Affiliation(s)
- T Urasinski
- Department of Paediatrics, Paediatric Haematology and Oncology, Pomeranian Medical University in Szczecin, Szczecin, Poland
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21
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Giordano P, Lassandro G, Valente M, Molinari AC, Ieranò P, Coppola A. Current management of the hemophilic child: a demanding interlocutor. Quality of life and adequate cost-efficacy analysis. Pediatr Hematol Oncol 2014; 31:687-702. [PMID: 25006797 DOI: 10.3109/08880018.2014.930768] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hemophilias are the most known inherited bleeding disorders. The challenges in the management of hemophilic children are different from those in adults: prophylaxis regimen removed the hallmark of crippling disease with lifelong disabilities; individualized regimens are being implemented in order to overcome venous access problems. Presently, at least in high-income countries, advances in treatment of hemophilia resulted in continuous improvement of the patients' quality of life and life expectancy. Inhibitors remain the most severe complication of hemophilia therapy. The treatment' compliance is the key to achieve a successful management. The patient, his family, the medical and psychological team are the players of a comprehensive care system. The current management of hemophilic children is the example of huge resource investments enabling long-term benefits in particular quality of life as a primary objective of the healthcare process.
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Affiliation(s)
- Paola Giordano
- 1Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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22
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Windyga J, Solano Trujillo MH, Hafeman AE. BAX326 (RIXUBIS): a novel recombinant factor IX for the control and prevention of bleeding episodes in adults and children with hemophilia B. Ther Adv Hematol 2014; 5:168-80. [PMID: 25324957 DOI: 10.1177/2040620714550573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hemophilia B management has improved considerably since the introduction of high-purity plasma-derived factor IX (pdFIX) products in the early 1990s. Recombinant FIX (rFIX) was introduced more recently and has potential safety advantages over the older blood-based products. Until recently, only one such product, nonacog alfa (BeneFIX(®), Pfizer, Inc.), has been available. However, a new rFIX product, BAX326 (RIXUBIS, Baxter Healthcare Corp.), has now been approved by the US Food and Drug Administration. BAX326 undergoes rigorous virus elimination and purification steps during manufacture, and has low activated FIX activity, which confers low thrombogenic potential in humans. Preclinical studies showed promising pharmacokinetic and safety profiles, and these early findings have since been expanded in a series of prospective, multicenter, clinical studies. Foremost among these is a pivotal phase I/III study of BAX326 and its use in routine prophylaxis or on-demand treatment in patients aged 12-65 years with severe (FIX level <1%) or moderately severe (FIX level ≤2%) hemophilia B. This study confirmed the pharmacokinetic equivalence of BAX326 and nonacog alfa, and showed a significant reduction in annualized bleeding rate with BAX326 prophylaxis compared with on-demand treatment (79% versus historic controls; p < 0.001). The hemostatic efficacy of BAX326 was rated as 'excellent' or 'good' in 96% of bleeds. BAX326 was also associated with statistically significant and clinically meaningful improvements in physical health-related quality of life. Results are similarly encouraging in a pediatric study in children aged up to 12 years and in a study in hemophilia B patients undergoing surgery. A further study showed safe transition, with no inhibitor formation in any patient, from treatment with a pdFIX product to BAX326. Overall, the safety profile of BAX326 in clinical trials has been strong, with no inhibitor or specific antibody formation, thrombosis, or treatment-related serious adverse events or anaphylaxis.
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Affiliation(s)
- Jerzy Windyga
- Department of Disorders of Hemostasis and Internal Medicine, Institute of Hematology and Transfusion Medicine, 14 I. Gandhi Str., 02-776 Warsaw, Poland
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