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Boender J, Eikenboom J, van der Bom JG, Meijer K, de Meris J, Fijnvandraat K, Cnossen MH, Laros-van Gorkom BAP, van Heerde WL, Mauser-Bunschoten EP, de Maat MPM, Leebeek FWG. Clinically relevant differences between assays for von Willebrand factor activity. J Thromb Haemost 2018; 16:2413-2424. [PMID: 30358069 DOI: 10.1111/jth.14319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 01/07/2023]
Abstract
Essentials It is unclear whether there are differences between von Willebrand factor (VWF) activity assays. We compared the four most used VWF activity assays in 661 von Willebrand disease (VWD) patients. All assays correlated excellently, but a discrepant classification was seen in 20% of patients. Differences between VWF activity assays have a large impact on the classification of VWD. SUMMARY: Background Measuring the ability of von Willebrand factor (VWF) to bind to platelets is crucial for the diagnosis and classification of von Willebrand disease (VWD). Several assays that measure this VWF activity using different principles are available, but the clinical relevance of different assay principles is unclear. Objective To compare the four most widely used VWF activity assays in a large VWD patient population. Methods We measured VWF:RCo (ristocetin to activate VWF + whole platelets), VWF:GPIbR (ristocetin + platelet glycoprotein Ib receptor [GPIb] fragments), VWF:GPIbM (gain-of-function GPIb fragments that bind VWF spontaneously without ristocetin) and VWF:Ab (monoclonal antibody directed against the GPIb binding epitope of VWF to mimic platelets) in 661 VWD patients from the nationwide 'Willebrand in the Netherlands' (WiN) Study. Results All assays correlated excellently (Pearson r > 0.9), but discrepant results led to a different classification for up to one-fifth of VWD patients. VWF:RCo was not sensitive enough to classify 18% of patients and misclassified half of genotypic 2B VWD patients, especially those with p.Arg1306Trp. VWF:GPIbR was more sensitive, accurately classified the vast majority of patients, and was unaffected by the p.Asp1472His variant that causes artificially low VWF:RCo. VWF:GPIbM was the most precise assay but misclassified over a quarter of genotypic 2A, 2B and 3 patients. VWF:Ab, often not considered an actual VWF activity assay, performed at least equally to the other assays with regard to accurate VWD classification. Conclusion Although the different VWF activity assays are often considered similar, differences between assays have a large impact on the classification of VWD.
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Affiliation(s)
- J Boender
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J Eikenboom
- Internal Medicine, Division, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - J G van der Bom
- Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Sanquin Research, Jon J van Rood Center for Clinical Transfusion Medicine, Leiden, the Netherlands
| | - K Meijer
- Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J de Meris
- Netherlands Hemophilia Society, Nijkerk, the Netherlands
| | - K Fijnvandraat
- Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - M H Cnossen
- Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - W L van Heerde
- Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E P Mauser-Bunschoten
- University Medical Center Utrecht, van Creveld Kliniek, University Utrecht, Utrecht, the Netherlands
| | - M P M de Maat
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F W G Leebeek
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Preijers T, Hazendonk HCAM, Liesner R, Chowdary P, Driessens MHE, Hart D, Keeling D, Laros-van Gorkom BAP, van der Meer FJM, Meijer K, Fijnvandraat K, Leebeek FWG, Collins PW, Cnossen MH, Mathôt RAA. Population pharmacokinetics of factor IX in hemophilia B patients undergoing surgery. J Thromb Haemost 2018; 16:2196-2207. [PMID: 30394056 DOI: 10.1111/jth.14292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Indexed: 01/19/2023]
Abstract
Essentials Factor IX (FIX) dosing using body weight frequently results in under and overdosing during surgery. We aimed to establish a population pharmacokinetic (PK) model describing the perioperative FIX levels. Population PK parameter values for clearance and V1 were 284 mL h-170 kg-1 and 5450 mL70 kg-1. Perioperative PK parameters differ from those during non-surgical prophylactic treatment. SUMMARY: Background Hemophilia B is a bleeding disorder characterized by a deficiency of coagulation factor IX (FIX). In the perioperative setting, patients receive FIX concentrates to ensure hemostasis. Although FIX is usually dosed according to bodyweight, under- and overdosing occurs frequently during surgery. Aim The objective was to quantify and explain the interpatient variability of perioperatively administered plasma-derived (pd) and recombinant (r) FIX concentrates. Methods Data were collected from 118 patients (median age, 40 years [range, 0.2-90]; weight, 79 kg [range, 5.3-132]) with moderate (28%) or severe hemophilia B (72%), undergoing 255 surgical procedures. Population pharmacokinetic (PK) parameters were estimated using nonlinear mixed-effect modeling in NONMEM. Results Measured perioperative FIX level vs. time profiles were adequately described using a three-compartment PK model. For a typical 34-year-old patient receiving rFIX, clearance (CL), intercompartmental clearance (Q2, Q3), distribution volume of the central compartment (V1) and peripheral compartments (V2, V3) plus interpatient variability (%CV) were: CL, 284 mL h-170 kg-1 (18%); V1, 5450 mL70 kg-1 (19%); Q2, 110 mL h-170 kg-1; V2, 4800 mL70 kg-1; Q3, 1610 mL h-170 kg-1; V3, 2040 mL70 kg-1. From 0.2 years, CL and V1 decreased 0.89% and 1.15% per year, respectively, until the age of 34 years. Patients receiving pdFIX exhibited a lower CL (11%) and V1 (17%) than patients receiving rFIX. Interpatient variability was successfully quantified and explained. Conclusions The estimated perioperative PK parameters of both pdFIX and rFIX are different from those reported for prophylactic treatment. The developed model may be used to apply PK-guided dosing of FIX concentrates during surgery.
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Affiliation(s)
- T Preijers
- Hospital Pharmacy-Clinical Pharmacology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - H C A M Hazendonk
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, Rotterdam, the Netherlands
| | - R Liesner
- Great Ormond Street Haemophilia Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - P Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - M H E Driessens
- Netherlands Hemophilia Patient Society (NVHP), Nijkerk, the Netherlands
| | - D Hart
- Department of Haematology, The Royal London Hospital Barts Health NHS Trust, London, UK
| | - D Keeling
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, Churchill Hospital, Oxford, UK
| | | | - F J M van der Meer
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - K Meijer
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - F W G Leebeek
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - P W Collins
- Arthur Bloom Haemophilia Centre, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, Rotterdam, the Netherlands
| | - R A A Mathôt
- Hospital Pharmacy-Clinical Pharmacology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
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3
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Hazendonk HCAM, Preijers T, Liesner R, Chowdary P, Hart D, Keeling D, Driessens MHE, Laros-van Gorkom BAP, van der Meer FJM, Meijer K, Fijnvandraat K, Leebeek FWG, Mathôt RAA, Collins PW, Cnossen MH. Perioperative replacement therapy in haemophilia B: An appeal to "B" more precise. Haemophilia 2018; 24:611-618. [PMID: 29707861 DOI: 10.1111/hae.13469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Haemophilia B is caused by a deficiency of coagulation factor IX (FIX) and characterized by bleeding in muscles and joints. In the perioperative setting, patients are treated with FIX replacement therapy to secure haemostasis. Targeting of specified FIX levels is challenging and requires frequent monitoring and adjustment of therapy. AIM To evaluate perioperative management in haemophilia B, including monitoring of FIX infusions and observed FIX levels, whereby predictors of low and high FIX levels were assessed. METHODS In this international multicentre study, haemophilia B patients with FIX < 0.05 IU mL-1 undergoing elective, minor or major surgical procedures between 2000 and 2015 were included. Data were collected on patient, surgical and treatment characteristics. Observed FIX levels were compared to target levels as recommended by guidelines. RESULTS A total of 255 surgical procedures were performed in 118 patients (median age 40 years, median body weight 79 kg). Sixty percent of FIX levels within 24 hours of surgery were below target with a median difference of 0.22 IU mL-1 [IQR 0.12-0.36]; while >6 days after surgery, 59% of FIX levels were above target with a median difference of 0.19 IU mL-1 [IQR 0.10-0.39]. Clinically relevant bleeding complications (necessity of a second surgical intervention or red blood cell transfusion) occurred in 7 procedures (2.7%). CONCLUSION This study demonstrates that targeting of FIX levels in the perioperative setting is complex and suboptimal, but although this bleeding is minimal. Alternative dosing strategies taking patient and surgical characteristics as well as pharmacokinetic principles into account may help to optimize and individualize treatment.
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Affiliation(s)
- H C A M Hazendonk
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - T Preijers
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - R Liesner
- Great Ormond Street Haemophilia Centre, Great Ormond Street Hospital for Children NHS trust, London, UK
| | - P Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - D Hart
- Department of Haematology, The Royal London Hospital Barts Health NHS Trust, London, UK
| | - D Keeling
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, Churchill Hospital, Oxford, UK
| | - M H E Driessens
- Netherlands Haemophilia Patient Society (NVHP), Nijkerk, The Netherlands
| | | | - F J M van der Meer
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Meijer
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K Fijnvandraat
- Department of Paediatric Haematology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - F W G Leebeek
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - R A A Mathôt
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - P W Collins
- Arthur Bloom Haemophilia Centre, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
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4
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Hazendonk HCAM, Heijdra JM, de Jager NCB, Veerman HC, Boender J, van Moort I, Mathôt RAA, Meijer K, Laros-van Gorkom BAP, Eikenboom J, Fijnvandraat K, Leebeek FWG, Cnossen MH. Analysis of current perioperative management with Haemate ® P/Humate P ® in von Willebrand disease: Identifying the need for personalized treatment. Haemophilia 2018; 24:460-470. [PMID: 29573506 DOI: 10.1111/hae.13451] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patients with Von Willebrand disease (VWD) are regularly treated with VWF-containing concentrates in case of acute bleeding, trauma and dental or surgical procedures. AIM In this multicentre retrospective study, current perioperative management with a von Willebrand factor (VWF)/Factor VIII (FVIII) concentrate (Haemate® P) in patients with VWD was evaluated. PATIENTS/METHODS Patients with VWD undergoing minor or major surgery between 2000 and 2015, requiring treatment with a VWF/FVIII concentrate (Haemate® P), were included. Achieved VWF activity (VWF:Act) and FVIII during FVIII-based treatment regimens were compared to predefined target levels in national guidelines. RESULTS In total, 103 patients with VWD (148 surgeries) were included: 54 type 1 (73 surgeries), 43 type 2 (67 surgeries) and 6 type 3 (8 surgeries). Overall, treatment resulted in high VWF:Act and FVIII levels, defined as ≥0.20 IU/mL above predefined levels. In patients with type 1 VWD, respectively, 65% and 91% of trough VWF:Act and FVIII levels were higher than target levels. In patients with type 2 and type 3 VWD, respectively, 53% and 57% of trough VWF:Act and 72% and 73% of trough FVIII levels were higher than target level. Furthermore, FVIII accumulation over time was observed, while VWF:Act showed a declining trend, leading to significantly higher levels of FVIII than VWF:Act. CONCLUSION High VWF:Act and accumulation of FVIII were observed after perioperative FVIII-based replacement therapy in patients with VWD, both underlining the necessity of personalization of dosing regimens to optimize perioperative treatment.
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Affiliation(s)
- H C A M Hazendonk
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands
| | - J M Heijdra
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands
| | - N C B de Jager
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
| | - H C Veerman
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands
| | - J Boender
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - I van Moort
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands
| | - R A A Mathôt
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
| | - K Meijer
- Department of Haematology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | - J Eikenboom
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, Netherlands
| | - K Fijnvandraat
- Department of Paediatric Haematology, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
| | - F W G Leebeek
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, Netherlands
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5
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Abdul S, Boender J, Malfliet JJMC, Eikenboom J, Fijn van Draat K, Mauser-Bunschoten EP, Meijer K, de Meris J, Laros-van Gorkom BAP, van der Bom JG, Leebeek FWG, Rijken DC, Uitte de Willige S. Plasma levels of plasminogen activator inhibitor-1 and bleeding phenotype in patients with von Willebrand disease. Haemophilia 2017; 23:437-443. [DOI: 10.1111/hae.13206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S. Abdul
- Department of Hematology; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - J. Boender
- Department of Hematology; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - J. J. M. C. Malfliet
- Department of Hematology; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - J. Eikenboom
- Department of Thrombosis and Hemostasis; Leiden University Medical Center; Leiden The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine; Leiden University Medical Center; Leiden The Netherlands
| | - K. Fijn van Draat
- Pediatric Hematology; Emma Children's Hospital AMC; Amsterdam The Netherlands
| | - E. P. Mauser-Bunschoten
- Van Creveldkliniek department of benign Hematology; University Medical Center Utrecht; Utrecht The Netherlands
| | - K. Meijer
- Hematology; University Medical Center Groningen; Groningen The Netherlands
| | - J. de Meris
- Netherlands Hemophilia Society; Leiden The Netherlands
| | | | - J. G. van der Bom
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
- Jon J Van Rood Center for Clinical Transfusion Medicine, Sanquin Research; Leiden The Netherlands
| | - F. W. G. Leebeek
- Department of Hematology; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - D. C. Rijken
- Department of Hematology; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - S. Uitte de Willige
- Department of Hematology; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
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6
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Hazendonk HCAM, Lock J, Mathôt RAA, Meijer K, Peters M, Laros-van Gorkom BAP, van der Meer FJM, Driessens MHE, Leebeek FWG, Fijnvandraat K, Cnossen MH. Perioperative treatment of hemophilia A patients: blood group O patients are at risk of bleeding complications. J Thromb Haemost 2016; 14:468-78. [PMID: 26714028 DOI: 10.1111/jth.13242] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/30/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED ESSENTIALS: Targeting of factor VIII values is a challenge during perioperative replacement therapy in hemophilia. This study aims to identify the extent and predictors of factor VIII underdosing and overdosing. Blood group O predicts underdosing and is associated with perioperative bleeding. To increase quality of care and cost-effectiveness of treatment, refining of dosing is obligatory. SUMMARY BACKGROUND Perioperative administration of factor VIII (FVIII) concentrate in hemophilia A may result in both underdosing and overdosing, leading to respectively a risk of bleeding complications and unnecessary costs. OBJECTIVES This retrospective observational study aims to identify the extent and predictors of underdosing and overdosing in perioperative hemophilia A patients (FVIII levels < 0.05 IU mL(-1)). PATIENTS AND METHODS One hundred nineteen patients undergoing 198 elective, minor, or major surgical procedures were included (median age 40 years, median body weight 75 kg). Perioperative management was evaluated by quantification of perioperative infusion of FVIII concentrate and achieved FVIII levels. Predictors of underdosing and (excessive) overdosing were analyzed by logistic regression analysis. Excessive overdosing was defined as upper target level plus ≥ 0.20 IU mL(-1). RESULTS Depending on postoperative day, 7-45% of achieved FVIII levels were under and 33-75% were above predefined target ranges as stated by national guidelines. A potential reduction of FVIII consumption of 44% would have been attained if FVIII levels had been maintained within target ranges. Blood group O and major surgery were predictive of underdosing (odds ratio [OR] 6.3, 95% confidence interval [CI] 2.7-14.9; OR 3.3, 95% CI 1.4-7.9). Blood group O patients had more bleeding complications in comparison to patients with blood group non-O (OR 2.02, 95% CI 1.00-4.09). Patients with blood group non-O were at higher risk of overdosing (OR 1.5, 95% CI 1.1-1.9). Additionally, patients treated with bolus infusions were at higher risk of excessive overdosing (OR 1.8, 95% CI 1.3-2.4). CONCLUSION Quality of care and cost-effectiveness can be improved by refining of dosing strategies based on individual patient characteristics such as blood group and mode of infusion.
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Affiliation(s)
- H C A M Hazendonk
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, Rotterdam, the Netherlands
| | - J Lock
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, Rotterdam, the Netherlands
| | - R A A Mathôt
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - K Meijer
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Peters
- Department of Pediatric Hematology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | | | - F J M van der Meer
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M H E Driessens
- Netherlands Hemophilia Patient Society (NVHP), Nijkerk, the Netherlands
| | - F W G Leebeek
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - M H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, Rotterdam, the Netherlands
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7
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Timmer MA, Pisters MF, de Kleijn P, Veenhof C, Laros-van Gorkom BAP, Kruip MJHA, de Bie RA, Schutgens REG. How do patients and professionals differentiate between intra-articular joint bleeds and acute flare-ups of arthropathy in patients with haemophilia? Haemophilia 2015; 22:368-73. [PMID: 26634961 DOI: 10.1111/hae.12858] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The overlap in symptoms between joint bleeds and flare-ups of haemophilia arthropathy (HA) creates difficulties in differentiating between the two conditions. Diagnosis of haemarthrosis is currently empirically made based upon clinical presentations. However, no standard diagnostic criteria are available. To offer appropriate treatment, rapid and accurate diagnosis is essential. Additionally, adequate differentiation can decrease health costs significantly. AIM The aim of this study was to identify signs and symptoms to differentiate between an intra-articular joint bleed and an acute flare-up of HA in patients with haemophilia and make an initial proposal of items to include in a diagnostic criteria set. METHODS Six focus group interviews with a total of 13 patients and 15 professionals were carried out. The focus groups were structured following the Nominal Group Technique (NGT). RESULTS The most important signs and symptoms used to differentiate between joint bleeds and HA were (i) course of the symptoms, (ii) cause of the complaints, (iii) joint history, (iv) type of pain and (v) degree of impairments in range of motion. CONCLUSION This qualitative study provides insight into signs and symptoms that are currently used to differentiate between joint bleeds and flare-ups of HA. Results of this study can be used to develop a valid and standardized clinical diagnostic criteria set to differentiate between these two conditions. Further research is necessary to validate the signs and symptoms found in this study.
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Affiliation(s)
- M A Timmer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.,Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M F Pisters
- Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Center, Utrecht, the Netherlands
| | - P de Kleijn
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.,Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C Veenhof
- Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - M J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - R A de Bie
- Physical Therapy Research, Departement of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - R E G Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
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8
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van Galen KPM, Meijer K, Vogely HC, Eikenboom J, Schutgens REG, Cnossen MH, Fijnvandraat K, van der Bom JG, Laros-van Gorkom BAP, Leebeek FWG, Mauser-Bunschoten EP. Joint surgery in von Willebrand disease: a multicentre cross-sectional study. Haemophilia 2015; 22:256-262. [DOI: 10.1111/hae.12834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 02/07/2023]
Affiliation(s)
- K. P. M. van Galen
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht The Netherlands
| | - K. Meijer
- Department of Haematology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - H. C. Vogely
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - J. Eikenboom
- Department of Thrombosis and Haemostasis and Einthoven Laboratory for Experimental Vascular Medicine; Leiden University Medical Center; Leiden The Netherlands
| | - R. E. G. Schutgens
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht The Netherlands
| | - M. H. Cnossen
- Department of Paediatric Haematology; Erasmus University Medical Center-Sophia Children's Hospital; Rotterdam The Netherlands
| | - K. Fijnvandraat
- Department of Paediatric Haematology; Academisch Medisch Centrum; Emma Children's Hospital; Amsterdam The Netherlands
| | - J. G. van der Bom
- Jon J van Rood Center for Clinical Transfusion Medicine; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | | | - F. W. G. Leebeek
- Department of Haematology; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
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9
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van Meegeren MER, Mancini TL, Schoormans SCM, van Haren BJT, van Duren C, Diekstra A, Laros-van Gorkom BAP, Brons PPT, Simons A, Hoefsloot L, van Heerde WL. Clinical phenotype in genetically confirmed von Willebrand disease type 2N patients reflects a haemophilia A phenotype. Haemophilia 2015. [DOI: 10.1111/hae.12733] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- M. E. R. van Meegeren
- Hemophilia Treatment Center; Radboud University Medical Center; Nijmegen The Netherlands
| | - T. L. Mancini
- Unit Thrombosis Hemostasis; Laboratory of Hematology; Department of Laboratory Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - S. C. M. Schoormans
- Unit Thrombosis Hemostasis; Laboratory of Hematology; Department of Laboratory Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - B. J. T. van Haren
- Unit Thrombosis Hemostasis; Laboratory of Hematology; Department of Laboratory Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - C. van Duren
- Unit Thrombosis Hemostasis; Laboratory of Hematology; Department of Laboratory Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - A. Diekstra
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - B. A. P. Laros-van Gorkom
- Hemophilia Treatment Center; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Hematology; Radboud University Medical Center; Nijmegen The Netherlands
| | - P. P. T. Brons
- Hemophilia Treatment Center; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Pediatrics; Radboud University Medical Center; Nijmegen The Netherlands
| | - A. Simons
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - L. Hoefsloot
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - W. L. van Heerde
- Hemophilia Treatment Center; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Pediatrics; Radboud University Medical Center; Nijmegen The Netherlands
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10
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Sanders YV, van der Bom JG, Isaacs A, Cnossen MH, de Maat MPM, Laros-van Gorkom BAP, Fijnvandraat K, Meijer K, van Duijn CM, Mauser-Bunschoten EP, Eikenboom J, Leebeek FWG. CLEC4M and STXBP5 gene variations contribute to von Willebrand factor level variation in von Willebrand disease. J Thromb Haemost 2015; 13:956-66. [PMID: 25832887 DOI: 10.1111/jth.12927] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND von Willebrand factor (VWF) levels in healthy individuals are influenced by variations in genetic loci other than the VWF gene, whose contribution to VWF levels in patients with von Willebrand disease (VWD) is largely unknown. OBJECTIVES To investigate the association between single-nucleotide polymorphisms (SNPs), VWF levels, and bleeding phenotype. PATIENTS/METHODS In 364 type 1 VWD and 240 type 2 VWD patients from the nationwide cross-sectional 'Willebrand in The Netherlands' (WiN) study, we studied the association between eight SNPs in STXBP5, SCARA5, ABO, VWF, STAB2, STX2, TC2N, and CLEC4M, and VWF antigen (VWF:Ag), VWF activity (VWF:Act), and bleeding phenotype as assessed with the Tosetto bleeding score. RESULTS In type 1 patients, STXBP5 was associated with a lower VWF:Ag level (adjusted difference of -3.0 IU dL(-1) per allele; 95% confidence interval [CI] -6.0 to 0.1) and CLEC4M with both a lower VWF:Ag level (-4.3 IU dL(-1) per allele; 95% CI -7.9 to -0.6) and lower VWF:Act (-5.7 IU dL(-1) per allele; 95% CI -10.9 to -0.5). In type 2 patients, none of the SNPs was associated with VWF levels. None of the genetic variants was associated with bleeding score. CONCLUSIONS Genetic variations in STXBP5 and CLEC4M are associated with VWF level variation in type 1 VWD, but not in type 2 VWD. This study increases our understanding of the pathophysiology of VWD, and provides a further indication of the involvement of STXBP5 and CLEC4M in determining VWF levels in VWD.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers/blood
- Blood Coagulation/genetics
- Blood Coagulation Tests
- Cell Adhesion Molecules/genetics
- Child
- Child, Preschool
- Cross-Sectional Studies
- Female
- Gene Frequency
- Genetic Association Studies
- Genetic Predisposition to Disease
- Hemorrhage/blood
- Hemorrhage/genetics
- Humans
- Infant
- Lectins, C-Type/genetics
- Male
- Middle Aged
- Molecular Diagnostic Techniques
- Nerve Tissue Proteins/genetics
- Netherlands
- Phenotype
- Polymorphism, Single Nucleotide
- R-SNARE Proteins/genetics
- Receptors, Cell Surface/genetics
- Risk Factors
- Young Adult
- von Willebrand Disease, Type 1/blood
- von Willebrand Disease, Type 1/diagnosis
- von Willebrand Disease, Type 1/genetics
- von Willebrand Disease, Type 2/blood
- von Willebrand Disease, Type 2/diagnosis
- von Willebrand Disease, Type 2/genetics
- von Willebrand Factor/analysis
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Affiliation(s)
- Y V Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Jon J. van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, The Netherlands
| | - A Isaacs
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M P M de Maat
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - K Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - K Meijer
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M van Duijn
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E P Mauser-Bunschoten
- van Creveldkliniek/Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Eikenboom
- Department of Thrombosis and Hemostasis, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - F W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
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11
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Sanders YV, Giezenaar MA, Laros-van Gorkom BAP, Meijer K, van der Bom JG, Cnossen MH, Nijziel MR, Ypma PF, Fijnvandraat K, Eikenboom J, Mauser-Bunschoten EP, Leebeek FWG. von Willebrand disease and aging: an evolving phenotype. J Thromb Haemost 2014; 12:1066-75. [PMID: 24750783 DOI: 10.1111/jth.12586] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/14/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because the number of elderly von Willebrand disease (VWD) patients is increasing, the pathophysiology of aging in VWD has become increasingly relevant. OBJECTIVES To assess age-related changes in von Willebrand factor (VWF) and factor VIII (FVIII) levels and to compare age-related differences in bleeding phenotype between elderly VWD patients and those < 65 years. We also studied co-morbidity in elderly patients. PATIENTS/METHODS We included VWD patients with VWF levels ≤ 30 U dL(-1) in the nationwide cross-sectional 'Willebrand in the Netherlands' (WiN-) study. Patients reported bleeding episodes and treatment of VWD in the year preceding inclusion and during life. This was compared between VWD patients older (n = 71) and younger (16-64 years, n = 593) than 65 years. In elderly patients, age-related changes in VWF and FVIII levels were studied longitudinally by including all historically measured levels. All medical records were examined for co-morbidity. RESULTS In elderly type 1 patients, a decade age increase was associated with a 3.5 U dL(-1) (95% CI, -0.6 to 7.6) VWF:Ag increase and 7.1 U dL(-1) (95% CI, 0.7 to 13.4) FVIII:C increase. This increase was not observed in elderly type 2 patients. Elderly type 2 patients reported significantly more bleeding symptoms in the year preceding inclusion than younger patients (16/27, 59% vs. 87/221, 39%; P = 0.048), which was not observed in type 1 VWD. CONCLUSIONS von Willebrand factor parameters and bleeding phenotype evolve with increasing age in VWD. VWF and FVIII levels increase with age in type 1 patients with no mitigation in bleeding phenotype. In type 2 patients VWF parameters do not increase with age and in these patients aging is accompanied by increased bleeding.
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Affiliation(s)
- Y V Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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12
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Richters A, van Vliet M, Peer PGM, Verweij PE, Laros-van Gorkom BAP, Blijlevens NMA, Donnelly JP, van der Velden WJFM. Incidence of and risk factors for persistent gram-positive bacteraemia and catheter-related thrombosis in haematopoietic stem cell transplantation. Bone Marrow Transplant 2013; 49:264-9. [DOI: 10.1038/bmt.2013.172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/04/2013] [Accepted: 09/18/2013] [Indexed: 11/09/2022]
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13
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Sanders YV, Eikenboom J, de Wee EM, van der Bom JG, Cnossen MH, Degenaar-Dujardin MEL, Fijnvandraat K, Kamphuisen PW, Laros-van Gorkom BAP, Meijer K, Mauser-Bunschoten EP, Leebeek FWG. Reduced prevalence of arterial thrombosis in von Willebrand disease. J Thromb Haemost 2013; 11:845-54. [PMID: 23506463 DOI: 10.1111/jth.12194] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 03/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND High von Willebrand factor (VWF) levels are an established risk factor for arterial thrombosis, including coronary heart disease and ischemic stroke. It has been hypothesized that von Willebrand disease (VWD) patients are protected against arterial thrombosis; however, this has never been confirmed in clinical studies. OBJECTIVES To investigate the prevalence of arterial thrombosis in VWD patients relative to the general population. PATIENTS/METHODS We included 635 adult patients with VWF levels ≤ 30 U dL(-1) , aged 16-85 years, from the nationwide cross-sectional 'Willebrand in the Netherlands' (WiN) study and compared the prevalence of arterial thrombosis with two reference populations from the general Dutch population adjusted for age and sex as standardized morbidity ratios (SMRs). RESULTS Twenty-nine arterial thrombotic events occurred in 21 patients (3.3%). Five patients suffered an acute myocardial infarction and three an ischemic stroke. Unstable angina pectoris was recorded 12 times, transient ischemic attack nine. The prevalence of all arterial thrombotic events combined (acute myocardial infarction, ischemic stroke and coronary heart disease) was 39% and 63% lower than in the two reference populations. The prevalence of cardiovascular disease in VWD was lower than in the general population, SMR 0.60 (95% CI, 0.32-0.98) for coronary heart disease and SMR 0.40 (95% CI, 0.13-0.83) for acute myocardial infarction. For ischemic stroke the prevalence was 35-67% lower compared with two reference populations, SMR 0.65 (95% CI, 0.12-1.59) and 0.33 (95% CI, 0.06-0.80), respectively. CONCLUSIONS This is the first study showing that VWD patients have a reduced prevalence of arterial thrombosis and provides important insights into the role of VWF in the pathogenesis of arterial thrombosis.
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Affiliation(s)
- Y V Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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14
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Van Geffen M, Menegatti M, Loof A, Lap P, Karimi M, Laros-van Gorkom BAP, Brons P, Van Heerde WL. Retrospective evaluation of bleeding tendency and simultaneous thrombin and plasmin generation in patients with rare bleeding disorders. Haemophilia 2012; 18:630-8. [PMID: 22404435 DOI: 10.1111/j.1365-2516.2012.02759.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rare bleeding disorders (RBDs) are a heterogeneous group of diseases with varying bleeding tendency, only partially explained by their laboratory phenotype. We analysed the separate groups of RBD abnormalities, and we investigated retrospectively whether the novel haemostasis assay (NHA) was able to differentiate between bleeding tendency. We have performed simultaneous thrombin generation (TG) and plasmin generation (PG) measurements in 41 patients affected with deficiencies in prothrombin, factor (F) V, FVII, FX, FXIII and fibrinogen. Parameters of the NHA were classified based on (major or minor) bleeding tendency. Patients with deficiencies in coagulation propagation (FII, FV and FX) and major type of bleedings had diminished TG (expressed as AUC) below 20% of control. FVII deficient patients only had prolonged thrombin lag-time ratio of 1.6 ± 0.2 (P < 0.05) and normal AUC (92-125%). Afibrinogenemic patients demonstrated PG of 2-29% of normal and appeared to correlate with the type of mutation. Thrombin peak-height (57 ± 16%) was reduced (not significant) in these patients and AUC was comparable to the reference (102 ± 27%). FXIII-deficient plasmas resulted in a reduced thrombin peak-height of 59 ± 13% (P < 0.05) and normal AUC (90 ± 14%). Thrombin peak-height (P < 0.01) and plasmin potential (P < 0.05) were lower in the major bleeders compared with the minor bleeders. These results provided distinct TG and PG curves for each individual abnormality and differentiation of bleeding tendency was observed for thrombin and PG parameters. Prospective studies are warranted to confirm these retrospective results.
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Affiliation(s)
- M Van Geffen
- Laboratory of Haematology, Department of Laboratory Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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15
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de Wee EM, Mauser-Bunschoten EP, Van Der Bom JG, Degenaar-Dujardin MEL, Eikenboom HCJ, Fijnvandraat K, de Goede-Bolder A, Laros-van Gorkom BAP, Meijer K, Raat H, Leebeek FWG. Health-related quality of life among adult patients with moderate and severe von Willebrand disease. J Thromb Haemost 2010; 8:1492-9. [PMID: 20345712 DOI: 10.1111/j.1538-7836.2010.03864.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
SUMMARY BACKGROUND von Willebrand Disease (VWD) is the most frequent inherited bleeding disorder. It is unknown how this disorder affects quality of life. OBJECTIVES This nationwide multicenter cross-sectional study determined health-related quality of life (HR-QoL) in adult patients with moderate or severe VWD, and assessed whether bleeding severity and type of VWD are associated with HR-QoL. METHODS HR-QoL was assessed using the Short Form (SF)-36, and bleeding severity was measured using the Bleeding Score (BS). RESULTS Five hundred and nine patients participated; 192 males and 317 females, median age and range 45 (16-87) and 47 (16-84) years, respectively. Compared with the general population, HR-QoL in VWD patients was lower in the vitality domain (61 vs. 66 P < 0.001 for females, 67 vs. 72 P < 0.001 for males). Patients with the most severe bleeding phenotype (highest quartile BS, BS > 17) had a lower HR-QoL in eight domains than patients with a less severe bleeding type (lowest quartile BS, BS < 7) in the univariate analysis. After adjustment for age, gender, co-morbidity and employment/educational status, a more severe bleeding phenotype was associated with lower scores on the domains of physical functioning, role limitations due to physical functioning, bodily pain, general health, social functioning and physical component summary. CONCLUSIONS HR-QoL is lower in VWD patients compared with the general population. HR-QoL is strongly associated with bleeding phenotype.
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Affiliation(s)
- E M de Wee
- Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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16
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Laros-van Gorkom BAP, Huisman CAM, Wijermans PW, Schipperus MR. Experience with alemtuzumab in treatment of chronic lymphocytic leukaemia in the Netherlands. Neth J Med 2007; 65:333-338. [PMID: 17954952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Alemtuzumab (MabCampath) is a monoclonal antibody against CD52, indicated as third-line treatment of chronic lymphocytic leukaemia (CLL). As most important side effect opportunistic infections are mentioned. It is, however, unknown whether these complications often lead to problems in general patient care in the Netherlands. METHODS To gain insight into the use and complications of alemtuzumab therapy, the alemtuzumab-treated CLL patients in 15 hospitals in the Netherlands were evaluated by means of a questionnaire. RESULTS In the period from 31 October 2001 until 17 November 2005, 27 patients with CLL or prolymphocytic leukaemia (PLL), RAI stage I to IV, Binet stage A to C, received 32 treatments with alemtuzumab. The time from diagnosis until start of alemtuzumab treatment was 6 +/- 4.5 years (mean +/- SD ). The treatment lasted 11 +/- 7 weeks. Of the treatments, 41% could be administered for the full 12 weeks. The most frequent adverse events were fever (72%), shivering (47%), fatigue (22%) and dyspnoea (16%). Haematological side effects consisted of leucopenia (75%), thrombocytopenia (44%), and anaemia (13%). Infectious complications occurred in 12 of 32 (38%) treatments: pneumonia (25%; of which one Pneumocystis carini pneumonia and four Aspergillus infections), sepsis (9%; of which one Listeria), herpes zoster (9%), herpes simplex (6%), CMV reactivation (6%), meningitis (3%) and Guillain Barre (3%). The overall response was 53%, with complete remission in 13%, partial remission in 41%, stable disease in 25% and progressive disease in 13%, and lasted for 8.3 +/- 7.3 months. CONCLUSION Treatment with alemtuzumab is often terminated prematurely, leading to a suboptimal treatment effect. Fear of severe uncontrollable opportunistic infections seems unjustified.
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MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/administration & dosage
- Antibodies, Neoplasm/adverse effects
- Antibodies, Neoplasm/therapeutic use
- Antigens, CD/drug effects
- Antigens, Neoplasm/drug effects
- Aspergillosis/chemically induced
- CD52 Antigen
- Drug Evaluation
- Drug Resistance, Neoplasm
- Glycoproteins/drug effects
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Medical Records
- Netherlands
- Opportunistic Infections/chemically induced
- Pneumonia, Pneumocystis/chemically induced
- Remission Induction
- Retrospective Studies
- Surveys and Questionnaires
- Treatment Outcome
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- B A P Laros-van Gorkom
- Department of Haematology, Haga Hospital, location Leyenburg, The Hague, the Netherlands.
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