[Practice changes in the management of major paediatric haemophilia]

Recent therapeutic innovations are significantly changing the management of young children with severe haemophilia. A team from the University Hospital of Nice (06) introduced emicizumab, the first subcutaneous non-replacement therapy. Integrated into the multi-professional management of children and their families, this innovative therapeutic option has shown encouraging initial results. Experience sharing.

"Whatever Works": Innovations in the Treatment of Hemophilia in the United States 1783-1950

Treatment of the bleeding disorder hemophilia in the nineteenth century was empirical, based on clinical experience. Medications, transfusions of human or animal blood, and injections of blood sera were utilized in an attempt to halt life-threatening hemorrhages. After 1900, the application of clinical laboratory science facilitated the utilization of anti-coagulated blood and donor blood compatibility tests for safer emergency transfusions. But repeated transfusions produced blood incompatibility that limited future utilization. Investigation of hormones and snake venom as coagulants appeared hopeful during the 1930s, but plasma globulin research during World War II resulted in the isolation of antihemophilic factors that promptly reduced hemorrhage. Their application to bleeding episodes resulted in a more normal life for hemophiliacs after 1950.

[Therapeutic innovation in the treatment of haemophilia]

The pharmacological treatment of patients with haemophilia has evolved considerably over recent years. In the past, treatments were restrictive for patients and targeted only bleeding incidents. Nowadays, thanks to research, patients have access to prophylactic treatments which offer easier injection methods and are set to evolve further.

[Therapeutic education, a necessity for people with haemophilia]

Haemophilia is a chronic, restrictive and anxiety-inducing disease. In order to maintain a satisfactory quality of life, people can benefit from a therapeutic education programme to equip them with the skills they need to take care of their health.

[Understanding haemostasis to improve its management]

Haemostasis represents all the complex and interdependent mechanisms which enable bleeding to stop. This process involves the vessel walls, platelets, coagulation factors and von Willebrand factor. In the event of a disorder, the specific characterisation of the condition is the first stage of the diagnosis. Treatment is mainly based on substitution. All these disorders and their complications require multidisciplinary and specialised care.

[Training in haemophilia aimed at private practice nurses]

At the crossroads between the care delivered in the hospital and community nursing care, private practice nurses occupy a central role in supporting children with haemophilia and their family. Dedicated training helps to maintain the link with hospital structures and enables them to exchange with other professionals regarding practices, treatment difficulties and the contribution of new technologies in the care provision.