The use of a single von Willebrand factor-containing, plasma-derived FVIII product in hemophilia A immune tolerance induction: the US experience

BACKGROUND

Inhibitors are a serious complication for patients with severe hemophilia A. Immune tolerance induction (ITI) is the primary method for eradicating these inhibitors. The role of type of concentrate and in particular the use of von Willebrand factor-containing, plasma-derived factor VIII (VWF/pd-FVIII) concentrate in primary or rescue ITI remains unclear.

OBJECTIVES

To report retrospective collection of data on the use of a single VWF/pd-FVIII concentrate in primary and rescue ITI.

METHODS

Retrospective chart review of hemophilia A inhibitor patients at 11 US institutions who received VWF/pd-FVIII concentrate in primary or rescue ITI.

RESULTS

Primary ITI was carried out in eight inhibitor patients with a 75% complete and partial success. Secondary ITI was carried out in 25 inhibitor patients, with 52% attaining complete or partial success.

CONCLUSIONS

This report represents the largest group of primarily pediatric, high-titer inhibitor patients treated with a single VWF/pd-FVIII concentrate. It adds retrospective data to the use of VWF-containing plasma-derived factor VIII concentrate in primary and rescue ITI, particularly in those patients with characteristics of poor response to ITI.

Utilization patterns and associated costs of factor assistance programmes among persons with haemophilia: a single institution review

Although individuals with haemophilia have benefited from advances and the availability of safe, effective factor replacement products, high treatment costs and insurance coverage limits remains a significant concern among persons with this disease. Many uninsured haemophiliacs turn to emergency rooms for treatment and/or patient assistance programmes for treatment of a bleed or injury. However, neither of these options is a sustainable solution for managing the care of patients with this costly disease. This study was conducted to examine the use of factor assistance programmes and estimate annual amounts of factor dispensed by each programme along with their associated costs. Retrospective review of pharmacy and medical record of all patients who attended the Gulf States Hemophilia and Thrombophilia Center, and who were enrolled in any factor assistance programme(s) between January 2007 and December 2010 was performed. During the 4-year observation period, approximately 19% of the centre's haemophilia patient population was enrolled and received free factor products from at least one patient assistance programme. In addition, approximately 9.1 million dollars (US) worth of factor replacement therapy was donated to our patients during the study time. Although assistance programmes have helped many uninsured individuals with haemophilia to receive free factor products, they are not an enduring answer to the insurance problems many of our patients face. More effort needs to be focused on how to effectively manage uninsured persons with haemophilia to ensure that their health care and treatment needs are adequately met.

Immobilization stress responses in adult rats exposed in utero to immobilization

The present study investigated the influence of immobilization prenatal stress on adult male rats, with the same postnatal stress, on the immune parameters and its relation with plasma corticosterone (COR) and glucose levels. To study the immunity parameters, profiles of the leucocytes, size of spleen and number of the mononuclear cells of this organ were determined. Basal levels of COR and glucose were higher in prenatally stressed animals. When the adult animals were exposed to immobilization stress, COR increased but the increase was less than that for the control group, and glucose was equal in both groups. Although postnatal acute stress decreased the number of leucocytes and lymphocytes and increased the number of neutrophils, the effect was lower in prenatally stressed animals; for that reason, the ratio neutrophil/lymphocyte increased less. The number of mononuclear cells were higher in the spleen of prenatally stressed animals. This effect was probably due to retention of blood lymphocytes in the spleen. There seemed to be an alteration in the redistribution of leucocytes, both in basal conditions and under postnatal stress. The alteration of the immunological function may be partly due to an alteration in the functionality of the hypothalamic–pituitary–adrenal axis, which was hyperactive in basal conditions but appeared to suffer habituation to the same stress.

Relationship among maximal grip, throwing velocity and anthropometric parameters in elite water polo players

AIM

As independent aspects, body size, body composition, and physiological performance of elite athletes have aroused the interest of sports scientists but, unfortunately, studies that combine these aspects are scarcely avalaible in water polo. The aim of the present study was to: 1) to develop an anthropometric profile of highly skilled male Water Polo players, and 2) to identify significant relationships between these features and overhead throwing velocity in highly skilled male water polo players.

METHODS

Thirteen male water polo players, with a mean age of 26.10±4.82, were recruited from the Spanish Water Polo team and an anthropometric assessment on all of them was carried out. Throwing velocity was evaluated in three different situations from the 5 m-penalty line on the center of the water polo goal: A) throwing without a defender nor a goalkeeper; B) throwing with a goalkeeper only, and C) 3) armfuls running shot with goalkeeper. Maximal handgrip was also tested.

RESULTS

Biacromial breadth shows a significative correlation with hand grip in water polo players (r=0.792; P=0.001) and also correlates with Throwing velocity (r=0.716; P<0.001). Biepicondylar femur breadth correlates significatively with hand grip (r=0.727; P<0.05) and also with throwing velocity in "throwing with goalkeeper" situation (r=0.664; P<0.05). Hand grip shows a significant correlation with throwing velocity in "throwing with goalkeeper" situation (r=0.603; P<0.05).

CONCLUSION

In conclusion, body mass aspects are not related with throwing velocity in highly skilled Water Polo players. Maximal hand grip is related with throwing velocity in "throwing with goalkeeper" situation. More investigations about water polo are necessary.

[Primary lung paraganglioma. A case report]

Primary lung paragangliomas are rare. They are 1-2% of the paragangliomas, and most of them occur in patients of 43-61 years. They clinically appear as solitary tumors and are in general asymptomatic. These tumors show a nesting pattern (Zellballen) of chief polygonal cells locked by fibrovascular trabeculae with subtenticular cells. The main cells have uniform nuclei with granular eosinophilic cytoplasm, and they are positive for neuroendocrinal markers (Neuron Specific Enolase, sinaptofisine and cromogranine A). Sustentacular cells are positive for protein S-100 and neurofibrilar protein. A differential diagnosis with the carcinoid tumor can be very difficult. The surgical treatment is mandatory , specially high blood pressure and the chances of malignization.

Pathogenesis of haemophilic synovitis: experimental studies on blood-induced joint damage

Hemarthrosis is a common manifestation of haemophilia, and joint arthropathy remains a frequent complication. Even though the exact mechanisms related to blood-induced joint disease have not yet been fully elucidated, it is likely that iron deposition in the synovium induces an inflammatory response that causes not only immune system activation but also stimulates angiogenesis. This process ultimately results in cartilage and bone destruction. Investigating the processes that occur in the early stages of blood-induced joint disease in humans has been very limited. Therefore, the use of haemophilic animal models is critical to augment the understanding of this phenomenon. This article discusses three cellular regulators (p53, p21 and TRAIL) induced in synovial tissue that are important for iron metabolism. A cartilage remodelling programme induced by the release of cytokines and growth factors that result in articular damage is also discussed. Full elucidation of the pathogenesis of haemophilic joint disease is required to identify new avenues for prevention and therapy.

[Small intestinal plasmacytoid lymphoma. Clinical presentation with acute abdominal pain]

Primary tumors of the small intestine are rare; 15-20% of the cases are extranodal lymphomas from B or T cells. Higher Incidence occurs in patients between 21 and 50 years. The clinical symptoms are pain, intestinal obstruction, diarrhea, bleeding or perforated peritonitis. In high-grade lymphomas, the cells are large and pleomorphic, with immunoblastic and plasmacytoid features, and immunopositive for alpha chain immunoglobulins. We reported the case of a 56-year-old patient presented with abdominal pain associated with intestinal perforation. Resections of a 9-centimetres-long segment in the small intestine was performed, which was covered by purulent plaques, with a perforation of 5 mm, surrounded by a greyish-white thick intestinal wall. It can be observed in the microscopy a proliferation of neoplastic cells arranged diffusely and with frequent mitosis. Large areas of immunoblastic and plasmacytoid configuration were evident. The immunomarcation was consistent with a lymphoma of large cells, immunophenotype B, with plasmacytoid development. We highlighted the clinical presentation like acute abdominal pain and its clinical and pathological characteristics, especially in the plasmacytoid development that should differ of the true plasmocytoma.