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Teng WJ, Kung CH, Cheng MM, Tsai JR, Chang CY. Intramural Hematoma of Gastrointestinal Tract in People with Hemophilia A and B. J Clin Med 2023; 12:jcm12093093. [PMID: 37176534 PMCID: PMC10179287 DOI: 10.3390/jcm12093093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
People with hemophilia (PWH), especially severe hemophilia, often experience bleeding episodes, which occur mostly at major joints. Intramural hematoma of the gastrointestinal (GI) tract is a rare, potentially life-threatening clinical bleeding manifestation in PWH. Prompt identification and timely administration of clotting factor concentrates are of utmost importance for effective management and optimal patient outcomes. In this report, we present the case of a 48-year-old male with severe hemophilia A. The patient developed a spontaneous intramural hematoma of the jejunum, leading to signs of acute abdomen, bloody stool, and paralytic ileus. Conservative management with factor VIII (FVIII) infusion was successfully administered. However, within a span of three months, the patient suffered from a recurrent episode of intramural hematoma, which was again effectively treated with conservative therapy. Subsequently, prophylactic FVIII therapy was administered to the patient, resulting in the absence of recurrence for over three years. Inspired by this case, we conducted a comprehensive review of the relevant literature and gathered data from 79 reported cases of intramural hematoma that were documented between the years 1956 and 2022. We classified these cases based on the site affected within the gastrointestinal (GI) tract (spread across five different locations) and proceeded to conduct a simple pooling analysis on the data collected, which subsequently revealed that the overall mortality rate of intramural hematoma in people with hemophilia (PWH) was found to be 12.2%, while children have a higher mortality rate (23.3%) than adults (4.9%). We hope this case report and literature review increase awareness of this rare bleeding manifestation in PWH, the effectiveness of conservative treatment, and the possibility of prophylaxis against recurrence.
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Affiliation(s)
- Wei-Jung Teng
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Ching-Huei Kung
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei City 110, Taiwan
| | - Mei-Mei Cheng
- Division of Pediatric Gastroenterology, Department of Pediatrics, Cheng Hsin General Hospital, Taipei City 112, Taiwan
| | - Jia-Ruey Tsai
- Department of Hematology and Oncology, Taipei Medical University Hospital, Taipei City 110301, Taiwan
- Hemophilia Center, Taipei Medical University Hospital, Taipei City 110301, Taiwan
| | - Chia-Yau Chang
- Hemophilia Center, Taipei Medical University Hospital, Taipei City 110301, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Medical University Hospital, Taipei City 110301, Taiwan
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Matuk-Villazon O, Roberts JC, Corrales-Medina FF. Hemophilia: The Past, the Present, and the Future. Pediatr Rev 2021; 42:672-683. [PMID: 34850178 DOI: 10.1542/pir.2020-004143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Omar Matuk-Villazon
- Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX
| | - Jonathan C Roberts
- Bleeding & Clotting Disorders Institute, Peoria, IL.,Division of Hematology, Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Fernando F Corrales-Medina
- Holtz Children's Hospital, Jackson Memorial Medical Center, Miami, FL.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL.,University of Miami Hemophilia Treatment Center, Miami, FL
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Hemophilia A Complicated by Ulcerative Colitis. Case Rep Gastrointest Med 2018; 2018:2342618. [PMID: 30298109 PMCID: PMC6142740 DOI: 10.1155/2018/2342618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/16/2018] [Indexed: 11/26/2022] Open
Abstract
Background Hemophilia A is an X-linked recessive disorder characterized by defective synthesis of Factor VIII protein. Depending on the level of FVIII activity, patients may present with easy bruising, inadequate clotting of traumatic or mild injury, or in severe hemophilia, spontaneous hemorrhage. Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is reported to have a decreased frequency of occurrence in subjects with coagulation disorders. Case A 26-year-old white male with Hemophilia A was admitted for one month of rectal bleeding. The bleeding continued despite Factor VIII replacement and colonoscopy and biopsy were performed confirming the presence of active UC. Conclusion Ulcerative colitis with underlying F VIII deficiency can result in serious, prolonged, and possibly fatal bleeding if left unrecognized and untreated. Treatment of both conditions concurrently utilizing tertiary facilities and consultations appears to be the safest strategy for management.
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Chai-Adisaksopha C, Skinner MW, Curtis R, Frick N, Nichol MB, Noone D, O'Mahony B, Page D, Stonebraker J, Thabane L, Crowther M, Iorio A. Psychometric properties of the Patient Reported Outcomes, Burdens and Experiences (PROBE) questionnaire. BMJ Open 2018; 8:e021900. [PMID: 30093520 PMCID: PMC6089314 DOI: 10.1136/bmjopen-2018-021900] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess the psychometric properties of the Patient Reported Outcomes, Burdens and Experiences (PROBE) questionnaire. METHODS This study was a cross-sectional, multinational study. Participants were enrolled if they were more than 10 years old and people with haemophilia A or B or people without a bleeding disorder. Participants were invited through non-governmental patient organisations in 21 countries between 01/27/2016 and 02/23/2017. The following psychometric properties: missing data, floor and ceiling effects, exploratory factor analysis and internal consistency reliability were examined. A PROBE Score was derived and assessed for its convergent and known groups validity. RESULTS The study analysed the data on 916 participants with median age of 37.0 (IQR 27.0 to 48.0) years, 74.8% male. In the domain assessing patient-reported outcomes (PROs), more than 15% of participants presented a ceiling effect for all items but two, and a floor effect for one item. Factor analysis identified three factors explaining the majority of the variance. Cronbach's alpha coefficient indicated good internal consistency reliability (0.84). PROBE items showed moderate to strong correlations with corresponding EuroQol five dimension 5-level instrument (EQ-5D-5L) domains. The PROBE Score has a strong correlation (r=0.67) with EQ-5D-5L utility index score. The PROBE Score has a known groups validity among various groups. CONCLUSIONS The results of this study suggest that PROBE is a valid questionnaire for evaluating PROs in people with haemophilia as well as control population. The known-group property of PROBE will allow its use in future clinical trials, longitudinal studies, health technology assessment studies, routine clinical care or registries. Additional studies are needed to test responsiveness and sensitivity to change. TRIAL REGISTRATION NUMBER NCT02439710; Results.
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Affiliation(s)
- Chatree Chai-Adisaksopha
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mark W Skinner
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute for Policy Advancement Ltd, Washington, District of Columbia, USA
| | | | - Neil Frick
- Research and Medical Information, National Hemophilia Foundation, New York City, New York, USA
| | - Michael B Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | | | - Brian O'Mahony
- Irish Haemophilia Society, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - David Page
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Jeffrey Stonebraker
- Poole College of Management, North Carolina State University, Raleigh, North Carolina, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alfonso Iorio
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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He JP, Feng JX. Two-incision laparoscopic appendectomy for a severe hemophilia A child patient with coagulation factor VII deficiency: Case report and review of literature. Medicine (Baltimore) 2017; 96:e8197. [PMID: 29019885 PMCID: PMC5662308 DOI: 10.1097/md.0000000000008197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time. PATIENT CONCERNS An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting. DIAGNOSES He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency. INTERVENTIONS Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy. OUTCOMES The patient had an uneventful recovery. LESSONS It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment.
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Janic D, Smoljanic Z, Krstovski N, Dokmanovic L, Rodic P. Ruptured intramural intestinal hematoma in an adolescent patient with severe hemophilia A. Int J Hematol 2009; 89:201-203. [PMID: 19132458 DOI: 10.1007/s12185-008-0236-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 11/17/2008] [Accepted: 11/20/2008] [Indexed: 11/24/2022]
Abstract
We report on a 17-year-old patient with severe hemophilia A without inhibitors who developed abdominal bleeding after an episode of severe cough. Abdominal ultrasound showed intramural intestinal hematoma as well as large amount of peritoneal fluid appearing as blood and right hematocele. Abdominal CT revealed markedly thickened intestinal wall in sigmoidal region. Patient was managed with replacement therapy as well as peritoneal drainage with favorable outcome. This is the first report on a hematoperitoneum in a hemophiliac due to ruptured intramural sigmoidal hematoma.
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Affiliation(s)
- Dragana Janic
- Department of Hematology/Oncology, University Children's Hospital, Tirsova 10, 11000, Belgrade, Serbia
| | - Zeljko Smoljanic
- Department of Radiology, University Children's Hospital, Belgrade, Serbia
| | - Nada Krstovski
- Department of Hematology/Oncology, University Children's Hospital, Tirsova 10, 11000, Belgrade, Serbia
| | - Lidija Dokmanovic
- Department of Hematology/Oncology, University Children's Hospital, Tirsova 10, 11000, Belgrade, Serbia
| | - Predrag Rodic
- Department of Hematology/Oncology, University Children's Hospital, Tirsova 10, 11000, Belgrade, Serbia.
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Panagoulias G, Tentolouris N, Ladas SS. Abdominal pain in an adult with Type 2 diabetes: A case report. CASES JOURNAL 2008; 1:154. [PMID: 18798976 PMCID: PMC2556666 DOI: 10.1186/1757-1626-1-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 09/17/2008] [Indexed: 11/10/2022]
Abstract
Introduction Chronic abdominal pain (CAP) may be a manifestation of diseases involving many intra-abdominal organs. Beside diseases affecting subjects without diabetes mellitus, diabetic patients may have CAP due to diabetes-related complications like neuritis, motor diseases of the gastrointestinal tract and autonomic dysfunction. Atherosclerosis is 2–4 times more common in patients with diabetes and affects mainly carotid, coronary, iliac and lower limb arteries as well as aorta. Another less common complication is chronic mesenteric ischemia (CMI, intestinal angina), caused by atherosclerotic obstruction of the celiac artery and its branches and results in episodic or constant intestinal hypoperfusion. Case presentation We present a case of a diabetic patient with CMI in whom the diagnosis was delayed by almost 5 years. The dominant symptoms were crampy abdominal postprandial pain, anorexia, changes in bowel habits and cachexia. Conventional angiography revealed significant stenosis of the celiac artery and complete obstruction of the inferior mesenteric artery. Noteworthy, no significant stenoses in carotids or limbs' arteries were found. Revascularization resulted in clinical improvement 1 week post-intervention. Conclusion CAP in patients with diabetes may be due to CMI. The typical presentation is crampy postprandial abdominal pain in a heavy smoker male patient with long-standing diabetes, accompanied by anorexia, changes in bowel habits and mild to moderate weight loss. At least two of the three main splanchnic arteries must be significantly occluded in order CMI to be symptomatic. The diagnostic procedure of choice is conventional angiography and revascularization of the occluded arteries is the radical treatment.
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Mainwaring CJ, Pleydell-Pearce J, Chana J, Evans J, Roy A, Lewis H. An unusual complication of ice skating and the emergence of a previously undiagnosed bleeding disorder. Haemophilia 2006; 12:551-4. [PMID: 16919089 DOI: 10.1111/j.1365-2516.2006.01309.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report the case of an 8-year-old boy with no prior abnormal bleeding history who presented with severe central abdominal pain following a freak accident at a local ice rink. Clinical examination confirmed a tender periumbilical mass. An ultrasound scan confirmed a large haemorrhagic fluid collection adjacent to the second part of his duodenum that was causing a subacute small-bowel obstruction. He was found to have a persistently prolonged prothrombin time between 17.3 and 18.1 s but normal liver function tests. There was no suggestion of dietary vitamin K deficiency. Further investigations confirmed factor VII deficiency with levels between 30.4 and 33.6 IU dL-1. His prothrombin time did not normalize with intravenous vitamin K. He was subsequently treated with three 30 microg kg-1 body weight doses of novoseven at 4-h interval and made an excellent recovery. The haematoma virtually resolved completely confirmed by a follow-up ultrasound scan 3 months after the initial event.
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Nakayama Y, Fukushima M, Sakai M, Hisano T, Nagata N, Shirahata A, Itoh H. Intramural Hematoma of the Cecum as the Lead Point of Intussusception in an Elderly Patient with Hemophilia A: Report of a Case. Surg Today 2006; 36:563-5. [PMID: 16715431 DOI: 10.1007/s00595-006-3185-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Accepted: 11/15/2005] [Indexed: 11/29/2022]
Abstract
Hemophilia A is a congenital bleeding disorder characterized by a deficiency of coagulation factor VIII. Intramural hematoma of the colon is a very rare complication of this disease. We report a case of intramural hematoma of the cecum serving as the lead point of intussusception in a 65-year-old man with hemophilia A. The patient presented with right-sided abdominal pain and bloody stool. Palpation of his abdomen revealed a fist-sized mass. Abdominal computed tomography (CT) showed a circular mass with concentric rings, consistent with an intussuscepted intestine. Because his activated partial thromboplastin time (APTT) was prolonged, we gave him a continuous infusion of factor VIII during and after surgery. Laparotomy revealed an irreducible colo-colic intussusception and we identified a cecal hematoma as the lead point. After an unsuccessful attempt at Hutchinson's maneuver, we performed right colectomy. We report this case to illustrate the necessity of monitoring APTT in patients with hemophilia A who undergo surgery.
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Affiliation(s)
- Yoshifumi Nakayama
- Department of Surgery 1, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kita-kyushu, 807-8555, Japan
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Ramadan KMA, Lowry JP, Wilkinson A, McNulty O, McMullin MF, Jones FGC. Acute intestinal obstruction due to intramural haemorrhage in small intestine in a patient with severe haemophilia A and inhibitor. Eur J Haematol 2005; 75:164-6. [PMID: 16000133 DOI: 10.1111/j.1600-0609.2005.00445.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with severe haemophilia A usually present with joint, gastrointestinal and urinary tract haemorrhage. Bleeding elsewhere is often precipitated by pre-existing pathology or trauma. We report a patient with severe haemophilia A, who presented with symptoms of acute intestinal obstruction. He has a factor VIII inhibitor and receives recombinant factor VIIa on demand at home. The CT scan of abdomen showed dilated small intestine with fluid filled loops and a long segment in the jejunum with marked transmural thickening. There was no other pathology in the small intestine. These appearances were consistent with intramural haemorrhage in the small intestine as the cause of acute obstruction. He was managed conservatively with recombinant factor VIIa and this resulted in resolution of his symptoms. This case highlights an unusual presentation of bleeding in a haemophilia patient. Intestinal obstruction due to haemorrhage in the small intestinal wall is extremely rare and only previously reported in a few haemophilia patients. It also highlights the effectiveness of conservative management with recombinant factor VIIa as opposed to immediate exploratory surgery.
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Affiliation(s)
- Khaled M A Ramadan
- Haemophilia Centre in Northern Ireland, Belfast City Hospital, Belfast, UK.
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Abstract
Musculoskeletal dysfunction is a common manifestation of haemophilia. This dysfunction may be associated with imbalances between muscle groups. Evidence emerging from the literature suggests that the rehabilitation of this dysfunction is very relevant for the patient with musculoskeletal problems. Treatment of muscle imbalance may be linked with a reduction in recurrence of symptoms. Further research is needed to establish the relevance of this area in patients with haemophilia but the clinical evidence supports the developing work in this field.
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Affiliation(s)
- K Beeton
- Department of Physiotherapy, University of Hertfordshire, UK.
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