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Menegatti M, Peyvandi F. Clinical, Laboratory Aspects and Management of Factor X Deficiency. Semin Thromb Hemost 2024. [PMID: 39209291 DOI: 10.1055/s-0044-1789595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Coagulation factor X (FX), originally named Stuart-Prower factor, plays a pivotal role in the coagulation cascade, activating thrombin to promote platelet plug formation and prevent excess blood loss. Genetic variants in F10 may lead to FX deficiency and to impaired coagulation. FX variants are phenotypically classified as being type I, with the concomitant reduction of FX coagulant activity and FX antigen levels or type II, corresponding to a reduction in activity with normal antigen plasma levels. Patients affected with FX deficiency tend to be one of the most seriously affected among those with rare bleeding disorders. They show a variable bleeding tendency strongly associated with FX coagulant activity levels in plasma and may present, in the severe form of the deficiency, life-threatening symptoms such as gastrointestinal and umbilical stump bleeding and intracranial hemorrhages or central nervous system bleeding. Treatment of FX deficiency was originally based on the replacement of the missing factor using fresh frozen plasma, cryoprecipitate and prothrombin complex concentrates; however, a plasma-derived concentrate, shown to be safe and effective in clinical trials, is now available. In addition, novel nonreplacement therapy such as small interference RNA, gene therapy, drug repurposing, and gene editing may also represent novel therapeutic approaches for FX deficiency, but further, much focused studies are needed before considering this emerging therapy in such patients.
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Affiliation(s)
- Marzia Menegatti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Peyvandi F, Auerswald G, Austin SK, Liesner R, Kavakli K, Álvarez Román MT, Millar CM. Diagnosis, therapeutic advances, and key recommendations for the management of factor X deficiency. Blood Rev 2021; 50:100833. [PMID: 34024682 DOI: 10.1016/j.blre.2021.100833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022]
Abstract
Factor X deficiency is a rare coagulation disorder that can be hereditary or acquired. The typology and severity of the associated bleeding symptoms are highly heterogeneous, adding to the difficulties of diagnosis and management. Evidence-based guidelines and reviews on factor X deficiency are generally limited to publications covering a range of rare bleeding disorders. Here we provide a comprehensive review of the literature on factor X deficiency, focusing on the hereditary form, and discuss the evolution in disease management and the evidence associated with available treatment options. Current recommendations advise clinicians to use single-factor replacement therapy for hereditary disease rather than multifactor therapies such as fresh frozen plasma, cryoprecipitate, and prothrombin complex concentrates. Consensus in treatment guidelines is still urgently needed to ensure optimal management of patients with factor X deficiency across the spectrum of disease severity.
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Affiliation(s)
- Flora Peyvandi
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy.
| | - Guenter Auerswald
- Klinikum Bremen-Mitte, Professor Hess Children's Hospital, Bremen, Germany.
| | - Steven K Austin
- St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Ri Liesner
- Haemophilia Comprehensive Care Centre/NIHR GOSH BRC, Great Ormond Street Hospital for Children NHS Trust, London, UK.
| | - Kaan Kavakli
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Hematology, Izmir, Turkey.
| | | | - Carolyn M Millar
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK.
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Argyrou A, Valsami S, Pouliakis A, Gavalaki M, Aggelidis A, Voulgaridou V, Pliatsika V, Adraktas T, Papachronis A, Alepi C, Giannopoulou V, Siourounis P, Tsagia S, Martinis G, Kontekaki E, Zervou E, Koliofotis S, Kyriakou E, Mougiou A, Dimitra L, Chairopoulou A, Tsakania A, Baka M, Apostolidou I, Moschandreou D, Livada A, Politou M, Roussinou F, Pappa C, Koika V, Vgontza N, Gafou A, Dendrinou I, Sakellaridi F, Labrianou L, Alexandropoulou Z, Sochali V, Malekas K, Skordilaki A, Kakava G, Lebesopoulos K, Stamoulis K, Grouzi E. Current Practice in FFP Preparation and Use in Greece: A National Survey. Turk J Haematol 2021; 38:22-32. [PMID: 33233876 PMCID: PMC7927442 DOI: 10.4274/tjh.galenos.2020.2020.0241] [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] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/18/2020] [Indexed: 12/01/2022] Open
Abstract
Objective Fresh frozen plasma (FFP) transfusion is widely used in modern clinical settings. Practices regarding its use vary due to lack of guidelines from randomized trials. The aim of this study was to assess both the current practices regarding FFP production, use, and wastage and the implementation of quality control (QC), female donor plasma production policies, and use of pharmaceutical hemostatic agents in Greece. Materials and Methods The study was conducted during February-April 2018. For the first part of the study, data including FFP transfusion indication, hospital department, diagnosis, FFP units/transfusion episode, ABO compatibility, blood donor’s sex, and reasons for discarding were collected. For the second part, questionnaire data were analyzed. Results According to data from 20 Greek hospitals, 12655 FFP units were transfused to 2700 patients during 5069 transfusion episodes in the studied period of time. Most patients were hospitalized in internal medicine, general surgery, and intensive care unit departments. Each patient received on average 4.69 units (2.5 units/episode). Transfusion requests were in accordance with international guidelines in 63.44% of cases and 99.04% of the units were given to ABO-identical patients. Main reasons for discarding included failure to meet quality requirements (30.06%), female donors (22.17%), and other causes (27.26%). Among 96.9% of all transfusion services across the country, 28.26% perform QC according to the directions of the European Directorate for the Quality of Medicines & Health Care and 68.83% discard plasma from female donors. Pharmaceutic hemostatic agents are used in 37.23% of the hospitals. Conclusion This is the first national survey regarding FFP production and transfusion in Greece. Staff of internal medicine, general surgery, and ICU departments, where most FFP-transfused patients are hospitalized, should be regularly involved in training on contemporary transfusion guidelines. Upcoming centralization of FFP production and inventory management could help in homogenizing practices regarding FFP use and improve product quality. Strengthening the use of pharmaceutic hemostatic agents could improve patients’ management.
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Affiliation(s)
- Aspasia Argyrou
- These authors contributed equally to this work
- Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
| | - Serena Valsami
- These authors contributed equally to this work
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Abraham Pouliakis
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Maria Gavalaki
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Antonis Aggelidis
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Vasiliki Voulgaridou
- AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
| | - Vasiliki Pliatsika
- AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
| | - Theofanis Adraktas
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Andreas Papachronis
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Chrysoula Alepi
- General Hospital Tzaneio, Department of Blood Transfusion, Piraeus, Greece
| | | | - Panagiotis Siourounis
- Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
| | - Sofia Tsagia
- Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
| | - Georges Martinis
- University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
| | - Eftihia Kontekaki
- University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
| | - Eleftheria Zervou
- University Hospital, Department of Blood Transfusion, Ioannina, Greece
| | - Spiridon Koliofotis
- Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
| | - Elias Kyriakou
- Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
| | - Athina Mougiou
- University Hospital, Blood Transfusion Center, Patras, Greece
| | | | | | - Aggeliki Tsakania
- Sismanogleio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Maria Baka
- Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Ioanna Apostolidou
- Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Dimitra Moschandreou
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| | - Anastasia Livada
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| | - Marianna Politou
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Fragoula Roussinou
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Christina Pappa
- General Hospital, Department of Blood Transfusion, Korinthos, Greece
| | - Vasiliki Koika
- General Hospital, Department of Blood Transfusion, Korinthos, Greece
| | - Niki Vgontza
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Anthippi Gafou
- Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
| | - Ioanna Dendrinou
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | | | | | | | - Vasiliki Sochali
- General Hospital, Department of Blood Transfusion, Giannitsa, Greece
| | - Kostas Malekas
- General Hospital, Department of Blood Transfusion, Livadia, Greece
| | - Areti Skordilaki
- General Hospital, Department of Blood Transfusion, Chania, Greece
| | - Georgia Kakava
- Pammakaristos General Hospital, Department of Blood Transfusion, Athens, Greece
| | | | | | - Elisavet Grouzi
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
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