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Baglo T, Zohoun A, Mohamed FA, Araba F, Houssou B, Anani L, Kindé-Gazard D, Fall AT, Ryman A, Gruel Y, Pouplard C. Bioclinical features of haemophilia patients in Benin in 2023: Towards better care. Haemophilia 2024. [PMID: 39118287 DOI: 10.1111/hae.15082] [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: 01/08/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To analyse the demographic, clinical and laboratory data of Beninese patients with haemophilia. METHOD A prospective survey was conducted in three different hospitals of Benin from April 2021 to March 2022, to analyse clinical and biological features of patients with haemophilia previously diagnosed or identified based on personal/family history. RESULTS A total of 101 patients were studied, 97 with haemophilia A and 4 with haemophilia B, including 26 new cases identified after family investigation. Their median age was 11 years, and the most frequent initial manifestations were cutaneous-mucosal haemorrhages (29.70%) and post-circumcision haemorrhages (25.74%). Previous joint bleedings were present in 77% of them, with an arthropathy in 65 cases, which particularly affected the knees (75%), elbows (41%) and ankles (29%). Factor VIII (FVIII) levels combined with activated partial thromboplastin time (APTT) values did not always enable, as would be expected, the distinction between severe and moderate haemophilia, since they were >1 IU/dl in 31 of 74 patients with APTT > 80 s, and between 1 and 2 IU/dl in 26 other cases with previous joint haemorrhages, including 18 with chronic arthropathy. Therefore, for these patients, severe haemophilia could not be excluded, and this uncertainty probably reflects technical difficulties affecting the pre-analytical and analytical stages of the APTT and FVIII/IX assays. CONCLUSION Our study proved that haemophilia is a significant reality in Benin, but also remains under-diagnosed in some districts of the country. In addition, more reliable biological tests are needed in the future to better define the severity of the disease and improve treatment of patients.
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Affiliation(s)
- Tatiana Baglo
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Alban Zohoun
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | | | - Ferrelle Araba
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
| | - Bienvenu Houssou
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
| | - Ludovic Anani
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Dorothée Kindé-Gazard
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Awa Touré Fall
- Haematology laboratory, Aritide le Dantec Hospital, Dakar, Senegal
- Pharmacy and Odontostomatology, Faculty of Medicine, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Anne Ryman
- Laboratory of Hematology, Bordeaux University Hospital, Pessac, France
| | - Yves Gruel
- University of Tours, Inserm U1327, ISCHEMIA, Tours, France
| | - Claire Pouplard
- University of Tours, Inserm U1327, ISCHEMIA, Tours, France
- Department of Haemostasis, University Hospital of Tours, Tours, France
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Español MG, Mistretta JN, Tarantino MD, Roberts JC. The Evolution of Hemophilia Therapeutics: An Illustrated Review. Res Pract Thromb Haemost 2024; 8:102308. [PMID: 38883215 PMCID: PMC11180375 DOI: 10.1016/j.rpth.2023.102308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 06/18/2024] Open
Abstract
Hemophilia is a rare genetic bleeding disorder historically associated with high morbidity and mortality. Some individuals with hemophilia suffer associated chronic joint disease, chronic pain, and other physical and mental health challenges. In the last 50 years, a better understanding of the pathophysiology of the disease has resulted in extraordinary therapeutic advances leading to enhanced quality of life and increased life expectancy. We present an illustrated review of the evolution of hemophilia treatment from the development of non-factor therapies to gene therapy.
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Affiliation(s)
- María G Español
- The Bleeding & Clotting Disorders Institute, Peoria, IL
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
| | | | - Michael D Tarantino
- The Bleeding & Clotting Disorders Institute, Peoria, IL
- Department of Pediatrics and Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Jonathan C Roberts
- The Bleeding & Clotting Disorders Institute, Peoria, IL
- Department of Pediatrics and Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL
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Abdelgawad HAH, Foster R, Otto M. Nothing short of a revolution: Novel extended half-life factor VIII replacement products and non-replacement agents reshape the treatment landscape in hemophilia A. Blood Rev 2024; 64:101164. [PMID: 38216442 DOI: 10.1016/j.blre.2023.101164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
Hemophilia A, an X-linked genetic disorder, is characterized by a deficiency or dysfunction of clotting Factor VIII. The treatment landscape has substantially changed by introducing novel extended half-life factor VIII (EHL-FVIII) replacement therapies such as efanesoctocog Alfa and non-factor replacement therapy such as emicizumab. These agents signal a shift from treatments requiring multiple weekly infusions to advanced therapies with long half-lives, offering superior protection against bleeding and improving patient adherence and quality of life. While EHL-FVIII treatment might lead to inhibitor development in some patients, non-factor replacement therapy carries thrombotic risks. Therefore, ongoing research and the generation of robust clinical evidence remain vital to guide the selection of optimal and cost-effective first-line therapies for hemophilia A patients.
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Affiliation(s)
- Hussien Ahmed H Abdelgawad
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
| | - Rachel Foster
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Mario Otto
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
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Nekkal MS, Mesli N, Grifi F, Cherif N, Ouchenane Z, Bettayeb MS. Haemophilia B in Algeria: Realities and therapeutic perspectives. Haemophilia 2023; 29:1176-1183. [PMID: 37467156 DOI: 10.1111/hae.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Haemophilia B is a debilitating hereditary coagulation disorder characterized by prolonged or spontaneous episodes of bleeding caused by a deficiency of endogenous factor IX. In Algeria, even though many studies are being carried out to evaluate the prevalence and management of haemophilia B, there is a paucity of locally published literature that can be used to understand the most recent information on the disease's epidemiology, diagnostic techniques and treatment options. AIMS The aim of this manuscript is to raise awareness among patients and family clinicians about current practices, recent developments and unmet needs related to haemophilia B in Algeria. METHODS A comprehensive literature search was conducted through online scientific databases to review publications regarding haemophilia B in Algeria. Exclusions of the review include case studies, interregional comparisons, abstract-only papers and studies outside the range of 2012-2022. RESULTS The findings discussed relate to the epidemiology of haemophilia B in Algeria, the clinical diagnostic process, disease symptoms, the benefits of molecular and genetic testing, advancements in prophylactic care, as well as unmet needs hindering the progression of optimal haemophilia B management. CONCLUSION These findings are crucial to encourage the maintenance of national registries with updated epidemiological data, facilitate early and timely detection of disease symptoms, improve the provision of diagnostic facilities and enhance the overall treatment landscape for better patient outcomes.
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Affiliation(s)
| | - Naima Mesli
- Dr Tidjani Damerdji University Hospital, Tlemcen, Algeria
| | | | | | - Zohra Ouchenane
- Constantine Dr Benbadis University Hospital, Constantine, Algeria
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Touré SA, Seck M, Sy D, Senghor AB, Faye BF, Diop S. Clinical outcome and incidence of inhibitor development in severe hemophilia patients receiving low-dose prophylaxis: a 3-year follow-up study in Senegal, West Africa. Hematol Transfus Cell Ther 2023; 45 Suppl 2:S95-S100. [PMID: 35606318 PMCID: PMC10433309 DOI: 10.1016/j.htct.2022.04.004] [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: 09/30/2021] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION In Africa, where access to diagnosis and treatment of hemophilia is the lowest in the world, prophylaxis is rarely used in preference to on-demand treatment. There are limited data of prophylaxis treatment from sub-Saharan Africa. The aim of this study was to evaluate clinical outcomes and inhibitor development in people with hemophilia receiving low-dose prophylaxis (LDP) in a sub-Saharan African setting. METHODS We conducted a three-year prospective study. A once or twice weekly prophylaxis regimen of 25 IU/kg of rFVIIIFc or 30 IU/kg of rFIXFc was given to Hemophilia A and B, respectively. We evaluated clinical outcomes and inhibitors occurrence, determined by screening and titration using the Nijmegen technique. RESULTS A total of 15 patients were included in the LDP regimen. The mean age was 6.3 years (1.5 - 10). A significant reduction was noted in the annualized bleeding rate, from 7.53 to 1.33 (p = 0.0001); the annualized joint bleeding rate passed from 3.6 to 1.4 (p = 0.001) and the proportion of severe bleeding, from 86.1% to 16.7% (p = 0.0001). The Hemophilia Joint Health Score (HJHS) moved from 9.6 to 3.4 (p = 0.0001) and the Functional Independence Score in Hemophilia (FISH) improved from 25.8 to 30.9 (p = 0.0001). School absenteeism decreased from 7.33% to 2.59%. Adherence to prophylaxis was 89.5% versus 60%. Consumption was 580 IU/kg/year versus 1254.6 IU/kg/year before and after prophylaxis, respectively. Incidence of inhibitors was 23% (3 /13 HA). CONCLUSION The LDP in Hemophilia improves the clinical outcome without a surplus risk of inhibitor development. Using extended half-life clotting factor concentrates (CFCs) is better for prophylaxis in resource-limited countries, as they allow better compliance in treatment.
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Affiliation(s)
- Sokhna Aïssatou Touré
- Cheikh Anta Diop University, Dakar, Senegal; National Blood Transfusion Center, Dakar, Senegal.
| | - Moussa Seck
- Cheikh Anta Diop University, Dakar, Senegal; National Blood Transfusion Center, Dakar, Senegal
| | - Diariatou Sy
- National Blood Transfusion Center, Dakar, Senegal
| | | | - Blaise Felix Faye
- Cheikh Anta Diop University, Dakar, Senegal; National Blood Transfusion Center, Dakar, Senegal
| | - Saliou Diop
- Cheikh Anta Diop University, Dakar, Senegal; National Blood Transfusion Center, Dakar, Senegal
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Ndoumba-Mintya A, Diallo YL, Tayou TC, Mbanya DN. Optimizing Haemophilia Care in Resource-Limited Countries: Current Challenges and Future Prospects. J Blood Med 2023; 14:141-146. [PMID: 36846349 PMCID: PMC9951595 DOI: 10.2147/jbm.s291536] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
About 75% of persons with hemophilia live in the developing world and do not have access to routine care due to many barriers. There are a lot of challenges associated with hemophilia care in resource-limited settings, ranging from financial to organisational and government commitments. This review discusses some of these challenges and future prospects, while highlighting the important role of the World Federation of Hemophilia in hemophilia patient care. A participative approach involving all stakeholders is key to optimizing care in resource-limited settings.
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Affiliation(s)
- Annick Ndoumba-Mintya
- Hematology & Transfusion Service, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | | | - Tagny C Tayou
- Hematology & Transfusion Service, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Dora N Mbanya
- Hematology & Transfusion Service, Yaoundé University Teaching Hospital, Yaoundé, Cameroon,Correspondence: Dora N Mbanya, Centre Hospitalier et Universitaire, B.P. 8046, Yaoundé, Cameroon, Tel +237 677607037, Email
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Touré SA, Seck M, Sy D, Bousso ES, Faye BF, Diop S. Life-threatening bleeding in patients with hemophilia (PWH): a 10-year cohort study in Dakar, Senegal. Hematology 2022; 27:379-383. [DOI: 10.1080/16078454.2022.2047286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sokhna Aïssatou Touré
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Moussa Seck
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Diariatou Sy
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Elimane Seydi Bousso
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Blaise Felix Faye
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Saliou Diop
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
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