Inherited coagulation disorders in Turkish children: A retrospective, single-center cohort study

Clinicopathological Parameters of Haemophilia Patients at a Tertiary Care Centre in Northern India

INTRODUCTION

Haemophilia affects a large number of people all over the world, yet very little is known about the clinical manifestations and diagnostic protocols of the condition in areas with limited access to resources in developing countries. Understanding the clinical spectrum and diagnostic approach will help with the design of measures to address the situation in these places. The primary objective of this study was to examine the clinicopathological parameters of haemophiliac patients.

MATERIALS AND METHODS

From the departmental archive, a thorough history of each patient was retrieved, including values of bleeding time, prothrombin time, activated partial prothrombin time, and percentage of specific factor activity.

RESULTS

Out of a total of 385 cases over the period of six years, 86.75% were classified as haemophilia A and 13.25% of cases were diagnosed as haemophilia B. In terms of the severity of the disease, 44.93% were classified as severe, 42.08% as moderate, and 12.99% as mild. Joint bleeding was the first and most typical clinical manifestation of the disease, accounting for 34.80% of cases, followed by ecchymosis (23.12%), post-traumatic bleeding (12.73%), epistaxis (12.20%), and gum bleeding (8.05%). 1.56% of patients had a positive screening test for the hepatitis C virus, followed by 1.30% for HIV and 0.78% for hepatitis B surface antigen.

CONCLUSION

In the presence of joint bleeding, ecchymosis, and post-traumatic bleeding in an otherwise healthy individual, a clinician should be alerted to the possibility that the patient has haemophilia and should request a work-up for the bleeding disorder.

Von Willebrand Disease Epidemiology, Burden of Illness and Management: A Systematic Review

Introduction

Although hereditary von Willebrand disease (VWD) is the most common bleeding disorder, its epidemiology is not well understood. A systematic review (PROSPERO CRD42020197674/CRD42021244374) on the epidemiology/burden of illness of VWD was conducted to better understand patients' unmet needs.

Methods

Observational studies (published January 1, 2010 to April 14, 2021) were identified in MEDLINE and Embase databases, using free-text keywords and thesaurus terms for VWD and outcomes of interest. Pragmatic web-based searches of the gray literature, including conference abstracts, were performed, and reference lists of retained publications were manually searched for additional sources. Case reports and clinical trials (phase 1-3) were excluded. Outcomes of interest were incidence, prevalence, mortality, patient characteristics, burden of illness, and therapeutic management/treatments currently used for VWD.

Results

Of the 3095 identified sources, 168 were included in this systematic review. Reported VWD prevalence (22 sources) ranged from 108.9 to 2200 per 100,000 in population-based studies and from 0.3 to 16.5 per 100,000 in referral-based studies. Reported times between first symptom onset and diagnosis (two sources; mean 669 days; median 3 years) highlighted gaps in timely VWD diagnosis. Bleeding events reported in 72-94% of the patients with VWD (all types; 27 sources) were mostly mucocutaneous including epistaxis, menorrhagia, and oral/gum bleeding. Poorer health-related quality of life (three sources) and greater health care resource utilization (three sources) were reported for patients with VWD than in general populations.

Conclusion

Available data suggest that patients with VWD experience high disease burden in terms of bleeding, poor quality of life, and health care resource utilization.

Management of haemophilia A with inhibitors: A regional cross-talk

INTRODUCTION

The development of inhibitors with factor VIII (FVIII) replacement therapy is one of the most common and challenging complications of haemophilia A (HA) treatment, jeopardising treatment efficacy and predisposing patients to high risks of morbidity and mortality. The management of patients with inhibitors is particularly challenging in countries where resources are limited.

AIM

To provide a comprehensive summary of the management of HA with inhibitors while focusing on differences in practice between Western and non-Western countries and how resource scarcity can impact HA management, leading to suboptimal outcomes in patients with inhibitors.

METHODS

Summary of key evidence and regional expert opinion.

RESULTS

We address, particularly, the diagnosis of and testing for inhibitors, as well as the epidemiology of inhibitors, including incidence, prevalence and disease burden. Secondly, we provide an overview of the current treatment landscape in HA with inhibitors regarding the eradication of inhibitors with immune tolerance induction and the treatment and prevention of bleeding with bypassing agents, non-factor replacement agents and other experimental therapies. This is complemented with insights from the authors around the applicability of, and challenges associated with, such therapies in their settings of practice.

CONCLUSIONS

We conclude by proposing some key steps towards bridging the gaps in the management of HA with inhibitors in resource-limited countries, including: (1) the collection of quality data that can inform healthcare reforms and policies; (2) improving disease knowledge among healthcare practitioners and patients with the aim of standardising disease management across centres and (3) working towards promoting equal access to HA care and therapies for everyone.

Artificial Intelligence Algorithm-Based Magnetic Resonance Imaging to Evaluate the Effect of Radiation Synovectomy for Hemophilic Arthropathy

This study aimed to discuss magnetic resonance imaging (MRI) based on artificial intelligence (AI) algorithm to evaluate the effect of radiation synovectomy for hemophilic arthropathy (HA). MRI based on the Canny algorithm was applied and compared with conventional MRI to evaluate its application effects according to the PSNR and SSIM. Sixty patients diagnosed with HA were selected as the research subjects. According to the detection method, the patients were divided into group A (pathological detection after radiation synovectomy), group B (conventional MRI detection), and group C (MRI detection based on the Canny algorithm). The application value of MRI based on the Canny algorithm was judged by comparing the differences between the two detection methods and pathological results. The results displayed that the reconstruction effect of the Canny algorithm was remarkably better than that of the traditional algorithm regarding the peak signal-to-noise ratio (PSNR) and structural similarity (SSIM), which showed a clearer synovial contour. The results of the IPSG score of joint effusion and hemorrhage showed that there was a difference in the detection rate of joints between conventional MRI and pathological results on the score of 1 and 2 (P < 0.05); and there was no significant difference between the MRI and pathological results based on the Canny algorithm (P > 0.05). The results of the IPSG score of synovial hyperplasia showed that the detection rate of conventional MRI was different from pathological results on the score of 1 and 2 (P < 0.05); and there was no significant difference between the MRI and pathological results based on the Canny algorithm (P > 0.05). The results of the IPSG score of hemosiderin deposition showed that the detection rate of conventional MRI was different from the pathological results on the score of 1 and 2 (P < 0.05); and there was no significant difference between the MRI and pathological results based on the Canny algorithm (P > 0.05). The synovial volume of patients after surgery was reduced compared with that before surgery. One-factor variance was used to analyze the clinical hemorrhage frequency before and after surgery, and the results showed that the differences were statistically significant (P < 0.05). Therefore, MRI on account of AI algorithm made it easier to detect synovial contour, which was helpful to evaluate the efficacy of polygenic risk scores (PRS) surgery in HA patients. MRI based on the Canny algorithm had less differences between the score of hemophilic arthropathy and pathological results, which could replace conventional MRI examination and have clinical application value.

Temporomandibular disorders in patients with inherited coagulation disorders: A clinical study

INTRODUCTION

One of the most common problems in patients with inherited coagulation disorders, especially hemophilia, is joint problems. This study aims to investigate whether temporomandibular joint (TMJ) is affected in patients with hemophilia or other coagulation factor disorders.

MATERIAL & METHODS

In this study, a patient group and a control group were formed. The patient group consisted of 44 individuals with hemophilia or other coagulation disorders (von Willebrand disease and rare factor deficiencies) and the control group consisted of 45 healthy individuals. In both groups, TMJ health was evaluated through a questionnaire and clinical examination.

RESULTS

The prevalence of signs and symptoms of temporomandibular disorders (TMD) that we evaluated was higher in the patient group than in the healthy individuals. Pain in the jaw, temple, in the ear or in front of the ear; pain in the jaw, temple, ear or front of the ear by opening the mouth or moving the jaw forward/sideways; closed locking (subjective); jaw joint noises (subjective) and TMJ noises during open & close movements on the right side in clinical examination were statistically significantly higher in the patient group than in the control group.

DISCUSSION

There are very limited studies on temporomandibular joint health in patients with coagulation factor deficiency. In this study, it was observed that patients with inherited coagulation disorders, especially hemophilia, were more likely to develop TMD than healthy individuals. This situation was thought to be due to the increased susceptibility to TMJ bleeding in patients with coagulation factor deficiency.

Incidence and mortality rates of intracranial hemorrhage in hemophilia: a systematic review and meta-analysis

Intracranial hemorrhage (ICH) is a severe complication that is relatively common among hemophilia patients. This systematic review aimed to obtain more precise estimates of ICH incidence and mortality in hemophilia, which may be important for patients, caregivers, researchers and health policy-makers. PubMed and EMBASE were systematically searched using terms related to "hemophilia" and "intracranial hemorrhage" or "mortality". Studies that allowed calculation of ICH incidence or mortality rates in a hemophilia population of at least 50 patients were included. We summarized evidence on ICH incidence and calculated pooled ICH incidence and mortality in three age groups: (1) persons of all ages with hemophilia, (2) children and young adults below 25 years of age with hemophilia and (3) neonates with hemophilia. Incidence and mortality were pooled with a Poisson-Normal model or a Binomial-Normal model. We included 45 studies that represented 54 470 patients, 809 151 person-years and 5326 live births of hemophilia patients. In persons of all ages, the pooled ICH incidence and mortality rates were 2.3 (95% CI 1.2-4.8) and 0.8 (95% CI 0.5-1.2) per 1000 person-years, respectively. In children and young adults, the pooled ICH incidence and mortality rates were 7.4 (95% CI 4.9-11.1) and 0.5 (95% CI 0.3-0.9) per 1000 person-years, respectively. In neonates, the pooled cumulative ICH incidence was 2.1% (95% CI 1.5-2.8) per 100 live births. ICH was classified as spontaneous in 35-58% of cases. Our findings suggest that ICH is an important problem in hemophilia that occurs among all ages, requiring adequate preventive strategies.

Severe Rare Bleeding Disorders: A Single-center Experience

Although rare bleeding disorders (RBDs) are not common diseases, they are important for life-threatening bleedings and prophylaxis approaches, especially in severe forms. In this retrospective study, the authors have analyzed data from children with severe RBDs who were examined at the center over a period of 10 years to describe the distribution, clinical features, treatment patterns, and outcome of severe RBDs in patients. Data from all children (age under 18 y) with RBDs who were examined in the center between 2005 and 2015 were retrospectively reviewed. In total, 12 patients were included in the study. Four of the cases had factor (F) VII (33.3%), 6 had FX (50%), 1 had FXIII (8.3%), and 1 had fibrinogen deficiency (8.3%). Of the 12 children with severe RBDs, 8 (67%) experienced at least 1 major bleeding. Prophylaxis was applied to 10 patients. In conclusion, RBDs are more common in our country because of the high parental consanguinity rates. So, it is necessary to raise public awareness about the risks of consanguineous marriages and increase access to genetic counseling and testing facilities. Delayed diagnosis and lack of adequate prophylactic replacement therapy are the most important risk factors that increase life-threatening bleeding.

Rare bleeding disorders: spectrum of disease and clinical manifestations in the Pakistani population

Background

Rare inherited coagulation factor deficiencies constitute an important group of bleeding disorders. A higher frequency of these disorders is seen in areas of high consanguinity. Our aim was to study the prevalence and spectrum of rare inherited bleeding disorders, characterize the severity of the deficiencies, identify different clinical manifestations, and evaluate different treatments provided.

Methods

This cross-sectional study was conducted in the Department of Haematology, Armed Forces Institute of Pathology Rawalpindi, between January 2014 and December 2018. A detailed history was taken, and an examination was performed. The signs and symptoms were noted, and the patients were diagnosed on the basis of a coagulation profile. The disease severity was assessed using factor assays.

Results

Among 2,516 patients with suspected coagulation disorders, 774 (30.8%) had an inherited bleeding disorder. Of the 774 patients, 165 (21.3%) had a rare bleeding disorder; 91 (55.2%) of them were males, and 74 (44.9%) were females, with a male-to-female ratio of 1.2:1. The median patient age was 9 years 3 months. The most common disorder was factor VII deficiency (46 patients, 27.9%). The most common clinical presentation was bruising in 102 (61.8%) and gum bleeding in 91 (55.2%) patients.

Conclusion

The most common rare bleeding disorder in our population is factor VII deficiency. The prevalence of these bleeding disorders is high in our population due to a high number of consanguineous marriages.