Recent Advances in the Management of Haemophilia and Christmas Disease

Current status of Swedish hemophiliacs. I. A demographic survey

A comprehensive survey of the Swedish hemophilic population (hemophilia A and B) was undertaken in 1980. The total number of known hemophiliacs was 564. The ratio of hemophilia A to B was 4:1. The severe form constituted about 30% of each type. The incidence has remained fairly constant since 1957 and was 1.67 per year per 10,000 males born. The prevalence was 6.8 per 100,000 inhabitants. There was an increase in the prevalence in all counties but the increase varied considerably, 19-383%. The overall increase of hemophilia was 123%. Among mild cases the increase was 245%, whereas it was only 48% among the severe hemophiliacs. This skewness was attributed to better laboratory diagnoses and increased life expectancy. The proportion of mild cases increased from 35% in 1960 to 54% at the time of the present investigation. The situation was the reverse for the severe cases, a decrease from 45% to 30%. The mean and median ages among moderate and mild hemophiliacs deviated only little from the corresponding figure in the total population. Among severe cases, however, mean and median age were 8-13 years less than in the normal population.

Intracranial hemorrhage and hemophilia: case report and management guidelines

Hemophiliacs, as a result of low coagulation factor levels, may suffer spontaneous intracranial hemorrhage. A case of intracranial hemorrhage in a hemophiliac patient with a history of intravenous drug abuse and HIV infection is reported. Factor replacement, airway management, and risks of HIV exposure to emergency department personnel are discussed.

Life expectancy of Swedish haemophiliacs, 1831-1980

Life expectancy of Swedish haemophiliacs has been estimated for the period 1831-1980. The data were derived from 948 haemophiliacs of whom 580 survived throughout 1980. Applying standard demographic techniques, median life expectancy of patients with severe haemophilia was found to have increased fivefold, from a mere 11 years during the period 1831-1920 to 56.8 years during 1961-80. The corresponding estimates for patients with moderate haemophilia were 27.5 and 71.5 years, respectively. The limited data on patients with mild haemophilia did not indicate any significant improvements in mortality. From the beginning of this century to 1980 median life expectancy for Swedish males increased from 61.7 years to 75.6 years, an increase of 23%. Analysing the last 12 years of the study (1969-80), death rates for patients with severe haemophilia below the age of 45 were not much different from those of Swedish males in the population as a whole. The investigation implies that the mortality of haemophiliacs in Sweden is approaching that of the total male population.

Abnormalities of the spleen and liver in patients with hemophilia

Previous studies have demonstrated functional and histologic abnormalities of the liver, and, more recently, splenomegaly in patients with hemophilia. Since these observations usually were derived from hemophiliacs who had received intensive replacement therapy, the question was posed as to whether the frequency of splenic and hepatic abnormalities was secondary to the amount of therapy utilized. In this study, a variety of tests were employed to evaluate spleen and liver size and function to determine if abnormalities in these organs correlated with the intensity of the transfusion program. The study group was comprised of 25 hemophiliacs (mean factor replacement-18,361 U/year; median factor replacement-12,920 U/year). Over 70% of our patients had elevations of aspartate and alanine aminotransferase. Immunoglobulin and complement levels were normal in most subjects. Ninety-six percent had evidence of exposure to hepatitis B virus. Liver-spleen imaging suggested significant hepatic abnormalities in most of the patients as evidenced by inhomogeneity of tracer uptake in the liver in 33% and relatively increased colloid uptake in the spleen in 90%. Splenomegaly (palpable spleen or enlargement on liver-spleen imaging) was detected in 40% of our patients, and tended to occur in the more frequently transfused patients. These findings indicate that significant abnormalities of the spleen and liver can occur in hemophiliacs who have received moderate amounts of replacement therapy and that liver-spleen imaging may be a useful method for monitoring the development of hepatic and splenic abnormalities.