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Islam MN, Biswas AR, Nazneen H, Chowdhury N, Alam M, Banik J, Hassan MK, Khan AAZ, Karim N, Hasan MJ, Khan MAS. Clinical profile and demographic characteristics of moderate and severe hemophilia patients in a tertiary care hospital of Bangladesh. Orphanet J Rare Dis 2022; 17:254. [PMID: 35804421 PMCID: PMC9264493 DOI: 10.1186/s13023-022-02413-7] [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: 02/02/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemophilia is one of the commonest inherited bleeding disorders which may lead to chronic bleeding tendencies and life-long disabilities if not properly managed. Knowing the pattern of the disease aids in the prevention of disability and improvement of quality of life in hemophilia. However, there is a dearth of literature on the issue in Bangladesh. So, this study was designed to explore the frequency and site of spontaneous bleeding in moderate and severe hemophilia patients visiting in a tertiary level hospital. METHODS This descriptive cross-sectional study was conducted at the department of Hematology and Bone Marrow Transplantation (BMT) Center in Dhaka Medical College Hospital, Dhaka between February 2020 and August 2020. A total of 44 diagnosed cases of moderate to severe hemophilia were included in the study according to inclusion criteria. A detailed inquiry of history, thorough physical examination and relevant investigations were done and were recorded in case-record form. Informed written consent was taken from patients or their guardians where appropriate. All procedures were done according to Declaration of Helsinki. After entry and checking, data was analysed using SPSS version 26. RESULTS Out of 44 participants, 25 (56.8%) and 19 (43.2%) had moderate and severe hemophilia. Mean age of the study population was 21.31 (± 9.78) years with the majority aged between 11 and 20 years (45.5%). All sociodemographic features were similar across severity. Hemophilia A and B was found in 90.9% and 9.1%, respectively. However, all type B patients severe hemophilia making it statistically significantly different from type A (p = 0.029). The median age of first bleeding was 3.5 years and median age of first diagnosis was 5 years. Nevertheless, approximately 67.4% patients were diagnosed as a case of hemophilia at the time of their first diagnosis. The median spontaneous bleedings episodes among all patients was 32 (range: 0-97) which did not different significantly between severe and moderate patients. The most common affected (target) joint was knee joint (88.6%) followed by elbow joint (64%) among all patients. The knee joint was more commonly involved in severe than moderate disease. CONCLUSION This study observed the variations in pattern and frequency of spontaneous bleeding in patients with hemophilia. Severe disease was more frequent in hemophilia B than A and knee joint was the most frequent site of bleeding. However, further extensive studies are recommended.
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Affiliation(s)
| | - Akhil Ranjon Biswas
- Department of Haematology and BMT, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Humayra Nazneen
- Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | | - Mahbubul Alam
- Sheikh Russell National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | | | - Md Kamrul Hassan
- Department of Pathology, Shaheed Syed Nazrul Islam Medical College, Kishoreganj, Bangladesh
| | - Abdullah Az Zubayer Khan
- Department of Haematology, National Institute of Laboratory Medicine and Referral Center, Dhaka, Bangladesh
| | - Najmul Karim
- Medicine Department, Rangpur Medical College Hospital, Rangpur, Bangladesh
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Approach to the Patient with Bleeding. Hematol Oncol Clin North Am 2021; 35:1039-1049. [PMID: 34535288 DOI: 10.1016/j.hoc.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Approach to the patient with bleeding begins with a thorough bleeding, medical, and family history to determine the nature of bleeding and severity of bleeding symptoms. Use of a Bleeding Assessment Tool allows the clinician to obtain a comprehensive bleeding history and ultimately determine the individual bleeding score that reflects bleeding severity and is classifiable as either normal or abnormal. In the absence of significant findings within patient history or presenting symptoms clearly pointing to a specific bleeding pathology, an approach to laboratory investigation is presented that proceeds through first-line, second-line, and third-line testing.
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Identification of the Profile of the Patients with Hemophilia B Eligible for Treatment with Nonacog Alfa Once-Weekly. REPORTS 2020. [DOI: 10.3390/reports3010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to identify the characteristics of patients with hemophilia B eligible for once-weekly treatment with Nonacog alfa. Methods: A survey was conducted in 14 Hemophilia (HCs) of Italy. These centers were given a questionnaire consisting of ten closed multiple-choice questions. The centers were asked: (a) the percentages of their hemophilia B (HB) patients undergoing replacement therapy, “On-demand”, or weekly prophylaxis, (b) the criteria guiding the monitoring of patients, the advantages according to the age of patients, and (c) the obstacles to prophylaxis. The percentage of patients receiving “On-demand” (OD) treatment or continuous prophylaxis (prophy) differed depending on patient age and the severity of the disease. Only 57% of HCs provided “On-demand” therapy to the mild HB patients, about 93% to moderate ones, of whom 43% on prophylaxis. About 78% of patients <6 years old, were on treatment in 9 out of 14 HCs, by prophylaxis 66.7% and 33.3% by On-demand. In the 6–18 age group, 90.1% of HCs treated HB patients with prophylaxis, 42.8% in the 18–30 age range. On-demand treatment was the therapy of choice in 61.5% of HCs for patients aged 30–65 years. In total, 64% of the HCs assigned the maximum score to bleeding frequency, especially in the <6 and 6–18 age groups. Bleeding severity was also taken into significant consideration, particularly in subjects up to 30 years old. The scores regarding venous access were distributed relatively evenly throughout all age groups. The majority of the centers attributed a medium-high score to treatment compliance, especially in the 6–65 age range. In actuality, 55% of HCs attributed pro-thrombotic comorbidity a low score in the 18–30 age group, whereas 81% gave pro-hemorrhagic comorbidity a high rating in patients aged >65 years old. Many centers assigned a medium-high score to the baseline concentration of FIX level at diagnosis in all age groups. Most HCs attributed a medium-high score to type of genetic mutation in the younger age groups. As for socio-cultural barriers and quality of life, the majority of respondents gave a medium-high score in all age groups. For periodic monitoring of patients receiving continuous prophylaxis, 59% of the centers reported using clinical assessment. With regard to prophylaxis administration method, the majority of hemophiliacs were given infusions twice weekly, while as regards to the dose of FIX concentrate delivered, 50% of the centers reported administering prophylaxis once-weekly at a dose ranging from 5–100 IU/kg in 10–50% of HB patients. Thus, 93% of the centers reported using a dose of 25–50 IU/kg for twice-weekly prophylaxis in 6–100% of the patients. The majority of centers (86%) believe that, in a program of early primary prevention, once-weekly treatment with nonacog alfa may represent an alternative strategy to dose escalation. The results show that patients with mild hemophilia, with functional musculoskeletal status and difficulties with venous access, are candidates for once-weekly prophylaxis with nonacog alfa. For such patients, this regimen can improve treatment compliance and quality of life.
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Hazendonk HCAM, Preijers T, Liesner R, Chowdary P, Hart D, Keeling D, Driessens MHE, Laros-van Gorkom BAP, van der Meer FJM, Meijer K, Fijnvandraat K, Leebeek FWG, Mathôt RAA, Collins PW, Cnossen MH. Perioperative replacement therapy in haemophilia B: An appeal to "B" more precise. Haemophilia 2018; 24:611-618. [PMID: 29707861 DOI: 10.1111/hae.13469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Haemophilia B is caused by a deficiency of coagulation factor IX (FIX) and characterized by bleeding in muscles and joints. In the perioperative setting, patients are treated with FIX replacement therapy to secure haemostasis. Targeting of specified FIX levels is challenging and requires frequent monitoring and adjustment of therapy. AIM To evaluate perioperative management in haemophilia B, including monitoring of FIX infusions and observed FIX levels, whereby predictors of low and high FIX levels were assessed. METHODS In this international multicentre study, haemophilia B patients with FIX < 0.05 IU mL-1 undergoing elective, minor or major surgical procedures between 2000 and 2015 were included. Data were collected on patient, surgical and treatment characteristics. Observed FIX levels were compared to target levels as recommended by guidelines. RESULTS A total of 255 surgical procedures were performed in 118 patients (median age 40 years, median body weight 79 kg). Sixty percent of FIX levels within 24 hours of surgery were below target with a median difference of 0.22 IU mL-1 [IQR 0.12-0.36]; while >6 days after surgery, 59% of FIX levels were above target with a median difference of 0.19 IU mL-1 [IQR 0.10-0.39]. Clinically relevant bleeding complications (necessity of a second surgical intervention or red blood cell transfusion) occurred in 7 procedures (2.7%). CONCLUSION This study demonstrates that targeting of FIX levels in the perioperative setting is complex and suboptimal, but although this bleeding is minimal. Alternative dosing strategies taking patient and surgical characteristics as well as pharmacokinetic principles into account may help to optimize and individualize treatment.
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Affiliation(s)
- H C A M Hazendonk
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - T Preijers
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - R Liesner
- Great Ormond Street Haemophilia Centre, Great Ormond Street Hospital for Children NHS trust, London, UK
| | - P Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - D Hart
- Department of Haematology, The Royal London Hospital Barts Health NHS Trust, London, UK
| | - D Keeling
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, Churchill Hospital, Oxford, UK
| | - M H E Driessens
- Netherlands Haemophilia Patient Society (NVHP), Nijkerk, The Netherlands
| | | | - F J M van der Meer
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Meijer
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K Fijnvandraat
- Department of Paediatric Haematology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - F W G Leebeek
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - R A A Mathôt
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - P W Collins
- Arthur Bloom Haemophilia Centre, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
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Yazer MH, van de Watering L, Lozano M, Sirdesai S, Rushford K, Wood EM, Yokoyama AP, Kutner JM, Lin Y, Callum J, Cserti-Gazdewich C, Lieberman L, Pendergrast J, Pendry K, Murphy MF, Selleng K, Greinacher A, Marwaha N, Sharma R, Jain A, Orlin Y, Yahalom V, Perseghin P, Incontri A, Masera N, Okazaki H, Ikeda T, Nagura Y, Zwaginga JJ, Pogłod R, Rosiek A, Letowska M, Yuen J, Cid J, Harm SK, Adhikari P. Development of RBC transfusion indications and the collection of patient-specific pre-transfusion information. Vox Sang 2017; 112:e22-e47. [PMID: 28524359 DOI: 10.1111/vox.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - S Sirdesai
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - K Rushford
- Monash Pathology, Monash Health, Melbourne, Victoria, Australia
| | - E M Wood
- Department of Clinical Haematology Monash Health and Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A P Yokoyama
- Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Bloco E, São Paulo, SP, 05651-901, Brazil
| | - J M Kutner
- Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Bloco E, São Paulo, SP, 05651-901, Brazil
| | - Y Lin
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room B2-04, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, 2075 Bayview Avenue, Room B2-04, Toronto, ON, M4N 3M5, Canada
| | - J Callum
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room B2-04, Toronto, ON, Canada
| | - C Cserti-Gazdewich
- Department of Medicine / Laboratory Medicine & Pathobiology, University of Toronto, Toronto General Hospital 3EC-306, 200 Elizabeth Street, Toronto, ON, Canada, M5G-2C4.,Laboratory Medicine Program, Laboratory Hematology: Blood Transfusion Laboratory, University Health Network, Toronto General Hospital 3EC-306, 200 Elizabeth Street, Toronto, ON, Canada, M5G-2C4
| | - L Lieberman
- Department of Laboratory Hematology (Transfusion Medicine), University Health Network, 200 Elizabeth Street, Suite 306, Toronto, ON, Canada, M5G 2C4
| | - J Pendergrast
- Department of Laboratory Hematology (Transfusion Medicine), University Health Network, 200 Elizabeth Street, Suite 306, Toronto, ON, Canada, M5G 2C4
| | - K Pendry
- Central Manchester University Hospitals, NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL.,NHS Blood and Transplant Manchester Blood Centre, Plymouth Grove, Manchester, M13 9LL, UK
| | - M F Murphy
- Blood Transfusion Medicine, University of Oxford, Headley Way, Headington, Oxford, OX3 9BQ, UK.,NHS Blood andTransplant and Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9BQ, UK.,NHS Blood & Transplant, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9BQ, UK
| | - K Selleng
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany
| | - A Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany
| | - N Marwaha
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - R Sharma
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A Jain
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Y Orlin
- Transfusion & Apheresis Services, Rabin Medical Center, Petach Tikva, Israel
| | - V Yahalom
- Transfusion & Apheresis Services, Rabin Medical Center, Petach Tikva, Israel
| | - P Perseghin
- UOS Aferesi e nuove tecnologie trasfusionali-Laboratorio di Criobiologia, ASST-Monza Ospedale San Gerardo, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - A Incontri
- UOS Aferesi e nuove tecnologie trasfusionali, ASST-Monza Ospedale San Gerardo, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - N Masera
- Clinica Pediatrica, Università di Milano Bicocca and A. O. San Gerardo, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - H Okazaki
- Department of Blood Transfusion, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - T Ikeda
- Department of Blood Transfusion, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Y Nagura
- Department of Blood Transfusion, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - J J Zwaginga
- Department of Immunohematology and Bloodtransfusion, Center for Stem Cell Therapies, Leiden University Medical Center, Albinusdreef 2, Building 1, E3-Q P.O. Box 9600, 2300, RC Leiden, The Netherlands
| | - R Pogłod
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine, ul. Indira Gandhi 14, Warsaw, 02-776, Poland
| | - A Rosiek
- Department for Quality Assurance and Organization of Blood Transfusion Service, Institute of Hematology and Transfusion Medicine, ul. Indira Gandhi 14, Warsaw, 02-776, Poland
| | - M Letowska
- Department for Diagnostics for Hematology and Transfusion Service, Institute of Hematology and Transfusion Medicine, ul. Indira Gandhi 14, Warsaw, 02-776, Poland
| | - J Yuen
- Blood Transfusion Services, Department of Laboratory Medicine, Tan Tock Seng Hospital, Level 2 - Podium Block, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - J Cid
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Hospital Clínic, Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - S K Harm
- University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT, 05401, USA
| | - P Adhikari
- University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT, 05401, USA
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Riva S, Oliveri S, Fioretti C, Masiero M, Pravettoni G. The Role of Frontal-Subcortical Circuitry in Neuropsychological Deficit of Attention: Hypothesis and Results in Two Coagulation Disorders. Front Hum Neurosci 2016; 10:89. [PMID: 27014021 PMCID: PMC4783412 DOI: 10.3389/fnhum.2016.00089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Silvia Riva
- Department of Oncology and Hemato-oncology, University of Milan Milan, Italy
| | - Serena Oliveri
- Department of Oncology and Hemato-oncology, University of Milan Milan, Italy
| | - Chiara Fioretti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology Milan, Italy
| | - Marianna Masiero
- Department of Oncology and Hemato-oncology, University of Milan Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, University of MilanMilan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
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Vaglio S, Prisco D, Biancofiore G, Rafanelli D, Antonioli P, Lisanti M, Andreani L, Basso L, Velati C, Grazzini G, Liumbruno GM. Recommendations for the implementation of a Patient Blood Management programme. Application to elective major orthopaedic surgery in adults. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:23-65. [PMID: 26710356 PMCID: PMC4731340 DOI: 10.2450/2015.0172-15] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianni Biancofiore
- Liver Transplant Anaesthesia and Critical Care, University Hospital Pisana, Pisa, Italy
| | - Daniela Rafanelli
- Immunohaematology and Transfusion Unit, Pistoia 3 Local Health Authority, Pistoia, Italy
| | - Paola Antonioli
- Department of Infection Prevention Control and Risk Management, Ferrara University Hospital, Ferrara, Italy
| | - Michele Lisanti
- 1 Orthopaedics and Trauma Section, University Hospital Pisana, Pisa, Italy
| | - Lorenzo Andreani
- 1 Orthopaedics and Trauma Section, University Hospital Pisana, Pisa, Italy
| | - Leonardo Basso
- Orthopaedics and Trauma Ward, Cottolengo Hospital, Turin, Italy
| | - Claudio Velati
- Transfusion Medicine and Immunohaematology Department of Bologna Metropolitan Area, Bologna, Italy, on behalf of Italian Society of Transfusion Medicine and Immunohaematology (SIMTI); Italian Society of Italian Society of Orthopaedics and Traumatology (SIOT); Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Therapy (S.I.A.A.R.T.I.); Italian Society for the Study of Haemostasis and Thrombosis (SISET), and the National Association of Hospital Medical Directors (ANMDO) working group
| | - Giuliano Grazzini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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Principles of treatment and update of recommendations for the management of haemophilia and congenital bleeding disorders in Italy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 12:575-98. [PMID: 25350962 DOI: 10.2450/2014.0223-14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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10
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Riva S, Cutica I, Krampe C, Reinecke LF, Russell-Edu W, Santoro C, Rocino A, Santagostino E, Rusconi V, Pravettoni G. A Cohort Pilot Study on HIV-Associated Neuropsychological Impairments in Hemophilia Patients. Front Hum Neurosci 2015; 9:313. [PMID: 26082706 PMCID: PMC4451691 DOI: 10.3389/fnhum.2015.00313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 05/16/2015] [Indexed: 11/13/2022] Open
Abstract
Despite advances in the management of HIV infection with the introduction of combination antiretroviral therapy, it is well known that HIV can directly infect the central nervous system and, as a result of such infection, neuropsychological impairments can be manifested. In this study, we tried to determine whether seropositivity was associated with a poor neuropsychological performance in patients with hemophilia and HIV. Such a cohort of patients is very often underrepresented and understudied in the HIV literature. To amend such a gap, we carried out an extensive neuropsychological evaluation on these patients, and compared their performance with that of a group of seronegative hemophilia patients. The results revealed that HIV infection in HIV-seropositive (HIV+) hemophilia patients was associated with deficits in attention, short-term memory, abstraction, and visual recognition. Such results are still preliminary and explorative due to the small cohort of patients enrolled. However, the results do seem to have some important implications for day-to-day functioning, as the level of impairment detected may cause difficulties in completing common everyday tasks such as maintaining adherence to complex medication regimens or maintaining social life activities. Continued research into the mechanisms related to HIV and neurocognitive dysfunction may provide targets for interventions that could have meaningful consequences in the real world for HIV hemophilia patients.
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Affiliation(s)
- Silvia Riva
- Department of Health Sciences, University of Milan , Milan , Italy
| | - Ilaria Cutica
- Department of Health Sciences, University of Milan , Milan , Italy
| | - Caspar Krampe
- Department of Health Sciences, University of Milan , Milan , Italy
| | - Laura F Reinecke
- Department of Health Sciences, University of Milan , Milan , Italy
| | | | - Cristina Santoro
- Haemophilia and Thrombosis Centre, Umberto I Hospital , Rome , Italy
| | - Angiola Rocino
- Haemophilia and Thrombosis Centre, S. Giovanni Bosco Hospital , Naples , Italy
| | | | - Vega Rusconi
- ABB Haemophilia and Thrombosis Centre, IRCCS Ca'Granda , Milan , Italy
| | - Gabriella Pravettoni
- Department of Health Sciences, University of Milan , Milan , Italy ; European Institute of Oncology (IEO) , Milan , Italy
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11
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Tagliaferri A, Feola G, Molinari AC, Santoro C, Rivolta GF, Cultrera DB, Gagliano F, Zanon E, Mancuso ME, Valdré L, Mameli L, Amoresano S, Mathew P, Coppola A. Benefits of prophylaxis versus on-demand treatment in adolescents and adults with severe haemophilia A: the POTTER study. Thromb Haemost 2015; 114:35-45. [PMID: 25855376 DOI: 10.1160/th14-05-0407] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 03/01/2015] [Indexed: 11/05/2022]
Abstract
Rigorous evidence is lacking on long-term outcomes of factor VIII (FVIII) prophylaxis initiated in adolescent or adult patients with severe haemophilia A. The prospective, open-label Prophylaxis versus On-demand Therapy Through Economic Report (POTTER) study (ClinicalTrials.gov NCT01159587) compared long-term late secondary prophylaxis (recombinant FVIII-FS 20-30 IU/kg thrice weekly) with on-demand treatment in patients aged 12 to 55 years with severe haemophilia A. The annual number of joint bleeding episodes (primary endpoint), total bleeding episodes, orthopaedic and radiologic (Pettersson) scores, health-related quality of life (HRQoL), pharmacoeconomic impact, and safety were evaluated over a > 5-year period (2004-2010). Fifty-eight patients were enrolled at 11 centres in Italy; 53 (27 prophylaxis, 26 on demand) were evaluated and stratified into 2 age subgroups (12-25 and 26-55 years). Patients receiving prophylaxis experienced a significantly lower number of joint bleeding episodes vs the on-demand group (annualised bleeding rate, 1.97 vs 16.80 and 2.46 vs 16.71 in younger and older patients, respectively; p=0.0043). Results were similar for total bleeding episodes. Prophylaxis was associated with significantly fewer target joints (p< 0.001), better orthopaedic (p=0.0019) and Pettersson (p=0.0177) scores, better HRQoL, and fewer days of everyday activities lost (p< 0.0001) but required significantly higher FVIII product consumption. The POTTER study is the first prospective, controlled trial documenting long-term benefits of late secondary prophylaxis in adolescents and adults with severe haemophilia A. The benefits of reduced bleeding frequency, improved joint status, and HRQoL may offset the higher FVIII consumption and costs.
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Affiliation(s)
- Annarita Tagliaferri
- Annarita Tagliaferri, MD, Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Via Gramsci, 14-43126, Parma, Italy, Tel.: +39 0521 703971, Fax: +39 0521 704332, E-mail:
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12
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Uncovered needs in the management of inherited bleeding disorders in Italy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 12 Suppl 3:s563-6. [PMID: 24922296 DOI: 10.2450/2014.0036-14s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Coppola A, Windyga J, Tufano A, Yeung C, Di Minno MND. Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery. Cochrane Database Syst Rev 2015; 2015:CD009961. [PMID: 25922858 PMCID: PMC11245682 DOI: 10.1002/14651858.cd009961.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In people with haemophilia or other congenital bleeding disorders undergoing surgical interventions, haemostatic treatment is needed in order to correct the underlying coagulation abnormalities and minimise the bleeding risk. This treatment varies according to the specific haemostatic defect, its severity and the type of surgical procedure. The aim of treatment is to ensure adequate haemostatic coverage for as long as the bleeding risk persists and until wound healing is complete. OBJECTIVES To assess the effectiveness and safety of different haemostatic regimens (type, dose and duration, modality of administration and target haemostatic levels) administered in people with haemophilia or other congenital bleeding disorders for preventing bleeding complications during and after surgical procedures. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of the last search: 20 November 2014. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing any hemostatic treatment regimen to no treatment or to another active regimen in children and adults with haemophilia or other congenital bleeding disorders undergoing any surgical intervention. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials (eligibility and risks of bias) and extracted data. Meta-analyses were performed on available and relevant data. MAIN RESULTS Of the 16 identified trials, four (112 participants) were eligible for inclusion.Two trials evaluated 59 people with haemophilia A and B undergoing 63 dental extractions. Trials compared the use of a different type (tranexamic acid or epsilon-aminocaproic acid) and regimen of antifibrinolytic agents as haemostatic support to the initial replacement treatment. Neither trial specifically addressed mortality (one of this review's primary outcomes); however, in the frame of safety assessments, no fatal adverse events were reported. The second primary outcome of blood loss was assessed after surgery and these trials showed the reduction of blood loss and requirement of post-operative replacement treatment in people receiving antifibrinolytic agents compared with placebo. The remaining primary outcome of need for re-intervention was not reported by either trial.Two trials reported on 53 people with haemophilia A and B with inhibitors treated with different regimens of recombinant activated factor VII (rFVIIa) for haemostatic coverage of 33 major and 20 minor surgical interventions. Neither of the included trials specifically addressed any of the review's primary outcomes (mortality, blood loss and need for re-intervention). In one trial a high-dose rFVIIa regimen (90 μg/kg) was compared with a low-dose regimen (35 μg/kg); the higher dose showed increased haemostatic efficacy, in particular in major surgery, with shorter duration of treatment, similar total dose of rFVIIa administered and similar safety levels. In the second trial, bolus infusion and continuous infusion of rFVIIa were compared, showing similar haemostatic efficacy, duration of treatment and safety. AUTHORS' CONCLUSIONS There is insufficient evidence from randomised controlled trials to assess the most effective and safe haemostatic treatment to prevent bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgical procedures. Ideally large, adequately powered, and well-designed randomised controlled trials would be needed, in particular to address the cost-effectiveness of such demanding treatments in the light of the increasing present economic constraints, and to explore the new challenge of ageing patients with haemophilia or other congenital bleeding disorders. However, performing such trials is always a complex task in this setting and presently does not appear to be a clinical and research priority. Indeed, major and minor surgeries are effectively and safely performed in these individuals in clinical practice, with the numerous national and international recommendations and guidelines providing regimens for treatment in this setting mainly based on data from observational, uncontrolled studies.
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Morfini M, Marchesini E, Paladino E, Santoro C, Zanon E, Iorio A. Pharmacokinetics of plasma-derived vs. recombinant FVIII concentrates: a comparative study. Haemophilia 2014; 21:204-209. [PMID: 25274155 DOI: 10.1111/hae.12550] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2014] [Indexed: 11/26/2022]
Abstract
Only very few pharmacokinetic (PK) studies comparing plasma derived FVIII (pd-FVIII) against recombinant FVIII (rFVIII) concentrates are available. The studies have been generally conducted to demonstrate the bioequivalence of a new product with an old one. The switch from a plasma-derived FVIII (pd-FVIII) to a rFVIII concentrate is a good moment to enrol the patients in a comparative PK study. To achieve information on the PK characteristics of two different classes of FVIII concentrates, according to two different designs: a 10 FVIII concentration/time point design and a reduced 4-point design. A single dose PK comparing pd- and rFVIII concentrates has been performed in four Haemophilia Centres of Italy. Seventeen haemophilia A patients underwent two subsequent single dose PK studies at the moment of switching. Two-compartment- and Non-compartment-analysis did not show significant differences between the outcomes of PK of pd-FVIII and rFVIII, due to inter-patient variability. In vivo recovery (IVR) of rFVIII was slightly higher than that of pd-FVIII and rFVIII/pd-FVIII AUC ratio was 1.37 in 11/17 patients. The difference is only due to the initial distribution phase because after the first 10 h from the end of the infusion, the two decay curves are overlapping. The elimination half-life of the concentrates was very similar even though a complete bioequivalence was not demonstrated because of a higher AUC of rFVIII concentrates, limited to the distribution phase. The higher Cmax and IVR of rFVIII may be due to the presence of heterodimers activated forms of the recombinant molecules.
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Affiliation(s)
- M Morfini
- Agency for Haemophilia, University Hospital of Florence, Florence, Italy
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15
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Franchini M. Current management of hemophilia B: recommendations, complications and emerging issues. Expert Rev Hematol 2014; 7:573-81. [DOI: 10.1586/17474086.2014.947955] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Saulyte Trakymiene S, Steen Carlsson K. On-demand treatment in persons with severe haemophilia. Eur J Haematol 2014; 76:39-47. [PMID: 24957106 DOI: 10.1111/ejh.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 02/06/2023]
Abstract
There are two main modes of replacement therapy for haemophilia patients: either to stop bleeding (on-demand) or regular infusions of clotting factor to prevent bleeds (prophylaxis). Fifty yr of clinical experience have provided evidence of the superiority of prophylaxis by showing a reduction in bleeds and development of arthropathy. Prophylaxis has been described extensively in terms of efficacy and health-economic aspects; however, on-demand treatment has received less attention. The aim of this study was to critically review the published literature on PubMed and discuss potential gaps of knowledge in on-demand treatment in persons with severe haemophilia without inhibitors by focusing on two key aspects: how on-demand treatment is provided and what outcome measures have been reported. We identified 134 papers of which 112 were excluded. Of the remaining 22 papers, 16 were comparative studies between prophylaxis and on-demand treatment and six were descriptions of on-demand treatment. The results showed limited reporting on data related to the key aspects of treatment on-demand. Early studies looked at degrees of joint bleeds and different treatment regimens in finding the optimal dose. However, from the late 1980s, there was almost no research into on-demand therapy except efficacy and safety studies of new rFVIII products and studies to prove superiority of prophylaxis over treatment on-demand. The success of on-demand therapy may depend on several factors, for example time to initial dose after a bleed and duration of treatment. Data on these key factors are limited and highlight the necessity of research to optimise replacement therapy.
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Affiliation(s)
- Sonata Saulyte Trakymiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Centre for Pediatric Hematology/Oncology, Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
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17
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Abbonizio F, Giampaolo A, Coppola A, Arcieri R, Hassan HJ. Therapeutic management and costs of severe haemophilia A patients with inhibitors in Italy. Haemophilia 2014; 20:e243-50. [DOI: 10.1111/hae.12456] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 12/25/2022]
Affiliation(s)
- F. Abbonizio
- Department of Haematology; Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
| | - A. Giampaolo
- Department of Haematology; Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
| | - A. Coppola
- Regional Reference Centre for Coagulation Disorders; Department of Clinical and Experimental Medicine; Federico II University; Naples Italy
| | - R. Arcieri
- Federation of Haemophiliac Associations; Milan Italy
| | - H. J. Hassan
- Department of Haematology; Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
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18
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Franchini M, Coppola A, Rocino A, Zanon E, Morfini M. Perceived challenges and attitudes to regimen and product selection from Italian haemophilia treaters: the 2013 AICE survey. Haemophilia 2014; 20:e128-35. [DOI: 10.1111/hae.12334] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 12/23/2022]
Affiliation(s)
- M. Franchini
- Department of Transfusion Medicine and Haematology; Carlo Poma Hospital; Mantova Italy
| | - A. Coppola
- Regional Reference Centre for Coagulation Disorders; Federico II University Hospital; Naples Italy
| | - A. Rocino
- Haemophilia and Thrombosis Centre; San Giovanni Bosco Hospital; Naples Italy
| | - E. Zanon
- Haemophilia Centre; Department of Cardiologic, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - M. Morfini
- Agency for Haemophilia; Department of Emergency and Reception; Azienda Ospedaliero-Universitaria Careggi; Firenze Italy
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Key issues in inhibitor management in patients with haemophilia. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12 Suppl 1:s319-29. [PMID: 24333092 DOI: 10.2450/2013.0246-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 05/16/2013] [Indexed: 12/13/2022]
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20
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Morfini M, Coppola A, Franchini M, Di Minno G. Clinical use of factor VIII and factor IX concentrates. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11 Suppl 4:s55-63. [PMID: 24333314 PMCID: PMC3853992 DOI: 10.2450/2013.010s] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Massimo Morfini
- Agency for Haemophilia, Department of Emergency and Reception, Careggi University Hospital, Florence, Italy
| | - Antonio Coppola
- Regional Reference Centre for Coagulation Disorders, Federico II University Hospital, Naples, Italy
| | - Massimo Franchini
- Department of Transfusion Medicine and Haematology, Carlo Poma Hospital, Mantua, Italy
| | - Giovanni Di Minno
- Regional Reference Centre for Coagulation Disorders, Federico II University Hospital, Naples, Italy
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22
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Abstract
With increasing recognition of the complications related to coagulopathies, it is of paramount importance for all orthopedic surgeons to possess a basic knowledge of common bleeding disorders. The evaluation of the coagulopathic patient requires a careful history, physical examination, and laboratory evaluation. Bleeding disorders commonly include quantitative and qualitative platelet and coagulation factor disorders and coagulation inhibitors. The management of these coagulopathies that can be encountered in elective and nonelective practice is often ignored. With appropriate knowledge and a multidisciplinary approach with hematologists and cardiologists, surgeons can perform minor and major orthopedic procedures safely and effectively.
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Affiliation(s)
- John Mansour
- Department of Orthopaedic Trauma, Cooper University Hospital, Camden, New Jersey, USA.
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24
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Gringeri A, Lambert T, Street A, Aledort L. Tertiary prophylaxis in adults: is there a rationale? Haemophilia 2012; 18:722-8. [DOI: 10.1111/j.1365-2516.2012.02843.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/29/2022]
Affiliation(s)
- A. Gringeri
- Department of Medicine; University of Milan, and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | - T. Lambert
- Centre de Traitement des Hémophiles; Hôpital de Bicêtre AP-HP; Le Kremlin Bicêtre; France
| | - A. Street
- Ronald Sawers Haemophilia Centre; Alfred Health; Melbourne; Australia
| | - L. Aledort
- The Mary Weinfeld Professor of Clinical Research in Hemophilia; Mount Sinai School of Medicine; New York; NY; USA
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Mancuso ME, Mannucci PM, Rocino A, Garagiola I, Tagliaferri A, Santagostino E. Source and purity of factor VIII products as risk factors for inhibitor development in patients with hemophilia A. J Thromb Haemost 2012; 10:781-90. [PMID: 22452823 DOI: 10.1111/j.1538-7836.2012.04691.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Inhibitor development is influenced by several factors and the type of factor VIII (FVIII) products may play a role. OBJECTIVES In order to explore such a role, we designed a cohort study whose novelty resides in the classification of products not only according to the source of FVIII (plasmatic, pd, or recombinant, r) but also to their degree of purity (expressed as specific activity). PATIENTS/METHODS Treatment data up to inhibitor development or 150 exposure days were collected in 377 patients with hemophilia A. RESULTS Inhibitors developed in 111 patients (29%; 96 high-responders, 25%). The cumulative incidence was progressively higher from patients treated with low/intermediate-purity pdFVIII compared with those treated with high-purity pd and rFVIII. The adjusted hazard ratio of inhibitor development was 4.9 with rFVIII and 2.0 with high-purity pdFVIII (95% CI, 2.9-8.3 and 1.1-4.0), taking as reference low/intermediate-purity pdFVIII. There was no difference in the frequency of inhibitor testing between treatment groups. Sensitivity analyses (in patients who never switched product type, previously untreated patients, those treated on-demand and those with high-risk F8 mutations) confirmed an increased inhibitor risk with rFVIII and high-purity pdFVIII. CONCLUSIONS This study shows that the degree of purity of FVIII products influences inhibitor development independently from other risk factors, and emphasizes that differences exist within pdFVIII products.
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Affiliation(s)
- M E Mancuso
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milan, Italy.
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26
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Abstract
The evaluation of a patient presenting with bleeding symptoms is challenging. Bleeding symptoms are frequently reported by a normal population, and overlap significantly with bleeding disorders, such as type 1 Von Willebrand disease. The history is subjective; bleeding assessment tools significantly facilitate an accurate quantification of bleeding severity. The differential diagnosis is broad, ranging from defects in primary hemostasis, coagulation deficiencies, to connective tissue disorders. Finally, despite significant clinical evidence of abnormal bleeding, many patients will have not an identifiable disorder. Clinical management of bleeding disorders is highly individualized and focuses on the particular symptoms experienced by the patient.
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Affiliation(s)
- Natalia Rydz
- Department of Pathology and Molecular Medicine, Queen's University, Room 2025, Etherington Hall, Kingston, ON, Canada K7L 3N6
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27
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Immune tolerance induction for patients with severe hemophilia A: a critical literature review. J Thromb Thrombolysis 2012; 32:439-47. [PMID: 21818664 DOI: 10.1007/s11239-011-0624-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The development of inhibitors that neutralize the function of clotting factor VIII (FVIII) is currently the most challenging complication associated with the treatment of hemophilia A as it increases the disease-related morbidity and mortality. Immune tolerance induction (ITI) is the only documented strategy to eradicate persistent inhibitors in severe hemophilia A patients. Several studies have been conducted so far to identify patient- and treatment-related factors associated with greater ITI success. The currently available literature on ITI in hemophilia A will be critically reviewed in this article. In particular, we will focus on the role of the type of FVIII product on ITI outcome by analyzing the clinical and experimental data.
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Affiliation(s)
- Rolf C. R. Ljung
- Lund University, Departments of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö; Sweden
| | - Karin Knobe
- Lund University, Departments of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö; Sweden
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COPPOLA A, FRANCHINI M, MAKRIS M, SANTAGOSTINO E, DI MINNO G, MANNUCCI PM. Thrombotic adverse events to coagulation factor concentrates for treatment of patients with haemophilia and von Willebrand disease: a systematic review of prospective studies. Haemophilia 2012; 18:e173-87. [DOI: 10.1111/j.1365-2516.2012.02758.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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DE MOERLOOSE P, FISCHER K, LAMBERT T, WINDYGA J, BATOROVA A, LAVIGNE-LISSALDE G, ROCINO A, ASTERMARK J, HERMANS C. Recommendations for assessment, monitoring and follow-up of patients with haemophilia. Haemophilia 2011; 18:319-25. [DOI: 10.1111/j.1365-2516.2011.02671.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Hermans C, Brackmann HH, Schinco P, Auerswald G. The case for wider use of recombinant factor VIII concentrates. Crit Rev Oncol Hematol 2011; 83:11-20. [PMID: 21964312 DOI: 10.1016/j.critrevonc.2011.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 08/05/2011] [Indexed: 12/21/2022] Open
Abstract
The introduction of clotting factor concentrates led to major advances in hemophilia care. Rather than simply providing an alternative to plasma-derived concentrates, the introduction in the 1990s of recombinant concentrates added value to replacement therapy particularly with respect to prophylaxis and immune-tolerance induction. While the safety of plasma-derived concentrates has improved considerably, these concentrates may still pose an infectious risk through as-yet unknown pathogens and poor impurity constituent characterization. Recombinant concentrates are increasingly used because of their benefits in pathogen safety, convenience and the potential for unfettered supply. Yet worldwide they remain accessible only to a limited number of patients due to fear of the potential for inhibitor development, overestimation of their costs and underestimation of their benefits. This article reviews the characteristics and properties of recombinant FVIII concentrates to help physicians and patient representatives promote the right of access of patients to the safest products.
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Affiliation(s)
- Cedric Hermans
- Hemostasis and Thrombosis Unit, Haemophilia Clinic, CliniquesUniversitaires Saint-Luc, Catholic University of Louvain, 1200 Brussels, Belgium.
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32
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JAMES AH. Diagnosis and management of women with bleeding disorders - international guidelines and consensus from an international expert panel. Haemophilia 2011; 17 Suppl 1:3-5. [DOI: 10.1111/j.1365-2516.2011.02557.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Giampaolo A, Abbonizio F, Puopolo M, Arcieri R, Mannucci PM, Hassan HJ. Consumption of clotting factors in severe haemophilia patients undergoing prophylaxis and on-demand treatment in Italy. Transfus Med 2011; 21:280-4. [DOI: 10.1111/j.1365-3148.2011.01074.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Colombo GL, Di Matteo S, Mancuso ME, Santagostino E. Cost-utility analysis of prophylaxis versus treatment on demand in severe hemophilia A. CLINICOECONOMICS AND OUTCOMES RESEARCH 2011; 3:55-61. [PMID: 21935333 PMCID: PMC3169977 DOI: 10.2147/ceor.s16670] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Indexed: 11/23/2022] Open
Abstract
Background: Individuals with severe hemophilia A have reduced blood levels of clotting factor VIII (FVIII) leading to recurrent bleeding into joints and muscles. Primary prophylaxis with clotting factor concentrates started early in childhood prevents joint bleeds, thus avoiding joint damage and improving people’s quality of life. There remain significant differences in the implementation of primary prophylaxis worldwide mainly due to the cost of prophylaxis compared with treatment on demand. Objective: To evaluate the cost-effectiveness of primary prophylaxis with FVIII concentrates versus secondary prophylaxis, versus treatment on demand, and versus a “hybrid” (primary prophylaxis followed by on-demand treatment in adults) in individuals with severe hemophilia A. Methods: A Markov model was developed and run using different sources of clinical, cost, and utility data. The model was populated with a hypothetical cohort of 100 individuals with severe hemophilia A. The perspective of the Italian National Health System was used. Results: The baseline results showed that primary and secondary prophylaxis is cost-effective compared both with treatment on demand and with a hybrid strategy. The incremental costs per quality-adjusted life-year gained for individuals with hemophilia A receiving primary and secondary prophylaxis were €40,229 to €40,236 versus an on-demand strategy. However, the sensitivity analyses performed showed that the results were sensitive to the unit cost of clotting FVIII, bleeding frequency, and the discount rate. Conclusion: Although primary prophylaxis is a costly treatment, our results show that it is cost-effective compared with treatment on demand.
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HERMANS C, DE MOERLOOSE P, FISCHER K, HOLSTEIN K, KLAMROTH R, LAMBERT T, LAVIGNE-LISSALDE G, PEREZ R, RICHARDS M, DOLAN G. Management of acute haemarthrosis in haemophilia A without inhibitors: literature review, European survey and recommendations. Haemophilia 2011; 17:383-92. [DOI: 10.1111/j.1365-2516.2010.02449.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Use of Glubran 2 and Glubran tissue skin adhesive in patients with hereditary bleeding disorders undergoing circumcision and dental extraction. Ann Hematol 2010; 90:463-8. [DOI: 10.1007/s00277-010-1086-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Accepted: 09/13/2010] [Indexed: 10/19/2022]
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37
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Coppola A, Di Capua M, Di Minno MND, Di Palo M, Marrone E, Ieranò P, Arturo C, Tufano A, Cerbone AM. Treatment of hemophilia: a review of current advances and ongoing issues. J Blood Med 2010; 1:183-95. [PMID: 22282697 PMCID: PMC3262316 DOI: 10.2147/jbm.s6885] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Indexed: 01/27/2023] Open
Abstract
Replacement of the congenitally deficient factor VIII or IX through plasma-derived or recombinant concentrates is the mainstay of treatment for hemophilia. Concentrate infusions when hemorrhages occur typically in joint and muscles (on-demand treatment) is able to resolve bleeding, but does not prevent the progressive joint deterioration leading to crippling hemophilic arthropathy. Therefore, primary prophylaxis, ie, regular infusion of concentrates started after the first joint bleed and/or before the age of two years, is now recognized as first-line treatment in children with severe hemophilia. Secondary prophylaxis, whenever started, aims to avoid (or delay) the progression of arthropathy and improve patient quality of life. Interestingly, recent data suggest a role for early prophylaxis also in preventing development of inhibitors, the most serious complication of treatment in hemophilia, in which multiple genetic and environmental factors may be involved. Treatment of bleeds in patients with inhibitors requires bypassing agents (activated prothrombin complex concentrates, recombinant factor VIIa). However, eradication of inhibitors by induction of immune tolerance should be the first choice for patients with recent onset inhibitors. The wide availability of safe factor concentrates and programs for comprehensive care has now resulted in highly satisfactory treatment of hemophilia patients in developed countries. Unfortunately, this is not true for more than two-thirds of persons with hemophilia, who live in developing countries.
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Affiliation(s)
- Antonio Coppola
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
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38
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Franchini M, Lippi G. Prothrombin complex concentrates: an update. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2010; 8:149-54. [PMID: 20671873 PMCID: PMC2906185 DOI: 10.2450/2010.0149-09] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/28/2010] [Indexed: 01/12/2023]
Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione, Azienda Ospedaliero-Universitaria di Parma, Italy.
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Abstract
Mild hemophilia A (HA), defined by clinical features and factor VIII coagulant activity (FVIII:C) between 0.05 and 0.40 IU mL(-1), is characteristically distinct from severe HA. Indeed, although the molecular characterization of mild HA has permitted the identification of specific underlying mutations, its clinical phenotype is strikingly different from that of patients with a severe FVIII defect, where spontaneous hemorrhages or recurrent joint bleeding are usual manifestations. With aging, mild HA patients may develop complications (i.e. cancers and cardiovascular disorders), the management of which may prove challenging due to the concomitant bleeding tendency. Furthermore, the development of inhibitors provides an additional major complication in these patients, because it increases the severity of the bleeding phenotype and complicates their management. Standard management of mild HA includes the use of desmopressin and antifibrinolytic agents for minor bleeding episodes or surgical procedures, whilst major bleeding or surgery requires replacement therapy with FVIII concentrates. As regards treatment of patients with inhibitors, bypassing agents (i.e. activated prothrombin complex concentrates and recombinant activated FVII) have proven effective in the treatment of bleeding episodes, but as there are insufficient data to determine the optimal approach to immune tolerance induction in this group of patients, their optimal management remains controversial. Rituximab is a newer, promising therapeutic option for inhibitor eradication in such patients. Many aspects concerning mild HA remain to be clarified, including the molecular basis, the natural history and the optimal diagnostic and therapeutic strategies. Only large prospective studies will shed light on this condition.
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Affiliation(s)
- M Franchini
- Servizio di Immunoematologia e Medicina Trasfusionale, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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40
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Hopmeier P. Faktor XI. Hamostaseologie 2010. [DOI: 10.1007/978-3-642-01544-1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Franchini M, Lippi G, Montagnana M, Targher G, Zaffanello M, Salvagno GL, Rivolta GF, Perna CD, Tagliaferri A. Hemophilia and cancer: A new challenge for hemophilia centers. Cancer Treat Rev 2009; 35:374-7. [DOI: 10.1016/j.ctrv.2009.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 01/07/2009] [Accepted: 01/08/2009] [Indexed: 01/02/2023]
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HERMANS C, ALTISENT C, BATOROVA A, CHAMBOST H, DE MOERLOOSE P, KARAFOULIDOU A, KLAMROTH R, RICHARDS M, WHITE B, DOLAN G. Replacement therapy for invasive procedures in patients with haemophilia: literature review, European survey and recommendations. Haemophilia 2009; 15:639-58. [DOI: 10.1111/j.1365-2516.2008.01950.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Primary prophylaxis in children with haemophilia. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2009; 6 Suppl 2:s4-11. [PMID: 19105503 DOI: 10.2450/2008.0030-08] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Starting from the clinical observations that moderate haemophiliacs experienced only few bleeding episodes and rarely developed significant joint deterioration (haemophilic arthropathy), and the pioneer experience in Sweden, prophylaxis (i.e. the regular and long-term administration of clotting factor concentrate in order to prevent bleeding) has been practiced for more than forty years in severe haemophilia and is currently recommended as the first choice of treatment by the World Health Organisation and World Federation of Hemophilia and by many national medical/scientific organizations. Observational studies clearly established the superiority of prophylaxis over on-demand treatment in reducing the risk of arthropathy, also showing that starting prophylaxis earlier in life and after very few joint bleeds was associated with better joint outcomes, and led to the current definitions of primary (started before the age of 2 yrs and after no more than one joint bleed) and secondary prophylaxis. More recently, evidences from randomized trials, which were previously lacking in this setting, were also provided. This review summarizes available data from which current clinical practice of primary (and early secondary) prophylaxis in children with severe haemophilia was drawn. Open issues concerning optimal regimens and barriers to the implementation of prophylaxis are also discussed.
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Franchini M, Coppola A, Molinari AC, Santoro C, Schinco P, Speciale V, Tagliaferri A. Forum on: the role of recombinant factor VIII in children with severe haemophilia A. Haemophilia 2009; 15:578-86. [PMID: 19187188 DOI: 10.1111/j.1365-2516.2008.01975.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The development of recombinant FVIII (rFVIII) products, fuelled by the need for improved safety of treatment arising from the dramatic widespread blood-borne virus transmission in the 1970-1980s revolutionized the care of children with haemophilia A over the last two decades. The larger availability of perceived safer replacement therapy associated with the introduction of rFVIII products reassured the haemophilia community and there was a strong push in some Western countries to treat haemophilic children only with rFVIII. Moreover, this significantly contributed in the 1990s to the diffusion outside Northern Europe of prophylactic regimens implemented at an early age to prevent bleeding and the resultant joint damage (i.e. primary prophylaxis), together with the possibility of home treatment. These changes led to a substantial improvement of the quality of life of haemophilic children and of their families. The general agreement that primary prophylaxis represents the first-choice treatment for haemophilic children has been recently supported by two randomized controlled trials carried out with rFVIII products, providing evidence on the efficacy of early prophylaxis over on-demand treatment in preserving joint health in haemophilic children. However, the intensity and optimal modalities of implementation of prophylaxis in children, in particular with respect to the issue of the venous access, are still debated. A number of studies also supports the role of secondary prophylaxis in children, frequently used in countries in which primary prophylaxis was introduced more recently. With viral safety now less than an issue and with the more widespread use of prophylaxis able to prevent arthropathy, the most challenging complication of replacement therapy for children with haemophilia remains the risk of inhibitor development. Despite conflicting data, there is no evidence that the type of FVIII concentrate significantly influences the complex multifactorial process leading to anti-FVIII alloantibodies, whereas other treatment-related factors are likely to increase (early intensive treatments due to surgery or severe bleeds) or reduce (prophylaxis) the risk. Although the optimal regimen is still uncertain, eradication of anti-FVIII antibodies by immune tolerance induction (ITI), usually with the same product administered at inhibitor detection, should be the first-choice treatment for all patients with recent onset inhibitors. This issue applies particularly to children, as most patients undergo ITI at an early age, when inhibitors usually appear. The availability of a stable and long-lasting venous access represents a leading problem also in this setting. These and other topics concerning rFVIII treatment of haemophilic children were discussed in a meeting held in Rome on 27 February 2008 and are summarized in this report.
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Affiliation(s)
- M Franchini
- Immunohaematology and Transfusion Centre, Department of Pathology and Laboratory Medicine, University Hospital of Parma, Parma, Italy
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Tagliaferri A, Franchini M, Coppola A, Rivolta GF, Santoro C, Rossetti G, Feola G, Zanon E, Dragani A, Iannaccaro P, Radossi P, Mannucci PM. Effects of secondary prophylaxis started in adolescent and adult haemophiliacs. Haemophilia 2008; 14:945-51. [PMID: 18540895 DOI: 10.1111/j.1365-2516.2008.01791.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital, Parma, Italy.
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NEUNERT CE, MILLER KL, JOURNEYCAKE JM, BUCHANAN GR. Implantable central venous access device procedures in haemophilia patients without an inhibitor: systematic review of the literature and institutional experience. Haemophilia 2008; 14:260-70. [DOI: 10.1111/j.1365-2516.2007.01605.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Richards M, Altisent C, Batorova A, Chambost H, Dolan G, de Moerloose P, Fraga M, Hermans C, Karafoulidou A, Klamroth R, Lassila R, Rothschild C. Should prophylaxis be used in adolescent and adult patients with severe haemophilia? An European survey of practice and outcome data. Haemophilia 2007; 13:473-9. [PMID: 17880432 DOI: 10.1111/j.1365-2516.2007.01478.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A survey of 21 haemophilia doctors, throughout Europe, who care for a total of approximately 5000 patients with bleeding disorders addressing practice and opinions regarding prophylaxis in patients aged 16-24 years and adults aged over 50 years, is presented. The outcome of adolescent patients who reduced or stopped prophylaxis was recorded. Eighteen of 19 respondents would consider modification of established prophylaxis in the adolescent age group, principal considerations being avoidance of risks of further concentrate exposure, predicted poor compliance and treatment costs. The preferred age for modification was 16-20 years, but there was very little consensus on the particular prophylactic regime recommended. Approximately, half of a cohort of 218 patients with severe haemophilia successfully reduced or stopped prophylaxis when they reached adolescence. Only 26 of 92 (28%) of the patient cohort who stopped prophylaxis, required reintroduction of a prophylactic regime and 12 of 59 (20%) of those who reduced the intensity of prophylaxis had to reintroduce a more intensive regime. A majority of respondents would consider starting prophylaxis in those over 50 years. There was no consensus as to indications for this practice or the nature of the prophylaxis protocol. We conclude that there is an absence of consensus on the management of patients with severe haemophilia, as they pass through adolescence and young adulthood, and reach the age of 50. Aggregate outcome data suggest a significant proportion of patients in the 18-22 years age range may be able to reduce or stop prophylaxis. A substantial number of older patients are on prophylaxis.
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Affiliation(s)
- M Richards
- Paediatric Haematology Department, Children's Day Hospital, St James University Hospital, Leeds, UK.
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Khair K, J Geraghty S. Haemophilia A: meeting the needs of individual patients. ACTA ACUST UNITED AC 2007; 16:987-93. [DOI: 10.12968/bjon.2007.16.16.27077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kate Khair
- Haemophilia, Haemophilia Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK,
| | - Susan J Geraghty
- Mountain State Regional Hemophilia and Thrombosis Center, University of Colorado Health Sciences Center, Aurora, Colorado, USA
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BARNES C, LILLICRAP D, PAZMINO-CANIZARES J, BLANCHETTE VS, STAIN AM, CLARK D, HENSMEN C, CARCAO M. Pharmacokinetics of recombinant factor VIII (Kogenate-FS�) in children and causes of inter-patient pharmacokinetic variability. Haemophilia 2006. [DOI: 10.1111/j.1365-2516.2006.01333.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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