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AlSaleh KA, Al-Numair NS, Alsuaiman A, Zolaly M, Khojah OT, AlZahrani FM, Siddiqui K, Al-Allaf FA, AlMomen A, Sajid R, Owaidah TM. Prevalence of bleeding symptoms among young adults in Saudi Arabia, a national survey. Medicine (Baltimore) 2021; 100:e27513. [PMID: 34713827 PMCID: PMC8556019 DOI: 10.1097/md.0000000000027513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 08/02/2021] [Accepted: 09/23/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Prevalence of bleeding disorders vary due to several factors including geographical location. Mild bleeding disorders can lead to iron deficiency, morbidity, and in severe cases mortality. Quantification of haemorrhagic symptoms is a key component in management of bleeding disorders and a challenging task for clinicians.An abridged version of MCMDM-1vWD questionnaire with validated Arabic translation was used to quantify bleeding disorders in adult students (n = 1138) in 4 different regions of Kingdom of Saudi Arabia. Statistical analysis was performed to indicate gender disparity and prevalence.74.5% of respondents answered at least 1 question with affirmation, with 32.3% affected in Riyadh showing the highest prevalence and 14.03% affected in Dammam showing the least prevalence (P-value < .001). Gender-wise, higher prevalence of bleeding disorders in females 54.9% than in males 45.1% was observed (P-value .01). Epistaxis prevalence was significantly higher in males 30.7% vs 23.2% in females (P-value .0004), while cutaneous symptoms were reported significantly more by female participants 29.7% vs 12.3% in males (P-value < .001). Menorrhagia was reported by 28% of females, with heavy bleeding experienced by 57.6% female participants for <7 days while in 42.4% of females for >7 days.The current study signifies the ethnic distribution and gender disparity of mild bleeding disorders, and highlights the need for national surveillance system in order to improve management of patients with bleeding disorders.
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Affiliation(s)
- Khalid A. AlSaleh
- Department of Medicine, College of Medicine, King Saud University, Riyadh, KSA
| | - Nouf S. Al-Numair
- Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Ayman Alsuaiman
- Research center, King Faisal Specialist Hospital, Alfaisal University, Riyadh, KSA
| | | | - Osamah T. Khojah
- Pathology Department, College of Medicine, King Saud University
- Corporate Medical Affairs, Dr. Sulaiman Alhabib Medical Group
| | - Faisal M. AlZahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Khawar Siddiqui
- Department of Statistics, King Faisal Specialist Hospital, Alfaisal University, Riyadh, KSA
| | - Faisal A. Al-Allaf
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, KSA
| | - Abdulkareem AlMomen
- Department of Pathology, College of Medicine, King Saud University, Riyadh, KSA
| | - Raihan Sajid
- Department of Pathology, Alfaisal University, Riyadh, KSA
| | - Tarek M. Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA
- Alfaisal University, Riyadh, KSA
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A homozygous loss-of-function mutation in GP1BB causing variable clinical phenotypes in a family with Bernard-Soulier syndrome. Blood Coagul Fibrinolysis 2021; 32:352-355. [PMID: 33657022 DOI: 10.1097/mbc.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bernard-Soulier syndrome is a rare autosomal recessive bleeding disorder and has a low incidence. Bernard-Soulier syndrome is caused by the deficiency of glycoprotein GPIb-V-IX complex, a receptor for von Willebrand factor and is characterized by thrombocytopenia, giant platelets and bleeding tendency. We are reporting three members of a same family with variable phenotypic clinical presentation. The index case is a 20-year-old boy who has a frequent presentation with epistaxis, and low platelet counts (25 × 109/l). He had been hospitalized multiple times and received platelet transfusions. His brother and cousin reported bleeding symptoms with less frequent medical intervention. Genetic analysis by next-generation sequencing identified a homozygous GP1BB variant (c.423C>A:p.Cys141Ter), which segregated amongst the family members. The results led us to an improved insight into the disease for this family with variable phenotypic expression, in addition to the identification of a variant for further structural and functional characterization.
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ElAlfy MS, Tantawy AAG, Eldin BEMB, Mekawy MA, Mohammad YAE, Ebeid FSE. Epistaxis in a Pediatric Outpatient Clinic: Could It be an Alarming Sign? Int Arch Otorhinolaryngol 2021; 26:e183-e190. [PMID: 35602268 PMCID: PMC9122762 DOI: 10.1055/s-0041-1726040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/24/2020] [Indexed: 11/01/2022] Open
Abstract
Abstract
Introduction Epistaxis is a common presentation among children.
Objective To investigate the suitability of a simple tool of assessment for patients with epistaxis that could guide in subgrouping those with possible bleeding tendencies who may need further assessment.
Methods Children who presented to a tertiary outpatient clinic with epistaxis of an unknown cause were recruited. They underwent thorough clinical assessment and answered the pediatric bleeding questionnaire and the epistaxis severity score. All patients underwent complete blood count as well as coagulation profile, and confirmatory diagnostic tests were performed as needed.
Results Among the 30,043 patients who presented to the outpatient clinic over a year, 100 children had epistaxis, with an estimated annual frequency of 1 in 300. A total of 84% of the patients were younger than 12, and nearly half of these were younger than 6 years. Seventy-six patients had recurrent epistaxis, and 12 had systemic comorbidities. A significant higher percentage of patients presented with epistaxis in the hot months of the year. A total of 90% of the patients presented anterior bleeding, and the majority were treated with nasal compression only. Forty-three patients presented with epistaxis only; 37 of them were diagnosed as idiopathic epistaxis, and 6 had local causes. Fifty-seven patients presented with other bleeding manifestations, 47 of whom had a definite bleeding disorder and the other 10 had undiagnosed bleeding tendency. Those with other bleeding manifestations showed a higher frequency of positive family history of epistaxis; of being referred from a primary care physician; of having alarming low platelet count, and of presenting less seasonal variability. A bleeding score ≥ 2 showed significant value in suspecting an underlying systemic pathology as a cause of epistaxis.
Conclusion The pediatric bleeding questionnaire is a useful and simple tool in the identification of pediatric patients who need further diagnostic testing to detect any underlying bleeding tendency.
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Affiliation(s)
- Mohsen Saleh ElAlfy
- Department of Pediatrics, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | | | | | - Mohamed Amin Mekawy
- Department of Clinical Pathology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Zolaly MA, Tarwah A, Albalawi M, Alwasaidi T, Owaidah T. The prevalence of self-reported bleeding tendency symptoms among adolescents in Almadinah Almunawwarah, Kingdom of Saudi Arabia. J Family Med Prim Care 2021; 10:826-830. [PMID: 34041084 PMCID: PMC8138373 DOI: 10.4103/jfmpc.jfmpc_1480_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/17/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
Bleeding tendency is a common medical problem that is usually caused by either coagulation factors abnormalities, platelets disorders, or vasculopathy. Detection of patients with high bleeding risk through history taking and accurate diagnosis followed by appropriate management will help decreasing chances of significant complications. Methodology A cross-sectional survey of a random sample of adolescent students in the preparatory year at Taibah University in Almadinah Almunawwarah, Saudi Arabia were interviewed using a validated semi-structured condensed bleeding tendency questionnaire generated from Molecular and Clinical Markers for the Diagnosis and Management of (MCMDM-1). Results A total of 680 questionnaires were collected, the phase I data were analyzed to determine participants who gave a positive response to any related question while in Phase II respondents with at least one positive response of any bleeding symptom were interviewed. More than half 52.6% (358 out of 680) were positive for any bleeding symptoms. The incidence rose to 70.9% (482 out of 680) if "Mild" symptoms were also included. Epistaxis was positive in 21.8%, Cutaneous symptoms were reported by 22.65%, Bleeding from the oral cavity was reported in 39.6%, Gastrointestinal bleeding was observed by 5.9%, bleeding after the first surgery reported in 21% and Muscle hematomas/hemoarthrosis was observed by 3.2%, Among female papulation, 16.1% reported having 6-10 "Heavy Days" during their menstrual cycles. Discussion High prevalence of bleeding symptoms having the possibility of the presence of an Inherited Bleeding Disorders were observed in our study in comparison to other studies, this might be attributed to the high percentage of consanguinity marriages in our area. Recommendations Raising awareness among family doctors and pediatricians about the possibility of presence of bleeding tendency utilizing good history taking followed by appropriate examination and laboratory confirmatory testing will help in early detection and managements.
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Affiliation(s)
- Mohammed A Zolaly
- Department of Pediatrics, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Ahmad Tarwah
- Department of Pediatrics, Madinah Maternity Children Hospital, Almadinah Almunawwarah, Saudi Arabia
| | - Mohammed Albalawi
- Department of Internal Medicine, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Turki Alwasaidi
- Department of Internal Medicine, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Tarek Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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AlSaleh KA, Al-Numair N, AlSuliman A, Zolaly M, Albanyan AM, AlOtaishan N, Abudouleh E, Bayoumy N, Tarawah A, AlZahrani F, AlAllaf F, AlMomen AK, Sajid R, Owaidah TM. Prevalence of Coagulation Factors Deficiency among Young Adults in Saudi Arabia: A National Survey. TH OPEN 2020; 4:e457-e462. [PMID: 33376945 PMCID: PMC7758154 DOI: 10.1055/s-0040-1721500] [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: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction
Inherited bleeding disorders vary in prevalence due to genetic disparity and ethnicity. Little is known about the prevalence of coagulation factor deficiency and bleeding disorders in middle-eastern population.
Methods
Young Saudi adults with at least one positive bleeding symptom reported in semi-structured validated condensed MCMDM-1vWD questionnaire were tested for complete blood count, routine and special coagulation tests, serum ferritin level, and capillary zone electrophoresis. After initial testing, those with prolonged prothrombin time (PT) or activated prothrombin time (APTT) had further testing to evaluate coagulation factors level. Platelet function was tested through platelet function analyzer (PFA)-100, and multiplate aggregometer (MEA) on patients suspected of having platelet disorders.
Results
Six-hundred-forty patients (male = 347, 54.2%) were included. A possible platelet function defect was diagnosed in three patients with one matching Glanzmann's thrombasthenia trait pattern, and one that of Bernard-Soulier trait pattern. One patient was diagnosed with von Willebrand disease. Deficiencies in coagulation factor levels were revealed as F-VIII in 14 (7.4%), F-IX in 15 (7.6%), F-II in two (3.3%), F-V in 17 (26.1%), FVII in two (3.1%), and F-X in one (1.8%) of study subjects; low vWF activity (<50%) was found in 14 (8%). Abnormal values were found for various laboratory tests with prolongation of platelet function analyzer-epinephrine (PFA-EPI) in 11%, PFA-ADP or arachidonic acid in 15.2%, PT in 35.9%, and APTT in 63.7%. Five-hundred-seventy-six patients (90%) had normal results in the coagulation factor assays and were categorized as patients with bleeding of unknown cause (BUC). A diagnosis of a bleeding disorder was more frequently made in men than in women (38 vs. 26). Iron deficiency anemia was found in 18 (25%) females positively associated with F-IX deficiency (
p
-value 0.000). Male gender (73.3%,
p
= 0.007) was independently associated with the diagnosis of coagulation factor deficiency.
Conclusion
The current study reports a higher prevalence of coagulation factors deficiency in Saudi population than reported in the western population.
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Affiliation(s)
- Khalid A AlSaleh
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Al-Numair
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ayman AlSuliman
- Research Center, King Faisal Specialist Hospital, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed Zolaly
- Department of Pediatric, Taibah University, Medina, Saudi Arabia
| | | | - Nouf AlOtaishan
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Esra Abudouleh
- College of Medical Applied Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nervana Bayoumy
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Tarawah
- Medina Maternity and Children Hospital, Medina, Saudi Arabia
| | - Faisal AlZahrani
- Department of Pathology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal AlAllaf
- Department of Molecular Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Abdul Kareem AlMomen
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raihan Sajid
- Department of Pathology, Alfaisal University, Riyadh, Saudi Arabia
| | - Tarek M Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, Saudi Arabia
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Chagas AP, Peixoto BP, Costa BBD, Moreira TA, Cinelli LP, da Silva LL, Miranda-Alves L, Berto-Junior C. Effects of bisphenol A and S on blood coagulation: in vivo, in vitro and in silico approaches in toxicodynamic. Toxicol Mech Methods 2020; 31:90-99. [PMID: 33054482 DOI: 10.1080/15376516.2020.1836102] [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: 10/23/2022]
Abstract
Bisphenol A (BPA) is a well-known endocrine disruptor with several effects on mammalian systems and has been linked to diseases, such as cancer. Bisphenol S (BPS) emerged as a likely alternative to BPA in industrial production. Despite being well studied and exhibiting BPA-like toxic capacity, many effects are still being elucidated. The blood coagulation system is well controlled in an effort to minimize blood loss. To our knowledge, no study reported actions of bisphenols in this system. The aim of this work was to evaluate the effects of bisphenols on blood coagulation. Zebrafish were used to measure bleeding time. To assess possible mechanisms, platelet-rich plasma was incubated with both bisphenols in the presence of arachidonic acid. Prothrombin time (PT) and activated partial thromboplastin time (APTT) assays were performed in the presence of BPA and BPS. Alignment of human factor VII sequence was compared to zebrafish and docking simulations performed with FVIIa and bisphenols. An extended time was observed in BPA-treated but not BPS-treated animals in bleeding time; in PT, bisphenols showed no effect. APTT was increased in the highest concentration of bisphenols, with no effects in platelet aggregation, indicating interference with factor VII. Protein alignment showed that both proteins have well conserved residues, as those being required for interaction of FVIIa-BPA and FVIIa-BPS complexes, as shown in molecular docking. Taken together, these data show BPA and BPS as capable of interfering with the coagulation process via FVIIa.
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Affiliation(s)
- Artur Paes Chagas
- Curso de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Bianca Barros da Costa
- Laboratório de Prospecção em Produtos Bioativos, Grupo de Glicofármacos, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-graduação em Produtos Bioativos e Biociências, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thamyris Almeida Moreira
- Laboratório de Prospecção em Produtos Bioativos, Grupo de Glicofármacos, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-graduação em Produtos Bioativos e Biociências, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Paes Cinelli
- Laboratório de Prospecção em Produtos Bioativos, Grupo de Glicofármacos, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-graduação em Produtos Bioativos e Biociências, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro Louback da Silva
- Curso de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratório Integrado de Pesquisa - LIC, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro Miranda-Alves
- Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratório de Endocrinologia Experimental- LEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-graduação em Farmacologia e Química Medicinal, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-graduação em Ciências Morfológicas, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clemilson Berto-Junior
- Curso de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratório de Endocrinologia Experimental- LEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Sahoo T, Naseem S, Ahluwalia J, Marwaha RK, Trehan A, Bansal D. Inherited Bleeding Disorders in North Indian Children: 14 years' Experience from a Tertiary Care Center. Indian J Hematol Blood Transfus 2019; 36:330-336. [PMID: 32425385 DOI: 10.1007/s12288-019-01233-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/15/2019] [Indexed: 01/19/2023] Open
Abstract
Inherited bleeding disorders are not uncommon in pediatric practice: most of them being chronic, require lifelong replacement therapy. To frame a management policy, it is essential to assess the load and pattern of bleeding disorders in the local population. However, there is paucity of data reporting the clinical spectrum of coagulation and platelet function disorders in Indian children. Hence to find out the exact burden and clinico-investigational profile of these patients we conducted this study. In this retrospective case review, detailed clinical information was extracted from case records in 426 children with a suspected diagnosis of hereditary bleeding disorder registered in the Pediatric Hematology clinic of a tertiary referral centre over a period of 14 years (1998-2011) and pooled for analysis. In our cohort prevalence of hemophilia A, hemophilia B, platelet function disorders, von Willebrand disease and other rare factor deficiencies were 72%, 11%, 7%, 4% and 4% respectively. Common clinical spectrum included skin bleeds, arthropathy, mucosal bleeds. 10% had deeper tissue bleeding and 16% received replacement therapy at the first visit. Nearly 3/4th of cases were lost for follow up after the initial visit. Hemophilia A was the commonest inherited bleeding disorder in our population. Skin bleeds and arthropathy were common clinical presentations. Factor replacement therapy was restricted to a minority. There is an urgent need for establishing centres of excellence with administrative commitment for factor replacement therapy for comprehensive management of such children in resource-limited countries.
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Affiliation(s)
- Tanushree Sahoo
- 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Shano Naseem
- 2Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Jasmina Ahluwalia
- 2Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - R K Marwaha
- 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Amita Trehan
- 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Deepak Bansal
- 1Division of Pediatric Hemato-Oncology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
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Prevalence of Bleeding Symptoms among Adolescents and Young Adults in the Capital City of Saudi Arabia. Adv Hematol 2018; 2018:1858241. [PMID: 29853900 PMCID: PMC5954960 DOI: 10.1155/2018/1858241] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/25/2018] [Indexed: 11/21/2022] Open
Abstract
Background Bleeding disorders vary in prevalence. While some are rare, some can be common in both sexes. Most bleeding disorders manifest as chronic bleeding tendencies or as an increase in bleeding during surgical procedures or trauma. The consequences of bleeding can be as simple as iron deficiency or catastrophic, resulting in severe morbidity and mortality. Bleeding disorders typically affect both sexes except hemophilia A and B, which mainly affects males. Method We conducted a questionnaire-based survey among adolescents and young adults (1901 [49%] boys, 1980 [51%] girls) in Riyadh city regarding bleeding symptoms. Of these, 1849 (47.6%) responded “Yes/Positive” for at least one question about the bleeding symptoms. Results The most common bleeding symptom was epistaxis (19.7% of the sample population) detected in Phase I of the study. A tandem survey was conducted among 525 adolescents who had responded “Yes/Positive” to any one of the questions inquiring about bleeding symptoms. Conclusion In this study, we report for the first time the prevalence of bleeding symptoms in a representative sample of Saudi adolescents and young adults.
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Abdel Wahab MS, Fathy H, Ismail R, Mahmoud N. Recurrent epistaxis in children: When should we suspect coagulopathy? THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2014. [DOI: 10.4103/1012-5574.133207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Asymmetrical crying face concomitant with Glanzmann's thrombasthenia. Blood Coagul Fibrinolysis 2014; 25:186-7. [DOI: 10.1097/mbc.0b013e3283658ab2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Hampshire DJ, Abuzenadah AM, Cartwright A, Al-Shammari NS, Coyle RE, Eckert M, Al-Buhairan AM, Messenger SL, Budde U, Gürsel T, Ingerslev J, Peake IR, Goodeve AC. Identification and characterisation of mutations associated with von Willebrand disease in a Turkish patient cohort. Thromb Haemost 2013; 110:264-74. [PMID: 23702511 DOI: 10.1160/th13-02-0135] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 05/04/2013] [Indexed: 11/05/2022]
Abstract
Several cohort studies have investigated the molecular basis of von Willebrand disease (VWD); however, these have mostly focused on European and North American populations. This study aimed to investigate mutation spectrum in 26 index cases (IC) from Turkey diagnosed with all three VWD types, the majority (73%) with parents who were knowingly related. IC were screened for mutations using multiplex ligation-dependent probe amplification and analysis of all von Willebrand factor gene (VWF) exons and exon/intron boundaries. Selected missense mutations were expressed in vitro. Candidate VWF mutations were identified in 25 of 26 IC and included propeptide missense mutations in four IC (two resulting in type 1 and two in recessive 2A), all influencing VWF expression in vitro. Four missense mutations, a nonsense mutation and a small in-frame insertion resulting in type 2A were also identified. Of 15 type 3 VWD IC, 13 were homozygous and two compound heterozygous for 14 candidate mutations predicted to result in lack of expression and two propeptide missense changes. Identification of intronic breakpoints of an exon 17-18 deletion suggested that the mutation resulted from non-homologous end joining. This study provides further insight into the pathogenesis of VWD in a population with a high degree of consanguineous partnerships.
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Affiliation(s)
- Daniel J Hampshire
- Haemostasis Research Group, Department of Cardiovascular Science, Faculty of Medicine, Dentistry and Health, University of Sheffield, Beech Hill Road, Sheffield, UK.
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12
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A longitudinal prospective study of bleeding diathesis in Egyptian pediatric patients: single-center experience. Blood Coagul Fibrinolysis 2013; 23:411-8. [PMID: 22610136 DOI: 10.1097/mbc.0b013e3283540bf8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Keeping an updated registry of bleeding disorders is crucial for planning care and documenting prevalence. We aimed to assess the prevalence of various bleeding disorders including rare inherited coagulation and platelet disorders concerning their clinico-epidemiological, diagnostic data and bleeding manifestations severity. Patients suffering from manifestations of bleeding or coagulation disorders presented to Hematology Clinic during 16 years were included and prospectively followed up. Demographics, clinical characteristics, complete blood count, bleeding, prothrombin and activated partial thromboplastin times, platelet aggregation tests and bone marrow aspiration were recorded. Overall 687 patients with bleeding disorders from total 2949 patients were identified. Inherited coagulation defects were found in 27.2%; hemophilia A (70.6%), hemophilia B (13.9%), factor I deficiency (2.3%), factor V deficiency (1.6%), factor X deficiency (4.2%), factor VII deficiency (2.6%), factor XIII deficiency (1.1%), combined factor deficiency (2.1%) and unclassified coagulation disorders in 1.6% of studied patients. Overall 72.7% had diagnosed with platelet disorders; immune thrombocytopenia was the commonest (74.8%), and inherited conditions represent (25.2%) in the following order: Glanzman's thrombasthenia (11.2%), von Willebrand disease (6.6%), Bernard-Soulier syndrome (1%) and Chediak Higashi in 0.4% and unclassified in 6%. Median age of diagnosis of coagulation and platelet disorders were 33 and 72 months. Presenting symptoms of coagulation disorders were: 25.1% post circumcision bleeding, 22.5% ecchymosis, 20.9% hemoarthrosis and 15% epistaxis. Symptoms of rare coagulation disorders were postcircumcision bleeding (20%), bleeding umbilical stump (20%), epistaxis (12%), hemoarthrosis (8%) and hematomas (4%). Presenting symptoms in rare inherited platelet disorders were purpura, ecchymosis, epistaxis and bleeding gums, respectively. Analysis of the clinico-epidemiological data of patients with bleeding disorders is a useful tool for monitoring and improving their quality of care.
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13
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An investigation of the spectrum of common and rare inherited coagulation disorders in north-eastern Iran. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 11:233-40. [PMID: 23114518 DOI: 10.2450/2012.0023-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 05/22/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Health care officials and legislators need accurate data on prevalence and numbers of individuals with bleeding disorders in order to plan and allot their budgets; the manufacturers of coagulation factors also need these data to estimate the amount of factors required to prevent scarcity of these products. MATERIALS AND METHODS We surveyed the prevalence of haemophilia A, haemophilia B, von Willebrand's disease and rare bleeding disorders in North-Eastern Iran. The survey was done in the period from September 2009 to March 2011. Information was collected from the medical records in three major hospitals and a haemophilia centre; the patients' updated data were obtained by telephone. RESULTS Overall in the current survey 552 patients with inherited coagulation disorders were identified and their medical records obtained. Of these, 429 (77.5%) had common bleeding disorders (haemophilia A, haemophilia B, von Willebrand's disease), 85 (15.6%) had rare bleeding disorders (deficiency of coagulation factors V, VII, X, XIII, I, XI, combined factor V and VIII deficiency) and 38 (6.9%) had platelet disorders.The commonest bleeding disorders were haemophilia A (n=287, 51.9%), haemophilia B (n=92, 16.6%), von Willebrand's disease (n=50, 9%), factor V deficiency (n=21, 3.8%), factor VII deficiency (n=19, 3.4%), factor X deficiency (n=2, 0.36%), combined factor V and VIII deficiency (n=28, 5.8%), factor XIII deficiency (n=11, 1.99%), factor XI deficiency (n=2, 0.4%), afibrinogenaemia (n=2, 0.36%) and platelet disorders (n=38, 6.9%). DISCUSSION There is notable population of individuals with bleeding disorders in North-Eastern Iran.
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Al Tonbary Y, ElAshry R, El Sayed Zaki M. Descriptive epidemiology of hemophilia and other coagulation disorders in mansoura, egypt: retrospective analysis. Mediterr J Hematol Infect Dis 2010; 2:e2010025. [PMID: 21415978 PMCID: PMC3033150 DOI: 10.4084/mjhid.2010.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 07/16/2010] [Indexed: 12/26/2022] Open
Abstract
Hemophilia represent the most severe inherited bleeding disorder (INB), it's thought to affect inviduals from all geographical areas in equal frequency. In Egypt which has a population of approximately (80million) consanguineous marriage are frequent, therefore autosomal recessive coagulation disorders reach a higher prevalence than in many other countries.The primary aim of this study was to describe the epidemiological situation of hemophilia in Mansoura, Egypt, as based on retrospective analysis of clinical records Mansoura University Children Hospital between years 2000 and 2008. The second aim was to assess the orthopedic complications and occurrence of hepatitis C in those patients and relate this status to the type of replacement therapy received prior to the study.The study included 72 children with hematological disorders registered from 2000 to 2008 in MUCH. The hemophilic patient was defined as a person with physician-diagnosed hemophilia A or B and a measured factor VIII or IX activity level of 30% or less. Persons with acquired inhibitors of FVIII or FIX excluded. Severity level was categorized as mild if the factor activity level was 6-30%, moderate if 1-5% and severe if <1% of normal.The severe presentation represents the majority in 76.7% followed by moderate severity in 17.2%. The commonest IBDs was hemophilia A affecting 44 patients, followed by Hemophilia B affecting 15 patients. The rare types were Factor XI deficiency, Factor V deficiency, Factor VII deficiency and combined FVIII, FIX and FX deficiency. The commonest orthopedic manifestation needing therapy was found among hemophilia A representing 8.3%. Hepatitis C viremia detected by PCR was found in 11.1% of patients. The bleeding complications as hematoma or hemarthrosis were the common complications. Nevertheless, 44.4% of patients had no complications, From this study we can conclude that the most common IBDs in our locality is hemophilia A followed by hemophilia B. The common presenting symptom was bleeding following male circumcision. Hepatitis C infection and arthropathy represented the main complications. The discovery of IBDs in young age children with proper supportive therapy could prevent arthropathy. Proper screening of blood and blood products reduce the risk of viral hepatitis and HIV acquisition.
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