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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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Ryoo SH, Kwon D, Lee JH, Seo KS, Kim HJ, Karm MH. An anesthetic management of head and neck cancer reconstructive surgery in a patient having hemophilia A: a case report. J Dent Anesth Pain Med 2021; 21:261-268. [PMID: 34136648 PMCID: PMC8187023 DOI: 10.17245/jdapm.2021.21.3.261] [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: 04/27/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022] Open
Abstract
Hemophilia A is a hemorrhagic disease caused by coagulation factor VIII deficiency. In head and neck cancer surgery, especially during a reconstructive one, complications can occur. These include hematomas due to bleeding which can then lead to flap ischemia, necrosis, and impaired wound healing. There are fewer cases of reconstructive surgery in patients with hemophilia A. Here in we report, a reconstructive surgery that involved mass resection, partial glossectomy (right), selective neck dissection (right, Levels I, II, III, IV), and reconstruction at the lateral arm free flap (left) in a 25-year-old man with hemophilia A. The surgery was successfully performed without any complications after pretreatment with Factor VIII concentrate, which has not been reported earlier.
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Affiliation(s)
- Seung-Hwa Ryoo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Dohyun Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Polzella P, Coutts K, Bignell P, Curry N. Unexpectedly high response to DDAVP in two patients with moderate haemophilia A. Haemophilia 2018; 24:e292-e294. [PMID: 30024654 DOI: 10.1111/hae.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 10/28/2022]
Affiliation(s)
- P Polzella
- Oxford Haemophilia& Thrombosis Centre, Churchill Hospital, Oxford, UK.,Radcliffe Department of Medicine, University Department of Haematology, Oxford University, Oxford, UK.,Haematology Theme, Oxford Biomedical Research Centre, Oxford, UK
| | - K Coutts
- Oxford Haemophilia& Thrombosis Centre, Churchill Hospital, Oxford, UK
| | - P Bignell
- Department of Genetics, Churchill Hospital, Oxford, UK
| | - N Curry
- Oxford Haemophilia& Thrombosis Centre, Churchill Hospital, Oxford, UK.,Radcliffe Department of Medicine, University Department of Haematology, Oxford University, Oxford, UK.,Haematology Theme, Oxford Biomedical Research Centre, Oxford, UK
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Diagnosis and care of patients with mild haemophilia: practical recommendations for clinical management. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:535-544. [PMID: 29328905 DOI: 10.2450/2017.0150-17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/26/2017] [Indexed: 12/17/2022]
Abstract
Mild haemophilia is defined by factor levels between 0.05 and 0.40 IU/mL and is characterised by traumatic bleeds. Major issues associated with mild haemophilia are that it may not present for many years after birth, and that awareness, even within families, may be low. Methodological problems exist in diagnosis, such as inconsistencies in results obtained from different assays used to measure factor levels in mild haemophilia. Advances in genetic testing provide insight into diagnosis as well as the likelihood of inhibitor development, which is not uncommon in patients with mild or moderate haemophilia and can increase morbidity. The management of patients with mild haemophilia is a challenge. This review includes suggestions around formulating treatment plans for these patients, encompassing the full spectrum from clinical care of the newly diagnosed neonate to that of the ageing patient with multiple comorbidities. Management strategies consider not only the vast differences in these patients' needs, but also risks of inhibitor development and approaches to optimally engage patients.
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Iorio A, Remmington T, Jahnke N, Dwan K, Hall N. Desmopressin acetate (DDAVP) for preventing and treating bleeding in people with mild or moderate haemophilia A. Hippokratia 2015. [DOI: 10.1002/14651858.cd011985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alfonso Iorio
- McMaster University; Department of Clinical Epidemiology and Biostatistics; 1280 Main Street West CRL - 140 Hamilton ON Canada L8S 4K1
| | - Tracey Remmington
- University of Liverpool; Department of Women's and Children's Health; Alder Hey Children's NHS Foundation Trust Eaton Road Liverpool UK L12 2AP
| | - Nikki Jahnke
- University of Liverpool; Department of Women's and Children's Health; Alder Hey Children's NHS Foundation Trust Eaton Road Liverpool UK L12 2AP
| | - Kerry Dwan
- University of Liverpool; Department of Biostatistics; Alder Hey Children's NHS Foundation Trust Eaton Road Liverpool England UK L12 2AP
| | - Natalie Hall
- Institute of Child Health; Cochrane Cystic FIbrosis and Genetic Disorders Group; Alder Hey Children's NHS Foundation Trust Eaton Road Liverpool UK L12 2AP
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Shepherd AJ, Skelton S, Sansom CE, Gomez K, Moss DS, Hart DP. A large-scale computational study of inhibitor risk in non-severe haemophilia A. Br J Haematol 2014; 168:413-20. [PMID: 25244644 DOI: 10.1111/bjh.13131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/29/2014] [Indexed: 01/13/2023]
Abstract
Over 500 missense F8 mutations have been reported to cause non-severe haemophilia A. Some F8 genotypes appear to confer a higher risk of inhibitor formation than others and individuals with the same F8 genotype may have differing risks of inhibitor formation. We present an in silico strategy demonstrating the heterogeneity of factor VIII (FVIII)-derived antigen presentation whilst identifying patterns of human leucocyte antigen (HLA) peptide binding that might predict future inhibitor risk. A well-validated computational tool, NetMHCII, enabled large-scale comparison of predicted antigen presentation between endogenous, mutated FVIII-derived peptides and wild-type, therapeutic FVIII-derived peptides spanning all F8 missense mutation positions reported to The Haemophilia A Mutation, Structure and Resource Site (HADB). We identify 40 F8 genotypes to be 'low risk' at a 50% inhibitory concentration (IC50 )-binding threshold of 300 nmol/l (P = 0·00005), defined as absence of novel peptide-major histocompatibility complex (MHC) surfaces for all 14 common HLA-DR alleles assessed. Analysing each of the possible 7280 F8 genotype/HLA-DR permutations individually at an IC50 threshold of 300 nmol/l, 65% are predicted to not generate a novel peptide-MHC surface that would be necessary to engage T cell help for subsequent anti-FVIII antibody generation. This study demonstrates the future importance of interpreting F8 genotype in the context of an individual's HLA profile to personalize inhibitor risk prediction.
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Affiliation(s)
- Adrian J Shepherd
- Department of Biological Sciences and Institute of Structural and Molecular Biology, Birkbeck, University of London, London, UK
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Peisker A, Raschke GF, Schultze-Mosgau S. Management of dental extraction in patients with Haemophilia A and B: a report of 58 extractions. Med Oral Patol Oral Cir Bucal 2014; 19:e55-60. [PMID: 24121912 PMCID: PMC3909433 DOI: 10.4317/medoral.19191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 08/12/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Patients with inherited bleeding disorders are at high risk of bleeding following oral surgery and present challenges to the oral surgeons. Aim of this study was to report our experience in dental extraction in patients exhibiting Haemophilia A and B between 2007 and 2012. PATIENT AND METHODS 58 dental extractions in 15 patients during 19 interventions were performed. Replacement therapy with recombinant and plasma-derived factor VIII and IX was applied systematically in combination with antifibrinolytic treatment and local haemostatic measures. The following data were recorded: type of surgery, applied local haemostatic measures, general substitution, systemic antifibrinolytic agents and occurrence of postoperative bleeding complications. RESULTS Two patients presented postoperative bleeding. One had secondary bleeding requiring additional injection of factor concentrates. The other one presented epistaxis which was managed conservatively with a nasal tamponade. CONCLUSIONS Excellent haemostasis is achievable after dental extractions in patients with Haemophilia A and B by following a protocol using defined pre- and postoperative doses of factor concentrates in combination with haemostatic measures.
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Affiliation(s)
- Andre Peisker
- Department of Cranio-Maxillofacial, Plastic Surgery, Friedrich Schiller University Jena, Universitätsklinikum Jena, D-07747 Jena, Germany,
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Nance D, Fletcher SN, Bolgiano DC, Thompson AR, Josephson NC, Konkle BA. Factor VIII mutation and desmopressin-responsiveness in 62 patients with mild haemophilia A. Haemophilia 2013; 19:720-6. [DOI: 10.1111/hae.12173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2013] [Indexed: 11/30/2022]
Affiliation(s)
- D. Nance
- Puget Sound Blood Center; 921 Terry Avenue; Seattle; WA; 98104
| | - S. N. Fletcher
- Puget Sound Blood Center; 921 Terry Avenue; Seattle; WA; 98104
| | - D. C. Bolgiano
- Puget Sound Blood Center; 921 Terry Avenue; Seattle; WA; 98104
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Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A. Guidelines for the management of hemophilia. Haemophilia 2012; 19:e1-47. [PMID: 22776238 DOI: 10.1111/j.1365-2516.2012.02909.x] [Citation(s) in RCA: 1274] [Impact Index Per Article: 106.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 01/23/2023]
Affiliation(s)
- A. Srivastava
- Department of Hematology; Christian Medical College; Vellore; India
| | - A. K. Brewer
- Department of Oral Surgery; The Royal Infirmary; Glasgow; Scotland
| | - E. P. Mauser-Bunschoten
- Van Creveldkliniek and Department of Hematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - N. S. Key
- Department of Medicine; University of North Carolina; Chapel Hill; NC; USA
| | - S. Kitchen
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield; UK
| | - A. Llinas
- Department of Orthopaedics and Traumatology; Fundación Santa Fe University Hospital Fundación Cosme y Damián and Universidad de los Andes and Universidad del Rosario; Bogotá; Colombia
| | - C. A. Ludlam
- Comprehensive Care Haemophilia and Thrombosis Centre; Royal Infirmary; Edinburgh; UK
| | - J. N. Mahlangu
- Haemophilia Comprehensive Care Centre; Johannesburg Hospital and Department of Molecular Medicine and Haematology; Faculty of Health Sciences; National Health Laboratory Services and University of the Witwatersrand; Johannesburg; South Africa
| | - K. Mulder
- Bleeding Disorders Clinic; Health Sciences Center; Winnipeg; Canada
| | - M. C. Poon
- Departments of Medicine; Pediatrics and Oncology, and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; University of Calgary, Foothills Hospital and Calgary Health Region; Calgary; Canada
| | - A. Street
- Haematology; Alfred Hospital; Melbourne; Victoria; Australia
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Tsukamoto I. Recent patenting activities in the discovery and development of vasopressin V2receptor agonists. Expert Opin Ther Pat 2012; 22:579-86. [DOI: 10.1517/13543776.2012.692778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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Effects of peptide cyclization on the interaction with oppositely charged microgels. Colloids Surf A Physicochem Eng Asp 2011. [DOI: 10.1016/j.colsurfa.2011.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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The use of desmopressin in acquired haemophilia A: a systematic review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:377-82. [PMID: 21839010 DOI: 10.2450/2011.0113-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 03/09/2011] [Indexed: 11/21/2022]
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