1
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Maas DPMSM, Saes JL, Blijlevens NMA, Cnossen MH, den Exter PL, van der Heijden OWH, Kruis IC, Meijer K, Peters M, Schutgens REG, van Heerde WL, Nieuwenhuizen L, Schols SEM. High prevalence of postpartum hemorrhage in women with rare bleeding disorders in the Netherlands: retrospective data from the RBiN study. J Thromb Haemost 2023; 21:499-512. [PMID: 36696205 DOI: 10.1016/j.jtha.2022.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/27/2022] [Accepted: 11/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Women with rare bleeding disorders (RBDs), including coagulation factor deficiencies and fibrinolytic disorders, may have a higher risk of postpartum hemorrhage (PPH). Information on this patient category is lacking in the existing PPH guidelines because data on PPH in patients with RBDs are scarce. OBJECTIVE To describe the prevalence of PPH in women with an RBD and evaluate the use of peripartum hemostatic prophylaxis. METHODS In the Rare Bleeding Disorders in the Netherlands (RBiN) study, patients with RBDs (n = 263) were included from all 6 Dutch hemophilia treatment centers. Patient-reported information on delivery, peripartum hemostatic prophylaxis, and occurrence of PPH was collected retrospectively. If available, information about the precise volume of postpartum blood loss was extracted from electronic patient files. PPH was defined as blood loss ≥500 mL (World Health Organization guideline). RESULTS A total of 244 pregnancies, including 193 livebirths, were reported by 85 women. A considerable proportion of these women experienced PPH, ranging from 30% in factor V deficiency to 100% in hyperfibrinolysis. Overall, PPH was reported in 44% of deliveries performed with and 53% of deliveries performed without administration of peripartum hemostatic prophylaxis. Blood loss was significantly higher in deliveries without administration of hemostatic prophylaxis (median 1000 mL) compared to deliveries with administration of prophylaxis (median 400 mL) (p = 0.011). Patients with relatively mild deficiencies also frequently experienced PPH when peripartum hemostatic prophylaxis was omitted. CONCLUSION PPH is common in rare coagulation factor deficiencies, both severe and mild, and fibrinolytic disorders, especially when peripartum prophylactic hemostatic treatment was not administered. The use of prophylactic hemostatic treatment was associated with less postpartum blood loss.
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Affiliation(s)
- Dominique P M S M Maas
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, The Netherlands
| | - Joline L Saes
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul L den Exter
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ilmar C Kruis
- Netherlands Hemophilia Society, Nijkerk, The Netherlands
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein Peters
- Department of Pediatric Hematology, Amsterdam University Medical Centers, Location Emma Children's Hospital, Amsterdam, The Netherlands
| | - Roger E G Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, The Netherlands
| | - Waander L van Heerde
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, The Netherlands; Enzyre BV, Novio Tech Campus, Nijmegen, The Netherlands
| | - Laurens Nieuwenhuizen
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, The Netherlands; Department of Hematology, Maxima Medical Center, Eindhoven, The Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, The Netherlands.
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2
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Young A, Lim MY, Sanders J, Branch DW, Simonsen SE. Pregnancy and childbirth in women with bleeding disorders: A retrospective cohort study. Haemophilia 2023; 29:240-247. [PMID: 36395791 DOI: 10.1111/hae.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Reproductive-age women with bleeding disorders (BDs) are underdiagnosed and understudied, despite their increased risk for adverse health outcomes and pregnancy complications. AIM This study examines pregnancy outcomes and obstetric complications of Utah women with BDs. METHODS This retrospective cohort study utilized linked birth records and clinical billing data from two large Utah healthcare systems. Utah residents who had their first birth at > 20 weeks gestation (2008-2015) and who received non-emergent care within either system before delivery were included (n = 61 226). Multivariable logistic regression models were used to examine relationships between BDs and neonatal and obstetric outcomes. RESULTS A total of 295 women (.48%) were included in the BD study population. Women with BDs had significantly increased odds of preterm birth (aOR 1.85, 95% CI 1.32-2.60), Caesarean delivery (aOR 1.38, 95% CI 1.06-1.79), postpartum blood transfusion (aOR 2.55, 95% CI 1.05-6.22), unplanned postpartum hysterectomy (aOR 33.96, 95% CI 7.30-157.89) and transfer to an intensive care unit (aOR 18.18, 95% CI 7.17-46.08). All of the women with BDs who experienced these serious complications were not diagnosed with a BD until the year of their first birth. Additionally, those with BDs were more likely to experience maternal and infant mortality. CONCLUSION Women with BDs had an increased risk for preterm birth, Caesarean delivery, blood transfusion, unplanned hysterectomy, intensive care unit admission, maternal and infant mortality. Those who were not diagnosed with a BD before the year of their first birth were at an increased risk for serious pregnancy complications.
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Affiliation(s)
- Ashli Young
- University of Utah Health, Salt Lake City, Utah, USA
| | - Ming Y Lim
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - D Ware Branch
- James R. and Jo Scott Research Chair, University of Utah Health and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Sara E Simonsen
- University of Utah College of Nursing, Salt Lake City, Utah, USA
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3
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Johnsen JM, MacKinnon HJ. JTH in Clinic - Obstetric bleeding: VWD and other inherited bleeding disorders. J Thromb Haemost 2022; 20:1568-1575. [PMID: 35621921 DOI: 10.1111/jth.15770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 01/19/2023]
Abstract
Individuals with inherited bleeding disorders (IBDs) have higher bleeding risk during pregnancy, childbirth, and the postpartum period. Clinical management requires recognition of the IBD as high risk for postpartum hemorrhage and a personalized multidisciplinary approach that includes the patient in decision making. When the fetus is known or at risk to inherit a bleeding disorder, fetal and neonatal bleeding risk also need to be considered. In pregnant IBD patients, it is common for providers to need to make decisions in the absence of high level of certainty evidence. We here present the case of a pregnant von Willebrand disease patient that reached multiple decision points where there is currently clinical ambiguity due to a lack of high level of certainty evidence. For each stage of her care, from diagnosis to the postpartum period, we discuss current literature and describe our approach. This is followed by a brief overview of considerations in other IBDs and pregnancy.
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Affiliation(s)
- Jill M Johnsen
- Bloodworks Research Institute, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Washington Center for Bleeding Disorders, Seattle, Washington, USA
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4
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Clarke L, Curnow J, Cutts B, Ross B, Kidson-Gerber G. Pregnancy, childbirth and neonatal outcomes in women with inherited bleeding disorders: A retrospective analysis. BJOG 2022; 129:1772-1778. [PMID: 35157368 DOI: 10.1111/1471-0528.17125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
Women with inherited bleeding disorders can deliver without complication when best practices are maintained.
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Affiliation(s)
- Lisa Clarke
- Department of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Transfusion Policy and Education, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Jennifer Curnow
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Briony Cutts
- Department of Obstetrics, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetric Medicine, Joan Kirner Women's and Children's at Sunshine Hospital, Melbourne, Victoria, Australia
| | - Bryony Ross
- Department of Haematology, Calvary Mater Newcastle, Waratah, New South Wales, Australia.,NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Giselle Kidson-Gerber
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Royal Hospital for Woman, Sydney, New South Wales, Australia
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5
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Naderi M, Mirzaei I, Yaghoubi S, Milani I, Cohan N. Postpartum Hemorrhage in Heterozygote Factor XIII Deficient Women Compared With Healthy Women. A Cross-Sectional Experience From Iran. Clin Appl Thromb Hemost 2021; 27:10760296211051714. [PMID: 34697946 PMCID: PMC8552392 DOI: 10.1177/10760296211051714] [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] [Indexed: 11/16/2022] Open
Abstract
Postpartum hemorrhage (PPH) is a major cause of maternal mortality, which is a common clinical manifestation in women with rare bleeding disorders. In this study, we compare PPH and its complications in heterozygote factor XIII (FXIII) deficient women with healthy women. In this cross sectional case study, 50 women with heterozygote FXIII deficiency and 50 healthy women are evaluated. Data were initially collected by interviewing the women who were receiving FXIII replacement therapy after their childbirths. Data were analysed using SPSS (Version 22) and a P-value of less than .05 was considered statistically significant. The mean age in the patient and control groups were 31.2 and 32.5 years respectively. The occurring rate of PPH in the patient group was significantly higher than the control group (34% vs 2%) (P-value <.0001). None of the confounding variables such as maternal age, gestational age, numbers, and types of delivery in women with PPH showed any significant differences between the control and patient groups. According to the results of this study, the risk of PPH (early and late), miscarriage, and menorrhagia in women who are heterozygous for FXIII deficiency is significantly higher than healthy women. However, the effect of other factors such as maternal age, gestational age, number, and type of delivery require further studies to delineate any confounding factors.
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Affiliation(s)
- Majid Naderi
- 48538Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ilia Mirzaei
- 48538Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Ida Milani
- 48538Zahedan University of Medical Sciences, Zahedan, Iran
| | - Nader Cohan
- Shiraz University of Medical Sciences, Shiraz, Iran
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Patel P, Balanchivadze N. Hematologic Findings in Pregnancy: A Guide for the Internist. Cureus 2021; 13:e15149. [PMID: 34164247 PMCID: PMC8214837 DOI: 10.7759/cureus.15149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/25/2022] Open
Abstract
Hematologic changes in pregnancy are common and can potentially lead to maternal and fetal morbidity. Here, we present various hematologic manifestations seen in pregnant women. Iron deficiency anemia (IDA) is the most common cause of anemia in pregnancy. Physiologically, the state of pregnancy results in increased iron demand. Iron deficiency is important to diagnose and treat early for better maternal and fetal outcomes. An algorithmic approach is used for the repletion of iron storage, starting with oral elemental iron daily and escalating to intravenous iron if necessary. Folate and cobalamin are necessary elements for deoxyribonucleic acid (DNA) synthesis, fetal growth, and maternal tissue development, and deficiency in these elements can be a cause for anemia in pregnancy. Thrombocytopenia is currently the second most common hematologic condition in pregnancy after anemia. There is a wide range of etiology for thrombocytopenia in pregnancy from benign to life-threatening causes that require prompt diagnosis and treatment. These conditions include gestational thrombocytopenia, thrombotic thrombocytopenic purpura, pregnancy-associated atypical hemolytic-uremic syndrome, and immune thrombocytopenia. Acquired bleeding disorders that can cause major complications in pregnancy include von Willebrand disease (vWD) and coagulation factor deficiencies. Women with vWD are at increased risk of pregnancy bleeding and postpartum hemorrhage. Pregnancy can also produce a physiologic hypercoagulable state, leading to life-threatening conditions like thromboembolism. Diagnosis, treatment options, and guidelines for the management of these conditions will be explored in this review.
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Affiliation(s)
- Pooja Patel
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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7
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How I manage pregnancy in carriers of hemophilia and patients with von Willebrand disease. Blood 2021; 136:2143-2150. [PMID: 32797211 DOI: 10.1182/blood.2019000964] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Women with inherited bleeding disorders, including carriers of hemophilia A and B, or with von Willebrand disease, have an increased risk of bleeding during pregnancy and delivery. The unborn child may also be affected by the bleeding disorder for which specific measures have to be considered. This requires a multidisciplinary approach, with a team that includes a hematologist, a pediatric hematologist, a clinical geneticist, an obstetrician-perinatologist, and an anesthesiologist. An optimal approach includes prepregnancy genetic counseling, prenatal diagnostic procedures, and a treatment plan for delivery for both the mother and child. Recent retrospective studies show that even if strict guidelines are followed, these women are still at risk of postpartum bleeding. This occurs even if coagulation factor levels are normalized, either due to the pregnancy-induced rise of factor levels or by infusion of coagulation factor concentrates at the time of delivery. In this article, we describe our current diagnostic and clinical management of pregnancy and delivery in women with inherited bleeding disorders. We also briefly discuss possible interventions to improve the outcome of current strategies by increasing target factor levels during and after delivery.
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8
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Nau A, Gillet B, Guillet B, Beurrier P, Ardillon L, Cussac V, Guillou S, Raj L, Trossaërt M, Horvais V, Bayart S, Potin J, Rose J, Macchi L, Couturaud F, Lacut K, Pan-Petesch B. Bleeding complications during pregnancy and delivery in haemophilia carriers and their neonates in Western France: An observational study. Haemophilia 2020; 26:1046-1055. [PMID: 32842170 DOI: 10.1111/hae.14117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pregnancy, delivery and the postpartum period expose haemophilia carriers, as well as their potentially affected neonates to a high risk of haemorrhagic complications. OBJECTIVES To describe bleeding complications in haemophilia carriers and their newborns throughout pregnancy and postpartum and to identify potential factors increasing the risk of bleeding in this population. PATIENTS/METHODS The ECHANGE multicentre observational cohort study was conducted between January 2014 and February 2019 using the BERHLINGO database comprised of patients from seven French haemophilia centres. RESULTS During the 5 years study period, a total of 104 haemophilia carriers and 119 neonates were included, representing 124 pregnancies and 117 deliveries. Thirty-five (30%) bleeding events were observed, most of them (83%) occurred during the postpartum period, and 37% were reported during the secondary postpartum. Neuraxial anaesthesia was not complicated by spinal haematoma. Three (2.5%) neonates experienced cerebral bleeding. Caesarean section was associated with an increased risk of maternal bleeding in primary and secondary postpartum periods. Basal factor level <0.4 IU/mL was also found to be associated with an increased risk of bleeding during secondary postpartum. CONCLUSION In our cohort, bleeding events occurred in more than a third of haemophilia carriers mainly in the postpartum period, and a significant portion of this bleeding occurred during the secondary postpartum. Haemophilia carriers warrant specific attention during primary and secondary postpartum, in particular in case of caesarean section and low basal factor level. The ECHANGE study is registered at clinicaltrials.gov identifier: NCT03360149.
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Affiliation(s)
- Alice Nau
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France
| | - Benjamin Gillet
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Benoît Guillet
- Centre de traitement des maladies hémorragiques, CHU Rennes, Rennes, France.,INSERM, U1085, IRSET, Université Rennes 1, Rennes, France
| | | | - Laurent Ardillon
- Service d'hématologie - hémostase, Hôpital Trousseau, CHU Tours, Tours, France
| | | | - Sophie Guillou
- Service d'hématologie biologique, CHU Poitiers, Poitiers, France.,INSERM, U1082, IRTOMIT, Université de Poitiers, Poitiers, France
| | - Leela Raj
- EA3878, Université de Bretagne Occidentale, Brest, France
| | - Marc Trossaërt
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Valérie Horvais
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Sophie Bayart
- Centre de traitement des maladies hémorragiques, CHU Rennes, Rennes, France
| | - Jérôme Potin
- Service d'obstétrique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Johan Rose
- Laboratoire d'hématologie, CH Le Mans, Le Mans, France
| | - Laurent Macchi
- Service d'hématologie biologique, CHU Poitiers, Poitiers, France.,INSERM, U1082, IRTOMIT, Université de Poitiers, Poitiers, France
| | - Francis Couturaud
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France.,EA3878, Université de Bretagne Occidentale, Brest, France
| | - Karine Lacut
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France.,EA3878, Université de Bretagne Occidentale, Brest, France
| | - Brigitte Pan-Petesch
- EA3878, Université de Bretagne Occidentale, Brest, France.,Centre de traitement des maladies hémorragiques, Hémostase clinique, Service d'hématologie clinique, CHU Brest, Brest, France
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9
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Majluf‐Cruz K, Anguiano‐Robledo L, Calzada‐Mendoza CC, Hernández‐Juárez J, Moreno‐Hernández M, Domínguez‐Reyes VM, Figueroa‐Torres AG, Gomez‐Rosas P, Arreola‐Diaz R, García‐Lee MT, Ricardo‐Moreno MT, Sosa‐Camas RE, Garcia‐Chavez J, Vela Ojeda J, Isordia‐Salas I, Majluf‐Cruz A. von Willebrand Disease and other hereditary haemostatic factor deficiencies in women with a history of postpartum haemorrhage. Haemophilia 2019; 26:97-105. [DOI: 10.1111/hae.13900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Karim Majluf‐Cruz
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
- Laboratorio de Farmacologia Molecular Escuela Superior de Medicina Instituto Politecnico Nacional Ciudad de Mexico Mexico
| | - Liliana Anguiano‐Robledo
- Laboratorio de Farmacologia Molecular Escuela Superior de Medicina Instituto Politecnico Nacional Ciudad de Mexico Mexico
| | - Claudia C. Calzada‐Mendoza
- Seccion de Estudios de Postgrado e Investigación Escuela Superior de Medicina Instituto Politecnico Nacional Ciudad de Mexico Mexico
| | - Jesús Hernández‐Juárez
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
- CONACYT‐Facultad de Odontología Universidad Autónoma Benito Juárez de Oaxaca Ciudad Universitaria Oaxaca de Juarez Oaxaca México
| | - Manuel Moreno‐Hernández
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
| | | | | | - Patricia Gomez‐Rosas
- Servicio de Hematologia Hospital General Regional Tecamac IMSS Estado de Mexico Mexico
| | - Rodrigo Arreola‐Diaz
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
| | - María Teresa García‐Lee
- Servicio de Hematologia Hospital General Regional Carlos McGregor Sanchez Navarro IMSS Ciudad de Mexico Mexico
| | | | - Rosa Elena Sosa‐Camas
- Departamento de Medicina Interna Hospital General de Hermosillo Secretaria de Salud Hermosillo Mexico
| | - Jaime Garcia‐Chavez
- Unidad de Investigación en Enfermedades Hematologicas Hospital de Especialidades CMN La Raza IMSS Ciudad de Mexico Mexico
| | - Jorge Vela Ojeda
- Unidad de Investigación en Enfermedades Hematologicas Hospital de Especialidades CMN La Raza IMSS Ciudad de Mexico Mexico
| | - Irma Isordia‐Salas
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
| | - Abraham Majluf‐Cruz
- Hemostasia y Aterogénesis Unidad de Investigación Médica en Trombosis IMSS Ciudad de Mexico Mexico
- Servicio de Hematologia Hospital General Regional Carlos McGregor Sanchez Navarro IMSS Ciudad de Mexico Mexico
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10
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Allerkamp H, Lehner S, Ekhlasi-Hundrieser M, Detering C, von Depka Prondzinski M, Pfarrer C. Expression of angiogenic factors in the uteroplacental unit is altered at time of placentation in a porcine model of von Willebrand disease type 1. Reprod Biol 2019; 19:412-420. [PMID: 31806575 DOI: 10.1016/j.repbio.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/27/2019] [Accepted: 09/29/2019] [Indexed: 11/15/2022]
Abstract
Von Willebrand disease (VWD) affects blood coagulation and correlates with angiodysplasia. Data on VWD-affected women point to slightly increased miscarriage rates. We aimed to investigate the impact of VWD on angiogenesis in the uteroplacental unit of pregnant pigs of a model of VWD type 1 (T1). Uteri, placentae, and embryos were harvested at time of placentation (day 29 to 31) from four sows (two wildtype (WT) and two heterozygous for a von Willebrand factor (VWF) mutation diagnosed with T1). T1 sows were bred to a T1 boar creating embryos of three different genotypes: WT, T1 or homozygous for the VWF mutation corresponding with VWD type 3 (T3). Uteroplacental tissues were examined histologically. Embryos were genotyped. Gene expression of angiogenic factors possibly related to VWF was determined by quantitative real-time PCR. Corresponding protein expression was analyzed by immunohistochemistry. Genotyping revealed 35.3% WT, 52.9% T1 and 5.9% T3 embryos (5.9% not classified confidently). No histological alterations were found. Gene expression of VEGF was significantly increased in T1 placentae while expression of ANG1, ANG2, TIE2, and ITGB3 was significantly reduced, confirmed on protein level for different cell types. TIE2/TIE1 ratios were significantly lower in T1 placentae. Distribution of embryo genotypes indicates selection favoring the WT. Significant expression differences of angiogenic factors in placentae suggest influence of VWF on these factors during placentation, although angiodysplasia was not observed. The alterations concerning VEGF/VEGFR-2 signaling, integrin expression and the ANG/TIE system may influence angiogenesis and vascular adaptation during placentation and thus the overall outcome of pregnancy.
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Affiliation(s)
- Hanna Allerkamp
- Werlhof Institute, Department of Fundamental and Clinical Research, Schillerstr. 23, 30159 Hannover, Germany.
| | - Stefanie Lehner
- Werlhof Institute, Department of Fundamental and Clinical Research, Schillerstr. 23, 30159 Hannover, Germany
| | - Mahnaz Ekhlasi-Hundrieser
- Werlhof Institute, Department of Fundamental and Clinical Research, Schillerstr. 23, 30159 Hannover, Germany
| | - Carsten Detering
- Werlhof Institute, Department of Fundamental and Clinical Research, Schillerstr. 23, 30159 Hannover, Germany
| | - Mario von Depka Prondzinski
- Werlhof Institute, Department of Fundamental and Clinical Research, Schillerstr. 23, 30159 Hannover, Germany
| | - Christiane Pfarrer
- University of Veterinary Medicine Hannover Foundation, Institute for Anatomy, Bischofsholer Damm 15, 30173 Hannover, Germany
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11
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Hirayama AB, Silva AKCD, Rocha JS, Roberti MDRF. Prevalence of symptoms in hemophilia carriers in comparison with the general population: a systematic review. Hematol Transfus Cell Ther 2019; 41:349-355. [PMID: 31412987 PMCID: PMC6978539 DOI: 10.1016/j.htct.2019.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/29/2018] [Accepted: 02/27/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction Hemophilia is well known in males, but poorly recognized in hemophilia carriers, who may have a hemorrhagic tendency, and the symptoms may be frequent and severe. Few studies have been done evidencing this bleeding in female carriers of the hemophilia gene. Objectives To verify the prevalence of hemorrhagic symptoms in HC, compared to women in the general population. Material and method The articles published between October 1996 and November 2016 were searched in the PubMed, Scielo, Lilacs, Web of Science, Scopus and Cochrane Central databases. Results and discussion Seventy-five articles were found in electronic databases and 2 additional articles, through manual search in journal summaries and bibliographical references of other review articles. There is a limitation as to the number of studies that explore the association between the risk of hemorrhagic events and HC A or B. Among the few existing studies, there is a methodological difference, evidenced by control groups with distinct recruitments, divergent questionnaires and non-standardized concepts. Conclusion This review verified the existence of a higher prevalence of hemorrhagic symptoms in the HC in some outcomes, however, due to the limitations of the few studies found, there is still insufficient evidence to state that the HC has a greater hemorrhagic tendency in relation to the general population.
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12
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Delbrück C, Miesbach W. The Course of von Willebrand Factor and Factor VIII Activity in Patients with von Willebrand Disease during Pregnancy. Acta Haematol 2019; 142:71-78. [PMID: 31085919 DOI: 10.1159/000496820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Women with von Willebrand disease (VWD) are at a higher risk of bleeding, which might affect the health of mother and child during pregnancy and the intra- and postpartum periods. This retrospective cohort study evaluates changes in the coagulation parameters von Willebrand factor antigen (VWF:Ag), von Willebrand ristocetin cofactor (VWF:RCo), and Factor VIII activity (FVIII:C) during pregnancy in patients with VWD. In total, 44 pregnancies of 38 patients were assessed (VWD type 1 n = 32, type 2A n = 3, type 2B n = 1, type 2 subtype unidentified n = 2). The patients' median age at childbirth was 32 years (range 22-40). RESULTS A significant increase in coagulation parameters was found in patients with VWD type 1 (VWF:Ag, VWF:RCo, and FVIII:C p = 0.000). In the third trimester, VWF:Ag and FVIII:C normalized in all patients with VWD type 1; in 3 patients VWF:RCo remained below the normal range. Patients with VWD type 2 showed a significant increase of VWF:Ag (p = 0.003) and FVIII:C (p = 0.011), and a non-significant increase of VWF:RCo (p = 0.097). In 4 of 9 pregnancies of patients with VWD type 2, all surveyed coagulation parameters normalized until the third trimester. CONCLUSION For the majority of the observed patients, the von Willebrand parameters increased during pregnancy.
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Affiliation(s)
- Christiane Delbrück
- Department of Haemostaseology and Haemophilia Centre, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Wolfgang Miesbach
- Department of Haemostaseology and Haemophilia Centre, University Hospital Frankfurt, Frankfurt am Main, Germany,
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Zwagemaker A, Gouw SC, Valk C, Ganzevoort W, Coppens M, Peters M. Postpartum haemorrhage in an unselected cohort of carriers of haemophilia. Haemophilia 2018; 24:e256-e259. [DOI: 10.1111/hae.13521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2018] [Indexed: 12/21/2022]
Affiliation(s)
- A. Zwagemaker
- Department of Paediatric Haematology; Academic Medical Center; Amsterdam the Netherlands
| | - S. C. Gouw
- Department of Paediatric Haematology; Academic Medical Center; Amsterdam the Netherlands
- Haemophilia Comprehensive Care Centre; Academic Medical Center; Amsterdam the Netherlands
| | - C. Valk
- Haemophilia Comprehensive Care Centre; Academic Medical Center; Amsterdam the Netherlands
| | - W. Ganzevoort
- Department of Obstetrics; Academic Medical Center; Amsterdam the Netherlands
| | - M. Coppens
- Haemophilia Comprehensive Care Centre; Academic Medical Center; Amsterdam the Netherlands
- Department of Vascular Medicine; Academic Medical Center; Amsterdam the Netherlands
| | - M. Peters
- Department of Paediatric Haematology; Academic Medical Center; Amsterdam the Netherlands
- Haemophilia Comprehensive Care Centre; Academic Medical Center; Amsterdam the Netherlands
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14
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Hermans C, Kulkarni R. Women with bleeding disorders. Haemophilia 2018; 24 Suppl 6:29-36. [DOI: 10.1111/hae.13502] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/26/2022]
Affiliation(s)
- C. Hermans
- Haemostasis and Thrombosis Unit; Division of Haematology; Cliniques universitaires Saint-Luc; Brussels Belgium
| | - R. Kulkarni
- Department of Pediatrics and Human Development; Michigan State University; East Lansing MI USA
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15
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How I treat type 2B von Willebrand disease. Blood 2018; 131:1292-1300. [PMID: 29378695 DOI: 10.1182/blood-2017-06-742692] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 01/04/2018] [Indexed: 12/26/2022] Open
Abstract
Type 2B von Willebrand disease (VWD) is an inherited bleeding disorder caused by changes in von Willebrand factor (VWF) that enhance binding of VWF to GPIb on platelets. Although this disorder is seemingly well defined because of this single molecular defect, in reality type 2B VWD is a clinically heterogeneous disorder that can be difficult to identify and manage. Diagnostic criteria include a history of mucocutaneous bleeding, laboratory studies showing enhanced VWF binding of platelets and/or a 2B VWD genetic variant, and a family history consistent with autosomal dominant inheritance. Thrombocytopenia, although not always present, is common and can be exacerbated by physiologic stressors such as pregnancy. The mainstay of therapy for type 2B VWD is VWF replacement therapy. Adjunct therapies useful in other types of VWD, such as antifibrinolytics, are also used in type 2B VWD. 1-Desamino-8-d-arginine vasopressin (DDAVP) is controversial because of exacerbation of thrombocytopenia, but is, in practice, sometimes used for minor bleeding. Here we review the available evidence and provide 3 clinical cases to illustrate the intricacies of diagnosing type 2B VWD to describe the response to DDAVP and to review complexities and management during pregnancy.
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Königs C, James A, Federici A. Contemporary issues in the management of von Willebrand disease. Thromb Haemost 2017; 116 Suppl 1:S18-25. [DOI: 10.1160/th16-01-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/22/2016] [Indexed: 01/28/2023]
Abstract
SummaryVon Willebrand disease (VWD) is the most common inherited bleeding disorder. Bleeding scores in VWD, focused in particular on mucosal bleeding, can be very useful in the diagnosis and validation of different types of treatment. The results of an extended prospective study with a large amount of information on clinical phenotype and implications in treatment are reviewed in this article. Treatment of mucosal and joint bleeding in severe VWD remains difficult in some patients. Due to the lack of data on the use of prophylaxis in these patients it is difficult to establish optimal treatment regimens. An overview of the literature, with a focus on the ongoing PRO.WILL study, is provided here. Furthermore, understanding the changes in von Willebrand factor (VWF) levels during pregnancy is very important for establishing the optimal management strategy for pregnancy and delivery in women with VWD. A recently published prospective observational cohort study in women with and without VWD during the postpartum period provides important data that should allow the improvement of postpartum treatment protocols.
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Exploring the Postpartum Pyrexia Related to Inherited Coagulopathies in a Cohort of Iranian Women. WOMEN’S HEALTH BULLETIN 2017. [DOI: 10.5812/whb.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Abstract
INTRODUCTION Many aspects of hemostasis, both primary and secondary, as well as fibrinolysis display sex differences. From a clinical viewpoint, certain differential phenotypic presentations clearly arise within various disorders of thrombosis and hemostasis. Areas covered: The present mini-review summarizes selected clinical entities where sex differences are reflected in both frequency and clinical presentation of hemostasis disorders. Sex differences are discussed within the settings of cardiovascular disease, including coronary artery disease and ischemic stroke, venous thromboembolism and inherited bleeding disorders. Moreover, pregnancy and labor present particular challenges in terms of increased thromboembolic and bleeding risk, and this is also summarized. Expert commentary: Available knowledge on sex differences in risk factors and clinical presentation of disorders within thrombosis and hemostasis is increasing. However, more evidence is needed to further clarify different risk factors and treatment effect in men and women, both as regards to cardiovascular disease and venous thromboembolism. This should facilitate improved gender guided risk stratification, and prevention and treatment of these diseases. Finally, risk assessment during pregnancy remains a challenge; this applies both to thromboembolic risk assessment during normal pregnancy and special care of women with inherited bleeding disorders during labor.
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Affiliation(s)
- Anne-Mette Hvas
- a Centre for Hemophilia and Thrombosis, Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
| | - Emmanuel J Favaloro
- b Department of Hematology , Sydney Centres for Thrombosis and Hemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, NSW Health Pathology , Sydney , NSW , Australia
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19
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20
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Hussain S, Moiz B, Aqeel S, Zaidi N. Issues in reproductive health in females having inherited bleeding disorders in Pakistan. Haemophilia 2017; 23:e367-e370. [PMID: 28497870 DOI: 10.1111/hae.13254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S Hussain
- Department of Haematology, Fatimid Foundation, Karachi, Pakistan
| | - B Moiz
- Section of Haematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, The Aga Khan University and Hospital, Karachi, Pakistan
| | - S Aqeel
- Haemophilia Department, Fatimid Foundation, Karachi, Pakistan
| | - N Zaidi
- Gynecology & Obstetric Department, Fatimid Foundation, Karachi, Pakistan
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Hawke L, Grabell J, Sim W, Thibeault L, Muir E, Hopman W, Smith G, James P. Obstetric bleeding among women with inherited bleeding disorders: a retrospective study. Haemophilia 2016; 22:906-911. [PMID: 27704714 DOI: 10.1111/hae.13067] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Women with inherited bleeding disorders are at increased risk for bleeding complications during pregnancy and the postpartum period, particularly postpartum haemorrhage (PPH). AIM This retrospective study evaluates pregnancy management through the Inherited Bleeding Disorders Clinic of Southeastern Ontario, the clinical factors associated with pregnancy-related abnormal bleeding and assesses tranexamic acid use in the postpartum treatment of bleeding disorder patients. METHODS A chart review of 62 pregnancies, from 33 women, evaluated patient characteristics (age, haemostatic factor levels) and delivery conditions (mode of delivery, postpartum treatment) in relation to abnormal postpartum bleeding. RESULTS This cohort revealed increased risk of immediate PPH with increased age at delivery (mean age: 30.1 years with PPH, 26.5 years without PPH, P < 0.013), and birth by vaginal delivery (P < 0.042). Low von Willebrand factor (VWF) antigen or factor VIII (FVIII) in the third trimester was not associated with an increased risk of PPH; however, low VWF:RCo was associated with increased immediate PPH despite treatment with continuous factor infusion (P < 0.042). Women treated with tranexamic acid postpartum had less severe bleeding in the 6-week postpartum (P < 0.049) with no thrombotic complications. CONCLUSIONS This study contributes to the growing body of work aimed at optimizing management of bleeding disorder patients through pregnancy and the postpartum period, showing patients are at a higher risk of PPH as they age. Risk factors such as low third trimester VWF:RCo have been identified. Treatment with tranexamic acid in the postpartum period is associated with a reduced incidence of abnormal postpartum bleeding.
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Affiliation(s)
- L Hawke
- Queen's University, Kingston, ON, Canada
| | - J Grabell
- Queen's University, Kingston, ON, Canada
| | - W Sim
- Queen's University, Kingston, ON, Canada
| | - L Thibeault
- Kingston General Hospital, Kingston, ON, Canada
| | - E Muir
- Queen's University, Kingston, ON, Canada
| | - W Hopman
- Queen's University, Kingston, ON, Canada
| | - G Smith
- Queen's University, Kingston, ON, Canada
| | - P James
- Queen's University, Kingston, ON, Canada.,Kingston General Hospital, Kingston, ON, Canada
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22
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Kouides PA. Present day management of inherited bleeding disorders in pregnancy. Expert Rev Hematol 2016; 9:987-95. [DOI: 10.1080/17474086.2016.1216312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
PURPOSE OF REVIEW The morbidity and mortality of postpartum hemorrhage (PPH) in women with an underlying bleeding disorder requires vigilance by the hematologist. RECENT FINDINGS Recent studies suggest that women with underlying bleeding disorders may be 'undertreated' at the time of delivery in aiming for too low a target elevation that historically per numerous society guidelines has aimed for VWF/FVIII:C levels to be 'only' greater than 50% when in actuality the levels should be akin to what is achieved in a normal pregnancy. The result appears to be an increase in the rate and degree of PPH. In this context, although recent studies imply DDAVP is well tolerated, DDAVP may not be appropriate because it may not raise the levels into the normal supraphysiological range nor maintain it for several days. Particularly in women with rare bleeding disorders, i.e., non- FVIII C or VWF deficient, adjunctive antifibrinolytic therapy, e.g., tranexamic acid, appears to be in order as a prophylactic measure. SUMMARY Women with an underlying bleeding disorder appear to be at a heightened risk for PPH if the respective coagulation factor level is not appropriately replaced to the level that is physiologically achieved in a normal pregnancy. Furthermore, there appears to be underuse of tranexamic acid for prophylaxis of PPH in this population.
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24
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Kulkarni R. Improving care and treatment options for women and girls with bleeding disorders. Eur J Haematol 2015; 95 Suppl 81:2-10. [DOI: 10.1111/ejh.12580] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Roshni Kulkarni
- Department of Pediatrics and Human Development; Center for Bleeding and Clotting Disorders; Michigan State University; East Lansing MI USA
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25
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Malec LM, Moore CG, Yabes J, Li J, Ragni MV. Postpartum haemorrhage in women with von Willebrand disease: an observational study of the Pennsylvania Health Care Cost Containment Council (PHC4) database. Haemophilia 2015; 21:e442-5. [DOI: 10.1111/hae.12739] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- L. M. Malec
- Department of Pediatrics; Division of Hematology/Oncology; Children's Hospital of Pittsburgh of UPMC and Hemophilia Center of Western Pennsylvania; Pittsburgh PA USA
| | - C. G. Moore
- Center for Healthcare Research Data Center; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - J. Yabes
- Center for Healthcare Research Data Center; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - J. Li
- Center for Healthcare Research Data Center; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - M. V. Ragni
- Department of Medicine; Division Hematology/Oncology; University of Pittsburgh and Hemophilia Center of Western Pennsylvania; Pittsburgh PA USA
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Clotting factor level is not a good predictor of bleeding in carriers of haemophilia A and B. Blood Coagul Fibrinolysis 2015; 25:471-5. [PMID: 24509327 DOI: 10.1097/mbc.0000000000000083] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Carriers of haemophilia are known to have a wide range of clotting factor levels and bleeding symptoms. This study aimed at investigating whether carriers of severe and moderate haemophilia had an increased bleeding tendency, compared with a control group, using a condensed version of a bleeding assessment tool developed by the Molecular and Clinical Markers for the Diagnosis and Management of Type 1 VWD study group (MCMDM-1VWD). One hundred and twenty-six genetically verified carriers of severe and moderate haemophilia and 90 controls were interviewed regarding bleeding symptoms. A bleeding score of at least 4 was considered positive, indicating a significant bleeding tendency. Clotting factor levels were tested in the carriers.Nineteen of the women were carriers of haemophilia B, with a mean factor (F)IX:C level of 0.54 (± 0.27) kIU/l, and 107 were carriers of haemophilia A, with a mean FVIII:C level of 0.74 (± 0.32) kIU/l. The median bleeding score was 2 (-3-12) among carriers and -1 (-3-8) among controls (P < 0.001). The bleeding score was weakly correlated to clotting factor levels in carriers of haemophilia A (rs = -0.36, P < 0.001). We conclude that the bleeding tendency in our cohort of carriers differed significantly from that in the controls and that clotting factor levels might not be sufficient to predict the bleeding tendency.
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27
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Dogba MJ, Rauch F, Douglas E, Bedos C. Impact of three genetic musculoskeletal diseases: a comparative synthesis of achondroplasia, Duchenne muscular dystrophy and osteogenesis imperfecta. Health Qual Life Outcomes 2014; 12:151. [PMID: 25649344 PMCID: PMC4332447 DOI: 10.1186/s12955-014-0151-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 10/06/2014] [Indexed: 12/03/2022] Open
Abstract
Achondroplasia, Duchenne muscular dystrophy, and osteogenesis imperfecta are among the most frequent rare genetic disorders affecting the musculoskeletal system in children. Rare genetic disorders are severely disabling and can have substantial impacts on families, children, and on healthcare systems. This literature review aims to classify, summarize and compare these non-medical impacts of achondroplasia, Duchenne muscular dystrophy and osteogenesis imperfecta.
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Affiliation(s)
- Maman Joyce Dogba
- Shriners Hospital for Children, 1529 Cedar Avenue, H3G 1A6, Montreal, QC, Canada. .,Department of family and emergency medicine, Faculty of Medicine, Université Laval, 1050 Medicine Avenue, Quebec, G1V0A6, Canada.
| | - Frank Rauch
- Shriners Hospital for Children, 1529 Cedar Avenue, H3G 1A6, Montreal, QC, Canada.
| | - Erin Douglas
- Shriners Hospital for Children, 1529 Cedar Avenue, H3G 1A6, Montreal, QC, Canada.
| | - Christophe Bedos
- Faculty of Dentistry, McGill University, 3550 University Street, H3A 2A7, Montreal, QC, Canada. .,Department of Social and Preventive Medicine, Faculty of Medicine, Université de Montréal, H3C 3 J7, C.P. 6128, Succ. Centre-Ville, Montreal, QC, Canada.
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28
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James AH, Konkle BA, Kouides P, Ragni MV, Thames B, Gupta S, Sood S, Fletcher SK, Philipp CS. Postpartum von Willebrand factor levels in women with and without von Willebrand disease and implications for prophylaxis. Haemophilia 2014; 21:81-7. [DOI: 10.1111/hae.12568] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - B. A. Konkle
- Puget Sound Blood Center Seattle WA USA
- University of Washington Seattle WA USA
| | - P. Kouides
- Rochester General Hospital Rochester NY USA
| | - M. V. Ragni
- University of Pittsburgh Pittsburgh PA USA
- Hemophilia Center of Western Pennsylvania Pittsburgh PA USA
| | | | - S. Gupta
- Indiana Hemophilia & Thrombosis Center Indianapolis IN USA
| | - S. Sood
- University of Michigan Ann Arbor MI USA
| | | | - C. S. Philipp
- Rutgers Robert Wood Johnson Medical School New Brunswick NJ USA
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[Carriers of haemophilia: Experience of a French university hospital]. ACTA ACUST UNITED AC 2014; 44:565-76. [PMID: 25263159 DOI: 10.1016/j.jgyn.2014.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/23/2014] [Accepted: 08/28/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To report the management of carriers of haemophilia in a French university hospital and assess different issues of these patients. PATIENTS AND METHODS Retrospective study of the carriers of haemophilia who consulted at the university hospital of Montpellier, France, between 1995 and 2011. Information were obtained from medical records and from a questionnaire sent to carriers. We recorded data about biological characteristics, bleeding tendency and management of pregnancies. RESULTS Sixty-four carriers of haemophilia A or B were included. Their median FVIII or FIX level was 52 % (range, 15-137 %). Menstrual bleeding lasted more than 7 days in 31 % of carriers. A total of 142 pregnancies started in 54 carriers, and 101 resulted in live births with 26 boys with haemophilia. Sixty-two prenatal diagnoses carried out, 15 have terminated their pregnancy because of a hemophiliac male fetus. Seventy-six percent of deliveries were vaginal delivery and 49 % took place in a level-3 maternity. There were 10.8 % and 8.5 % primary and secondary post-partum hemorrhage, respectively. CONCLUSION The risk of bleeding among carriers of haemophilia is associated with their antihemophilic factor level. To improve the management of carriers, a multidisciplinary and standardized medical record, with a specific questionnaire to evaluate bleedings, could be considered. A regional register that lists all carriers, regardless of their antihemophilic factor level, would also be useful.
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Schwartz M, Vasudevan A. Current Concepts in the Treatment of Major Obstetric Hemorrhage. CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The past few decades have seen major advances in multidisciplinary obstetric care and management of gynecological conditions in women with bleeding disorders. Awareness of the impact of bleeding disorders has improved among the obstetric and gynecological community. Undiagnosed bleeding disorders can be the underlying cause for a significant proportion of women with heavy menstrual bleeding. They may also be the cause or a contributory factor for other gynecological problems, such as dysmenorrhea, intermenstrual bleeding, and endometriosis. Hemostatic assessment should be considered in women referred for menstrual abnormalities if they have a positive bleeding history as quantified by bleeding assessment tools. The reproductive choices and options for prenatal diagnosis are also expanding for families with hemophilia with a drive toward achieving a non-invasive approach. Current non-invasive prenatal diagnostic techniques are limited to identification of fetal gender. Research is ongoing to overcome the specific diagnostic challenges of identifying hemophilia mutations, utilizing free fetal DNA circulating in maternal plasma. The management of obstetric hemorrhage has recently evolved to include a greater focus on the identification of and early treatment for coagulation disorders. Deficiencies in certain hemostatic variables are associated with progression to more severe bleeding; therefore, specific interventions have been proposed to target this. Evidence is still lacking to support such strategy, and future research is required to assess the efficacy and the safety of these hemostatic interventions in women with persistent PPH.
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Affiliation(s)
- R A Kadir
- The Haemophilia Centre and Thrombosis Unit, The Royal Free Hospital, London, UK.
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