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Souter J, Behbahani M, Sharma S, Cantrell D, Alden TD. Middle meningeal artery embolization in pediatric patient. Childs Nerv Syst 2022; 38:1861-1866. [PMID: 35962222 DOI: 10.1007/s00381-022-05639-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is paucity of data in management of recurrent and expanding subdural hematomas (SDH) within the pediatric population, who are otherwise not surgical candidates. Middle meningeal artery (MMA) embolization has been utilized minimally in this population and here, we explore the utility of this procedure in a 15-month-old-child, along with review of the literature. METHODS A case report of a 15-month-old child who underwent MMA embolization for recurrent and expanding SDH in the setting of anticoagulation for cardiac condition. A literature review of MMA embolization in pediatric patients was conducted. RESULTS Initially stabilization of SDH was noted on serial imaging; however, recurrent hemorrhages were noted with subsequent boluses of antiplatelet and anticoagulating agents. There are only 5 total reported cases, included ours, of MMA embolization in pediatrics with an overall success rate of 80%. CONCLUSION Treatment of chronic or recurrent subdural hematoma by MMA embolization in the pediatric population is understudied. Our case notes limitation of this procedure and impact on long-term success, specifically in patients with systemic illness and ongoing anticoagulation.
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Affiliation(s)
- John Souter
- Department of Neurological Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Shelly Sharma
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Donald Cantrell
- Division of Interventional Radiology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Tord D Alden
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Zanon E, Pasca S, Demartis F, Tagliaferri A, Santoro C, Cantori I, Molinari AC, Biasoli C, Coppola A, Luciani M, Sottilotta G, Ricca I, Pollio B, Borchiellini A, Tosetto A, Peyvandi F, Frigo AC, Simioni P. Intracranial Haemorrhage in Haemophilia Patients Is Still an Open Issue: The Final Results of the Italian EMO.REC Registry. J Clin Med 2022; 11:jcm11071969. [PMID: 35407576 PMCID: PMC8999820 DOI: 10.3390/jcm11071969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Intracranial hemorrhage (ICH) is a highly serious event in patients with haemophilia (PWH) which leads to disability and in some cases to death. ICH occurs among all ages but is particularly frequent in newborns. Aim: The primary aim was to assess the incidence and mortality due to ICH in an Italian population of PWH. Secondary aims were to evaluate the risk factors for ICH, the role of prophylaxis, and the clinical management of patients presenting ICH. Methods: A retrospective-prospective registry was established in the network of the Italian Association of Haemophilia Centers to collect all ICHs in PWH from 2009 to 2019 reporting clinical features, treatments, and outcomes. Results: Forty-six ICHs were collected from 13 Centers. The ICHs occurred in 15 children (10 < 2 years), and in 31 adults, 45.2% of them with mild hemophilia. Overall, 60.9% patients had severe haemophilia (15/15 children). Overall ICH incidence (×1000 person/year) was 0.360 (0.270−0.480 95% CI), higher in children <2 years, 1.995 (1.110−3.442 95% CI). Only 7/46 patients, all with severe haemophilia, had received a prophylactic regimen before the ICH, none with mild. Inhibitors were present in 10.9% of patients. In adult PWHs 17/31 suffered from hypertension; 85.7% of the mild subjects and 29.4% of the moderate/severe ones (p < 0.05). ICH was spontaneous in the 69.6% with lower rate in children (46.7%). Surgery was required in 21/46 patients for cerebral hematoma evacuation. Treatment with coagulation factor concentrates for at least three weeks was needed in 76.7% of cases. ICH was fatal in 30.4% of the cases. Of the survivors, 50.0% became permanently disabled. Only one-third of adult patients received long term prophylaxis after the acute treatment. Conclusion: The results from our Registry confirm the still high incidence of ICH in infants <2 years and in adults, particularly in mild PWHs presenting hypertension and its unfavorable outcomes. The majority of PWHs were treated on-demand before ICH occurred, suggesting the important role of prophylaxis in preventing such life-threatening bleeding.
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Affiliation(s)
- Ezio Zanon
- Haemophilia Center-General Medicine, Padua University Hospital, 35128 Padua, Italy;
- Correspondence: ; Tel.: +39-049-8212-2666
| | - Samantha Pasca
- Department of Biomedical Sciences, Padua University Hospital, 35128 Padua, Italy;
| | - Francesco Demartis
- Centre for Bleeding Disorders, Careggi University Hospital of Florence, 50134 Florence, Italy;
| | - Annarita Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, 43126 Parma, Italy; (A.T.); (A.C.)
| | - Cristina Santoro
- Hematology Division, Umberto I University Hospital of Rome, 00185 Rome, Italy;
| | - Isabella Cantori
- Haemophilia Center, Department of Transfusion Medicine, Hospital of Macerata, 62100 Macerata, Italy;
| | - Angelo Claudio Molinari
- Regional Reference Centre for Hemorrhagic Diseases, Thrombosis and Hemostasis Unit, Gaslini Children Hospital of Genoa, 16147 Genova, Italy;
| | - Chiara Biasoli
- Haemophilia Center, Transfusion Medicine, Department of Clinical Pathology, Hospital of Cesena, 47521 Cesena, Italy;
| | - Antonio Coppola
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, 43126 Parma, Italy; (A.T.); (A.C.)
| | - Matteo Luciani
- Haemostasis and Thrombosis Center, Onco-Hematology Department, Bambin Gesù Children Hospital of Rome, 00165 Roma, Italy;
| | - Gianluca Sottilotta
- Haemophilia Center, Department of Onco-Hematology and Radioterapy, Hospital of Reggio Calabria, 89124 Reggio Calabria, Italy;
| | - Irene Ricca
- Transfusion Medicine, Department of Diagnostic, Regina Margherita Children Hospital of Turin, 10126 Turin, Italy; (I.R.); (B.P.)
| | - Berardino Pollio
- Transfusion Medicine, Department of Diagnostic, Regina Margherita Children Hospital of Turin, 10126 Turin, Italy; (I.R.); (B.P.)
| | | | - Alberto Tosetto
- Hemorrhagic and Thrombotic Diseases Unit, S. Bortolo Hospital of Vicenza, 36100 Vicenza, Italy;
| | - Flora Peyvandi
- Hemophilia and Thrombosis Center, University Hospital of Milan, 20132 Milan, Italy;
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health Padua University Hospital, 35122 Padova, Italy;
| | - Paolo Simioni
- Haemophilia Center-General Medicine, Padua University Hospital, 35128 Padua, Italy;
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Touré SA, Seck M, Sy D, Bousso ES, Faye BF, Diop S. Life-threatening bleeding in patients with hemophilia (PWH): a 10-year cohort study in Dakar, Senegal. Hematology 2022; 27:379-383. [DOI: 10.1080/16078454.2022.2047286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sokhna Aïssatou Touré
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Moussa Seck
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Diariatou Sy
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Elimane Seydi Bousso
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Blaise Felix Faye
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
| | - Saliou Diop
- Department of Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Hemophilia Treatment Center, National Blood Transfusion Center, Dakar, Senegal
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Incidence and mortality rates of intracranial hemorrhage in hemophilia: a systematic review and meta-analysis. Blood 2021; 138:2853-2873. [PMID: 34411236 DOI: 10.1182/blood.2021011849] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
Intracranial hemorrhage (ICH) is a severe complication that is relatively common among hemophilia patients. This systematic review aimed to obtain more precise estimates of ICH incidence and mortality in hemophilia, which may be important for patients, caregivers, researchers and health policy-makers. PubMed and EMBASE were systematically searched using terms related to "hemophilia" and "intracranial hemorrhage" or "mortality". Studies that allowed calculation of ICH incidence or mortality rates in a hemophilia population of at least 50 patients were included. We summarized evidence on ICH incidence and calculated pooled ICH incidence and mortality in three age groups: (1) persons of all ages with hemophilia, (2) children and young adults below 25 years of age with hemophilia and (3) neonates with hemophilia. Incidence and mortality were pooled with a Poisson-Normal model or a Binomial-Normal model. We included 45 studies that represented 54 470 patients, 809 151 person-years and 5326 live births of hemophilia patients. In persons of all ages, the pooled ICH incidence and mortality rates were 2.3 (95% CI 1.2-4.8) and 0.8 (95% CI 0.5-1.2) per 1000 person-years, respectively. In children and young adults, the pooled ICH incidence and mortality rates were 7.4 (95% CI 4.9-11.1) and 0.5 (95% CI 0.3-0.9) per 1000 person-years, respectively. In neonates, the pooled cumulative ICH incidence was 2.1% (95% CI 1.5-2.8) per 100 live births. ICH was classified as spontaneous in 35-58% of cases. Our findings suggest that ICH is an important problem in hemophilia that occurs among all ages, requiring adequate preventive strategies.
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Mason JA, Young G. Emicizumab prophylaxis in infants with severe haemophilia A without inhibitors: Illustrative real-world cases to support shared decision-making. Haemophilia 2021; 27:724-729. [PMID: 34085367 DOI: 10.1111/hae.14353] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Emicizumab has been shown to be safe and effective for prevention of bleeds in patients with severe haemophilia A (SHA), both with and without inhibitors. The subcutaneous administration and long half-life make emicizumab an attractive option for prophylaxis in infants with SHA, however data to inform treatment decisions in this younger age group are almost absent. AIM The aim of this report is to share real world experience to illustrate how the availability of emicizumab has shifted the prophylaxis paradigm in the management of infants with SHA. METHOD We selected four cases from our own cohort of infants with SHA to outline the rationale for emicizumab prophylaxis in a range of scenarios familiar to paediatric haemophilia treaters. RESULTS In Case 1 emicizumab was commenced at 7 days following initial treatment of neonatal ICH with a FVIII infusion. In Case 2 emicizumab was commenced at 5 weeks due to parental anxiety regarding the potential for ICH during infancy. Case 3 commenced emicizumab at 15 months in lieu of standard primary prophylaxis. Case 4 switched to emicizumab prophylaxis at 14 months after a period of primary prophylaxis with FVIII concentrates to alleviate parental anxiety regarding future inhibitor development. No patient had any bleeding events after commencement of emicizumab (median follow up 12 months), and no drug-related adverse effects were observed. CONCLUSION Despite the paucity of data in infants with SHA the potential role of emicizumab prophylaxis should be discussed with families when clinically relevant, with decisions tailored to individual need.
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Affiliation(s)
- Jane A Mason
- Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Little Red Drop Haematology, The Wesley Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Guy Young
- Children's Hospital Los Angeles, Los Angeles, California, USA.,University of Southern California Keck School of Medicine, Los Angeles, California, USA
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