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Cuesta-Barriuso R, Donoso-Úbeda E, Meroño-Gallut J, Ucero-Lozano R, Pérez-Llanes R. Hemophilic Arthropathy: Barriers to Early Diagnosis and Management. J Blood Med 2022; 13:589-601. [PMID: 36277171 PMCID: PMC9586168 DOI: 10.2147/jbm.s343924] [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: 05/06/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Hemophilia is a congenital coagulopathy characterized by a deficiency of one of the clotting factors. It is characterized by the development of hematomas and hemarthrosis, either spontaneously or after minor trauma. The recurrence of hemarthroses leads to progressive and degenerative joint damage from childhood (hemophilic arthropathy). This arthropathy is characterized by disabling physical effects that limit the functionality and quality of life of these patients. Medical progress achieved over the last decade in the drug treatment of hemophilia has improved the medium and long-term prospects of patients with more effective and long-lasting drugs. The universal use of safer, more effective and prolonged prophylactic treatments may promote the prevention of bleeding, and also therefore, of the development of hemarthrosis and joint damage. A number of imaging instruments have been developed for the assessment of hemarthrosis and hemophilic arthropathy, using ultrasound, magnetic resonance imaging and simple radiology. Different physical examination scores and questionnaires allow the assessment of joint health, self-perceived activity and functionality of patients with hemophilia. The approach to these patients should be interdisciplinary. Assessment of the processes that affect pain in these patients and the development of pain education models should be implemented. Expert advice and information to patients with hemophilia should be based on individual functional prevention diagnoses, advice on available therapies and sports practice, as well as health recommendations.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain,Royal Victoria Eugenia Foundation, Madrid, Spain,Correspondence: Rubén Cuesta-Barriuso, Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Campus de El Cristo s/n, Faculty of Medicine, Oviedo, 33006, Spain, Tel +34 985 103 386, Email
| | - Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | | | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
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Kumar R, Bouskill V, Schneiderman J, Pluthero F, Kahr W, Craik A, Clark D, Whitney K, Zhang C, Rand M, Carcao M. Impact of aerobic exercise on haemostatic indices in paediatric patients with haemophilia. Thromb Haemost 2017; 115:1120-8. [DOI: 10.1160/th15-09-0757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/11/2016] [Indexed: 11/05/2022]
Abstract
SummaryThis study investigated the impact of aerobic exercise on laboratory assessments of haemostatic activity in boys (5–18 years of age) with haemophilia A (HA) or B (HB), examining the hypothesis that laboratory coagulation parameters temporarily improve with exercise. Thirty subjects meeting eligibility criteria (19 HA; 11 HB; mean age: 12.8 years) were invited to participate. They underwent a replacement factor washout period and were advised against strenuous activity for three days prior to the planned intervention. At study visit, baseline blood samples were drawn prior to exercise on a stationary cycle ergometer, aiming to attain 3 minutes (min) of cycling at 85 % of predicted maximum heart rate. Blood work was repeated 5 min (t5) and 60 min (t60) post exercise completion. Samples were assessed for platelet count (PC), factor VIII activity (FVIII:C), von Willebrand antigen (VWF:Ag), ristocetin cofactor activity (VWF:RCo) and platelet function analysis (PFA-100); maximum rate of thrombus generation (MRTG) in blood was measured via thromboelastography and plasma peak thrombin generation (PTG) via calibrated automated thrombography. Mean duration of exercise was 13.9 (± 2.6) min. On average, t5 samples showed significant elevation, relative to baseline in PC, FVIII:C, VWF:Ag, VWF:RCo and PTG, while FVIII:C, VWF:Ag, VWF:RCo and MRTG were significantly elevated in t60 samples. Within the cohort, participants with severe HA showed no change in FVIII:C levels with exercise. The greatest improvement in haemostatic indices was observed in post-adolescent males with mild-moderate HA, who thus represent the group most likely to benefit from a reduction of bleeding risk in the setting of exercise.
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Sholzberg M, Floros G, Schneiderman JE, Kahr WHA, Rand M, Pluthero F, Hossain T, Mahamad S, Nisenbaum R, Zhang C, O'Neill NE, Teitel J, Carcao M. Effect of moderate intensity exercise on haemostatic capacity in adults with haemophilia A and B: pilot study. Haemophilia 2017; 23:e162-e165. [PMID: 28111839 DOI: 10.1111/hae.13181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 11/27/2022]
Affiliation(s)
- M Sholzberg
- Division of Haematology/Oncology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Haematology/Oncology Clinical Research Group, St. Michael's Hospital, Toronto, ON, Canada
| | - G Floros
- Department of Nursing, St. Michael's Hospital, Toronto, ON, Canada
| | - J E Schneiderman
- Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - W H A Kahr
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - M Rand
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Biochemistry, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - F Pluthero
- Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - T Hossain
- Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - S Mahamad
- Haematology/Oncology Clinical Research Group, St. Michael's Hospital, Toronto, ON, Canada
| | - R Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - C Zhang
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - N E O'Neill
- Haematology/Oncology Clinical Research Group, St. Michael's Hospital, Toronto, ON, Canada
| | - J Teitel
- Division of Haematology/Oncology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - M Carcao
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Baumgartner CK, Zhang G, Kuether EL, Weiler H, Shi Q, Montgomery RR. Comparison of platelet-derived and plasma factor VIII efficacy using a novel native whole blood thrombin generation assay. J Thromb Haemost 2015; 13:2210-9. [PMID: 26453193 PMCID: PMC4715732 DOI: 10.1111/jth.13169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/30/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND We have recently developed a successful gene therapy approach for hemophilia A in which factor VIII (FVIII) expression is targeted to platelets by the αIIb promoter. Levels of platelet-expressed FVIII (2bF8) achieved by gene therapy may vary between individuals due to differences in ex vivo transduction and gene expression efficiency. Accurate assays to evaluate 2bF8 efficacy are desirable. OBJECTIVE To compare the hemostatic efficacy of 2bF8 with replacement therapy over a wide therapeutic dose range. METHODS Efficacy of 2bF8 was assessed using a new transgenic mouse model expressing high 2bF8 levels (LV18(tg) ). Blood from LV18(tg) mice or FVIII(null) mice infused with recombinant FVIII was mixed with FVIII(null) blood at different ratios ex vivo to achieve several concentrations of 2bF8 or plasma FVIII. Samples were evaluated with a novel native whole blood thrombin generation assay that uses recalcified whole blood without the addition of tissue factor to initiate coagulation. RESULTS FVIII dose dependency was observed in all five thrombin generation parameters. While the total amount of thrombin generated was similar, 2bF8 significantly accelerated thrombin generation compared with plasma FVIII. Remarkably, a 10-fold lower dose of 2bF8 than plasma FVIII (0.2% vs. 2%) significantly shortened the onset and peak of thrombin generation compared with FVIII(null) blood. CONCLUSION Using a new transgenic mouse model, we showed that the novel native whole blood thrombin generation assay established here can be used to monitor platelet targeted FVIII gene therapy. The higher therapeutic efficacy of 2bF8 compared with factor replacement therapy seemed to be due to acceleration of thrombin generation.
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Affiliation(s)
- C K Baumgartner
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - G Zhang
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - E L Kuether
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - H Weiler
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - Q Shi
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - R R Montgomery
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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