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Baglo T, Zohoun A, Mohamed FA, Araba F, Houssou B, Anani L, Kindé-Gazard D, Fall AT, Ryman A, Gruel Y, Pouplard C. Bioclinical features of haemophilia patients in Benin in 2023: Towards better care. Haemophilia 2024. [PMID: 39118287 DOI: 10.1111/hae.15082] [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: 01/08/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To analyse the demographic, clinical and laboratory data of Beninese patients with haemophilia. METHOD A prospective survey was conducted in three different hospitals of Benin from April 2021 to March 2022, to analyse clinical and biological features of patients with haemophilia previously diagnosed or identified based on personal/family history. RESULTS A total of 101 patients were studied, 97 with haemophilia A and 4 with haemophilia B, including 26 new cases identified after family investigation. Their median age was 11 years, and the most frequent initial manifestations were cutaneous-mucosal haemorrhages (29.70%) and post-circumcision haemorrhages (25.74%). Previous joint bleedings were present in 77% of them, with an arthropathy in 65 cases, which particularly affected the knees (75%), elbows (41%) and ankles (29%). Factor VIII (FVIII) levels combined with activated partial thromboplastin time (APTT) values did not always enable, as would be expected, the distinction between severe and moderate haemophilia, since they were >1 IU/dl in 31 of 74 patients with APTT > 80 s, and between 1 and 2 IU/dl in 26 other cases with previous joint haemorrhages, including 18 with chronic arthropathy. Therefore, for these patients, severe haemophilia could not be excluded, and this uncertainty probably reflects technical difficulties affecting the pre-analytical and analytical stages of the APTT and FVIII/IX assays. CONCLUSION Our study proved that haemophilia is a significant reality in Benin, but also remains under-diagnosed in some districts of the country. In addition, more reliable biological tests are needed in the future to better define the severity of the disease and improve treatment of patients.
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Affiliation(s)
- Tatiana Baglo
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Alban Zohoun
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | | | - Ferrelle Araba
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
| | - Bienvenu Houssou
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
| | - Ludovic Anani
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Dorothée Kindé-Gazard
- Haematology laboratory, National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Awa Touré Fall
- Haematology laboratory, Aritide le Dantec Hospital, Dakar, Senegal
- Pharmacy and Odontostomatology, Faculty of Medicine, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Anne Ryman
- Laboratory of Hematology, Bordeaux University Hospital, Pessac, France
| | - Yves Gruel
- University of Tours, Inserm U1327, ISCHEMIA, Tours, France
| | - Claire Pouplard
- University of Tours, Inserm U1327, ISCHEMIA, Tours, France
- Department of Haemostasis, University Hospital of Tours, Tours, France
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Wada H, Shiraki K, Matsumoto T, Shimpo H, Sakano Y, Nishii H, Tamaki S, Suzuki K, Tawara I, Yamashita Y, Shimaoka M. Evaluating Factor VIII Concentrates Using Clot Waveform Analysis. J Clin Med 2024; 13:3857. [PMID: 38999423 PMCID: PMC11242304 DOI: 10.3390/jcm13133857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: FVIII reagent activity varies across different assays, as well as activated partial thromboplastin time (APTT) reagents. The hemostatic ability of various FVIII reagents was examined via clot waveform analysis (CWA). Methods: APTT was measured using 12 APTT reagents, a small amount of tissue factor-induced FIX activation (sTF/FIXa) and a small amount of thrombin time (sTT) in order to examine 10 FVIII reagents and reference plasma (RP) using CWA. FVIII activity was measured using CWA-APTT, a chromogenic assay, or CWA-sTT. Results: Although the peak time (PT) and peak height (PH) of the CWA-APTT were markedly different in different FVIII reagents using several APTT reagents, the PTs of CWA-APTT were generally normal or shortened and the PHs of CWA-APTT were generally lower than those of RP. The FVIII activity varied, as evaluated using APTT, and was higher when using the CWA-sTT method than the APTT or chromogenic methods. CWA-sTT showed an elevated second peak of first DPH in all FVIII reagents, and both CWA-sTF/FIXa and CWA-sTT were enhanced using APTT reagents. Conclusions: Our evaluation of the hemostatic ability of FVIII reagents varied among APTT reagents. CWA-sTT can be used to further evaluate the hemostatic ability of an FVIII concentrate based on thrombin burst.
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Affiliation(s)
- Hideo Wada
- Associated Department with Mie Graduate School of Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
| | - Katsuya Shiraki
- Associated Department with Mie Graduate School of Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
- Department of General Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan
| | - Takeshi Matsumoto
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu 514-8507, Japan;
| | - Hideto Shimpo
- Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
| | - Yumi Sakano
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (Y.S.); (H.N.); (M.S.)
| | - Hiroko Nishii
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (Y.S.); (H.N.); (M.S.)
| | - Shigehisa Tamaki
- Department of Hematology, Japanese Red Cross Ise Hospital, Ise 516-8512, Japan;
| | - Kei Suzuki
- The Advanced Emergency and Critical Care Center, Mie University Hospital, Tsu 514-8507, Japan;
| | - Isao Tawara
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (I.T.); (Y.Y.)
| | - Yoshiki Yamashita
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (I.T.); (Y.Y.)
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (Y.S.); (H.N.); (M.S.)
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Matsumoto T, Wada H, Shiraki K, Suzuki K, Yamashita Y, Tawara I, Shimpo H, Shimaoka M. The Evaluation of Clot Waveform Analyses for Assessing Hypercoagulability in Patients Treated with Factor VIII Concentrate. J Clin Med 2023; 12:6320. [PMID: 37834964 PMCID: PMC10573981 DOI: 10.3390/jcm12196320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Regular prophylactic therapy has become an increasingly common treatment for severe hemophilia. Therefore, hypercoagulability-a potential risk factor of thrombosis-is a cause for concern in hemophilic patients treated with a high dose of FVIII concentrate. In clot waveform analysis (CWA)-thrombin time (TT), a small amount of thrombin activates clotting factor VIII (FVIII) instead of fibrinogen, resulting in FVIII measurements using CWA-TT with a small amount of thrombin. METHODS The coagulation ability of patients treated with FVIII concentrate or emicizumab was evaluated using activated partial thromboplastin time (APTT), TT and a small amount of tissue factor-induced FIX activation assay (sTF/FIXa) using CWA. RESULTS The FVIII activity based on CWA-TT was significantly greater than that based on the CWA-APTT or chromogenic assay. FVIII or FVIII-like activities based on the three assays in plasma without emicizumab were closely correlated; those in plasma with emicizumab based on CWA-TT and chromogenic assays were also closely correlated. CWA-APTT and CWA-TT showed different patterns in patients treated with FVIII concentrates compared to those treated with emicizumab. In particular, CWA-TT in patients treated with FVIII concentrate showed markedly higher peaks in platelet-rich plasma than in platelet-poor plasma. CWA-APTT showed lower coagulability in hemophilic patients treated with FVIII concentrate than in healthy volunteers, whereas CWA-sTF/FIXa did not. In contrast, CWA-TT showed hypercoagulability in hemophilic patients treated with FVIII concentrate. CONCLUSIONS CWA-TT can be used to evaluate the thrombin bursts that cause hypercoagulability in patients treated with emicizumab. Although routine APTT evaluations demonstrated low coagulation ability in patients treated with FVIII concentrate, CWA-TT showed hypercoagulability in these patients, suggesting that the evaluation of coagulation ability may be useful when using multiple assays.
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Affiliation(s)
- Takeshi Matsumoto
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu 514-8507, Japan;
| | - Hideo Wada
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
| | - Katsuya Shiraki
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
| | - Kei Suzuki
- The Emergency and Critical Care Center, Mie University Hospital, Tsu 514-8507, Japan;
| | - Yoshiki Yamashita
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (Y.Y.); (I.T.)
| | - Isao Tawara
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (Y.Y.); (I.T.)
| | - Hideto Shimpo
- Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan;
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Bowyer AE, Gosselin RC. Factor VIII and Factor IX Activity Measurements for Hemophilia Diagnosis and Related Treatments. Semin Thromb Hemost 2023; 49:609-620. [PMID: 36473488 PMCID: PMC10421651 DOI: 10.1055/s-0042-1758870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accurate measurement of clotting factors VIII (FVIII) or IX (FIX) is vital for comprehensive diagnosis and management of patients with hemophilia A or B. The one-stage activated partial thromboplastin time (aPTT)-based clotting assay is the most commonly used method worldwide for testing FVIII or FIX activities. Alternatively, FVIII and FIX chromogenic substrate assays, which assess the activation of factor X, are available in some specialized laboratories. The choice of reagent or methodology can strongly influence the resulting activity. Variation between one-stage FVIII or FIX activities has been reported in the measurement of some standard and extended half-life factor replacement therapies and gene therapy for hemophilia B using different aPTT reagents. Discrepancy between one-stage and chromogenic reagents has been demonstrated in some patients with mild hemophilia A or B, the measurement of some standard and extended half-life factor replacement therapies, and the transgene expression of hemophilia A and B patients who have received gene therapy. Finally, the measurement of bispecific antibody therapy in patients with hemophilia A has highlighted differences between chromogenic assays. It is imperative that hemostasis laboratories evaluate how suitable their routine assays are for the accurate measurement of the various hemophilia treatment therapies.
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Affiliation(s)
- Annette E. Bowyer
- Department of Coagulation, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Robert C. Gosselin
- Hemostasis and Thrombosis Center, University of California, Davis Health System, Sacramento, California
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Guillet B, Hassoun A, Wibaut B, Harroche A, Biron-Andréani C, Repesse Y, d'Oiron R, Tardy B, Pan Petesch B, Chamouni P, Gay V, Fouassier M, Pouplard C, Martin C, Catovic H, Delavenne X. A French Real-World Evidence Study Evaluating the Efficacy, Safety, and Pharmacokinetic Parameters of rVIII-SingleChain in Patients with Hemophilia A Receiving Prophylaxis. Thromb Haemost 2023; 123:490-500. [PMID: 36758611 PMCID: PMC10113037 DOI: 10.1055/s-0043-1761449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND rVIII-SingleChain is a recombinant factor VIII (FVIII) with increased binding affinity to von Willebrand factor compared with other FVIII products. rVIII-SingleChain is indicated for the treatment and prevention of bleeding episodes in patients with hemophilia A. OBJECTIVES To collect real-world evidence data from patients treated with rVIII-SingleChain to confirm the efficacy and safety established in the clinical trial program and carry out a population pharmacokinetic (PK) analysis. PATIENTS/METHODS This interim analysis includes data, collected between January 2018 - September 2021, from patients treated with rVIII-SingleChain prophylaxis at French Hemophilia Treatment centers. Data on annualized bleeding rates, dosing frequency, and consumption before and after switching to rVIII-SingleChain were recorded. A population PK analysis was also conducted to estimate PK parameters. RESULTS Overall, 43 patients switched to prophylaxis with rVIII-SingleChain either from a previous prophylaxis regimen or from on-demand treatment. Following the switch to rVIII-SingleChain, patients maintained excellent bleed control. After switching to rVIII-SingleChain, most patients maintained or reduced their regimen. Interestingly, a majority of patients treated >2 ×/weekly with a standard half-life FVIII reduced both injection frequency and FVIII consumption with rVIII-SingleChain. A PK analysis revealed a lower clearance of rVIII-SingleChain (1.9 vs. 2.1 dL/h) and a longer half-life both in adolescents/adults (n = 28) and pediatric (n = 6) patients (15.5 and 11.9 hours, respectively vs. 14.5 and 10.3 hours) than previously reported. CONCLUSIONS Patients who switched to rVIII-SingleChain prophylaxis demonstrated excellent bleed control and a reduction in infusion frequency. A population PK analysis revealed improved PK parameters compared with those reported in the clinical trial.
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Affiliation(s)
- Benoit Guillet
- Haemophilia Treatment Center, University Hospital, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Abel Hassoun
- Haemophilia Treatment Center, Simone Veil Hospital, GH Eaubonne-Montmorency, France
| | - Bénédicte Wibaut
- Haemophilia Treatment Centre, National Reference Willebrand Centre, University Hospital, Lille, France
| | - Annie Harroche
- Department of Hematology, Haemophilia Treatment Centre, University Hospital Necker Enfants Malades, Paris, France
| | | | - Yohan Repesse
- Haematology Laboratory and Haemophilia Reference Centre, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Roseline d'Oiron
- CRH, CRC-MHC (Centre de Référence de l'Hémophilie, Centre de Ressource et de Compétence des Maladies Hémorragiques Constitutionnelles), Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Paris, France.,HITh, UMR_S1176, INSERM, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Brigitte Tardy
- Haemophilia Treatment Center, University Hospital, Saint-Etienne, France.,Inserm CIC 1408, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Brigitte Pan Petesch
- Haemophilia Treatment Center, Morvan University Hospital, Saint-Etienne Brest, France
| | - Pierre Chamouni
- Haemophilia Treatment Center, University Hospital, Rouen, France
| | - Valérie Gay
- Haemophilia Treatment Center, Hospital, Chambery, France
| | - Marc Fouassier
- Haemophilia Treatment Center, Hôtel-Dieu University Hospital, Nantes, France
| | | | | | | | - Xavier Delavenne
- INSERM, UMR 1059, Dysfonction Vasculaire et de l'Hémostase, Université de Lyon, Saint Etienne, France.,Laboratoire de Pharmacologie - Toxicologie, CHU de Saint-Etienne, Saint-Etienne, France
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Ternisien C, Lasne D, Grand F, Harzallah I, Jeanpierre E, Repesse Y, Ryman A, Sapin AF, Voisin S, Nougier C, Pouplard C. Impact of aPTT reagents on measurement of a PEGylated recombinant FVIII (Adynovi ® /Adynovate ® ): A French multicentric field assay study. Int J Lab Hematol 2021; 44:e55-e59. [PMID: 34559452 DOI: 10.1111/ijlh.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/18/2021] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Dominique Lasne
- Laboratoire d'hématologie générale, Hôpital Necker AP-HP, Paris, France
| | - Francois Grand
- Service d'Hématologie Biologique, CHU de Poitiers, Poitiers, France
| | - Ines Harzallah
- Service d'Hématologie Hémostase, Centre hospitalier de Mulhouse, Mulhouse, France
| | | | - Yoan Repesse
- Service d'Hématologie Biologique, CHU de Caen, Caen, France
| | - Anne Ryman
- Service d'Hématologie Biologique, CHU de Bordeaux, Bordeaux, France
| | - Anne Francoise Sapin
- Service d'Hématologie Biologique, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - Sophie Voisin
- Laboratoire d'Hématologie, Hôpital de Rangueil, CHU de Toulouse, Toulouse, France
| | | | - Claire Pouplard
- Service d'Hématologie-Hémostase, Hôpital Trousseau, CHU de Tours, Tours, France.,EA 7501 Université François Rabelais, Tours, France
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Wada H, Shiraki K, Matsumoto T, Ohishi K, Shimpo H, Sakano Y, Nishii H, Shimaoka M. The Evaluation of APTT Reagents in Reference Plasma, Recombinant FVIII Products; Kovaltry® and Jivi® Using CWA, Including sTF/7FIX Assay. Clin Appl Thromb Hemost 2021; 27:1076029620976913. [PMID: 33606948 PMCID: PMC7900842 DOI: 10.1177/1076029620976913] [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] [Indexed: 11/17/2022] Open
Abstract
The FVIII activity in patients treated with several extended half-life FVIII (EHL-FVIII) agents different when various activated partial thromboplastin time (APTT) reagents were used. The present study examined the difference in clot waveform analysis (CWA) findings and FVIII activity when various APTT reagents and CWA were used. The CWA including FVIII activity was measured using 12 APTT reagents, and the FIX activation based on a small amount of tissue factor assay (sTF/FIX) were examined in reference plasma (RP), EHL-FVIII (Jivi®) and Kovaltry®. The 3 APTT reagents were associated with high variation in the peak time and height in the CWA when analyzing low concentrations of FVIII. The peak time and height could not be measured with one APTT reagent, and there were marked differences in the CWA findings between Jivi® and Kovaltry® among APTT reagents. Several APTT reagents showed a markedly lower FVIII activity with Jivi® than with Kovaltry®. In the FVIII assay, the peak time measured with sTF/FIX did not differ markedly between Jivi® and Kovaltry®; however, the FVIII activity in Jivi® (as measured by the peak height) tended to be higher than in Kovaltry®. The CWA findings for monitoring Jivi® varied for monitoring Jivi® depending on the APTT reagents used, and sTF/FIX assay may be able to measure the EHL-FVIII.
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Affiliation(s)
- Hideo Wada
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan.,Associated Department with Mie Graduate School of Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Katsuya Shiraki
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan.,Associated Department with Mie Graduate School of Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Takeshi Matsumoto
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Kohshi Ohishi
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Hideto Shimpo
- Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Yumi Sakano
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of medicine, Tsu, Japan
| | - Hiroko Nishii
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of medicine, Tsu, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of medicine, Tsu, Japan
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