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Rodriguez-Merchan EC. Ankle arthrodesis and total ankle replacement in patients with congenital bleeding disorders suffering from severe ankle arthropathy. Expert Rev Hematol 2024; 17:1-8. [PMID: 38131332 DOI: 10.1080/17474086.2023.2299301] [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] [Received: 10/05/2023] [Accepted: 12/21/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In patients with congenital bleeding disorders suffering from severe ankle arthropathy, when conservative treatment and joint-preserving surgical techniques fail, there are two possible non-joint-preserving options: ankle arthrodesis (AA) and total ankle replacement (TAR). AREAS COVERED The scope and aim of this article was to analyze the current role of AA and TAR in patients with congenital bleeding disorders suffering from severe ankle arthropathy. EXPERT OPINION In patients with congenital bleeding disorders, both TAR and AA provide good results, mainly in terms of pain relief, although they are not exempt from complications (between 0% and 33% in TAR and between 5% and 23.5% in AA). The current controversy about which of the two surgical techniques, TAR or AA, gives better results, the current literature is not able to resolve it in patients with congenital bleeding disorders. While this question is being answered, my opinion regarding patients with congenital bleeding disorders is that the age of the patient must be taken into account. Given known prosthetic survival rates, the older the patient, the more we might be inclined to indicate TAR. Conversely, AA may be more appropriate for relatively young patients.
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Arthur RY, Mihas AK, Harris J, Reed LA, Billings R, Patch DA, Spitler CA, Johnson MD. Comparison of Total Ankle Replacement and Ankle Arthrodesis for Ankle Arthropathy in Patients With Bleeding Disorders: A Systematic Review and Meta-Analysis. Foot Ankle Int 2023; 44:645-655. [PMID: 37226806 DOI: 10.1177/10711007231171123] [Citation(s) in RCA: 1] [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] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is limited literature comparing the publications on ankle arthrodesis (AA) and total ankle arthroplasty (TAA) in the setting of hemophilic arthropathy. Our objective is to systematically review the existing literature and to assess ankle arthroplasty as an alternative to ankle arthrodesis in this patient population. METHODS This systematic review was conducted and presented according to the PRISMA statement standards. A search was conducted on March 7-10, 2023, using MEDLINE (via PubMed), Embase, Scopus, ClinicalTrials.gov, CINAHL Plus with Full Text, and the Cochrane Central Register of Controlled Studies. This search was restricted to full-text human studies published in English, and articles were screened by 2 masked reviewers. Systematic reviews, case reports with less than 3 subjects, letters to the editor, and conference abstracts were excluded. Two independent reviewers rated study quality using the MINORS tool. RESULTS Twenty-one of 1226 studies were included in this review. Thirteen articles reviewed the outcomes associated with AA in hemophilic arthropathy whereas 10 reviewed the outcomes associated with TAA. Two of our studies were comparative and reviewed the outcomes of both AA and TAA. Additionally, 3 included studies were prospective. Studies showed that the degree of improvement in American Orthopaedic Foot & Ankle Society hindfoot-ankle score, visual analog scale pain scores, and the mental and physical component summary scores of the 36-Item Short Form Health Survey were similar for both surgeries. Complication rates were also similar between the 2 surgeries. Additionally, studies showed a significant improvement in ROM after TAA. CONCLUSION Although the level of evidence in this review varies and results should be interpreted with caution, the current literature suggests similar clinical outcomes and complication rates between TAA and AA in this patient population.
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Affiliation(s)
- Rodney Y Arthur
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander K Mihas
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Harris
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Logan A Reed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca Billings
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David A Patch
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael D Johnson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Anazor FC, Uthraraj N, Southgate C, Dhinsa B. Mid-to long-term postoperative outcomes of ankle joint fusion in patients with haemophilia: A systematic review. Haemophilia 2023; 29:716-730. [PMID: 36883872 DOI: 10.1111/hae.14770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION AND AIM The ankle joint is the most common site for haemophilic arthropathy. The aim of this study was to review the outcomes of ankle joint fusion in patients with haemophilia A or B. The primary outcome measures were union rates, time to union, perioperative blood loss/transfusion, postoperative complications and length of hospital stay (LOS). Secondary outcome measures were hind foot functional outcome scores and the visual analogue pain scale (VAS). MATERIALS AND METHODS A search of PubMed, Medline, Embase, Journals@Ovid and the Cochrane register was performed conforming to the PRISMA guidelines. Only human studies with a minimum follow-up of 1-year were included. The MINORS and ROBINS-1 tools were used for quality appraisal. RESULTS A total of 952 articles were identified and only 17 studies met the eligibility criteria after the screening. The mean age of the patients was 37.6 (SD 10.2). A total of 271 ankle fusions were performed with the open crossed-screw fixation being the most common technique. Union rates were 71.5%-100% at 2-6 months. The pooled postoperative complication and revision rates were 13.7% and 6.5%, respectively. The range of LOS was 1.8-10.6 days. The mean preoperative American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score was 35 (SD 13.1) whereas the mean postoperative AOFAS score was 79.4 (SD 5.3). The mean preoperative VAS was 6.3 (SD 1.6) while the mean postoperative VAS score was .9 (SD .4) across 38 ankle fusions. CONCLUSION Ankle arthrodesis offers improved pain and function in haemophilic ankle arthropathy with lower revision and complication rates than that reported in the literature for total ankle replacement.
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Affiliation(s)
- Fitzgerald Chukwuemeka Anazor
- East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK.,Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Nachappa Uthraraj
- East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
| | - Crispin Southgate
- East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
| | - Baljinder Dhinsa
- East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
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Rodriguez-Merchan EC. The Current Role of Ankle Arthrodesis in Hemophilic Patients. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:129-134. [PMID: 35655735 PMCID: PMC9117902 DOI: 10.22038/abjs.2020.47865.2366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/10/2020] [Indexed: 01/24/2023]
Abstract
There are several manners to take care of the hemophilic ankle in the initial phases of degeneration of the articular cartilage, in the event that hematologic prophylaxis is unsuccessful in accomplishing no bleeds. Some of these are nonoperative, with which management must start. These are Physical and Rehabilitation Medicine protocols and the utilization of orthoses (patellar tendon bearing). When these are unsuccessful, more aggressive types of treatment can be utilized, such as radiosynovectomy and some surgical operations (open or arthroscopic removal of anterior osteophyte of the distal part of the tibia, arthroscopic ankle debridement). Nonetheless, in the late phases of degeneration of the articular cartilage (advanced arthropathy), the solely options are surgical: ankle fusion or total ankle arthroplasty. The review of the literature has shown that the percentage of consolidation is between 90% and 100%, and that the percentage of postoperative infection is between 0% and 10%%. When the Ilizarov external fixator is utilized for ankle fusion, the percentage of pin tract infection is around 14%. Ankle fusion is a secure surgical technique that meliorates articular pain and improves the quality of life of hemophilic patients.
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Affiliation(s)
- E. Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046-Madrid, Spain
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Rodriguez-Merchan EC, Encinas-Ullan CA, Gomez-Cardero P. Effectiveness of ankle fusion in patients with hemophilia, advanced ankle degeneration, and unbearable pain for whom nonsurgical and surgical treatments have been ineffective. Expert Rev Hematol 2021; 14:517-524. [PMID: 34042014 DOI: 10.1080/17474086.2021.1935850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: In underdeveloped countries, patients with hemophilia often experience repetitive ankle joint hemorrhages due to a shortage of coagulation factors (factor VIII [FVIII] and factor IX [FIX] for hemophilia A and B, respectively).Areas covered: This is a narrative literature review in which we searched the Cochrane Library and PubMed for articles related to ankle arthrodesis in patients with hemophilia. The searches covered the period from the databases´ inception to 28 February 2021. In the event of unsuccessful hematologic prophylaxis and conservative measures (e.g. analgesics, cyclooxygenase-2 inhibitors, taping, intra-articular injections of hyaluronic acid and corticosteroids, physical and rehabilitation medicine, orthoses, radiosynovectomy, and joint-preserving surgery (e.g. removal of the distal tibia by open surgery or by arthroscopic surgery, joint debridement by arthroscopic surgery), the classical surgical solution is ankle arthrodesis, which does not preserve the ankle joint.Expert opinion: Ankle pain is reduced after ankle arthrodesis (75% of patients experience no pain). Approximately 5% of patients require reoperation due to lack of fusion, and deep infection occurs in 2.5%. After tibiotalar fusion, a self-reported activity scale shows that approximately 12% of patients improve, 9% worsen, and 79% show no improvement. The results of ankle arthrodesis therefore appear to be poor.Therefore, although 75% of the patients stopped having ankle pain after arthrodesis, according to a self-reported activity scale 88% of them did not improve or worsened.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Rozis M, Benetos I, Afrati SR, Polyzois VD, Pneumaticos SG. Results and Outcomes of Combined Cross Screw and Ilizarov External Fixator Frame in Ankle Fusion. J Foot Ankle Surg 2021; 59:337-342. [PMID: 32131000 DOI: 10.1053/j.jfas.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/01/2019] [Accepted: 05/19/2019] [Indexed: 02/03/2023]
Abstract
Ankle fusion is a treatment option for end-stage ankle arthritis. Fusion site stability and optimal foot positioning are crucial parameters. We present the results of our double fixation technique, combining both cross-screw fixation and Ilizarov external fixator frame via transmalleolar approach. We reviewed the files from 52 patients operated for ankle fusion in our center. In our technique, we use a transmalleolar approach, initial stabilization with 2 cannulated, half-threaded cross screws, and final stabilization with an Ilizarov external fixator frame. Fusion stability, weightbearing time, complication rates, and final functional scores were recorded and evaluated. Mean frame removal time was 11.2 ± 2.1 weeks, and 71.6% of patients were fully weightbearing at that time. Absolute fusion stability was reported in 88.46% of patients at that time, while no pseudarthrosis was noted in final follow-up at 12 months. According to the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot-ankle score evaluation at 12 months, 90.4% of patients reported excellent and 9.6% good results. None of the patients was referred for symptomatic forefoot arthritis, and there were no cases of deep infection or deep vein thrombosis. Material-related complications were reported in 1 patient who was treated with implant removal after 1 year. Ankle fusion is a salvage procedure that offers optimal results in end-stage ankle arthritis. Our technique offers absolute fusion site stability with excellent functional results, minor complications, and the advantages of early protected weightbearing. Careful patient selection in addition to fine foot positioning should be regarded as crucial for the final outcome.
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Affiliation(s)
- Meletis Rozis
- Orthopaedic Resident, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece.
| | - Ioannis Benetos
- Orthopaedic Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Spyridoula-Roberta Afrati
- Anesthesiologist Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Vasilios D Polyzois
- Orthopaedic Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Spyros G Pneumaticos
- Orthopaedic Professor, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
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Wang S, Li Q, Zhang Z, Wang W, Li J, Liu L. Ankle arthrodesis for end-stage haemophilic ankle arthropathy using a Ilizarov method. INTERNATIONAL ORTHOPAEDICS 2020; 44:995-1001. [DOI: 10.1007/s00264-020-04513-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022]
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Tobase P, Lane H, Siddiqi AEA, Soucie JM, Ingram-Rich R, Ward S, Gill JC. Risk factors associated with invasive orthopaedic interventions in males with haemophilia enrolled in the Universal Data Collection program from 2000 to 2010. Haemophilia 2018; 24:964-970. [PMID: 29957840 DOI: 10.1111/hae.13511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Invasive orthopaedic interventions (IOI) are often used to control recurrent haemarthrosis, pain and loss of joint function, in males with haemophilia (Factor VIII and Factor IX deficiency). AIM Identify risk factors associated with IOIs in males with haemophilia enrolled in the Universal Data Collection (UDC) surveillance program from 2000 until 2010. METHODS Data were collected on IOIs performed on patients receiving care in 130 haemophilia treatment centers in the United States annually by health care providers using standardized forms. IOIs included in this study are as follows: 1) synovectomy and 2) arthrodesis or arthroplasty (A/A). Information about potential risk factors was obtained from the preceding UDC visit if available, or from the same visit if not. Patients with no reported IOI at any of their UDC visits were the reference group for the analysis. Multivariate analyses were conducted to identify independent risk factors for synovectomies and arthrodesis/arthroplasty. RESULTS Risk factors significantly associated with the two IOI categories were age, student status, haemophilia severity, number of joint bleeds within the last 6 months, HIV or hepatitis C (HCV) status. Multivariate analyses showed patients on continuous prophylaxis were 50% less likely to have had a synovectomy and were 40% less likely to have an A/A. CONCLUSIONS This study shows modifiable risk factors, including management of bleeding episodes with a continuous prophylactic treatment schedule are associated with a decreased likelihood of IOIs in males with haemophilia.
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Affiliation(s)
- P Tobase
- Hemophilia Treatment Center, University of California, San Francisco, CA, USA
| | - H Lane
- Intermountain Hemophilia and Thrombosis Center Primary Children's Medical Center, Salt Lake City, UT, USA
| | - A-E-A Siddiqi
- Division of Blood Disorders, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - J M Soucie
- Division of Blood Disorders, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - S Ward
- Department of Physical Therapy, University of Utah College of Health, Salt Lake City, UT, USA
| | - J C Gill
- Medical College of Wisconsin and Comprehensive Center for Bleeding Disorders, Blood Center of Wisconsin, Milwaukee, WI, USA
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de l’Escalopier N, Badina A, Padovani JP, Harroche A, Frenzel L, Wicart P, Glorion C, Rothschild C. Long-term results of ankle arthrodesis in children and adolescents with haemophilia. INTERNATIONAL ORTHOPAEDICS 2017; 41:1579-1584. [DOI: 10.1007/s00264-017-3478-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/27/2017] [Indexed: 12/19/2022]
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Barg A, Morris SC, Schneider SW, Phisitkul P, Saltzman CL. Surgical procedures in patients with haemophilic arthropathy of the ankle. Haemophilia 2016; 22:e156-76. [DOI: 10.1111/hae.12919] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 12/14/2022]
Affiliation(s)
- A. Barg
- Department of Orthopaedics University of Utah Salt Lake City UT USA
| | - S. C. Morris
- Department of Orthopaedics University of Utah Salt Lake City UT USA
| | - S. W. Schneider
- Department of Dermatology, Venerology, and Allergology University Medical Center and Medical Faculty Mannheim University of Heidelberg Mannheim Germany
| | - P. Phisitkul
- Department of Orthopaedics and Rehabilitation University of Iowa Iowa City IA USA
| | - C. L. Saltzman
- Department of Orthopaedics University of Utah Salt Lake City UT USA
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Brkljac M, Shah S, Hay C, Rodriguez-Merchan EC. Hindfoot fusion in haemophilic arthropathy: 6-year mean follow-up of 41 procedures performed in 28 adult patients. Haemophilia 2016; 22:e87-e98. [DOI: 10.1111/hae.12863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M. Brkljac
- Manchester Royal Infirmary; University of Manchester; Manchester UK
| | - S. Shah
- Department of Orthopaedic Surgery; Manchester Royal Infirmary; Manchester UK
| | - C. Hay
- Department of Haematology; Manchester Royal Infirmary; Manchester UK
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Rodriguez-Merchan EC. Total ankle replacement or ankle fusion in painful advanced hemophilic arthropathy of the ankle. Expert Rev Hematol 2015; 8:727-31. [DOI: 10.1586/17474086.2015.1087846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barry V, Lynch ME, Tran DQ, Antun A, Cohen HG, DeBalsi A, Hicks D, Mattis S, Ribeiro MJA, Stein SF, Truss CL, Tyson K, Kempton CL. Distress in patients with bleeding disorders: a single institutional cross-sectional study. Haemophilia 2015; 21:e456-64. [DOI: 10.1111/hae.12748] [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: 11/26/2022]
Affiliation(s)
- V. Barry
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - M. E. Lynch
- Department of Psychiatry and Behavioral Services; Emory University School of Medicine; Atlanta Georgia USA
| | - D. Q. Tran
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
| | - A. Antun
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
| | - H. G. Cohen
- Winship Cancer Institute of Emory University; Atlanta Georgia USA
| | - A. DeBalsi
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - D. Hicks
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - S. Mattis
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - M. J. A. Ribeiro
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
| | - S. F. Stein
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
| | - C. L. Truss
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - K. Tyson
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - C. L. Kempton
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
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