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Chigateri S, Jain A, Oli AK, Katti Sathyasheelappa SK. Factor X deficiency and pregnancy. BMJ Case Rep 2024; 17:e259458. [PMID: 38960427 DOI: 10.1136/bcr-2023-259458] [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: 07/05/2024] Open
Abstract
Factor X (FX) is a vitamin K-dependent enzyme, which acts as an important coagulation factor of coagulation cascade. FX deficiency is an autosomal recessive inherited disease and is often demonstrated in families with consanguity. Pregnancy in women with congenital FX deficiency has been associated with adverse fetal outcomes. We report a case of pregnancy in women with FX deficiency. The patient needed an immediate caesarean section at 38 weeks of gestation because of severe oligohydramnios and fetal distress. FX deficiency during pregnancy was effectively managed, leading to a positive outcome through the optimal utilisation of available resources.
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Affiliation(s)
- Seema Chigateri
- Obstetrics and Gynecology Department, SDM College of Medical Sciences and Hospital Shri Dharmasthala Manjunatheshwara University Sattur, Dharwad, Karnataka, India
| | - Apoorva Jain
- SDM Research Institute for Biomedical Sciences, Shri Dharmasthala Manjunatheshwara University Sattur, Dharwad, Karnataka, India
| | - Ajay Kumar Oli
- SDM Research Institute for Biomedical Sciences, Shri Dharmasthala Manjunatheshwara University Sattur, Dharwad, Karnataka, India
| | - Sunil Kumar Katti Sathyasheelappa
- Obstetrics and Gynecology Department, SDM College of Medical Sciences and Hospital Shri Dharmasthala Manjunatheshwara University Sattur, Dharwad, Karnataka, India
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2
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Mohsenian S, Mannucci PM, Menegatti M, Peyvandi F. Rare inherited coagulation disorders: no longer orphan and neglected. Res Pract Thromb Haemost 2024; 8:102460. [PMID: 39022653 PMCID: PMC11253144 DOI: 10.1016/j.rpth.2024.102460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/03/2024] [Accepted: 05/18/2024] [Indexed: 07/20/2024] Open
Abstract
Rare inherited coagulation disorders due to the deficiency or dysfunction of coagulation factors have until recently received less clinical attention than hemophilias and von Willebrand disease. This situation has changed in the last decades, mainly due to therapeutic progress with the availability of more and safer products for replacement therapy produced by plasma fractionation or recombinant DNA technology. This narrative review, based on the latest literature and expert opinion, emphasizes the progress achieved for each of the rare deficiencies, mentions the still unmet therapeutic needs, and sketches the perspectives for further progress.
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Affiliation(s)
- Samin Mohsenian
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Marzia Menegatti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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3
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Escobar MA, Kavakli K. Plasma-derived human factor X concentrate for the treatment of patients with hereditary factor X deficiency. Haemophilia 2024; 30:59-67. [PMID: 37902395 DOI: 10.1111/hae.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/18/2023] [Accepted: 10/07/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Hereditary factor X (FX) deficiency (HFXD) is an autosomal recessive rare bleeding disorder that leads to defects in the FX protein. Depending on the degree of deficiency, patients may be at risk of life-threatening bleeding episodes. Historical treatments for FX deficiency include prothrombin complex concentrates, which can increase the risk of thrombosis, and fresh frozen plasma, which can cause volume overload and transfusion reactions. Plasma-derived FX (pdFX), a single-factor, high-purity, high-potency human FX treatment, was approved in 2015 in the United States and in 2016 in Europe for on-demand treatment and prophylaxis of bleeding episodes and perioperative management of patients with HFXD. METHODS Five studies that examined the use of pdFX in patients with mild (plasma FX activity [FX:C] ≥5 IU/dL), moderate (FX:C ≥1 and <5 IU/dL), or severe (FX:C < 1 IU/dL) HFXD were reviewed: TEN01, TEN02 and TEN03 were prospective, open-label, multicentre, nonrandomised studies, and TEN05 and TEN06 were multicentre retrospective studies. RESULTS When used as an on-demand treatment, pdFX was judged by investigators to be successful in treating 41/42 (97.6%), 2/3 (66.6%) and 79/79 (100%) bleeds in TEN01, TEN02 and TEN05, respectively. When used prophylactically, pdFX was judged 'excellent' for the prevention of bleeds in nine (100%) and eight (100%) patients in TEN02 and TEN05, respectively. Perioperative treatment and pharmacokinetics were also assessed. pdFX was safe and well tolerated. CONCLUSIONS Together, these studies support the use of pdFX for on-demand treatment of bleeding, routine prophylaxis, and perioperative management of bleeding in patients with HFXD.
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Affiliation(s)
- Miguel A Escobar
- University of Texas Health Science Center at Houston-McGovern Medical School and the Gulf States Hemophilia and Thrombophilia Center, Houston, Texas, USA
| | - Kaan Kavakli
- Department of Pediatrics, Division of Hemato-Oncology, Ege University Faculty of Medicine, İzmir, Turkey
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4
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Livanou ME, Matsas A, Valsami S, Papadimitriou DT, Kontogiannis A, Christopoulos P. Clotting Factor Deficiencies as an Underlying Cause of Abnormal Uterine Bleeding in Women of Reproductive Age: A Literature Review. Life (Basel) 2023; 13:1321. [PMID: 37374104 DOI: 10.3390/life13061321] [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: 04/25/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Clotting Factor deficiencies are rare disorders with variations in clinical presentation and severity of symptoms ranging from asymptomatic to mild to life-threatening bleeding. Thus, they pose a diagnostic and therapeutic challenge, mainly for the primary health care providers, general practitioners, and gynecologists who are more likely to first encounter these patients. An additional diagnostic challenge arises from the variable laboratory presentations, as PT, PTT, and BT are not always affected. The morbidity is higher among women of reproductive age since Abnormal Uterine Bleeding-specifically Heavy Menstrual Bleeding-is one of the most prevalent manifestations of these disorders, and in some cases of severe deficiencies has led to life-threatening episodes of bleeding requiring blood transfusions or even immediate surgical intervention. Physician awareness is important as, in the case of some of these disorders-i.e., Factor XIII deficiency-prophylactic treatment is available and recommended. Although uncommon, the potential for rare bleeding disorders and for hemophilia carrier states should be considered in women with HMB, after more prevalent causes have been excluded. Currently, there is no consensus on the management of women in these instances and it is reliant on the physicians' knowledge.
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Affiliation(s)
- Maria Effrosyni Livanou
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Alkis Matsas
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Serena Valsami
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Dimitrios T Papadimitriou
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Athanasios Kontogiannis
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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5
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Trossaert M, Chamouard V, Biron-Andreani C, Casini A, De Mazancourt P, De Raucourt E, Drillaud N, Frotscher B, Guillet B, Lebreton A, Roussel-Robert V, Rugeri L, Dargaud Y. Management of rare inherited bleeding disorders: Proposals of the French Reference Centre on Haemophilia and Rare Coagulation Disorders. Eur J Haematol 2023; 110:584-601. [PMID: 36748278 DOI: 10.1111/ejh.13941] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The rare coagulation disorders may present significant difficulties in diagnosis and management. In addition, considerable inter-individual variation in bleeding phenotype is observed amongst affected individuals, making the bleeding risk difficult to assess in affected individuals. The last international recommendations on rare inherited bleeding disorders (RIBDs) were published by the United Kingdom Haemophilia Centre Doctors' Organisation in 2014. Since then, new drugs have been marketed, news studies on surgery management in patients with RIBD have been published, and new orphan diseases have been described. AIM Therefore, the two main objectives of this review, based on the recent recommendations published by the French Reference Centre on Haemophilia and Rare Bleeding Disorders, are: (i) to briefly describe RIBD (clinical presentation and diagnostic work-up) to help physicians in patient screening for the early detection of such disorders; and (ii) to focus on the current management of acute haemorrhages and long term prophylaxis, surgical interventions, and pregnancy/delivery in patients with RIBD.
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Affiliation(s)
- Marc Trossaert
- Haemophilia Treatment Centre, University Hospital of Nantes and French Reference Centre on Haemophilia, Nantes, France
| | - Valerie Chamouard
- Haemophilia Treatment Centre, University Hospital of Lyon and French Reference Centre on Haemophilia, Lyon, France
| | | | - Alessandro Casini
- Angiology and Haemostasis Division, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe De Mazancourt
- Laboratory of Biochemistry and Molecular Genetics, Hospital Ambroise Paré-GHU APHP, Université Paris-Saclay, Boulogne-Billancourt, France
| | | | - Nicolas Drillaud
- Haemophilia Treatment Centre, University Hospital of Nantes and French Reference Centre on Haemophilia, Nantes, France
| | - Birgit Frotscher
- Haemophilia Treatment Centre, University Hospital of Nancy, Nancy, France
| | - Benoit Guillet
- Haemophilia Treatment Centre, University Hospital of Rennes, Rennes, France
| | - Aurelien Lebreton
- Haemophilia Treatment Centre, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Lucia Rugeri
- Haemophilia Treatment Centre, University Hospital of Lyon and French Reference Centre on Haemophilia, Lyon, France
| | - Yesim Dargaud
- Haemophilia Treatment Centre, University Hospital of Lyon and French Reference Centre on Haemophilia, Lyon, France
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6
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Seidizadeh O, Aliabad GM, Mirzaei I, Yaghoubi S, Abtin S, Valikhani A, Naderi M. Prevalence of hemorrhagic ovarian cysts in patients with rare inherited bleeding disorders. Transfus Apher Sci 2022:103636. [PMID: 36635175 DOI: 10.1016/j.transci.2022.103636] [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: 07/14/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In comparison with the general population, women with bleeding disorders are more prone to develop obstetrical and gynecological problems. However, no comprehensive evaluation has investigated the prevalence of hemorrhagic ovarian cysts (HOCs) in rare bleeding disorders (RBDs). In this study, we sought to determine the prevalence of HOCs in a large cohort of Iranian patients with RBDs. METHODS A total of 210 symptomatic patients suspected of HOCs with RBD were included. The median age of the study population was 24 years. Patients were diagnosed with fibrinogen disorders (n = 7, 3%), factor (F) II (n = 4, 2%), FV (n = 28, 13%), FVII (n = 4, 2%), FX (n = 6, 3%), FXIII (n = 122, 58%), combined FV and FVIII (n = 8, 4%), Glanzmann's thrombasthenia (n = 10, 5%), and von Willebrand disease (VWD) type 3 (n = 21, 10%). RESULTS Following further clinical and ultrasound examinations of these 210 patients, 68 (32.4%) were confirmed with a diagnosis of HOCs. Of which, FXIII deficiency with 46 cases (67.6%), followed by VWD type 3 (6 cases, 8.8%) showed the highest number. Other coagulation defects associated with HOCs were including fibrinogen deficiency (n = 2, 3%), FII (n = 2, 3%), FV (n = 4, 6%), FVII (n = 2, 3%), FX (n = 1, 1.5%), combined FV and FVIII (n = 2, 3%), and Glanzmann's thrombasthenia (n = 3, 4.5%). CONCLUSION This study found a high prevalence of HOCs in patients with RBDs, indicating the importance of early diagnosis and optimal management of obstetric and gynecological complications in these patients.
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Affiliation(s)
- Omid Seidizadeh
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Ghasem Miri Aliabad
- Medical school, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ilia Mirzaei
- Medical school, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Sima Abtin
- Zabol University of Medical Sciences, Hamoon-City Health Centre, Teiymour-Abad Village, Iran
| | - Amir Valikhani
- Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Majid Naderi
- Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; Department of pediatrics, Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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7
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Swaminathan N, Sharathkumar A, Dowlut-McElroy T. Reproductive Tract Bleeding in Adolescent and Young Adult Females with Inherited Bleeding Disorders: An Underappreciated Problem. J Pediatr Adolesc Gynecol 2022; 35:614-623. [PMID: 35830928 DOI: 10.1016/j.jpag.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
Reproductive tract bleeding is an underappreciated health care problem among adolescent and young adult (AYA) females with inherited bleeding disorders (IBDs) comprising von Willebrand disease, platelet disorders, hemophilia carriership, and rare factor deficiencies. IBDs are prevalent in women of all ages and have been detected in about 50% of women with menorrhagia or heavy menstrual bleeding (HMB) and about 20% of women with postpartum hemorrhage (PPH). The clinical spectrum of gynecologic and obstetric bleeding in AYA with IBDs ranges from HMB, ovulation bleeding, and surgical bleeding to miscarriages and life-threatening PPH. Reproductive tract bleeding adversely affects the quality of life of this patient population, in addition to causing substantial morbidity and mortality. Early diagnosis of IBDs offers the opportunity for timely intervention with hormones, hemostatic agents, and prophylaxis with factor concentrates, thereby improving outcomes. This review summarizes the epidemiology, pathophysiology, clinical manifestations, diagnostic approach, management, and prophylaxis for reproductive tract bleeding in AYA with IBDs. This review provides a multidisciplinary approach to the problem, which is critical to improve the outcomes of this patient population.
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Affiliation(s)
- Neeraja Swaminathan
- Division of Pediatric Hematology Oncology, University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Anjali Sharathkumar
- Division of Pediatric Hematology Oncology, Stead Family Department of Pediatrics, University of Iowa Hospitals and Clinics, 1322 BT, 200 Hawkins Drive, Iowa City, IA 52242, United States.
| | - Tazim Dowlut-McElroy
- Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
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8
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Curry N, Bowles L, Clark TJ, Lowe G, Mainwaring J, Mangles S, Myers B, Kadir RA. Gynaecological management of women with inherited bleeding disorders. Haemophilia 2022; 28:917-937. [PMID: 35976756 DOI: 10.1111/hae.14643] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/20/2022] [Accepted: 07/17/2022] [Indexed: 12/17/2022]
Abstract
Women with inherited bleeding disorders (IBDs) may present to healthcare professionals in a variety of ways and commonly will be encountered by either haematology or gynaecology services. Heavy menstrual bleeding is very often the first manifestation of an IBD. There is a wide variation in severity of bleeding for women with IBD and diagnosis and subsequent management of their condition requires multidisciplinary specialised care which is tailored to the individual and includes excellent cross-specialty communication between gynaecology and haematology teams. This guideline is intended for both haematologists and gynaecologists who are involved in the diagnosis and management of women with bleeding disorders. It sets out recommendations about how to investigate heavy menstrual bleeding (HMB), the commonest presentation for women with IBD to hospital services, to guide physicians about how to diagnose an IBD and covers the management of women with known IBD and HMB. The second section sets out recommendations for patients known to have IBD and covers management of patients with IBD in the setting of gynaecological surgery and management for all other non-surgical gynaecological situations.
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Affiliation(s)
- Nicola Curry
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, and NIHR BRC Blood Theme, Oxford University, Oxford, UK
| | - Louise Bowles
- The Royal London Hospital Haemophilia Comprehensive Care Centre, The Royal London Hospital, Whitechapel, London, UK
| | - T Justin Clark
- Birmingham Women's NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Gillian Lowe
- West Midlands Comprehensive Care Haemophilia Unit, University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Jason Mainwaring
- Bournemouth and Poole Haemophilia Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset, UK
| | - Sarah Mangles
- Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Bethan Myers
- Leicester Haemostasis and Thrombosis Centre, University Hospitals of Leicester, Leicester, UK
| | - Rezan Abdul Kadir
- Department of Obstetrics and Gynaecology, Katharine Dormandy Haemophilia and Thrombosis Unit, The Royal Free NHS Foundation Hospital and Institute for Women's Health, University College London, London, UK
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9
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Batsuli G, Kouides P. Rare Coagulation Factor Deficiencies (Factors VII, X, V, and II). Hematol Oncol Clin North Am 2021; 35:1181-1196. [PMID: 34389198 DOI: 10.1016/j.hoc.2021.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although rare clotting factor deficiencies primarily referred to as rare bleeding disorders (RBD), including factors II, V, VII, and X, make up ∼5% of all inherited bleeding disorders worldwide, each of these clotting factors play a critical role in the coagulation cascade. Incomplete bleeding evaluation or misinterpretation of laboratory studies can result in delayed diagnoses that ultimately affect patient outcomes. Bleeding manifestations can range from mild to severe, but the most common are mucocutaneous bleeding. The ideal treatment in RBD is dedicated single-factor concentrates that can be used for acute bleeding events, surgical management, and prophylaxis.
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Affiliation(s)
- Glaivy Batsuli
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta; Department of Pediatrics, Emory University, Atlanta, GA, USA.
| | - Peter Kouides
- Mary M. Gooley Hemophilia Center, Rochester Regional Health, 1415 Portland Avenue, Rochester, NY 14621, USA
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10
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Tarantino MD. Occurrence and management of severe bleeding episodes in patients with hereditary factor X deficiency. Haemophilia 2021; 27:531-543. [PMID: 34021672 PMCID: PMC8361996 DOI: 10.1111/hae.14223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/12/2020] [Indexed: 11/29/2022]
Abstract
Vitamin K-dependent factor X (FX) plays an important role in thrombin formation, and a deficiency in FX can cause impaired coagulation, the severity of which is usually correlated with the degree of deficiency. Due to the critical role that FX plays in the coagulation cascade, FX deficiency is associated with a higher risk of bleeding than deficiencies in other coagulation factors. Patients with the hereditary autosomal-recessive homozygous form of FX deficiency, which occurs in approximately 1:1,000,000 individuals worldwide, are often diagnosed when they present with spontaneous life-threatening haemorrhage (most often intracranial haemorrhage) during the first month of life. In addition to central nervous system bleeds, other severe bleeding types experienced by such patients may include umbilical cord bleeding, gastrointestinal or pulmonary haemorrhage, intramuscular haematomas and/or haemarthrosis. Delayed treatment or inadequate replacement of FX may result in developmental delays, musculoskeletal disabilities or death. The high risk of recurrent severe bleeding necessitates prophylactic replacement therapy for many individuals with severe FX deficiency. Available products for replacement therapy include plasma-derived FX concentrate and prothrombin complex concentrates. Fresh-frozen plasma may be used when concentrates are not available but is a less efficient means of FX replacement. This article reviews the literature on severe bleeding in individuals with hereditary FX deficiency and discusses current treatment options.
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Affiliation(s)
- Michael D. Tarantino
- Bleeding and Clotting Disorders InstituteUniversity of Illinois College of MedicinePeoriaILUSA
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11
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Yen CB, Katz DJ. Management of Factor X Deficiency for Vaginal Delivery in a Parturient: A Case Report. A A Pract 2021; 15:e01405. [DOI: 10.1213/xaa.0000000000001405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Dargan C, Kaufman CB, Oroszi G, Miller CPK, Carter-Reardon L, Blue E, Wicklund BM. Management of a hemispherotomy for Rasmussen encephalitis in a patient with mild factor 10 deficiency and low von Willebrand factor levels. Haemophilia 2021; 27:e513-e516. [PMID: 33548145 DOI: 10.1111/hae.14249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Chandni Dargan
- Hematology/Oncology Division, Department of Pediatrics, Children's Mercy- Kansas City, Kansas City, Missouri, USA
| | - Christian B Kaufman
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Gabor Oroszi
- Department of Pathology and Laboratory Medicine, Children's Mercy- Kansas City, Kansas City, Missouri, USA
| | - Christopher P K Miller
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lucy Carter-Reardon
- Hematology/Oncology Division, Department of Pediatrics, Children's Mercy- Kansas City, Kansas City, Missouri, USA
| | - Eric Blue
- Department of Pathology and Laboratory Medicine, Children's Mercy- Kansas City, Kansas City, Missouri, USA
| | - Brian M Wicklund
- Hematology/Oncology Division, Department of Pediatrics, Children's Mercy- Kansas City, Kansas City, Missouri, USA
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13
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Dorgalaleh A, Tabibian S, Hosseini MS, Shams M. Pharmacological management of rare coagulation factor deficiencies besides hemophilia. Expert Rev Hematol 2020; 13:811-834. [PMID: 32667216 DOI: 10.1080/17474086.2020.1796622] [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] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Rare coagulation factor deficiencies are less-known disorders with variable effects on the patient's life. Management of such patients is a challenge due to the paucity of evidence-based data, more so when patients with these rare disorders encounter a more rare, related condition, like inhibitor development or thrombosis. AREA COVERED A comprehensive literature search related to RCFDs and management was performed in PubMed in order to discuss therapeutic options and challenges, prophylaxis, management of minor and major surgeries, obstetric and gynecological complications, inhibitor development, and thrombosis. EXPERT OPINION Although significant changes have occurred in the management of RCFDs in recent years, more evidence-based studies besides expert opinion are needed for optimal management.
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Affiliation(s)
- Akbar Dorgalaleh
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences , Tehran, Iran
| | - Shadi Tabibian
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences , Tehran, Iran.,Iranian Comprehensive Hemophilia Care Center , Tehran, Iran
| | - Maryam Sadat Hosseini
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mahmood Shams
- Department of Medical Laboratory, Faculty of Paramedical Sciences, Babol University of Medical Sciences , Babol, Iran
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14
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Yang H, Fan Y, Cheng J, Zou J, Zhang X, Shi Y, Guo D. Network Pharmacology-Based Prediction of Active Ingredients and Potential Targets of ShengDiHuang Decoction for Treatment of Dysfunctional Uterine Bleeding. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:7370304. [PMID: 32454870 PMCID: PMC7240676 DOI: 10.1155/2020/7370304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the potential active ingredients and related crucial targets of the ShengDiHuang Decoction (SDHD) formula in the treatment of dysfunctional uterine bleeding (DUB) by using network pharmacology and verification experiment. METHODS In this study, we determined the potential active ingredients from the traditional SDHD formula and their targets with the network pharmacology method. The network of "compound-disease-target" was constructed by the software of Cytoscape. Software of DAVID was used to enrich pathways for these 87 targets of SDHD. Further, the therapeutic effect of SDHD on DUB was verified by observing the morphological changes of the uterus and ovaries and determining the expression of ERS2 and progesterone in the plasma. RESULTS 52 compounds of Rheum and 5 compounds of Rehmannia were selected, and 87 potential targets were screened by network pharmacology. Furthermore, 7 main active ingredients were acquired by the ADME process. In addition, enrichment analysis of drug-target networks indicated that SDHD may play a role in overall coordination through "multicomponent and multitarget" in different organ patterns by regulating multiple pathways directly or indirectly. Finally, in the verification experiment of SDHD on DUB, it was found that SDHD can effectively repair the uterus and ovaries and also have an upregulation effect on the target ESR2 and increase the content of progesterone. CONCLUSION Overall, this study revealed potential mechanisms of multitarget and multicomponent about SDHD in the treatment of DUB and provided a scientific foundation for further studying the mechanism.
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Affiliation(s)
- Hui Yang
- Shaanxi Key Laboratory of Traditional Chinese Medicine Foundation and New Drug Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Yu Fan
- School of Basic Medical Science, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Jiangxue Cheng
- Shaanxi Key Laboratory of Traditional Chinese Medicine Foundation and New Drug Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Junbo Zou
- Shaanxi Key Laboratory of Traditional Chinese Medicine Foundation and New Drug Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Xiaofei Zhang
- Shaanxi Key Laboratory of Traditional Chinese Medicine Foundation and New Drug Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Yajun Shi
- Shaanxi Key Laboratory of Traditional Chinese Medicine Foundation and New Drug Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Dongyan Guo
- Shaanxi Key Laboratory of Traditional Chinese Medicine Foundation and New Drug Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China
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15
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Krkovic M, Koosova Gajic A, Tarčuković J, Sotosek V, Stimac T, Balen S, Dangubic B, Grubjesic I. Factor X Deficiency Management for Elective Cesarean Delivery in a Pregnant Patient. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920685. [PMID: 32184380 PMCID: PMC7117852 DOI: 10.12659/ajcr.920685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 39-year-old Final Diagnosis: Factor X deficiency Symptoms: Menstrual bleeding Medication: Solvent-detergent-treated fresh frozen plasma Clinical Procedure: Elective cesarean section Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Mirna Krkovic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Andrea Koosova Gajic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Janja Tarčuković
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Anesthesiology, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Vlatka Sotosek
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Anesthesiology, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tea Stimac
- Department of Gynaecology and Obstetrics, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Gynecology and Obstetrics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sanja Balen
- Clinical Institute for Transfusion Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Clinical Laboratory Diagnostics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Boban Dangubic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Igor Grubjesic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
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16
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Iannaccone A, Darkwah Oppong M, Dammann P, Kimmig R, Köninger A. Fetal subdural hematoma, sickle cell disease and storage pool disease: A case report. Case Rep Womens Health 2020; 26:e00183. [PMID: 32154119 PMCID: PMC7057149 DOI: 10.1016/j.crwh.2020.e00183] [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] [Received: 01/09/2020] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 11/16/2022] Open
Abstract
A fetal subdural hematoma (SDH) was diagnosed in a patient with sickle cell disease (SCD) during a routine ultrasound exam in the 30th week of pregnancy. A scan performed a few days earlier had revealed no abnormalities. After interdisciplinary consultation with neurosurgeons and neonatologists, a cesarean section was performed since acute subdural bleeding was hypothesized and the mother's condition was critical. After surgery, the diagnostic procedures revealed that the child and the mother had also suffered from thrombocytopathy, which probably jointly contributed to causing the bleeding; in general, anemia and hypoxia may also play an important role. The newborn had a good neurological outcome. Ultrasound features do not reflect the underlying cause and therefore predicting the prognosis is challenging. In most cases, prenatal counseling is difficult because of the unknown underlying cause and because there are no ultrasound or magnetic resonance imaging criteria to define which cases can benefit from delivery or expectant management. Where there is acute bleeding, the child could benefit from delivery and surgical evacuation of the hematoma. Further investigation to identify the cause of the bleeding can improve management and prognosis. Fetal subdural hematoma is difficult to recognize in utero. Ultrasound features do not reflect the underlying cause, which remains unknown in most cases. Sickle cell disease, storage pool disease and factor X deficiency jointly contributed to the bleedings described in our case. When there is acute fetal subdural bleeding, the child could benefit from delivery and surgical evacuation of the hematoma.
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Affiliation(s)
- Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Rainer Kimmig
- Department of Obstetrics and Gynecology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Angela Köninger
- Department of Obstetrics and Gynecology, University Hospital, University of Duisburg-Essen, Essen, Germany
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17
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Winikoff R, Scully MF, Robinson KS. Women and inherited bleeding disorders - A review with a focus on key challenges for 2019. Transfus Apher Sci 2019; 58:613-622. [PMID: 31582329 DOI: 10.1016/j.transci.2019.08.013] [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] [Indexed: 12/21/2022]
Abstract
The area of women and inherited bleeding disorders has undergone quick expansion in recent years. More patients are being identified and expertise to diagnose and manage these patients is now essential for practising physicians. Programs to help educate and empower patients and caregivers are now in place. Common inherited bleeding disorders affecting women include von Willebrand disease (VWD), inherited platelet disorders, and rare inherited bleeding disorders such as factor VII (FVII) deficiency and factor XI (FXI) deficiency. Specific clinical tools have been developed to help clinicians and patients screen for the presence of these bleeding disorders in both adult and pediatric populations. Affected women can experience heavy menstrual bleeding and resulting iron deficiency anemia, postpartum hemorrhage, and hemorrhagic ovarian cysts which need to be properly managed. Excessive bleeding can adversely affect quality of life in these women. Front line therapy for bleeding in mild cases focuses on the use of non-specific hemostatic agents such as DDAVP ®, tranexamic acid and hormonal agents but specific factor replacement and/or blood products may be required in more severe cases, in severe bleeding or as second line treatment when bleeding is not responsive to first line agents. Iron status should be optimised in these women especially in pregnancy and use of an electronic app can now help clinicians achieve this. These patients should ideally be managed by a multidisciplinary team whenever possible even remotely. Although clinical research has closed some knowledge gaps regarding the diagnosis and management of these women, there remains significant variation in practise and lack of evidence-based guidelines still exists in many spheres of clinical care in which caregivers must rely on expert opinion. Ongoing efforts in education and research will continue to improve care for these women and restore quality of life for them.
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Affiliation(s)
- R Winikoff
- Division of Hematology-Oncology, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - M F Scully
- Department of Medicine, Memorial University of Newfoundland Medical School, NL, Canada.
| | - K S Robinson
- Division of Hematology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Department of Medicine, Halifax, NS, Canada.
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