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Ho SKL, Ng SYL, Yung TK, Mok MTS, Yiu WC, Cheng HHY, Cheng SSW, Luk HM, Lo IFM, Kan ASY. Clinical and molecular characteristics of hemophilia A affected individuals and carriers: A 24 years experience from three centers. Am J Med Genet A 2024; 194:e63657. [PMID: 38747677 DOI: 10.1002/ajmg.a.63657] [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: 03/13/2024] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 08/10/2024]
Abstract
Hemophilia A is a rare bleeding disorder with variable expressivity and allelic heterogeneity. Despite the advancement of prenatal diagnostics and molecular studies, the number of studies reviewing the reproductive choices of hemophilia A carriers and affected individuals remains limited. Through this retrospective review, we hope to gain a deeper understanding of hemophilia A-affected individuals' clinical and molecular characteristics, as well as the reproductive choices of the at-risk couples. A total of 122 individuals harboring likely causative F8 gene alterations from 64 apparently unrelated families attending three centers between 3/2000 and 3/2023 were included in this study. Their clinical and molecular findings as well as reproductive choices were gathered in a clinical setting and verified through the electronic medical record database of the public health system. Forty-seven affected males and 75 female heterozygous carriers were included in the analysis. Among 64 apparently unrelated families, 36 distinct pathogenic/likely pathogenic variants were identified, of which 30.6% (11/36) of variants were novel. While the majority of clinical findings and genotype-phenotype correlations appear to be in accordance with existing literature, female carriers who had no fertility intention were significantly more likely to have affected sons than those who had fertility intention (5/19 vs. 4/5; p = 0.047). Through this retrospective review, we summarized the clinical and molecular characteristics of 122 individuals harboring pathogenic/likely pathogenic F8 variants, as well as their fertility intentions and reproductive outcomes. Further studies are required to look into the considerations involved in reproductive decision-making.
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Affiliation(s)
- Stephanie K L Ho
- Clinical Genetics Service Unit, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Samuel Y L Ng
- Clinical Genetics Service Unit, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Tsz-Kwai Yung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Myth T S Mok
- Clinical Genetics Service Unit, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Wing-Chung Yiu
- Clinical Genetics Service Unit, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Heidi H Y Cheng
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong SAR, China
| | - Shirley S W Cheng
- Clinical Genetics Service Unit, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Ho-Ming Luk
- Clinical Genetics Service Unit, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Ivan F M Lo
- Clinical Genetics Service Unit, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Anita S Y Kan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong SAR, China
- Prenatal Diagnostic Laboratory, Department of Obstetrics and Gynaecology, Tsan Yuk Hospital, Hong Kong SAR, China
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Punt M, van Leusden F, Bloemenkamp K, Coppens M, Driessens M, Heubel-Moenen F, Lely T, Mäkelburg A, Nieuwenhuizen L, Haitjema S, van Solinge W, Saes J, Schols S, Schutgens R, Eikenboom J, Kruip M, van Galen K. Primary postpartum hemorrhage in women with von Willebrand disease and carriers of hemophilia: a retrospective analysis. Res Pract Thromb Haemost 2024; 8:102508. [PMID: 39165610 PMCID: PMC11334897 DOI: 10.1016/j.rpth.2024.102508] [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: 01/07/2024] [Revised: 06/13/2024] [Accepted: 07/02/2024] [Indexed: 08/22/2024] Open
Abstract
Background Between 2002 and 2011, the incidence of severe primary postpartum hemorrhage (PPH) in Dutch women with von Willebrand disease (VWD) and hemophilia carriers (HCs) was 8% vs 4.5% in the general population. Objectives To determine the contemporary incidence of severe primary PPH in women with VWD and HCs. Methods All women with VWD or HCs who delivered between 2012 and 2017 were selected from all 6 Dutch hemophilia treatment centers. Data on patient and disease characteristics, peripartum hematologic and obstetric management, and outcomes were retrospectively collected. Incidence of severe primary (≥1000 mL of blood loss ≤24 hours after childbirth) and primary (≥500 mL within ≤24 hours after childbirth) PPH was compared with the (1) previous cohort and (2) general Dutch population and between (3) women with VWD and HCs with third-trimester coagulation activity levels <50 international units (IU)/dL vs ≥50 IU/dL and (4) women treated with vs without peripartum hemostatic prophylaxis. Results Three-hundred forty-eight deliveries (151 VWD, 167 hemophilia A, and 30 hemophilia B carriers) were included. The severe primary PPH incidence was 10% (36/348) and remained stable over time, whereas this incidence has increased in the general population (to 8%), leading to a similar risk (P = .17). Severe primary PPH risk was comparable between women with coagulation activity levels <50 and ≥50 IU/dL (11% [7/66] vs 10% [29/279]; odds ratio, 1.02; 95% CI, 0.43-2.44) and comparable between those with and those without prophylaxis (12% [11/91] vs 10% [25/254]; odds ratio, 1.26; 95% CI, 0.59-2.68). Conclusion Severe primary PPH in women with VWD and HCs remained stable and is comparable with the increasing prevalence in the general population. More research is needed to find the optimal pregnancy management strategy for safe delivery in VWD and HC.
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Affiliation(s)
- Marieke Punt
- University Medical Center Utrecht, University Utrecht, Van Creveldkliniek, Utrecht, the Netherlands
| | - Fe van Leusden
- University Medical Center Utrecht, University Utrecht, Van Creveldkliniek, Utrecht, the Netherlands
| | | | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands
| | | | - Floor Heubel-Moenen
- Department of Haematology-Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- Hemophilia Treatment Center, Nijmegen-Eindhoven-Maastricht, the Netherlands
| | - Titia Lely
- Department of Gynecology and Obstetrics, Utrecht, the Netherlands
| | - Anja Mäkelburg
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - Laurens Nieuwenhuizen
- Hemophilia Treatment Center, Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Thrombosis and Hemostasis, Maxima Medical Center, Veldhoven, the Netherlands
| | - Saskia Haitjema
- University Medical Center Utrecht, University Utrecht, Laboratory of Clinical Chemistry and Hematology, Utrecht, the Netherlands
| | - Wouter van Solinge
- University Medical Center Utrecht, University Utrecht, Laboratory of Clinical Chemistry and Hematology, Utrecht, the Netherlands
| | - Joline Saes
- Hemophilia Treatment Center, Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Saskia Schols
- Hemophilia Treatment Center, Nijmegen-Eindhoven-Maastricht, the Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roger Schutgens
- University Medical Center Utrecht, University Utrecht, Van Creveldkliniek, Utrecht, the Netherlands
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke Kruip
- Department of Hematology Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Karin van Galen
- University Medical Center Utrecht, University Utrecht, Van Creveldkliniek, Utrecht, the Netherlands
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Cutica I, Mortarino M, Garagiola I, Pravettoni G, Peyvandi F. Psychological and cognitive factors involved in decision-making process of haemophilia carriers in reproductive choices. Haemophilia 2023; 29:1313-1319. [PMID: 37548114 DOI: 10.1111/hae.14836] [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: 04/16/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Haemophilia carriers (HCs) face a multitude of psychological challenges, mainly linked to the possibility of having an affected child. Important reproductive decisions such as opting for pre-implantation genetic testing, or choosing prenatal diagnosis and then whether to continue or interrupt pregnancy in case of affected male fetus, have to be taken into consideration. Notwithstanding, the role of psychological characteristics on such decision-making process needs further investigation. AIM The aim of this study was to investigate whether HCs' beliefs and emotions about haemophilia and cognitive factors such as decision-making style, risk perception, coping strategies in response to stress, and need for cognitive closure might modulate HCs' reproductive decisions. METHODS Participants were interviewed about their beliefs and emotions on haemophilia and filled an on-line standardized questionnaire on cognitive variables. Sixty HCs participated in this study. RESULTS Results show that HCs with high distress for haemophilia given by negative childhood experiences for one or more family member illness and by high concern for their children's health, and with psychological traits characterized by logical (versus emotional) reasoning, active coping style and high need for certainty, tend to choose diagnostic prenatal tests over routine pregnancy analysis. CONCLUSION This study highlighted the influence of negative early-life experience with haemophilia and of several cognitive factors in HCs choice of prenatal test.
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Affiliation(s)
- Ilaria Cutica
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy
| | - Mimosa Mortarino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Isabella Garagiola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Chaigneau M, Botros M, Grabell J, Hopman W, James P. Challenges and knowledge gaps facing hemophilia carriers today: Perspectives from patients and health care providers. Res Pract Thromb Haemost 2022; 6:e12783. [PMID: 36186104 PMCID: PMC9487445 DOI: 10.1002/rth2.12783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/07/2022] [Accepted: 07/22/2022] [Indexed: 11/07/2022] Open
Abstract
Background Hemophilia carriers experience abnormal bleeding symptoms; however, a lack of awareness about this topic coupled with additional knowledge gaps and barriers leads to suboptimal care for this population. Objective The primary objective was to describe the current knowledge gaps and challenges from the perspective of both hemophilia carriers and their health care providers. Methods We carried out a mixed methods descriptive study with two population groups between September and December 2020. The hemophilia carrier perspective was obtained through both focus groups and questionnaires, whereas the health care providers perspective obtained via questionnaire sent to the Association of Hemophilia Care Directors of Canada and the Canadian Association of Nurses in Hemophilia Care. Focus groups were analyzed using descriptive thematic analysis and quantitative survey data was also analyzed. Results Eleven hemophilia carriers participated along with 19 health care providers (11 physicians, eight nurses). Hemophilia carrier focus group discussions identified four areas representing major challenges or knowledge gaps: (1) negative psychosocial impacts; (2) difficulty determining symptom significance; (3) need for self-advocacy; (4) testing concerns. Survey results from both groups were aligned with the most important topics for ongoing education identified as information on abnormal bleeding symptoms, where to seek treatment, and considerations for heavy menstrual bleeding/menstruation. The majority of both study groups believe obligate or potential carriers should have factor levels checked regardless of age if symptoms of abnormal bleeding occur or before an invasive procedure. However, hemophilia carriers were significantly more in favor of genetic testing under the age of consent than health care providers in all scenarios evaluated.
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Affiliation(s)
| | | | - Julie Grabell
- Deparment of MedicineQueen's UniversityKingstonOntarioCanada
| | - Wilma Hopman
- KGH Research InstituteKingstonOntarioCanada
- Department of Public Health SciencesQueen's UniversityKingstonOntarioCanada
| | - Paula James
- Deparment of MedicineQueen's UniversityKingstonOntarioCanada
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