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Parkash S, Pena C, Cepak J, Kimberly R, Zachariah M, Li W. Percutaneous arteriovenous fistula creation in the management of severe Hemophilia A and end-stage kidney disease needing hemodialysis access, and beyond. J Vasc Access 2024; 25:1023-1028. [PMID: 37066830 DOI: 10.1177/11297298231165809] [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: 04/18/2023] Open
Abstract
With the contemporary KDOQI, a patient-focused approach in vascular access care is emphasized more than ever when planning RRT. Nevertheless, functional vascular access continues to be the Achilles' heel for successful hemodialysis in specific patient sub-groups, such as the Hemophilia-A population. The newer percutaneous endovascular approach is a safer alternative when conventional surgical AVF poses high bleeding risks perioperatively, which subsequently prevents ESKD patients to have desired permanent dialysis access. This article presents the case of a 45-year-old male with severe Hemophilia-A, who has been dialysis-dependent due to diabetic kidney disease and hypertension. Due to the severity of his progressively worsening bleeding disorder, his previous surgeries to treat other comorbidities have been complicated and involved challenging peri-operative treatment courses that include blood and factor VIII infusions, bleeding wounds, along with prolonged hospital stays. With the fear of bleeding diathesis, a conventional surgical AVF was not pursued, which has left him with a prolonged tunneled CVC while not being considered a candidate for peritoneal dialysis. We offered the patient a left arm percutaneous endovascular AVF creation with the WavelinQ™ 4F Endo-AVF system as an alternative option for his permanent hemodialysis access. An Endo-AVF was created bloodlessly between the left radial artery and lateral radial vein percutaneously with only two 4-French accesses at left wrist. The patient has been receiving full sessions of hemodialysis with expected flow rates and free of the CVC since. Likely the first case of such utilization reported, the utilization of percutaneous Endo-AVF for this patient has suggested not only that the endovascularly created AVF offers a good alternative dialysis access for hemophilia A patient populations, but also due to this technology's unique features, it can be potentially employed in other situations, such as needs for reliable and chronic venous accesses and blood product exchanges.
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Affiliation(s)
- Shanti Parkash
- Division of Nephrology and Hypertension, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Camilo Pena
- Division of Nephrology and Hypertension, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Robison Kimberly
- Vascular and Endovascular Surgery, Department of Surgery, Texas Tech Health Sciences Center, Lubbock, TX, USA
| | - Mareena Zachariah
- Division of Nephrology and Hypertension, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Wei Li
- Texas Tech Health Sciences Center, Vascular Surgery and Endovascular Services, SUNY Upstate Medical University, Syracuse VA Medical Center
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Komatsumoto M, Nakazawa D, Endo T, Nishio S, Kawamura T, Miyoshi-Harashima A, Takenaka S, Shiratori-Aso S, Kurotori M, Matsuoka N, Atsumi T. Successful initiation of hemodialysis for a hemophilia A patient with factor VIII inhibitor: a case report and literature review. CEN Case Rep 2024; 13:117-120. [PMID: 37490239 PMCID: PMC10982231 DOI: 10.1007/s13730-023-00811-9] [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: 03/23/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
We report the first case of hemophilia A with factor VIII (FVIII) inhibitor who received hemodialysis via an arteriovenous (AV) fistula. Hemophilia A is a congenital deficiency of blood coagulation FVIII that is characterized by prolonged bleeding. Approximately 30% of patients with hemophilia develop allogeneic antibodies of FVIII. The inhibitors decrease the hemostatic effect of replacement therapy; thus, the prophylaxis strategy should be well designed. Prophylactic treatment with invasive procedures is needed to prevent excessive bleeding in patients with hemophilia undergoing hemodialysis. On the contrary, hemodialysis requires attention to the development of intracircuit coagulation during dialysis. Peritoneal dialysis or hemodialysis with a long-term tunneled central venous catheter has mainly been selected as the dialysis modality for patients with hemophilia and end-stage renal disease requiring renal replacement therapy because hemodialysis with an arteriovenous fistula may result in bleeding from the puncture site after each hemodialysis session. In our patient, hemodialysis was safely performed without any anticoagulant agents, and replacement therapy with FVIII concentrates prevented bleeding after puncture of the AV fistula.
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Affiliation(s)
- Maki Komatsumoto
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Daigo Nakazawa
- Department of Rheumatology, Nephrology and Endocrinology, Faculty of Medicine, Hokkaido University, Kita 14, Nishi 5, Kita-Ku, Sapporo, 060-8648, Japan.
| | - Tomoyuki Endo
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Saori Nishio
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Takuro Kawamura
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Shun Takenaka
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Satoka Shiratori-Aso
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Michiko Kurotori
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Naoko Matsuoka
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
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Li F, Guan Y, Wang L, Zhou Z. Urgent-start peritoneal dialysis in the hemophilia a patient with chronic kidney disease: A case report. Clin Case Rep 2023; 11:e7659. [PMID: 37692151 PMCID: PMC10483496 DOI: 10.1002/ccr3.7659] [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: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 09/12/2023] Open
Abstract
Key Clinical Message This case illustrates that under comprehensive management of individual and clinical needs, urgent-start peritoneal dialysis can be performed safely without bleeding complications in patients with hemophilia A who developed end-stage renal disease. Patients in these cases can benefit from synthetic strategy. Abstract Hemophilia A is a serious inherited bleeding disorder resulting from a deficiency of coagulation factor VIII (FVIII). Chronic kidney disease (CKD) involvement in hemophilia is relatively rare, but there has been an upward trend in the survival time of patients with prolonged hemophilia. Although peritoneal dialysis (PD) is often used as the first treatment modality for renal replacement treatment, limited data are available on comprehensive management in the hemophilia A population, especially for urgent-start PD. A 56-year-old man who had hemophilia A, was diagnosed with CKD 3 years ago and developed end-stage renal disease was admitted to our hospital after contracting pneumonia and undergoing subsequent Type I respiratory failure. Urgent-start PD improved his condition and health outcomes, and protected his residual renal function. This case is the first study of a Chinese male patient with hemophilia A who developed end-stage renal disease. We summarize the clinical treatment and nursing care strategies of urgent-start PD in a hemophilia A patient with end-stage renal disease. This case illustrates that under comprehensive management of individual and clinical needs, urgent-start PD can be performed safely without bleeding complications in patients with hemophilia A.
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Affiliation(s)
- Fang‐Fang Li
- Department of EndocrinologyPeking Union Medical College HospitalBeijingChina
| | - Yu‐Xia Guan
- Department of NephrologyPeking Union Medical College HospitalBeijingChina
| | - Long‐Fei Wang
- Medicine DepartmentPeking Union Medical College HospitalPekingChina
| | - Zi‐Juan Zhou
- Department of NephrologyPeking Union Medical College HospitalBeijingChina
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Induction of hemodialysis with an arteriovenous fistula in a patient with hemophilia A. CEN Case Rep 2020; 9:225-231. [PMID: 32180153 DOI: 10.1007/s13730-020-00461-1] [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: 03/12/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022] Open
Abstract
An 88-year-old man with congenital hemophilia A developed end-stage renal disease due to microscopic polyangiitis. He was at risk for catheter-related infection because he was taking immunosuppressive agents for the treatment of polyangiitis. He was also unable to manipulate the peritoneal dialysis device. Therefore, hemodialysis using an arteriovenous fistula was induced for renal replacement therapy. Recombinant coagulation factor VIII (1000 IU) was administered via the venous chamber of the hemodialysis circuit 10 min before the end of each hemodialysis session, and nafamostat mesylate (25 mg/h) was employed as an anticoagulant during hemodialysis. His clotting factor VIII activity level increased to > 50% and activated partial thromboplastin time decreased to 50 s at the end of each hemodialysis session. This method allowed him to achieve hemostasis at the puncture site of the arteriovenous fistula and undergo stable hemodialysis with no complications, including bleeding. This case suggests that hemodialysis using an arteriovenous fistula with coagulation factor replacement and nafamostat mesylate in each hemodialysis session is a therapeutic option for end-stage renal disease in patients of advanced age with hemophilia at high risk of bleeding.
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[Clinical management of patients with hemophilia A in nephrology: Diagnostic and therapeutic challenges illustrated by the cases of 2 patients]. Nephrol Ther 2019; 15:77-81. [PMID: 30660587 DOI: 10.1016/j.nephro.2018.10.002] [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: 07/18/2018] [Revised: 10/14/2018] [Accepted: 10/25/2018] [Indexed: 11/22/2022]
Abstract
Hemophilia A is an X-linked genetic hemorrhagic disorder characterized by a factor VIII deficiency. The availability of secured substitution products has led to a dramatic improvement of life expectancy in hemophiliac patients. Nowadays, adult hemophiliac patients may develop Chronic Kidney Disease (CKD) resulting from age-related comorbidities (hypertension, obesity, diabetes). In addition, the high prevalence of viral infections in this population exposes patients to an increased risk of CKD. The risk of hemorrhage in hemophiliac patients is a challenge for their clinical management, both for diagnostic procedures (kidney biopsy in particular) and for renal replacement therapy (dialysis or renal transplantation) when it is needed. This work provides an update of the literature data concerning the management of hemophiliac patients in nephrology, illustrated by the cases of two patients.
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Gopalakrishnan N, Usha T, Thopalan B, Dhanapriya J, Dineshkumar T, Thirumalvalavan K, Sakthirajan R. Hemodialysis in a patient with severe hemophilia A and factor VIII inhibitor. Hemodial Int 2016; 20:E11-E13. [DOI: 10.1111/hdi.12429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Natarajan Gopalakrishnan
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Thiruvengadam Usha
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Balasubramaniyan Thopalan
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Jeyachandran Dhanapriya
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Thanigachalam Dineshkumar
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Kaliaperumal Thirumalvalavan
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Ramanathan Sakthirajan
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
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Hamed AA, Shalaby MH, El-Kinawy NS, Elamawy AA, Abd El-Ghany SM. Renal Abnormalities Among Egyptian Children With Hemophilia A Using Renal Scintigraphy: Relation to Risk Factors and Disease Severity. Clin Appl Thromb Hemost 2015; 23:478-486. [PMID: 26659696 DOI: 10.1177/1076029615619484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Many risk factors may contribute to renal disease in patients with hemophilia A. AIM We aimed to evaluate functional and structural renal abnormalities among a group of Egyptian children with severe and moderate hemophilia A using technetium-99m diethylene triamine pentaacetic acid (99mTc-DTPA) and technetium-99 m dimercaptusuccinic acid (99mTc-DMSA) scan. We also aimed to determine the relation between these abnormalities and different risk factors and disease severity. PATIENTS AND METHODS Forty male patients, 16 with severe and 24 with moderate hemophilia A, were enrolled in this study. Their mean age was 10.2 ± 4.3 years (range, 5-17 years). Full history taking, clinical examination, laboratory, and radionuclide investigations including serum creatinine, blood urea nitrogen (BUN), urine analysis, creatinine clearance, 24-hour urinary protein, 99mTc-DTPA scan, and 99mTc-DMSA scan were performed to all enrolled patients. RESULTS Serum creatinine and BUN were normal in all patients, and corrected creatinine clearance was diminished in 2 patients. However, 99mTc-DTPA results yielded 19 (47.5%) patients with diminished glomerular filtration rate (GFR). Moreover, it showed that 14 (35%) had obstructive uropathy, 15 (37.5%) had obstructive nephropathy, while 11 (27.5%) patients showed normal scan. One patient had atrophy of 1 kidney on 99mTc-DMSA scan. Among our cohort, 5 (12.5%) patients were hypertensive. Microscopic hematuria was detected in 14 (35%) patients while 72.5% had proteinuria. We found an association between hematuria and hypertension with diminished GFR. CONCLUSION Despite normal kidney functions (serum creatinine and BUN), we found a high rate of diminished GFR and obstructive uropathy and nephropathy as detected by 99mTc-DTPA scan among children with hemophilia A.
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Affiliation(s)
- Ahmed Alsaeed Hamed
- 1 Department of Pediatrics, Hematology Unit, Ain Shams University, Cairo, Egypt
| | | | - Nihal Saad El-Kinawy
- 3 Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alaa Adel Elamawy
- 1 Department of Pediatrics, Hematology Unit, Ain Shams University, Cairo, Egypt
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Esposito P, Rampino T, Gregorini M, Fasoli G, Gamba G, Dal Canton A. Renal diseases in haemophilic patients: pathogenesis and clinical management. Eur J Haematol 2013; 91:287-94. [PMID: 23651176 DOI: 10.1111/ejh.12134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2013] [Indexed: 02/05/2023]
Abstract
Haemophilia A and B are genetic X-linked bleeding disorders, caused by mutations in genes encoding factors VIII and IX, respectively. Clinical manifestations of haemophilia are spontaneous haemorrhage or acute bleeding caused by minor trauma, resulting in severe functional consequences that can culminate in a debilitating arthropathy. Life expectancy and quality of life of patients with haemophilia have dramatically improved over the last years, mainly for new therapeutic options and the awareness to the risk of HCV and HIV infections. Different clinical problems arise from this important change in history of patients with haemophilia. In particular, ageing-related diseases, such as diabetes, hypertension and cancer, and chronic viral infections are emerging as new challenges in this patient population. Among the different types of chronic illnesses, renal diseases are of special interest as they involve some difficult management issues. In fact, decisions regarding adequate preventive strategies and viral infection treatment, the choice of the dialytic modality, placement of vascular access and prescription of dialytic treatments are particularly complicated, because only few data are available. In this review, we discuss the pathogenesis of renal damage in patients with haemophilia, especially in those with blood-transmitted viral infections, and the major issues about the management of renal diseases, including problems related to dialytic treatment and kidney transplantation, providing practical algorithms to guide the clinical decision-making process.
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Affiliation(s)
- Pasquale Esposito
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico S.Matteo and University of Pavia, Pavia, Italy
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Hermans C, de Moerloose P, Dolan G. Clinical management of older persons with haemophilia. Crit Rev Oncol Hematol 2013; 89:197-206. [PMID: 23953685 DOI: 10.1016/j.critrevonc.2013.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/23/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022] Open
Abstract
Life expectancy for people with haemophilia (PWH) has improved and is now approaching that of the general population. The growing population of elderly PWH will therefore increasingly face the age-related morbidities such as cardiovascular diseases, malignant disease, liver disease, and bone and joint related diseases, as well as the lifestyle and psychosocial factors that accompany many of these conditions. For many PWH, frequent contact with haemophilia specialists within the comprehensive care centres supplants the relationship that individuals in the general population have with their general practitioners. As a result, there is a risk that elderly PWH may miss the chronic disease screening opportunities offered to the general population. This review focuses on the screening tests and examinations recommended for age-related comorbidities in the general population that may be applicable to the growing population of older people with haemophilia.
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Affiliation(s)
- C Hermans
- Haemostasis-Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - P de Moerloose
- Hemostasis Unit, University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - G Dolan
- Nottingham Haemophilia Comprehensive Care Centre, Nottingham University Hospitals, Queens Medical Center, Nottingham, UK
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Khleif AA, Rodriguez N, Brown D, Escobar MA. Multiple Comorbid Conditions among Middle-Aged and Elderly Hemophilia Patients: Prevalence Estimates and Implications for Future Care. J Aging Res 2011; 2011:985703. [PMID: 21912745 PMCID: PMC3168380 DOI: 10.4061/2011/985703] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/27/2011] [Accepted: 07/07/2011] [Indexed: 12/23/2022] Open
Abstract
Introduction. Advances in hemophilia care and treatment have led to increases in the life expectancy among hemophiliacs. As a result, persons with hemophilia are reaching an older age and experiencing various age-related health conditions never seen before in this population. Aim. To determine the prevalence of comorbidities among middle-aged and elderly hemophilia A and hemophilia B patients. Methods. Retrospective chart review among all hemophilia patients, who attended the Gulf States Hemophilia and Thrombophilia Center. Results. All patients had at least one comorbid condition other than hemophilia, and the majority had between 3 and 6 comorbidities. The most common conditions identified were chronic hepatitis C, hypertension, HIV, chronic arthropathy, and overweight/obesity. Conclusions. Since persons with comorbidities are more likely to have poorer health outcomes and require greater care in managing their health needs, caring for aging hemophiliacs is likely to pose various social and economic challenges for both patients and providers.
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Affiliation(s)
- Aroub A Khleif
- Department of Pediatrics and Gulf States Hemophilia & Thrombophilia Center, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Successful renal replacement therapy for a patient with severe hemophilia after surgical treatment of intracranial hemorrhage and hydrocephalus. Case Rep Nephrol 2011; 2011:824709. [PMID: 24527238 PMCID: PMC3914129 DOI: 10.1155/2011/824709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 09/12/2011] [Indexed: 11/18/2022] Open
Abstract
A 21-year-old Japanese male with severe hemophilia A was developed end-stage renal failure. He was placed on combination therapy with peritoneal dialysis (PD) and hemodialysis (HD). Eight months later, he developed a hypertensive cerebral hemorrhage. After emergency surgery, he was managed with PD without HD to avoid cerebral edema. One month later, his renal replacement therapy was switched to HD (three times a week) from PD, since a ventriculoperitoneal shunt catheter was placed to treat his hydrocephalus. HD could be performed safety without anticoagulant agents on condition that factor VIII is given after every HD.
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Affiliation(s)
- G Dolan
- Nottingham University Hospitals, Nottingham, UK.
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Solak Y, Turkmen K, Atalay H, Turk S. Successful Peritoneal Dialysis in a Hemophilia a Patient with Factor VIII Inhibitor. Perit Dial Int 2010; 30:114-6. [DOI: 10.3747/pdi.2009.00011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic kidney disease and need for renal replacement therapy in hemophiliacs are relatively rare occurrences. Successful hemodialysis and peritoneal dialysis applications have been reported in the literature. We report a difficult-to-manage patient with hemophilia A plus factor VIII inhibitor who presented with gastrointestinal bleeding complicated by uremia. We admitted this hemophilia A patient with gastrointestinal bleeding who did not take regular factor infusions. He also had chronic kidney disease due to urinary stone disease. Since uremia might have contributed to bleeding, we chose hemodialysis along with factor VIII supplementation. His factor VIII and factor VIII inhibitor levels were 4% and 5 Bethesda units respectively. In order to bypass the inhibitor, we applied factor VIIA and prothrombin complex concentrate. After cessation of the hemorrhage, we placed a Tenckhoff catheter under prothrombin complex concentrate infusion. We did not observe any perioperative complication. To our knowledge, this is the first report of successful peritoneal dialysis in a hemophilia A patient who had factor VIII inhibitors.
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Affiliation(s)
- Y. Solak
- Department of Nephrology Meram Faculty of Medicine Selcuk University Konya, Turkey
| | - K. Turkmen
- Department of Nephrology Meram Faculty of Medicine Selcuk University Konya, Turkey
| | - H. Atalay
- Department of Nephrology Meram Faculty of Medicine Selcuk University Konya, Turkey
| | - S. Turk
- Department of Nephrology Meram Faculty of Medicine Selcuk University Konya, Turkey
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Franchini M, Mannucci PM. Co-morbidities and quality of life in elderly persons with haemophilia. Br J Haematol 2009; 148:522-33. [PMID: 19958358 DOI: 10.1111/j.1365-2141.2009.08005.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The life expectancy and quality of life of persons with haemophilia has dramatically increased since the 1970s, with the exception of the increased rate of deaths observed during the 1980s and the 1990s due to blood-borne viral infections. Improvements of factor replacement therapy, treatment of infectious diseases and comprehensive health care provided by specialised haemophilia centres are the main determinants of the increasing age of the haemophilia population. As a consequence, a growing number of these patients develop age-related co-morbidities, such as cardiovascular disease and cancer. The care of these previously rare conditions is a new challenge for caregivers in haemophilia centres. This review focuses on co-morbidities in the ageing haemophilia patients, their impact on quality of life and their complex management.
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Affiliation(s)
- Massimo Franchini
- Immunohaematology and Transfusion Centre, Department of Pathology and Laboratory Medicine, University Hospital of Parma, Italy
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