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Park JA. Treatment of Diffuse Alveolar Hemorrhage: Controlling Inflammation and Obtaining Rapid and Effective Hemostasis. Int J Mol Sci 2021; 22:ijms22020793. [PMID: 33466873 PMCID: PMC7830514 DOI: 10.3390/ijms22020793] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or systemic autoimmune disorders. Pathologic findings show pulmonary capillaritis, bland hemorrhage, diffuse alveolar damage, and hemosiderin-laden macrophages, but in the majority of cases, pathogenesis remains unclear. Despite the severity and high mortality, the current treatment options for DAH remain empirical. Systemic treatment to control inflammatory activity including high-dose corticosteroids, cyclophosphamide, and rituximab and supportive care have been applied, but largely unsuccessful in critical cases. Activated recombinant factor VII (FVIIa) can achieve rapid local hemostasis and has been administered either systemically or intrapulmonary for the treatment of DAH. However, there is no randomized controlled study to evaluate the efficacy and safety, and the use of FVIIa for DAH remains open to debate. This review discusses the pathogenesis, diverse etiologies causing DAH, diagnosis, and treatments focusing on hemostasis using FVIIa. In addition, the risks and benefits of the off-label use of FVIIa in pediatric patients will be discussed in detail.
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Affiliation(s)
- Jeong A Park
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Liu W, Xue F, Liu XF, Jiang EL, Yang DL, Liu KQ, Xiao ZJ, Zhang FK, Feng SZ, Han MZ, Zhang L, Yang RC. [Analysis of clinical efficacy of recombinant activated factor Ⅶ on bleeding in patients with hematologic disorders]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 38:410-414. [PMID: 28565741 PMCID: PMC7354194 DOI: 10.3760/cma.j.issn.0253-2727.2017.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
目的 研究重组人凝血因子Ⅶa(rFⅦa)治疗血液病患者出血的疗效。 方法 回顾性分析rFⅦa治疗31例血液病患者共38次出血的临床资料。 结果 rFⅦa治疗获得性血友病A(AHA)/血友病伴抑制物、急性早幼粒细胞白血病(APL)、急性非APL白血病患者出血的总体有效率分别为90%(9/10)、71.4%(5/7)、60.0%(3/5),高于造血干细胞移植后患者(30.8%);rFⅦa治疗评分为2分出血的有效率(100.0%)高于3分(66.7%)及4分(51.6%)出血;5例次颅内出血中2例次(25.0%)有效;9例次血尿中6例次(66.7%)有效;12例次消化道出血中5例次(41.7%)有效。3例次关节及肌肉出血的疗效均为极好,5例次出血部位为皮肤、鼻黏膜、咽部及齿龈,疗效均为极好;移植后患者在出血评分为4分时,高剂量以及多次使用rFⅦa并不一定能取得好的疗效。AHA/血友病伴抑制物及急性白血病患者合并的出血,在评分为4分时,使用低剂量rFⅦa能取得好的疗效,但最低用药剂量(22.5 µg/kg)的疗效差。 结论 rFⅦa的止血疗效受疾病类型、出血部位以及严重程度等多个因素的影响。rFⅦa对AHA/血友病伴抑制物以及急性白血病患者的出血具有较好的疗效,但对移植后患者的出血疗效欠佳。出血早期使用rFⅦa对于疗效至关重要。在止血治疗的同时,应积极治疗基础疾病。
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Affiliation(s)
- W Liu
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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Webb J, Abraham A. Complex Transfusion Issues in Pediatric Hematopoietic Stem Cell Transplantation. Transfus Med Rev 2016; 30:202-8. [PMID: 27439965 DOI: 10.1016/j.tmrv.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/15/2016] [Indexed: 12/13/2022]
Abstract
Advances in the fields of pediatric transfusion medicine and hematopoietic stem cell transplant have resulted in improved outcomes but also present new questions for research. The diagnostic capabilities involved in transfusion medicine have improved in recent times, now including methods for determination of red blood cell minor antigens, detection of anti-human leukocyte antigen antibodies, and noninvasive iron quantification. At the same time, transplants are being performed for more indications including nonmalignant disease and with less intense conditioning regimens that allow some recipient blood cells to persist after transplant. We are therefore faced with new opportunities to understand the implications of transfusion medicine testing and to develop data-driven guidelines relevant to the current-day approach to transfusion and transplantation.
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Affiliation(s)
- Jennifer Webb
- Division of Transfusion Medicine, Children's National Medical Center, Washington, DC.
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC
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Park JA. Diffuse alveolar hemorrhage and recombinant factor VIIa treatment in pediatric patients. KOREAN JOURNAL OF PEDIATRICS 2016; 59:105-13. [PMID: 27186216 PMCID: PMC4865620 DOI: 10.3345/kjp.2016.59.3.105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/12/2015] [Accepted: 07/07/2015] [Indexed: 01/13/2023]
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or autoimmune disorders. The current treatment options, which include corticosteroids, transfusions, extracorporeal membrane oxygenation (ECMO), and immunosuppressants, have been limited and largely unsuccessful. Recombinant activated factor VII (rFVIIa) has been successfully administered, either systemically or bronchoscopically, to adults for the treatment of DAH, but there are few data on its use in pediatric patients. The current literature in the PubMed database was reviewed to evaluate the efficacy and risk of rFVIIa treatment for DAH in pediatric patients. This review discusses the diagnosis and treatment of DAH, as well as a new treatment paradigm that includes rFVIIa. Additionally, the risks and benefits of off-label use of rFVIIa in pediatric patients are discussed.
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Affiliation(s)
- Jeong A Park
- Department of Pediatrics, Inje University Haeundae-Paik Hospital, Inje University College of Medicine, Busan, Korea
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Tang Y, Wu Q, Wu X, Qiu H, Sun A, Ruan C, Wu D, Han Y. Use of recombinant factor VIIa in uncontrolled gastrointestinal bleeding after hematopoietic stem cell transplantation among patients with thrombocytopenia. Pak J Med Sci 2016; 31:1389-93. [PMID: 26870102 PMCID: PMC4744287 DOI: 10.12669/pjms.316.8357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background and Objective: Recombinant-activated factor VII (rVIIa) is a vitamin K-dependent glycoprotein that is an analog of the naturally occurring protease. It has an off-label use to control life-threatening bleeding that is refractory to other measures and was shown to decrease transfusion requirements. Gastrointestinal (GI) bleeding is a severe complication following hematopoietic stem cell transplantation (HSCT) in patients with thrombocytopenia, while hemostatic measures based on antifibrinolytic or transfusion therapy may not always be successful. The present study investigated the treatment with rFVIIa in severe GI bleeding among thrombocytopenia patients undergoing HSCT. Methods: rFVIIa was given as a single dose of 60μg/kg in patients with GI bleeding following hematopoietic stem cell transplantation (HSCT). Results: Among all patients enrolled, 12 (75%) of 16 patients obtained a response, of which 5 achieved a complete response and 7 achieved a partial response. The 4 remiaing patients (25%) had no response. Nine patients (56.3%) died in a follow-up of 90 days. No thromboembolic events wereassociated with the drug administration occurred. Conclusions: Our study showed that rFVIIa may represent an additional therapeutic option in such cases.
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Affiliation(s)
- Yaqiong Tang
- Yaqiong Tang, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Qian Wu
- Qian Wu, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaojin Wu
- Xiaojin Wu, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Huiying Qiu
- Huiying Qiu, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Aining Sun
- Aining Sun, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Changgeng Ruan
- Changgeng Ruan, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- Depei Wu, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yue Han
- Yue Han, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
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Yadav SP, Sachdeva A. Pediatric allogeneic stem cell transplantation: experience from the developing world. Pediatr Hematol Oncol 2014; 31:205-6. [PMID: 23614451 DOI: 10.3109/08880018.2013.790526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Satya Prakash Yadav
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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Bahl A, Bakhshi S. Umbilical cord blood transplant for malignancies: a hope or hype. Indian J Pediatr 2013; 80:675-80. [PMID: 23660949 DOI: 10.1007/s12098-013-1046-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 04/10/2013] [Indexed: 12/20/2022]
Abstract
Cord blood is a rich and unlimited source of hematopoietic stem cells for allogeneic stem cell transplant to treat a variety of oncologic, genetic, hematologic, and immunodeficiency disorders. Since the first successful cord blood transplant in 1988, a large number of cord blood banks have been established world over for collection and storage of cord blood for future use. Majority of such transplants are performed in children, however, the number in adults have been growing steadily in recent years. Results from various transplant registries reveals that a single cord blood provides enough stem cells to provide short and long term engraftment, and has low incidence and less severity of graft versus host disease. With a high booming birth rate and a large genetic diversity, India has potential to become the largest supplier of cord blood stem cells in world. To meet the future transplant need of the country sincere efforts from various institutes and government agencies are needed to increase the number of public cord blood banks in the country. In this article the author will focus on the issue of public and private cord blood banking; the role of physicians in educating and counseling families with regard to the utility of cord blood for donor itself as well as the future of umbilical cord blood transplant in India.
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Affiliation(s)
- Ankur Bahl
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
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Recombinant activated factor VII usage in life threatening hemorrhage: a pediatric experience. Indian J Pediatr 2011; 78:961-8. [PMID: 21328080 DOI: 10.1007/s12098-011-0364-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the safety and efficacy of off label usage of Recombinant activated factor VII (rFVIIa) in children with severe bleeding in non-hemophiliac children with diverse etiologies like leukemia, post hematopoietic stem cell transplantation, dengue shock syndrome and Glanzmann thrombasthenia. METHOD Medical records of 16 non-hemophiliac children with 20 bleeding episodes where rFVIIa was administered only after failure of standard measures to control bleeding were retrospectively reviewed and data collected regarding patient demographics, diagnosis and location of bleeding. Blood counts, coagulation and other lab parameters, both pre and post rFVIIa, were also noted. Severity of bleeding was assessed using a scoring system used previously by Nevo S et al. A record of usage of the amount of blood components (red blood cells, platelets, fresh frozen plasma, and cryoprecipitate) 24 h pre and post rFVIIa was also made. The dose of rFVIIa and any adverse side effects were recorded. RESULTS Bleeding sites were gastrointestinal (13/20), pulmonary hemorrhage (6/20) and intracranial hemorrhage (1/20). Thrombocytopenia (platelet count <50,000/cumm) was present in 50% episodes and five had refractory low platelets. Usage of packed red cells and platelets was significantly less after usage of rFVIIa (p value 0.001 and 0.006, respectively). Mean dosage of rFVIIa was 77 μgm/kg/dose (range 60 to 90 μgm/kg/dose). The bleeding stopped completely in 11(55%), decreased to minimal in 2 (10%), reduced but transfusions needed in 4 (20%) and did not stop in 3 (15%) episodes. Five patients (31%) did not survive the bleeding episode. None of the patients developed thrombosis. CONCLUSIONS rFVIIa appears to be safe and effective in controlling life-threatening bleed in non-hemophiliac children.
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