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Gupta N, Dutta A, Ahmed B, Ross CR, S C, Dolan G, John MJ, Radhakrishnan N, Aggarwal S, Seth T, Kaul V, Shah V. Expert Opinions on the Management of Hemophilia A in India: The Role of Emicizumab. Cureus 2024; 16:e58941. [PMID: 38725780 PMCID: PMC11081140 DOI: 10.7759/cureus.58941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
Hemophilia A (HA) is a genetic disorder of hemostasis associated with a deficiency or reduced activity of clotting factor VIII (FVIII). This disorder remains unacceptably underdiagnosed in India. Early diagnosis and appropriate management of HA can substantially prevent morbidity and mortality. Currently, HA is managed with regular replacement therapy using standard or extended half-life FVIII concentrates or non-factor drug products. The challenges associated with FVIII concentrates include plateauing of drug effect, issues with its administration and adherence to treatment, breakthrough bleeds, and the development of inhibiting antibodies against administered clotting factors. Emicizumab is a bispecific antibody, launched in India in April 2019, for managing patients with HA. To investigate the role of emicizumab in Indian patients with HA, opinions were sought from 13 eminent hematologists and experts from India on the effectiveness of emicizumab in preventing all bleeds, spontaneous bleeds, perioperative bleeds, and intracranial hemorrhage; resolving target joints; and reducing the rate of hospitalizations and fatality associated with HA in children and adults, with or without inhibitors. The benefits of emicizumab over traditional FVIII concentrates include the subcutaneous route of delivery, less frequent dosing, and a lack of inhibitor development, in addition to providing sustained hemostasis without in-depth monitoring. It is a safe and effective management option for all HA patients, especially for patients with certain archetypes, such as those with inhibitors, those with high annualized bleed rates, those living far away from hemophilia care centers, pediatric patients and infants with intravenous access challenges, and those with a history of life-threatening bleeding events.
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Affiliation(s)
- Naresh Gupta
- Medicine and Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
- Haematology & Haemophilia, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, IND
| | - Anupam Dutta
- General Medicine, Assam Medical College and Hospital, Dibrugarh, IND
| | - Bilal Ahmed
- Pathology, Transfusion Medicine & Hemophilia, Government Medical College, Srinagar, IND
| | - Cecil R Ross
- Hematology, St. John's Medical College and Hospital, Bangalore, IND
| | - Chandrakala S
- Clinical Haematology, King Edward Memorial Hospital, Mumbai, IND
| | - Gerard Dolan
- Haematology, St. Thomas' Haemophilia Comprehensive Care Centre, Bournemouth, GBR
| | - M J John
- Clinical Hematology, Hemato-Oncology & Bone Marrow Transplant, Christian Medical College & Hospital, Ludhiana, IND
| | - Nita Radhakrishnan
- Hematology and Oncology, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, IND
| | | | - Tulika Seth
- Hematology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Varun Kaul
- Pediatrics, Guru Gobind Singh Medical College & Hospital, Faridkot, IND
| | - Vijay Shah
- Pediatrics, Nirmal Hospital Pvt. Ltd., Surat, IND
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Al-Shamsi HO, Abdelwahed N, Abyad A, Abu-Gheida I, Afrit M, Abu ElFuol T, Alasas R, Lababidi B, Dash P, Ahmad M, Dreier NW, ul Haq U, Joshua TLA, Otsmane S, Al-Nouri A, Al-Awadhi A, Tirmazy SH, Alterkait F, Elsabae S, Khan N, Albastaki NK, Sonawane Y, Jouda M, Perdawood F, Iqbal F, Jaafar H. Breast Cancer in the Arabian Gulf Countries. Cancers (Basel) 2023; 15:5398. [PMID: 38001658 PMCID: PMC10670541 DOI: 10.3390/cancers15225398] [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: 09/19/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Breast cancer stands as the prevailing malignancy across all six Gulf Cooperation Council (GCC) nations. In this literature review, we highlighted the incidence and trend of breast cancer in the GCC. Most of the studies reported a consistent increase in breast cancer incidence over the past decades, which was particularly attributed to the adoption of a Westernized lifestyle in the region and the implications of emerging risk factors and other environmental and societal factors, the increase in screening uptake, as well as the improvement in data collection and reporting in the GCC. The data on breast cancer risk factors in the GCC were limited. In this geographic region, breast cancer frequently manifests with distinctive characteristics, including an early onset, typically occurring before the age of 50; an advanced stage at presentation; and a higher pathological grade. Additionally, it often exhibits more aggressive features such as human epidermal growth factor receptor 2 (HER2) positivity or the presence of triple-negative (TN) attributes, particularly among younger patients. Despite the growing body of literature on breast cancer in the GCC, data pertaining to survival rates are, regrettably, meager. Reports on breast cancer survival rates emanating from the GCC region are largely confined to Saudi Arabia and the United Arab Emirates (UAE). In the UAE, predictive modeling reveals 2-year and 5-year survival rates of 97% and 89%, respectively, for the same period under scrutiny. These rates, when compared to Western counterparts such as Australia (89.5%) and Canada (88.2%), fall within the expected range. Conversely, Saudi Arabia reports a notably lower 5-year survival rate, standing at 72%. This disparity in survival rates underscores the need for further research directed toward elucidating risk factors and barriers that hinder early detection and screening. Additionally, there is a pressing need for expanded data reporting on survival outcomes within the GCC. In sum, a more comprehensive and nuanced understanding of breast cancer dynamics in this region is imperative to inform effective strategies for prevention, early detection, and improved patient outcomes.
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Affiliation(s)
- Humaid O. Al-Shamsi
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
- Department of Clinical Sciences, College of Medicine, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Nadia Abdelwahed
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Amin Abyad
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Ibrahim Abu-Gheida
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Mehdi Afrit
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Tasneem Abu ElFuol
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
| | - Ryad Alasas
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Bilal Lababidi
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Prasanta Dash
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Mudhasir Ahmad
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Norbert W. Dreier
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Urfan ul Haq
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Thanda Lucy Ann Joshua
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Sonia Otsmane
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Anwar Al-Nouri
- Kuwait Cancer Control Center, Kuwait City, Kuwait; (A.A.-N.); (F.A.)
| | - Aydah Al-Awadhi
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | | | - Faisal Alterkait
- Kuwait Cancer Control Center, Kuwait City, Kuwait; (A.A.-N.); (F.A.)
| | - Shimaa Elsabae
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
| | - Nyla Khan
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
| | - Nehad Kazim Albastaki
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
| | - Yoginee Sonawane
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
| | - Mohammed Jouda
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
| | - Frea Perdawood
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
| | - Faryal Iqbal
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
| | - Hassan Jaafar
- Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates; (N.A.); (A.A.); (I.A.-G.); (M.A.); (T.A.E.); (R.A.); (B.L.); (P.D.); (M.A.); (N.W.D.); (U.u.H.); (T.L.A.J.); (S.O.); (S.E.); (N.K.); (N.K.A.); (Y.S.); (M.J.); (F.P.); (F.I.); (H.J.)
- Emirates Oncology Society, Dubai P.O. Box 6600, United Arab Emirates;
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Mabrouk AG, Abbas MAEB, Ezzat DA, Sayed MT, Ali FM. Hemophilia Joint Health Score, Functional Independence Score in Hemophilia, and Pettersson Score in Pediatric Patients With Severe Hemophilia A. J Pediatr Hematol Oncol 2023; 45:344-348. [PMID: 37314882 DOI: 10.1097/mph.0000000000002692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/25/2023] [Indexed: 06/16/2023]
Abstract
Hemophilia is an X-linked recessive disorder. Children with hemophilia go through spontaneous and trauma-provoked bleeding. Recurring joint bleeds lead to ongoing incapacity. Achieving healthy joints is the primary target of hemophilia management. The current study objective was to assess hemophilic joints in individuals with hemophilic arthropathy clinically, radiographically, and functionally. This cross-sectional study included 50 children with severe hemophilia A who were selected from the pediatric hematology clinic. All children were assessed for Hemophilia Joint Health Score (HJHS). Joint assessed functionally by Functional Independence Score in Hemophilia (FISH) and radiologically by plain radiograph and scored by the Pettersson scoring system. Data were analyzed using Statistical Package for Social Sciences. The mean age of the studied cases of hemophilia was 8.5±3.1 years. The mean FISH score among the studied patients was 26.8±4.2, the mean HJHS was 16.8±12.8, and the Pettersson score was 4.9±2.7. The number of affected joints showed a significant negative correlation to the FISH score and a significant positive correlation to HJHS. The frequency of hemarthrosis/month showed a significant positive correlation to HJHS. The number of affected joints showed a significant negative correlation to the FISH score and a significant positive correlation to HJHS. Frequency of hemarthrosis/month showed a significant positive correlation to HJHS.
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Affiliation(s)
| | | | - Dina A Ezzat
- Departments of Pediatrics
- Delta University for Science and Technology, Belqas, Dakahlia Governorate, Egypt
| | | | - Faten M Ali
- Radiodiagnosis, Faculty of Medicine, Beni-Suef University, Beni-Suef
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Singh A, Rawat S, Kushwaha R, Jain M, Verma SP, Singh US. Clinicopathological Parameters of Haemophilia Patients at a Tertiary Care Centre in Northern India. Cureus 2023; 15:e41670. [PMID: 37575728 PMCID: PMC10412897 DOI: 10.7759/cureus.41670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Haemophilia affects a large number of people all over the world, yet very little is known about the clinical manifestations and diagnostic protocols of the condition in areas with limited access to resources in developing countries. Understanding the clinical spectrum and diagnostic approach will help with the design of measures to address the situation in these places. The primary objective of this study was to examine the clinicopathological parameters of haemophiliac patients. MATERIALS AND METHODS From the departmental archive, a thorough history of each patient was retrieved, including values of bleeding time, prothrombin time, activated partial prothrombin time, and percentage of specific factor activity. RESULTS Out of a total of 385 cases over the period of six years, 86.75% were classified as haemophilia A and 13.25% of cases were diagnosed as haemophilia B. In terms of the severity of the disease, 44.93% were classified as severe, 42.08% as moderate, and 12.99% as mild. Joint bleeding was the first and most typical clinical manifestation of the disease, accounting for 34.80% of cases, followed by ecchymosis (23.12%), post-traumatic bleeding (12.73%), epistaxis (12.20%), and gum bleeding (8.05%). 1.56% of patients had a positive screening test for the hepatitis C virus, followed by 1.30% for HIV and 0.78% for hepatitis B surface antigen. CONCLUSION In the presence of joint bleeding, ecchymosis, and post-traumatic bleeding in an otherwise healthy individual, a clinician should be alerted to the possibility that the patient has haemophilia and should request a work-up for the bleeding disorder.
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Affiliation(s)
- Anurag Singh
- Pathology, King George's Medical University, Lucknow, IND
| | - Shalini Rawat
- Pathology, King George's Medical University, Lucknow, IND
| | | | - Mili Jain
- Pathology, King George's Medical University, Lucknow, IND
| | | | - U S Singh
- Pathology, King George's Medical University, Lucknow, IND
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Ray D, Kumar N, Hans C, Kler A, Jain R, Bansal D, Trehan A, Jain A, Malhotra P, Ahluwalia J. Inhibitor; An Uncommon But Vexing Challenge In North Indian Patients With Hemophilia A. Indian J Hematol Blood Transfus 2022; 38:703-709. [PMID: 36258733 PMCID: PMC9569402 DOI: 10.1007/s12288-022-01539-9] [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: 12/21/2021] [Accepted: 04/09/2022] [Indexed: 10/18/2022] Open
Abstract
Factor VIII replacement is the mainstay of treatment in hemophilia A but may lead to the development of inhibitors. While a vexing clinical problem, some observations suggest that the presence of inhibitors may not necessarily portend a higher bleeding risk. Our aim was to assess the prevalence and clinicopathological correlates of inhibitors in a well characterized cohort of Indian patients with HA patients. We retrospectively reviewed the clinical details and laboratory findings of consecutive hemophilia A patients attending a north-Indian tertiary-care center from 2010 to 2020. Among 592 patients with HA, inhibitors were detected in 35 patients (5.9%). Prevalence of inhibitors in moderate and severe hemophilia was 4.2% and 6.7%, respectively. Most patients with inhibitors had history of transfusion with factor VIII alone (54.3%) or a combination of factor VIII concentrate and other blood-products (42.9%). Intracranial bleed was significantly more frequent in patients with inhibitors compared to those without inhibitors (20% vs. 4.1%; p-0.001). Time dependent and immediately acting inhibitors were seen in 60% and 40% patients, respectively. High-titre (> 5 BU) and low-titre inhibitors (< 5 BU) were detected in 28 (80%) and 7 (20%) patients, respectively. Prevalence of inhibitors in our cohort was 5.9% and most had high-titre, time dependent inhibitors. These patients may have a higher risk of intracranial bleeding.
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Affiliation(s)
- Debadrita Ray
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kumar
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chander Hans
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anita Kler
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Jain
- Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mafisa L, Dlova AN, Moodley V. The profile of patients with haemophilia managed at a haemophilia treatment centre in Pretoria, Gauteng. S Afr Fam Pract (2004) 2022; 64:e1-e7. [DOI: 10.4102/safp.v64i1.5551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 11/01/2022] Open
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Bhattarai A, Shah S, Bagherieh S, Mirmosayyeb O, Thapa S, Paudel S, Gyawali P, Khanal P. Endothelium, Platelets, and Coagulation Factors as the Three Vital Components for Diagnosing Bleeding Disorders: A Simplified Perspective with Clinical Relevance. Int J Clin Pract 2022; 2022:5369001. [PMID: 36101812 PMCID: PMC9440837 DOI: 10.1155/2022/5369001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/31/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
Bleeding disorders are a major group of hematological disorders, which are highly prevalent in the world. Excessive bleeding can result in serious consequences including hypoperfusion and cardiac arrest. The body has its selfmechanism to control excessive bleeding which is termed hemostasis. Hemostasis is achieved in two major steps, the formation of the primary and secondary hemostatic plugs. Endothelium, platelets, and coagulation factors are three components involved in hemostasis. Endothelium and platelets have a major role in forming the primary hemostatic plug. Consequently, the first step in investigating a bleeding disorder is platelet count. Despite normal platelet count, abnormality in the primary hemostatic plug may arise due to functional defects of the platelets including adhesion, activation, and aggregation. Von Willebrand disease (VWD) is an endothelial defect and the most prevalent inherited defect in coagulation. Abnormalities in the secondary hemostatic plug are largely due to coagulation factor deficiencies, and, to a lesser extent, the presence of inhibitors. Techniques involving viscoelastics have been aiding in rapid diagnosis and are useful in point-of-care testing. This article discusses the investigation of bleeding disorders from the perspective of the endothelium, platelet, and coagulation factor physiology. These three components should be properly investigated to achieve the definitive diagnosis of bleeding disorders.
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Affiliation(s)
- Abhinav Bhattarai
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
| | - Sangam Shah
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
| | | | | | - Sangharsha Thapa
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University, Buffalo, State University of NY, Buffalo, NY, USA
| | - Sandip Paudel
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
| | - Pawan Gyawali
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
| | - Pitambar Khanal
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
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Kulkarni S, Hegde R, Hegde S, Kulkarni SS, Hanagvadi S, Das KK, Kolagi S, Gai PB, Bulagouda R. Mutation analysis and characterisation of F9 gene in haemophilia- B population of India. Blood Res 2021; 56:252-258. [PMID: 34880139 PMCID: PMC8721457 DOI: 10.5045/br.2021.2021016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hemophilia B (HB) is an X-linked bleeding disorder resulting from coagulation factor IX defects. Over 3,000 pathogenic, HB-associated mutations in the F9 gene have been identified. We aimed to investigate the role of F9 variants in 150 HB patients using sequencing technology. Methods F9 gene sequences were amplified from peripheral blood-derived DNA and sequenced on an Applied Biosystems (ABI) 3500 Sanger sequencing platform. Functional and structural predictions of mutant FIX were analyzed. Results Among 150 HB patients, 102 (68%), 30 (20%), and 18 (12%) suffered from severe, moderate, and mild HB, respectively. Genetic analysis identified 16 mutations, including 3 novel mutations. Nine mutations (7 missense and 2 stop-gain) were found to be pathogenic. Only 3 mutations (c.127C>T, c.470G>A, and c.1070G>A) were associated with different severities. While 2 mutations were associated with mild HB cases (c.304C>T and c.580A>G), 2 (c.195G>A and c.1385A>G) and 3 mutations (c.223C>T, c.1187G>A, and c.1232G>A) resulted in moderate and severe disease, respectively. Additionally, 1 mutation each was associated with mild-moderate (c.*1110A>G) and mild-severe HB disease (c.197A>T), 4 mutations were associated with moderate-severe HB cases (c.314A>G, c.198A>T, c.676C>T, and c.1094C>A). FIX concentrations were lower in the mutated group (5.5±2.5% vs. 8.0±2.5%). Novel p.E66D and p.S365 mutations were predicted to be pathogenic based on changes in FIX structure and function. Conclusion Novel single nucleotide polymorphisms (SNPs) largely contributed to the pathogenesis of HB. Our study strongly suggests that population-based genetic screening will be particularly helpful to identify risk prediction and carrier detection tools for Indian HB patients.
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Affiliation(s)
- Sujayendra Kulkarni
- Human Genetics Laboratory, Department of Anatomy, Shri B.M Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, India.,Division of Human Genetics (Central Research Lab), Bagalkot, India
| | - Rajat Hegde
- Karnataka Institute for DNA Research (KIDNAR), Dharwad, India
| | - Smita Hegde
- Karnataka Institute for DNA Research (KIDNAR), Dharwad, India
| | | | - Suresh Hanagvadi
- Department of Pathology, J. J. M. Medical College, Davangere, Karnataka, India
| | - Kusal K Das
- Laboratory of Vascular Physiology and Medicine, Department of Physiology, Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, India
| | - Sanjeev Kolagi
- Department of Anatomy, S. Nijaliangappa Medical College, HSK Hospital and Research Center, Bagalkot, India
| | - Pramod B Gai
- Karnataka Institute for DNA Research (KIDNAR), Dharwad, India
| | - Rudragouda Bulagouda
- Human Genetics Laboratory, Department of Anatomy, Shri B.M Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, India
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9
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Fares AE, Gabr H, ShamsEldeen AM, Farghali HAM, Rizk MMSM, Mahmoud BE, Tammam ABA, Mahmoud AMA, Suliman AAM, Ayyad MAA, Ahmed SH, Hassan RM. Implanted subcutaneous versus intraperitoneal bioscaffold seeded with hepatocyte-like cells: functional evaluation. Stem Cell Res Ther 2021; 12:441. [PMID: 34362466 PMCID: PMC8344159 DOI: 10.1186/s13287-021-02531-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background and objectives The X-linked bleeding disorder, hemophilia A, is caused by defective production of factor VIII (FVIII). Hemophilic patients require regular FVIII infusions. Recombinant factor replacement poses the safest line of therapy. However, its main drawbacks are high expenses and the higher liability for formation of inhibitors. Recent studies confirmed the ability of bone marrow-derived stem cells to secrete FVIII. This study aims to generate bioscaffold from decellularized liver and subsequently seed it with trans-differentiated human stem cells into hepatic-like cells. This scaffold can then be implanted intraperitoneally or subcutaneously to provide FVIII.
Methods After generation of the bioscaffold, seeding of discoid scaffolds with trans-differentiated human hepatocyte-like cells was performed. Then, the generated organoid was implanted into peritoneal cavity or subcutaneous tissue of experimental rats. Results Serum human FVIII was significantly increased in rats subjected to subcutaneous implantation compared intraperitoneal implantation. Immunostaining for detecting Cytokeratin 19 and human anti-globulin confirmed the presence of mature human hepatocytes that were significantly increased in subcutaneous implanted scaffold compared to the intraperitoneal one. Conclusion Implantation of decellularized bioscaffold seeded with trans-differentiated stem cells in rats was successful to establish production of FVIII. Subcutaneous implantation showed higher FVIII levels than intraperitoneal implantation.
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Affiliation(s)
- Amal Elham Fares
- Histology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hala Gabr
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Haithem A M Farghali
- Surgery, Anesthesiology and Radiology Department, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | | | | | | | | | | | | | - Sahar Hassan Ahmed
- Medical Laboratory Technology Department, Faculty of Applied Health Science Technology, Misr University for Science and Technology, Giza, Egypt
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Pawan PK, Mahima Y, Vijai T, Manjula L. Clinicopathological features of hemophilia in a tertiary care centre of India. J Family Med Prim Care 2021; 10:295-299. [PMID: 34017743 PMCID: PMC8132779 DOI: 10.4103/jfmpc.jfmpc_1564_20] [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: 07/30/2020] [Revised: 09/29/2020] [Accepted: 10/30/2020] [Indexed: 11/04/2022] Open
Abstract
Context: Inherited bleeding disorders are common in India and hemophila and von Willebrand diseases are the most common among them. These patients can present in any department including paediatrics, medicine, orthopaedics and even gynaecology so knowledge about hemophilias and facilities for specialized tests for diagnosis are required. Few centres of north-eastern part of India perform these tests so hemophilias remain an underdiagnosed and underreported disease. Aims: The objective of this study was to estimate the prevalence of hemophilia in patients referred to this tertiary care centre and study the clinicopathological profile of these patients. Settings and Design: Prospective study. Methods and Material: Patients referred with suspicion of bleeding disorders in a time period of 4 years were evaluated. Complete clinical details, family history was retrieved and tests like complete blood counts, bleeding time, prothrombin time, activated partial thromboplastin time and factor assays were performed. Results: A total of 1126 patients with suspected bleeding disorder were tested and 237 were diagnosed of inherited bleeding disorders. Hemophilia A (HA) was diagnosed in 151 patients (63.7%), Hemophilia B (HB) in 31 (13%). Mean age was 10 years in HA and 11 years in HB patients. Clinical features of hemophilia varied according to Factor VIII levels. Coagulation type of bleeding such as hemarthrosis and hematoma were much more frequent than mucosal type bleeding. Conclusions: The present study is one of the very few studies from the north-eastern part of India estimating the prevalence and clinicopathological features of hemophilia, highlighting the need of specialized diagnostic facilities in this part of India.
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Affiliation(s)
- Pandey K Pawan
- Department of Pathology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Yadav Mahima
- Department of Pathology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Tilak Vijai
- Department of Pathology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Lader Manjula
- Department of Pathology, IMS, BHU, Varanasi, Uttar Pradesh, India
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