1
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Simoneau J, Tay C, Wheeler A, Amos L, McCormick M, Collado Y, Brown M, Weyand AC. Association between hemoglobin values and VWF assays: a multicenter investigation. Blood Adv 2024; 8:1152-1154. [PMID: 38295284 PMCID: PMC10910122 DOI: 10.1182/bloodadvances.2023011910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Affiliation(s)
- Jillian Simoneau
- Division of Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Cindy Tay
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Allison Wheeler
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren Amos
- Division of Hematology/Oncology, Children's Mercy Hospital, Kansas City, MO
| | - Meghan McCormick
- Division of Hematology-Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Yonairy Collado
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Megan Brown
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Angela C. Weyand
- Division of Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
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2
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Weyand AC, Malec L, Pipe SW. Advancements in haemophilia A and health equity: is it time to redefine severity? Lancet Haematol 2024; 11:e90-e92. [PMID: 38302228 DOI: 10.1016/s2352-3026(23)00270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/07/2023] [Accepted: 08/27/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109-5718, USA.
| | - Lynn Malec
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA
| | - Steven W Pipe
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109-5718, USA
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3
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Shieh A, Cranford JA, Weyand AC, Bohm LA, Tomlinson SE. Risk Factors and Management Outcomes in Pediatric Epistaxis at an Emergency Department. J Emerg Med 2024; 66:97-108. [PMID: 38307761 DOI: 10.1016/j.jemermed.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/05/2023] [Accepted: 10/22/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Most cases of pediatric epistaxis are spontaneous and self-resolve. However, a subset of children may experience significant bleeding and require procedural or medical intervention. OBJECTIVE We aim to identify risk factors associated with moderate and severe epistaxis in the emergency department (ED) and explore management outcomes. METHODS We retrospectively reviewed all patients under 22 years old with epistaxis who presented to our ED between 2013 and 2022. Epistaxis severity was defined as mild (required nasal compression or intranasal medications), moderate (required cautery or packing), or severe (required factor replacement, transfusion, hospital admission, or surgery). We performed univariable and multinomial regression analyses, with risk factors and outcomes analyzed according to severity. RESULTS Of 858 visits, 41 (5%) patients had moderate and 67 (8%) had severe epistaxis. Patients with moderate epistaxis were older than those with mild and severe epistaxis (median 15.6 vs. 8.3 vs. 10.7 years, p < 0.001). In regression analysis, moderate epistaxis was associated with older age, prior ED visit within 72 h, and antiplatelet medication use (p < 0.01). Severe epistaxis was associated with bleeding disorders, nasal procedures within 30 days, and anticoagulation medication use (p ≤ 0.001). Bleeding over 30 min prior to arrival was associated with both moderate and severe epistaxis (p < 0.05). Of the 67 patients with severe epistaxis, 10 (15%) required factor replacement, 28 (42%) required transfusion, 52 (77%) required hospital admission, and 5 (7%) underwent surgery. CONCLUSION Epistaxis severity is associated with certain risk factors. However, most cases of pediatric epistaxis are mild and do not require intervention or ED evaluation.
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Affiliation(s)
- Andrew Shieh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - James A Cranford
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Angela C Weyand
- Department of Pediatrics, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sarah E Tomlinson
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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4
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Merz LE, Weyand AC. Bad blood: inequity in hemophilia care. Res Pract Thromb Haemost 2024; 8:102290. [PMID: 38222078 PMCID: PMC10787282 DOI: 10.1016/j.rpth.2023.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Lauren E. Merz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Hematology, Department of Medicine, Mass General Brigham, Boston, Massachusetts, USA
| | - Angela C. Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
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5
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Wheeler AP, Lim MY, Huguelet PS, Jaffray J, Staber JM, Funkhouser K, Carpenter SL, Weyand AC. Trends in dedicated care for females with bleeding disorders within U.S. hemophilia treatment centers. Am J Hematol 2023; 98:E399-E402. [PMID: 37800397 DOI: 10.1002/ajh.27115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
Graphical representation of increasing percentage of female patients seen at HTCs, percentage of females by diagnosis, number of clinics in existence, and absolute number of female patients seen over a 10-year period (top left then clockwise).
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Affiliation(s)
- Allison P Wheeler
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ming Y Lim
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Patricia S Huguelet
- Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Julie Jaffray
- Division of Hematology/Oncology, Rady Children's Hospital, San Diego, California, USA
| | - Janice M Staber
- Department of Pediatrics, The University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Kerry Funkhouser
- Foundation for Women & Girls with Blood Disorders, Montclair, New Jersey, USA
| | - Shannon L Carpenter
- Division of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
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6
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Simoneau J, Weyand AC. Heavy menstrual bleeding in adolescents: a primary issue in primary care. Res Pract Thromb Haemost 2023; 7:102254. [PMID: 38193056 PMCID: PMC10772890 DOI: 10.1016/j.rpth.2023.102254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Jillian Simoneau
- Division of hematology/oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Angela C. Weyand
- Division of hematology/oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
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7
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Batsuli G, Wheeler AP, Weyand AC, Sidonio RF, Young G. Severe muscle bleeds in children and young adults with hemophilia A on emicizumab prophylaxis: Real-world retrospective multi-institutional cohort. Am J Hematol 2023; 98:E285-E287. [PMID: 37471655 DOI: 10.1002/ajh.27039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Glaivy Batsuli
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Allison P Wheeler
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Robert F Sidonio
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Guy Young
- Cancer and Blood Disorders Institute, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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8
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Rosen MW, Compton SD, Weyand AC, Quint EH. The Utility of Pelvic Ultrasounds in Adolescents Presenting to the Emergency Department with Abnormal Uterine Bleeding. J Pediatr Adolesc Gynecol 2023; 36:455-458. [PMID: 37182811 DOI: 10.1016/j.jpag.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
STUDY OBJECTIVE To analyze what factors influence a provider's decision to order a pelvic ultrasound (PUS) in the emergency department (ED) for adolescents with abnormal uterine bleeding (AUB), to determine if endometrial stripe (EMS) measurements are used in treatment decisions, and to evaluate if treatment outcomes differ based on EMS thicknesses. METHODS Retrospective chart review of patients aged 11-19 presenting to the ED with AUB from 2006 to 2018. Those receiving a PUS were divided into three EMS groups: ≤5 mm, 6-9 mm, and ≥10 mm. Outcomes were evaluated in admitted patients by progress notes indicating resolution of bleeding. Cross-tab, χ2, and logistic and linear regression analysis were performed. RESULTS Of 258 adolescents meeting study criteria, 113 (43.8%) had a PUS. None had an abnormality. A PUS was more likely to be performed in patients with lower hemoglobin values (P < .003). Provider decision to order a PUS did not differ by age or bleeding duration (P > .1). Among those with a PUS, 67 (59%) received hormonal therapy (pill, progestin-only, IV estrogen). There were no significant differences in treatment choices based on EMS (P < .061) or, among the 44 admitted patients (17%), in the time it took bleeding to stop after initiating treatment (pill: P = .227, progestin-only: P = .211, IV estrogen: P = .229). CONCLUSION In adolescents with AUB in the ED, performing a PUS was more common in those with low hemoglobin. EMS thickness did not appear to affect treatment decisions or inpatient outcomes. Larger studies are needed to confirm the current findings and determine if PUS is needed in the evaluation of AUB.
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Affiliation(s)
- Monica W Rosen
- Department of Obstetrics & Gynecology, Michigan Medicine, Ann Arbor, Michigan.
| | - Sarah D Compton
- Department of Obstetrics & Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | - Angela C Weyand
- Department of Pediatric Hematology, Michigan Medicine, Ann Arbor, Michigan
| | - Elisabeth H Quint
- Department of Obstetrics & Gynecology, Michigan Medicine, Ann Arbor, Michigan
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9
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Olaniyan H, Weyand AC. Optimal haemoglobin concentration in pregnancy. Lancet Haematol 2023; 10:e700-e702. [PMID: 37482060 DOI: 10.1016/s2352-3026(23)00206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Halimat Olaniyan
- Department of Pathology and Laboratory Medicine, Indiana UniversitySchool of Medicine, Indianapolis, IN, USA
| | - Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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10
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MacLean B, Sholzberg M, Weyand AC, Lim J, Tang G, Richards T. Identification of women and girls with iron deficiency in the reproductive years. Int J Gynaecol Obstet 2023; 162 Suppl 2:58-67. [PMID: 37538015 DOI: 10.1002/ijgo.14948] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Iron deficiency (ID) is the most common micronutrient deficiency in the world. It is of concern for women and girls of reproductive age as, despite frequent normalization, excessive menstrual blood loss and the iron demands associated with pregnancy increase the risk of developing an ID. Iron deficiency reduces health-related quality of life with symptoms of fatigue, heart palpitations, difficulty concentrating, and poor mental health. When left untreated, ID can escalate to iron deficiency anemia (IDA), where there is an insufficiency of red blood cells, or hemoglobin within these cells, to meet the bodily demands for oxygen transport. Substantial guidance on screening for ID can be found in specific at-risk groups, including pregnant women and patients with renal, cardiac, and inflammatory bowel disease. However, it was unclear whether guidance is available for women of reproductive age. We performed a literature search to explore the current recommendations for screening women of reproductive age for ID. While four manuscripts supportive of screening were found, no official guidance appears to exist regarding screening for this group. In line with the World Health Organization's 10 Principles of Screening, we present a case for ID screening in women and girls of reproductive age.
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Affiliation(s)
- Beth MacLean
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Michelle Sholzberg
- Department of Medicine, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Angela C Weyand
- Division of Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbour, Michigan, USA
| | - Jayne Lim
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Grace Tang
- Department of Medicine, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Toby Richards
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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11
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Weyand AC, Chaitoff A, Freed GL, Sholzberg M, Choi SW, McGann PT. Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21 Years, 2003-2020. JAMA 2023; 329:2191-2193. [PMID: 37367984 PMCID: PMC10300696 DOI: 10.1001/jama.2023.8020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
This study examines prevalence of iron deficiency among females aged 12 to 21 years to inform future screening strategies for iron deficiency and iron-deficiency anemia.
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Affiliation(s)
- Angela C. Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Alexander Chaitoff
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Gary L. Freed
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
| | | | - Sung Won Choi
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Patrick T. McGann
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
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12
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Kahn SR, Arnold DM, Casari C, Desch KC, Devreese KMJ, Favaloro EJ, Gaertner F, Gouw SC, Gresele P, Griffioen AW, Heger L, Kini RM, Kohli S, Leader A, Lisman T, Lordkipanidzé M, Mullins E, Okoye HC, Rosovsky RP, Salles-Crawley II, Selby R, Sholzberg M, Stegner D, Violi F, Weyand AC, Williams S, Zheng Z. Illustrated State-of-the-Art Capsules of the ISTH 2023 Congress. Res Pract Thromb Haemost 2023; 7:100193. [PMID: 37538494 PMCID: PMC10394567 DOI: 10.1016/j.rpth.2023.100193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
This year's Congress of the International Society of Thrombosis and Haemostasis (ISTH) took place in person in Montréal, Canada, from June 24-28, 2023. The conference, held annually, highlighted cutting-edge advances in basic, translational, population and clinical sciences relevant to the Society. As for all ISTH congresses, we offered a special, congress-specific scientific theme; this year, the special theme was immunothrombosis. Certainly, over the last few years, COVID-19 infection and its related thrombotic and other complications have renewed interest in the concepts of thromboinflammation and immunothrombosis; namely, the relationship between inflammation, infection and clotting. Other main scientific themes of the Congress included Arterial Thromboembolism, Coagulation and Natural Anticoagulants, Diagnostics and Omics, Fibrinolysis and Proteolysis, Hemophilia and Rare Bleeding Disorders, Hemostatic System in Cancer, Inflammation and Immunity, Pediatrics, Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies, Platelets and Megakaryocytes, Vascular Biology, Venous Thromboembolism and Women's Health. Among other sessions, the program included 28 State-of-the-Art (SOA) sessions with a total of 84 talks given by internationally recognized leaders in the field. SOA speakers were invited to prepare brief illustrated reviews of their talks that were peer reviewed and are included in this article. These illustrated capsules highlight the major scientific advances with potential to impact clinical practice. Readers are invited to take advantage of the excellent educational resource provided by these illustrated capsules. They are also encouraged to use the image in social media to draw attention to the high quality and impact of the science presented at the Congress.
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Affiliation(s)
- Susan R Kahn
- Medicine, Sir Mortimer B Davis Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Montreal, Quebec
| | - Donald M Arnold
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Caterina Casari
- Université Paris-Saclay, INSERM, Hémostase inflammation thrombose HITH U1176, 94276, Le Kremlin-Bicêtre, France
| | - Karl C Desch
- Cell and Molecular Biology Program, University of Michigan, Ann Arbor, USA
| | - Katrien M J Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Emmanuel J Favaloro
- Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW Australia
| | - Florian Gaertner
- Technische Universität München (TUM), Ismaninger Straße 22, München, Bayern 81675, Germany
| | - Samantha C Gouw
- Amsterdam UMC location University of Amsterdam, Department of Pediatric Hematology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Paolo Gresele
- University of Perugia, Department of Medicine and Surgery, Head Section of Internal and Cardiovascular Medicine
| | - Arjan W Griffioen
- Angiogenesis Laboratory, Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Lukas Heger
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Departement of Cardiology and Angiology, University Hospital Freiburg Bad Krozingen, 79106 Freiburg, Germany
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA 02115, USA
- Departement of Cardiology and Angiology, University Hospital Freiburg Bad Krozingen, 79106 Freiburg, Germany
| | | | - Shrey Kohli
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Universitätsklinikum Leipzig, Leipzig University, 04103 Leipzig, Germany
| | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ton Lisman
- Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Eric Mullins
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati - College of Medicine, Cincinnati, OH, USA
| | - Helen Chioma Okoye
- College of Medicine, University of Nigeria, Ituku Ozalla campus, Enugu Nigeria
| | | | | | - Rita Selby
- Departments of Laboratory Medicine & Pathobiology and Department of Medicine, University of Toronto
| | | | | | - Francesco Violi
- Department of Clinical, Internal Medicine, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School
| | | | - Ze Zheng
- Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
- Versiti Blood Research Institute, Milwaukee, Wisconsin 53226, USA
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13
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Barnes GD, Weyand AC. When technology improves patient care and provider experience. Res Pract Thromb Haemost 2023; 7:100088. [PMID: 37138551 PMCID: PMC10150177 DOI: 10.1016/j.rpth.2023.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
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14
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Merz LE, Siad FM, Creary M, Sholzberg M, Weyand AC. Laboratory-Based Inequity in Thrombosis and Hemostasis: Review of the Evidence. Res Pract Thromb Haemost 2023; 7:100117. [PMID: 37063772 PMCID: PMC10099330 DOI: 10.1016/j.rpth.2023.100117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/17/2023] Open
Abstract
The concept of normal in hematology, similar to that in other areas of medicine, is anchored to the perspective of those setting the standard. This means that several laboratory reference intervals and approaches to the conditions of thrombosis and hemostasis are influenced by the vantage point of those in power. Structural inequity, including systemic racism and sexism, can lead to inappropriate normalization of disease states, such as anemia or iron deficiency, or delayed diagnoses, such as in von Willebrand disease. This review will focus on how laboratory reference intervals perpetuate the cycles of inequity in care of patients with disorders of thrombosis and hemostasis. We provide examples and case studies in maternal mortality as well as in disorders such as von Willebrand disease and iron deficiency, question physiology versus pathophysiology, acknowledge the distinction between social constructs and biologic influence, and highlight opportunities for much-needed restructuring in areas such as defining anemia and iron deficiency.
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Affiliation(s)
- Lauren E. Merz
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Correspondence Lauren E. Merz, Department of Internal Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA. @LaurenMerzMD
| | - Fartoon M. Siad
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Melissa Creary
- School of Public Health, Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle Sholzberg
- Departments of Medicine, and Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada
| | - Angela C. Weyand
- Division of Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
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15
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Baldwin MK, Ahmadzia HK, Bartlett DL, Bensen-Kennedy D, Desai V, Haley KM, Herman-Hilker SL, Kilgore AM, Kulkarni R, Lavin M, Luckey S, Matteson KA, Paulyson-Nuñez K, Philipp CS, Ragosta S, Rosen K, Rotellini D, Weyand AC. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research to advance the health of people with inherited bleeding disorders with the potential to menstruate. Expert Rev Hematol 2023; 16:71-86. [PMID: 36920864 PMCID: PMC10020871 DOI: 10.1080/17474086.2023.2175660] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND People who have or had the potential to menstruate (PPM) with inherited bleeding disorders (BD) face particular challenges receiving appropriate diagnosis and care and participating in research. As part of an initiative to create a National Research Blueprint for future decades of research, the National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network conducted extensive all-stakeholder consultations to identify the priorities of PPM with inherited BDs and those who care for them. RESEARCH DESIGN AND METHODS Working group (WG) 4 of the NHF State of the Science Research Summit distilled community-identified priorities for PPM with inherited BDs into concrete research questions and scored their feasibility, impact, and risk. RESULTS WG4 identified important gaps in the foundational knowledge upon which to base optimal diagnosis and care for PPM with inherited BDs. They defined 44 top-priority research questions concerning lifespan sex biology, pregnancy and the post-partum context, uterine physiology and bleeding, bone and joint health, health care delivery, and patient-reported outcomes and quality-of-life. CONCLUSIONS The needs of PPM will best be advanced with research designed across the spectrum of sex and gender biology, with methodologies and outcome measures tailored to this population, involving them throughout.
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Affiliation(s)
- Maureen K. Baldwin
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Homa K. Ahmadzia
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Vidhi Desai
- CSL Behring, King of Prussia, Pennsylvania, USA
| | - Kristina M. Haley
- The Hemophilia Center, Oregon Health and Science University, Portland, Oregon, USA
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Sherry L. Herman-Hilker
- Hemophilia and Coagulation Disorders Program, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Roshni Kulkarni
- MSU Center of Bleeding and Clotting Disorders, Department Pediatrics and Human Development, Michigan State University, East Lansing, Michigan, USA
| | - Michelle Lavin
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - Shari Luckey
- Hemophilia Foundation of Michigan, Ypsilanti, Michigan, USA
| | - Kristen A. Matteson
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kristin Paulyson-Nuñez
- Duke Health Women & Children’s Services, Duke University Health Systems, Durham, North Carolina, USA
| | - Claire S. Philipp
- Division of Hematology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | - Kimberly Rosen
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA
| | | | - Angela C. Weyand
- Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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von Drygalski A, Chowdary P, Kulkarni R, Susen S, Konkle BA, Oldenburg J, Matino D, Klamroth R, Weyand AC, Jimenez-Yuste V, Nogami K, Poloskey S, Winding B, Willemze A, Knobe K. Efanesoctocog Alfa Prophylaxis for Patients with Severe Hemophilia A. N Engl J Med 2023; 388:310-318. [PMID: 36720133 DOI: 10.1056/nejmoa2209226] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Efanesoctocog alfa provides high sustained factor VIII activity by overcoming the von Willebrand factor-imposed half-life ceiling. The efficacy, safety, and pharmacokinetics of efanesoctocog alfa for prophylaxis and treatment of bleeding episodes in previously treated patients with severe hemophilia A are unclear. METHODS We conducted a phase 3 study involving patients 12 years of age or older with severe hemophilia A. In group A, patients received once-weekly prophylaxis with efanesoctocog alfa (50 IU per kilogram of body weight) for 52 weeks. In group B, patients received on-demand treatment with efanesoctocog alfa for 26 weeks, followed by once-weekly prophylaxis with efanesoctocog alfa for 26 weeks. The primary end point was the mean annualized bleeding rate in group A; the key secondary end point was an intrapatient comparison of the annualized bleeding rate during prophylaxis in group A with the rate during prestudy factor VIII prophylaxis. Additional end points included treatment of bleeding episodes, safety, pharmacokinetics, and changes in physical health, pain, and joint health. RESULTS In group A (133 patients), the median annualized bleeding rate was 0 (interquartile range, 0 to 1.04), and the estimated mean annualized bleeding rate was 0.71 (95% confidence interval [CI], 0.52 to 0.97). The mean annualized bleeding rate decreased from 2.96 (95% CI, 2.00 to 4.37) to 0.69 (95% CI, 0.43 to 1.11), a finding that showed superiority over prestudy factor VIII prophylaxis (P<0.001). A total of 26 patients were enrolled in group B. In the overall population, nearly all bleeding episodes (97%) resolved with one injection of efanesoctocog alfa. Weekly prophylaxis with efanesoctocog alfa provided mean factor VIII activity of more than 40 IU per deciliter for the majority of the week and of 15 IU per deciliter at day 7. Prophylaxis with efanesoctocog alfa for 52 weeks (group A) improved physical health (P<0.001), pain intensity (P = 0.03), and joint health (P = 0.01). In the overall study population, efanesoctocog alfa had an acceptable side-effect profile, and the development of inhibitors to factor VIII was not detected. CONCLUSIONS In patients with severe hemophilia A, once-weekly efanesoctocog alfa provided superior bleeding prevention to prestudy prophylaxis, normal to near-normal factor VIII activity, and improvements in physical health, pain, and joint health. (Funded by Sanofi and Sobi; XTEND-1 ClinicalTrials.gov number, NCT04161495.).
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Affiliation(s)
- Annette von Drygalski
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Pratima Chowdary
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Roshni Kulkarni
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Sophie Susen
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Barbara A Konkle
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Johannes Oldenburg
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Davide Matino
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Robert Klamroth
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Angela C Weyand
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Victor Jimenez-Yuste
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Keiji Nogami
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Stacey Poloskey
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Bent Winding
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Annemieke Willemze
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Karin Knobe
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
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Khalighi M, Wheeler AP, Adeyemi-Fowode OA, Kouides PA, Durazo-Arvizu RA, Haley K, Dersch CM, Weyand AC, Baldwin MK, Borzutzky C. Does a Bleeding Disorder Lessen the Efficacy of the 52-mg Levonorgestrel-Releasing Intrauterine System for Heavy Menstrual Bleeding in Adolescents? A Retrospective Multicenter Study. J Adolesc Health 2022; 71:204-209. [PMID: 35430143 PMCID: PMC9329177 DOI: 10.1016/j.jadohealth.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/29/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study is to compare the patient-reported bleeding outcomes and complication rates with the use of the 52-mg levonorgestrel-releasing intrauterine system (52-LNG-IUS) for treatment of heavy menstrual bleeding (HMB) among adolescents with and without a diagnosed inherited bleeding disorder (BD) within the first 12 months after insertion. METHODS Retrospective chart review was conducted of adolescents ages 14-21 years, with and without an inherited BD, who underwent 52-LNG-IUS insertion between September 2013 and February 2020 for the treatment of HMB. RESULTS One hundred forty-four 52-LNG-IUS insertions among 139 subjects were evaluated. Fifty-nine (41%) of these were among adolescents with a diagnosed inherited BD, and 85 (59%) were among those without a BD. Among subjects with follow-up, documentation of patient-reported bleeding outcome, and a retained IUS (92/144), both groups subjectively reported improvement in bleeding outcome, with 91.7% (33/36) of those with a BD and 94.6% (53/56) of those without a BD reporting that bleeding outcome was better than prior to IUS insertion (p = .675). There was no statistically significant difference in the rate of spontaneous expulsion (p = .233), with the rate of expulsion in the first 12 months after placement among those with a BD of 13.7% (7/51) and 6.8% for those without a BD (5/72). DISCUSSION Adolescents with HMB both with and without an inherited BD benefit from the 52-LNG-IUS for the treatment of HMB. Rates of spontaneous IUS expulsion are not statistically different regardless of the presence of a BD and are similar to rates found in other studies of intrauterine device use in adolescents.
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Affiliation(s)
- Misha Khalighi
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California.
| | - Allison P Wheeler
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Peter A Kouides
- Department of Hematology and Medical Oncology, Rochester General Hospital, University of Rochester School of Medicine and Mary M. Gooley Hemophilia Treatment Center, Rochester, New York
| | - Ramon A Durazo-Arvizu
- The Saban Research Institute Biostatistics Core, Children's Hospital Los Angeles, Los Angeles, California
| | - Kristina Haley
- Division of Hematology and Oncology, Oregon Health & Sciences University, Portland, Oregon
| | - Candice M Dersch
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine
| | - Angela C Weyand
- Division of Hematology and Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Maureen K Baldwin
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, Oregon
| | - Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
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Affiliation(s)
- Patrick T. McGann
- Department of PediatricsAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Division of Pediatric Hematology/OncologyHasbro Children's HospitalProvidenceRhode IslandUSA
| | - Angela C. Weyand
- Division of Pediatric Hematology and OncologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Weyand AC, Sidonio RF, Sholzberg M. Health issues in women and girls affected by haemophilia with a focus on nomenclature, heavy menstrual bleeding, and musculoskeletal issues. Haemophilia 2022; 28 Suppl 4:18-25. [PMID: 35521724 PMCID: PMC9321707 DOI: 10.1111/hae.14535] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Introduction Women and girls affected by haemophilia, including haemophilia carriers (WGH) are at risk of bleeding symptoms that may go unrecognized, including heavy menstrual bleeding (HMB) and musculoskeletal bleeding. Terminology continues to evolve. Aim To describe the current recommendations for nomenclature surrounding WGH, and the current understanding of HMB, iron deficiency, and musculoskeletal complaints in these patients. Methods Literature was reviewed and summarized. Results With regards to nomenclature, women with factor levels less than 50% should be classified as having haemophilia, while carriers with normal levels should be characterized accordingly to symptomatology. HMB and resultant iron deficiency are common among WGH, have a multitude of downstream effects, and maybe overlooked due to stigma around menstruation. Musculoskeletal bleeding and resultant joint changes are increasingly recognized in this population but do not necessarily correlate with factor levels. Conclusion Although progress has been made in the care of WGH, much work remains to further improve their care.
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Affiliation(s)
- Angela C Weyand
- Department of Pediatrics, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Robert F Sidonio
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Michelle Sholzberg
- Departments of Medicine, and Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
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Stoffers VL, Weyand AC, Quint EH, Rosen MW. Assessment of Iron Status in Adolescents Presenting to the Emergency Department With Heavy Menstrual Bleeding. Pediatr Emerg Care 2022; 38:e1266-e1270. [PMID: 35482504 DOI: 10.1097/pec.0000000000002591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Iron deficiency is extremely common in adolescents with heavy menstrual bleeding (HMB) presenting to the emergency department; however, patients are rarely screened for this. The objective of this study was to evaluate screening for iron deficiency in adolescents presenting to the emergency department for HMB. METHODS This is a secondary analysis of a single-center, cross-sectional observational study using retrospective chart review. The study subjects are adolescents ages 11 to 19 years with International Classification of Diseases, Ninth Revision, Clinical Modification/International Classification of Diseases, Tenth Revision, Clinical Modification, codes for HMB who presented to the emergency department at a national tertiary care hospital from 2006 to 2018. Pregnant adolescents with HMB were excluded. Chart abstraction for demographic data, symptoms, laboratory tests, treatments, and outcomes was performed. The main outcome measure was the number of adolescents who had an iron evaluation in the emergency department and were discharged on oral iron. RESULTS Of the 258 nonpregnant adolescents who sought care for HMB in the emergency department, 225 (87.2%) were evaluated with serum hemoglobin testing. Ninety-four (41.7%) of those tested were anemic. Only 23 of the 258 patients (8.9%) had iron studies (serum ferritin) performed; 18 of 23 (78.3%) had iron deficiency and 21 of 23 (92.3%) were anemic. Subjects presenting with fatigue, headache, or palpitations were more likely to have iron studies performed than those without these symptoms (all P < 0.01). Thirty-two of the 258 subjects (12.4%) were discharged on oral iron therapy, which included only 15 of the 18 subjects (83.3%) with iron deficiency determined by ferritin testing. CONCLUSIONS Adolescents presenting to the emergency department with HMB are at significant risk of iron deficiency but are not being screened or treated, which may have significant consequences.
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Affiliation(s)
| | | | | | - Monica W Rosen
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Weyand AC, McGann P, Zholzberg M. Sex specific definitions of anaemia reflect androgen production – Authors' reply. The Lancet Haematology 2022; 9:e243-e244. [DOI: 10.1016/s2352-3026(22)00053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
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22
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Connell NT, Weyand AC, Barnes GD. Use of Social Media in the Practice of Medicine. Am J Med 2022; 135:138-140. [PMID: 34560038 DOI: 10.1016/j.amjmed.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Nathan T Connell
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Angela C Weyand
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Geoffrey D Barnes
- Frankel Cardiovascular Center and Michigan Program on Value Enhancement, University of Michigan Health System, Ann Arbor
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Weyand AC, McGann PT, Sholzberg M. Sex specific definitions of anaemia contribute to health inequity and sociomedical injustice. The Lancet Haematology 2022; 9:e6-e8. [DOI: 10.1016/s2352-3026(21)00351-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/18/2022]
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Weyand AC, Fitzgerald KD, McGrath M, Gupta V, Braun TM, Quint EH, Choi SW. Depression in Female Adolescents with Heavy Menstrual Bleeding. J Pediatr 2022; 240:171-176. [PMID: 34517012 PMCID: PMC9055780 DOI: 10.1016/j.jpeds.2021.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the degree to which heavy menstrual bleeding is associated with depression, independent of hormonal contraception. STUDY DESIGN We performed a retrospective cohort study of 1168 female adolescents 9-18 years old presenting to general pediatricians for heavy menstrual bleeding or well visits. Depression was the primary outcome and defined as a diagnosis in the health record. Univariable and multivariable regression models were fit to the data to identify factors associated with depression diagnosis. RESULTS In total, 581 adolescents with heavy menstrual bleeding and 587 without heavy menstrual bleeding were included. Depression diagnoses occurred with greater frequency in youth with heavy menstrual bleeding compared with those without heavy menstrual bleeding (50.9% vs 24.2% P < .001; risk ratio 1.67, 95% CI 1.39-2.01) but did not significantly differ between those taking vs not taking hormonal contraception (risk ratio 0.99; 95% CI 0.84-1.17). Most patients with depression and heavy menstrual bleeding developed depression following or concurrent with heavy menstrual bleeding (261/296, 88%). Of these, 199 of 261 (76%) were treated with hormonal contraception, but the majority (168/199; 84%) were diagnosed with depression before initiation. CONCLUSIONS Heavy menstrual bleeding is associated with depression diagnosis in female adolescents. The use of hormonal contraception was not associated with depression diagnosis in multivariable analysis, covarying heavy menstrual bleeding, age, body mass index, anxiety, sexual activity, and substance use. As hormonal contraception is often used to treat heavy menstrual bleeding, heavy menstrual bleeding may be partially driving previous reports of increased depression risk in those taking hormonal contraception.
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Affiliation(s)
- Angela C Weyand
- Department of Pediatrics, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI; Division of Hematology/Oncology, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI.
| | - Kate D Fitzgerald
- Department of Psychiatry, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Mary McGrath
- Department of Pediatrics, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI; Division of Hematology/Oncology, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Vibhuti Gupta
- Department of Pediatrics, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Thomas M Braun
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Sung W Choi
- Department of Pediatrics, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI; Division of Hematology/Oncology, Division of Pediatric and Adolescent Gynecology, University of Michigan Medical School, Ann Arbor, MI
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Weyand AC, Kouides P, Malvar J, Jaffray J. Is ≥ 100% the magic number to rule out the laboratory diagnosis of von Willebrand disease based on initial testing? Am J Hematol 2021; 96:E439-E441. [PMID: 34478182 DOI: 10.1002/ajh.26343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Angela C. Weyand
- Department of Pediatrics, Division of Hematology/Oncology University of Michigan Medical School Ann Arbor Michigan USA
| | - Peter Kouides
- Department of Medicine, Division of Hematology/Oncology Mary M. Gooley Hemophilia Center Rochester New York USA
- Department of Medicine, Division of Hematology/Oncology University of Rochester Rochester New York USA
| | - Jemily Malvar
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant Children's Hospital of Los Angeles Los Angeles California USA
| | - Julie Jaffray
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant Children's Hospital of Los Angeles Los Angeles California USA
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Affiliation(s)
- Hannah S Lichtsinn
- Department of Medicine, Division of General Internal Medicine, Hennepin Healthcare, Minneapolis, MN 55415, USA; Department of Medicine, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA.
| | - Angela C Weyand
- Department of Pediatrics, Division of Hematology Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zeke J McKinney
- School of Public Health, Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN, USA; Occupational and Environmental Medicine Residency, HealthPartners Institute for Medical Education, Minneapolis, MN, USA
| | - Allecia M Wilson
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
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Abstract
Von Willebrand disease (VWD) is a common bleeding disorder, affecting male and female individuals equally, that often manifests in mucosal bleeding. VWD can be secondary to a quantitative (Type 1 and Type 3) or qualitative (Type 2) defects in Von Willebrand factor (VWF). Initial testing includes VWF antigen, as well as a platelet binding assay to differentiate between qualitative and quantitative defects. Further subtyping requires additional testing and is needed to ensure appropriate treatment. Desmopressin, antifibrinolytics, hormonal treatments for heavy menstrual bleeding, and VWF concentrates are commonly used in the treatment of VWD.
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Affiliation(s)
- Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School, 1150 W. Medical Center Dr, MSRB III, Room 8220E, Ann Arbor, MI 48109, USA
| | - Veronica H Flood
- Department of Pediatrics, Medical College of Wisconsin and Versiti Blood Research Institute, Milwaukee, WI, USA; Comprehensive Center for Bleeding Disorders, 8739 Watertown Plank Road, PO Box 2178, Milwaukee, WI 53201-2178, USA.
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Lim MY, Olson L, Rajpurkar MA, Weyand AC. Concomitant use of combined hormonal contraceptives and antifibrinolytic agents for the management of heavy menstrual bleeding: A practice pattern survey. Thromb Res 2021; 204:95-100. [PMID: 34153650 DOI: 10.1016/j.thromres.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Concomitant antifibrinolytic agents and combined hormonal contraceptives (CHC) have been anecdotally used to manage refractory heavy menstrual bleeding (HMB). Yet, there remains uncertainty among clinicians regarding the safety of this therapeutic option as concomitant CHC is listed as a contraindication to tranexamic acid use in the United States. AIM To describe current treatment practices and physician-reported safety and effectiveness of concomitant antifibrinolytics and CHCs. METHODS We surveyed clinician members of the Hemostasis and Thrombosis Research Society and the Foundation of Women and Girls with Blood Disorders using a web-based survey. We also shared the survey link on Twitter. RESULTS Of the 224 respondents who completed the survey, 214 treated women of reproductive age with HMB. Of the 214 respondents, 138 (64%) had treated at least 1 woman with concomitant antifibrinolytic agents and CHCs in the past 12 months. Over half of these respondents (n = 77, 57%) reported that at least 50% of women had resolution of refractory HMB. One respondent reported an arterial or venous thrombotic event that occurred in 1 woman. CONCLUSION We found that the use of concomitant CHCs and antifibrinolytic agent for refractory HMB is prevalent, appears to be efficacious and is relatively safe. Further research is warranted.
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Affiliation(s)
- Ming Y Lim
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Lenora Olson
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Madhvi A Rajpurkar
- Division of Hematology Oncology, Central Michigan University, Mt. Pleasant, MI, USA
| | - Angela C Weyand
- Division of Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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Nessle CN, Rivas-Rodriguez F, Weyand AC. Catastrophic cerebral sinovenous thrombosis with haemorrhagic conversion in a new diagnosis of paediatric acute myelogenous leukaemia. BMJ Case Rep 2021; 14:14/6/e242873. [PMID: 34099452 DOI: 10.1136/bcr-2021-242873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- C Nathan Nessle
- Pediatric Hematology Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Francisco Rivas-Rodriguez
- Radiology, Division of Neuroradiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela C Weyand
- Pediatric Hematology Oncology, University of Michigan Hospital, Ann Arbor, Michigan, USA
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Weyand AC, McGann PT. Eliminating race-based reference ranges in haematology: a call to action. Lancet Haematol 2021; 8:e462-e466. [PMID: 34048684 DOI: 10.1016/s2352-3026(21)00106-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022]
Abstract
In haematology, as in all of medicine, the use of reference intervals for laboratory variables is essential to define disease states and inform treatment decisions. There are many haematological variables, including haemoglobin, mean corpuscular volume, absolute neutrophil count, and iron indices, that are often reported to be different on the basis of a person's race or ethnicity. Although there are many haematological conditions with a genetic basis, such that it is appropriate to consider ancestry in the diagnostic algorithm, defining pathology on the basis of a social construct such as race is unacceptable. The inclusion of separate thresholds or simple statements that so-called normal values vary by race further validates the common misperception that there are physiological differences between Black and white patients. These statements might have downstream effects on diagnostic and treatment decisions that exacerbate existing racial health disparities. In this Viewpoint, we argued for the removal of race-based reference intervals across haematology.
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Affiliation(s)
- Angela C Weyand
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Patrick T McGann
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Weyand AC, Barbaro RP, Walkovich KJ, Frame DG. Adjustments to pharmacologic therapies for hemophagocytic lymphohistiocytosis while on extracorporeal support. Pediatr Blood Cancer 2021; 68:e29007. [PMID: 33751818 PMCID: PMC8068609 DOI: 10.1002/pbc.29007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 11/08/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an immune dysregulatory syndrome characterized by severe inflammation and end-organ damage. Due to significant organ dysfunction, patients often require extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). In this report, we describe consideration for adjusting treatment in the context of extracorporeal organ support. We describe agents commonly used and dosing adjustments made in light of extracorporeal organ support. We report six cases that illustrate the feasibility of initiating standard HLH therapies in patients requiring these modalities.
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Affiliation(s)
- Angela C. Weyand
- Department of Pediatrics, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Ryan P. Barbaro
- Department of Pediatrics, Division of Critical Care, University of Michigan, Ann Arbor, MI
| | - Kelly J. Walkovich
- Department of Pediatrics, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - David G. Frame
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI
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Zhao Y, Weyand AC, Shavit JA. Novel treatments for hemophilia through rebalancing of the coagulation cascade. Pediatr Blood Cancer 2021; 68:e28934. [PMID: 33577709 PMCID: PMC8751759 DOI: 10.1002/pbc.28934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/19/2020] [Accepted: 01/12/2021] [Indexed: 11/11/2022]
Abstract
Hemophilia A and B are inherited hemorrhagic disorders that result from alterations in the coagulation cascade. Aside from spontaneous bleeding, the main complication of hemophilia is hemarthrosis. Progress over the last three decades, specifically prophylaxis using recombinant factor, has prevented hemarthrosis and lengthened patient life expectancies. However, many treatments require frequent dosing up to three times a week, and alloantibodies (inhibitors) against replacement factor continues to be an issue. These problems call for novel treatments for patients with hemophilia. Although there has been progress in extended half-life factors and mimetics of factor VIII, an alternative treatment methodology is to rebalance the activities of pro- and anticoagulant factors through inhibition of the natural anticoagulants: antithrombin, tissue factor pathway inhibitor, protein C, and protein S. This review will explore the efficacy of targeting these inhibitory pathways from preclinical development through clinical trials, and delve into concerns of thrombotic risk.
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Affiliation(s)
- Yakun Zhao
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Angela C. Weyand
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Jordan A. Shavit
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
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Rajpurkar M, Zia A, Weyand AC, Thomas R, O'Brien SH, Srivaths L, Kouides P. Management of anticoagulation associated reproductive tract bleeding in adolescent and young adult females - Results of a multinational survey. Thromb Res 2021; 203:61-68. [PMID: 33957308 DOI: 10.1016/j.thromres.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/12/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Reproductive tract bleeding (RTB) is an important outcome in menstruating females on anticoagulant therapy (AC). The diagnosis and management of AC-RTB in adolescent and young adult (AYA) females is unknown. AIMS The aim of this study was to survey the contemporary patterns of diagnosis and management of AC-RTB in AYA females. METHODS SurveyMonkey® questions were sent to members of 1) Pediatric and Neonatal Thrombosis Hemostasis Subcommittee and Women's Health Subcommittee of the International Society on Thrombosis and Haemostasis and 2) Hemostasis and Thrombosis Research Society. Results are reported using descriptive statistics. RESULTS Response rate was 33% (251 out of 753). AC-RTB was infrequently reported. Menstrual history was not routinely reviewed prior to initiation of AC. Respondents indicated a differential risk of AC-RTB, most frequently with Rivaroxaban. Respondents continued hormonal therapy (HT) if an AYA female was on it at the start of AC. When AC-RTB occurred, management strategies were variable with initiation of HT or antifibrinolytic therapy being the most frequent. The timing of AC-RTB after the thrombotic event influenced the respondents' choice of therapy. Differences were seen in the management strategies between US and non-US participants, with more US respondents initiating HT while more non-US respondents modifying the AC regimen. Respondents uniformly reported complications with AC-RTB and with its treatment. CONCLUSION This survey highlights the need to review menstrual history at the start of and during AC and for future research into choosing the optimal AC in AYA females. The results can inform the design of future studies.
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Affiliation(s)
- Madhvi Rajpurkar
- Department of Pediatrics, Wayne State University, Detroit, MI, USA; Department of Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, MI, USA.
| | - Ayesha Zia
- Department of Pediatrics, The University of Texas Southwestern, Dallas, TX, USA
| | - Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ronald Thomas
- Department of Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Sarah H O'Brien
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Lakshmi Srivaths
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA
| | - Peter Kouides
- University of Rochester School of Medicine and the Mary M. Gooley Hemophilia Center, USA
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McGrath M, Quint EH, Weyand AC. Depression in adolescents and young adults with heavy menstrual bleeding in a referral clinic setting. Am J Hematol 2021; 96:E105-E108. [PMID: 33428781 DOI: 10.1002/ajh.26093] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/03/2021] [Accepted: 01/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Mary McGrath
- Department of Pediatrics University of Michigan Ann Arbor Michigan
| | - Elisabeth H. Quint
- Department of Obstetrics and Gynecology University of Michigan Ann Arbor Michigan
| | - Angela C. Weyand
- Department of Pediatrics University of Michigan Ann Arbor Michigan
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Michniacki TF, Weyand AC. Gastrointestinal Bleeding: Expanding the Shortened Telomere Disorder Phenotype. J Pediatr 2021; 230:12-14. [PMID: 33121962 DOI: 10.1016/j.jpeds.2020.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas F Michniacki
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Angela C Weyand
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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Othman M, Cormier M, Barnes GD, Comer SP, Connors JM, Denorme F, Khorana AA, Las Casas PH, Morla S, Muia J, Ní Áinle F, Taylor KA, van der Wal DE, Weyand AC, Lavin M. Harnessing Twitter to empower scientific engagement and communication: The ISTH 2020 virtual congress experience. Res Pract Thromb Haemost 2021; 5:253-260. [PMID: 33733023 PMCID: PMC7938622 DOI: 10.1002/rth2.12478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/05/2022] Open
Abstract
As a result of the coronavirus disease 2019 pandemic, the International Society on Thrombosis and Haemostasis (ISTH), like many societies around the world, canceled their in-person hematology congress planned for Milan, Italy, in July 2020. As a result, the first virtual ISTH congress in the organisation's 51-year history was delivered, inviting free registration from across the globe. As part of the social media support, marketing, and scientific dissemination efforts for the virtual congress, the ISTH assembled a group of official Twitter Ambassadors, which represented the broad and diverse ISTH community. Ambassadors were tasked to tweet daily throughout the congress and to share their commentary on the hematology research being presented with the "#ISTH2020" hashtag. Ambassadors were also supported by Twitter activities from the two official ISTH-affiliated journals: the Journal of Thrombosis and Haemostasis (JTH) and Research and Practice in Thrombosis and Haemostasis (RPTH). In this forum and through the Twitter ambassadors' lens, we present the Twitter Ambassadors' experience, reflect on the impact of social media on the ISTH 2020 congress, and share this experience with the wider scientific community. Specifically, we report on the role of Twitter communication for virtual meetings, discuss the pros and cons of the virtual congress, and offer Twitter-related recommendations for future virtual or blended congresses. We conclude that the ISTH Twitter Ambassador program broadened social media engagement and offers a novel route to improve social connectivity in the virtual research congress setting.
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Affiliation(s)
- Maha Othman
- Biomedical and Molecular SciencesSchool of MedicineQueen’s UniversityKingstonONCanada
- School of Baccalaureate NursingSt Lawrence CollegeKingstonONCanada
| | - Matthew Cormier
- Department of Pathology and Molecular MedicineSchool of MedicineQueen’s UniversityKingstonONCanada
| | - Geoffrey D. Barnes
- Frankel Cardiovascular CenterDepartment of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Shane P. Comer
- School of MedicineUCD Conway InstituteUniversity College DublinDublinIreland
| | - Jean M. Connors
- Hematology DivisionDepartment of MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | | | - Alok A. Khorana
- Department of Hematology and Medical OncologyTaussig Cancer Institute and Case Comprehensive Cancer CenterCleveland ClinicClevelandOHUSA
| | | | - Shravan Morla
- Department of Molecular MedicineThe Scripps Research InstituteLa JollaCAUSA
| | - Joshua Muia
- Department of Biochemistry and MicrobiologyOklahoma State University Center for Health SciencesTulsaOKUSA
| | - Fionnuala Ní Áinle
- Department of HaematologyUniversity College Dublin and Mater Misericordiae University HospitalDublinIreland
| | - Kirk A. Taylor
- Institute for Cardiovascular and Metabolic ResearchSchool of Biological SciencesUniversity of ReadingReadingUK
| | | | - Angela C. Weyand
- Division of Hematology and OncologyDepartment of PediatricsUniversity of Michigan Medical SchoolAnn ArborMIUSA
| | - Michelle Lavin
- Irish Centre for Vascular BiologyRCSIDublinIreland
- National Coagulation CentreSt. James’ HospitalDublinIreland
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Connell NT, James PD, Brignardello-Petersen R, Abdul-Kadir R, Ameer B, Arapshian A, Couper S, Di Paola J, Eikenboom J, Giraud N, Grow JM, Haberichter S, Jacobs-Pratt V, Konkle BA, Kouides P, Laffan M, Lavin M, Leebeek FWG, McLintock C, McRae S, Montgomery R, O'Brien SH, O'Donnell JS, Ozelo MC, Scappe N, Sidonio R, Tosetto A, Weyand AC, Kalot MA, Husainat N, Mustafa RA, Flood VH. von Willebrand disease: proposing definitions for future research. Blood Adv 2021; 5:565-569. [PMID: 33496750 PMCID: PMC7839375 DOI: 10.1182/bloodadvances.2020003620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Nathan T Connell
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Rezan Abdul-Kadir
- The Royal Free Foundation Hospital and Institute for Women's Health, University College London, London, United Kingdom
| | - Barbara Ameer
- Pharmacology Consulting, Princeton Junction, NJ
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - Jorge Di Paola
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | | | | | | | | | | | - Barbara A Konkle
- Bloodworks Northwest, Seattle, WA
- University of Washington, Seattle, WA
| | - Peter Kouides
- University of Rochester, Mary M. Gooley Hemophilia Treatment Center, Rochester, NY
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Michelle Lavin
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Claire McLintock
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Simon McRae
- Northern Cancer Service, Launceston General Hospital, Launceston, TAS, Australia
| | - Robert Montgomery
- Medical College of Wisconsin, Versiti Blood Research Institute, Milwaukee, WI
| | - Sarah H O'Brien
- Division of Hematology/Oncology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State College of Medicine, Columbus, OH
| | - James S O'Donnell
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Margareth C Ozelo
- Hemocentro UNICAMP, University of Campinas, Campinas, Sao Paulo, Brazil
| | | | - Robert Sidonio
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Alberto Tosetto
- Hemophilia and Thrombosis Center, Hematology Department, S. Bortolo Hospital, Vicenza, Italy
| | - Angela C Weyand
- Divison of Hematology/Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI; and
| | - Mohamad A Kalot
- Outcomes and Implementation Research Unit, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Nedaa Husainat
- Outcomes and Implementation Research Unit, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Reem A Mustafa
- Outcomes and Implementation Research Unit, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Veronica H Flood
- Medical College of Wisconsin, Versiti Blood Research Institute, Milwaukee, WI
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Connell NT, Flood VH, Brignardello-Petersen R, Abdul-Kadir R, Arapshian A, Couper S, Grow JM, Kouides P, Laffan M, Lavin M, Leebeek FWG, O'Brien SH, Ozelo MC, Tosetto A, Weyand AC, James PD, Kalot MA, Husainat N, Mustafa RA. ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease. Blood Adv 2021; 5:301-325. [PMID: 33570647 PMCID: PMC7805326 DOI: 10.1182/bloodadvances.2020003264] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/27/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND von Willebrand disease (VWD) is a common inherited bleeding disorder. Significant variability exists in management options offered to patients. OBJECTIVE These evidence-based guidelines from the American Society of Hematology (ASH), the International Society on Thrombosis and Haemostasis (ISTH), the National Hemophilia Foundation (NHF), and the World Federation of Hemophilia (WFH) are intended to support patients, clinicians, and health care professionals in their decisions about management of VWD. METHODS ASH, ISTH, NHF, and WFH formed a multidisciplinary guideline panel. Three patient representatives were included. The panel was balanced to minimize potential bias from conflicts of interest. The University of Kansas Outcomes and Implementation Research Unit and the McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process, including performing and updating systematic evidence reviews (through November 2019). The panel prioritized clinical questions and outcomes according to their importance to clinicians and patients. The panel used the GRADE approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 12 recommendations and outlined future research priorities. CONCLUSIONS These guidelines make key recommendations regarding prophylaxis for frequent recurrent bleeding, desmopressin trials to determine therapy, use of antiplatelet agents and anticoagulant therapy, target VWF and factor VIII activity levels for major surgery, strategies to reduce bleeding during minor surgery or invasive procedures, management options for heavy menstrual bleeding, management of VWD in the context of neuraxial anesthesia during labor and delivery, and management in the postpartum setting.
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Affiliation(s)
- Nathan T Connell
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Veronica H Flood
- Versiti Blood Research Institute, Medical College of Wisconsin, Milwaukee, WI
| | | | - Rezan Abdul-Kadir
- Department of Obstetrics and Gynaecology and Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Foundation Hospital and Institute for Women's Health, University College London, London, United Kingdom
| | | | | | - Jean M Grow
- Department of Strategic Communication, Marquette University, Milwaukee, WI
| | - Peter Kouides
- Mary M. Gooley Hemophilia Treatment Center, University of Rochester, Rochester, NY
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Michelle Lavin
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland and National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sarah H O'Brien
- Division of Hematology/Oncology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | | | - Alberto Tosetto
- Hemophilia and Thrombosis Center, Hematology Department, S. Bortolo Hospital, Vicenza, Italy
| | - Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada; and
| | - Mohamad A Kalot
- Outcomes and Implementation Research Unit, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Nedaa Husainat
- Outcomes and Implementation Research Unit, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Reem A Mustafa
- Outcomes and Implementation Research Unit, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
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Abstract
Sexism has been an issue in bleeding disorders for centuries. Women with bleeding disorders have been underrecognized and underdiagnosed. Those who are diagnosed often experience delays in diagnosis and feel that their symptoms are dismissed or minimized. Several factors contribute to this sexism. Historically, the clinical and research focus within the bleeding disorder community has been on men and hemophilia. Von Willebrand disease, a disease that has long been recognized as affecting women, is much more common than hemophilia, yet has significantly fewer resources devoted to it. The lack of knowledge and comfort that patients and health care providers have regarding menstruation compounds the issue, as heavy menstrual bleeding is one of the most common symptoms seen in women with bleeding disorders. Stemming from the universal stigmatization of periods, this lack of comfort and knowledge results in fewer women seeking care, fewer health care providers addressing the issue, and fewer women getting the care they deserve. Progress has been made, with many organizations dedicating resources to improving the care of these women. The road is long, and much more work is needed to ensure that women with bleeding disorders receive the care they deserve.
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Affiliation(s)
- Angela C. Weyand
- Department of PediatricsUniversity of Michigan Medical SchoolAnn ArborMIUSA
| | - Paula D. James
- Department of MedicineQueen’s UniversityKingstonONCanada
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Weyand AC, Zaidi AU. Tweetopoiesis: A peripheral review of twitter for hematologists. Am J Hematol 2021; 96:7-8. [PMID: 33064309 DOI: 10.1002/ajh.26017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Angela C. Weyand
- Division of Pediatric Hematology and Oncology University of Michigan Medical School Ann Arbor Michigan
| | - Ahmar U. Zaidi
- Division of Pediatric Hematology and Oncology Central Michigan University Mount Pleasant Michigan
- Children's Hospital of Michigan Detroit Michigan
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Weyand AC, Nichols DG, Freed GL. Current Efforts in Diversity for Pediatric Subspecialty Fellows: Playing a Zero-sum Game. Pediatrics 2020; 146:peds.2020-001248. [PMID: 33067344 DOI: 10.1542/peds.2020-001248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Angela C Weyand
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and
| | | | - Gary L Freed
- Susan B. Meister Child Health Evaluation and Research Center, Medical School, University of Michigan, Ann Arbor, Michigan; and
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42
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Pennesi CM, Quint EH, Rosen MW, Compton SD, Odukoya EJ, Weyand AC. Outpatient Management of Heavy Menstrual Bleeding in Adolescent and Young Women with Inherited Platelet Function Disorders. J Pediatr Adolesc Gynecol 2020; 33:489-493. [PMID: 32610148 DOI: 10.1016/j.jpag.2020.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/14/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To assess the treatment patterns and efficacy of hormonal (HM) and non-HM (NHM) management of heavy menstrual bleeding (HMB) in young women with inherited platelet function disorders (IPFDs). DESIGN, SETTING, AND PARTICIPANTS A retrospective chart review was performed of outpatient treatment of HMB in female patients age 9-25 years who were diagnosed with IPFDs and referred to gynecology and/or hematology at a tertiary care hospital between 2006 and 2018. INTERVENTIONS The study sample was identified using billing codes for IPFDs. Data on HM and NHM treatments and outcomes over a one- to two-year period were collected. Initial treatment was defined as the first treatment prescribed after referral. Descriptive statistics, Pearson χ2, and t tests were used for analysis. MAIN OUTCOME MEASURES Treatment failure was defined as a change in treatment method because of continued bleeding. RESULTS Thirty-four girls met inclusion criteria. After their initial visit, 19/34 (56%) were treated with HM, 12/34 (35%) with NHM, 2/34 (6%) with a combination of methods, and 1/34 (3%) were untreated. Initial treatment failed in 19/34 (56%) and those patients subsequently required a mean of 2 additional treatments during follow-up. Of the 34 included, 6/34 (18%) remained uncontrolled despite numerous treatment changes and 2/34 (6%) because of noncompliance. When control was achieved, 7/26 (27%) of patients were receiving combined oral contraceptives and 6/26 (23%) desmopressin acetate. CONCLUSION HMB in girls with IPFDs can be difficult to control despite ongoing follow-up and treatment changes. Although the most effective treatment for HMB in young women with IPFDs was not identified, these findings will help providers and patients with setting expectations. Prospective studies are needed to develop recommendations on best practices.
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Affiliation(s)
- Christine M Pennesi
- Michigan Medicine, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Elisabeth H Quint
- Michigan Medicine, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Monica W Rosen
- Michigan Medicine, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sarah D Compton
- Michigan Medicine, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Angela C Weyand
- Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Department of Pediatrics, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan
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43
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Rosen MW, Rominski SD, George JS, Stoffers VL, Bourdillon CM, Pennesi CM, Weyand AC, Quint EH. The utility of pelvic ultrasounds in adolescents presenting to the emergency department with heavy menstrual bleeding. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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Weyand AC, Quint EH, Freed GL. Incidence of Thyroid Disease in Adolescent Females Presenting with Heavy Menstrual Bleeding. J Pediatr 2019; 212:232-234. [PMID: 31130290 DOI: 10.1016/j.jpeds.2019.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/01/2022]
Abstract
The incidence of thyroid disease in adolescents with heavy menstrual bleeding is unknown. A retrospective cross-sectional study of 427 adolescents presenting with heavy menstrual bleeding found 0.23% (95% CI 0%-0.7%) had thyroid disease, lower than that expected in the general population. Thyroid testing should only be considered when other symptomatology is present.
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Affiliation(s)
- Angela C Weyand
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.
| | - Elisabeth H Quint
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Gary L Freed
- Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI; Division of General Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
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45
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Abstract
Hemophilia A and Hemophilia B are the most common of the severe bleeding disorders and are caused by a deficiency in blood clotting factor VIII or factor IX respectively. Factor replacement therapy has been the cornerstone of treatment to treat life threatening bleeds and prevent joint disease. The treatment of hemophilia has evolved tremendously over the past five decades from fresh frozen plasma as the only available therapy to more specific plasma-derived and recombinant-derived factor replacement. Now due to innovations in bioengineering, there are even more efficacious factor replacement options available to patients. Here we review these recent advancements and their impact on the treatment and management of hemophilia.
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Affiliation(s)
- Amanda D Sankar
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Angela C Weyand
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Steven W Pipe
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
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46
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Sengupta S, Weyand AC, Upadhyaya SA, Wu YM, Robinson DR, Mody RJ. Clinical Implications of Real-time Integrative Sequencing in Management of Patients With Suspected Germline BAP1 Mutations. J Pediatr Hematol Oncol 2019; 41:e263-e265. [PMID: 29554022 PMCID: PMC6139285 DOI: 10.1097/mph.0000000000001122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Germline mutation of BRCA-associated protein-1 has been implicated in the development of tumor predisposition syndrome and high risk for malignant mesothelioma, lung adenocarcinoma, uveal melanoma, and cutaneous melanoma. Here, we present the case of a patient with recurrent metastatic melanoma who was found to have germline BAP1 and somatic BRAF mutation by clinical genomic sequencing. Detection of a germline mutation prompted screening for other cancers and surveillance in family members. Prospective integrative sequencing for pediatric cancer patients may identify pathogenic germline mutations and may improve outcomes and treatment-related morbidity by early diagnosis of malignancy.
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Affiliation(s)
| | - Angela C. Weyand
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Yi-Mi Wu
- Division of Translational Pathology, Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Dan R. Robinson
- Division of Translational Pathology, Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Rajen J. Mody
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
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47
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Weyand AC, Dorfman AL, Shavit JA, Pipe SW. Emicizumab prophylaxis to facilitate anticoagulant therapy for management of intra‐atrial thrombosis in severe haemophilia with an inhibitor. Haemophilia 2019; 25:e203-e205. [DOI: 10.1111/hae.13721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Angela C. Weyand
- Department of Pediatrics, Division of Hematology and Oncology University of Michigan Ann Arbor Michigan
| | - Adam L. Dorfman
- Department of Pediatrics, Division of Cardiology University of Michigan Ann Arbor Michigan
| | - Jordan A. Shavit
- Department of Pediatrics, Division of Hematology and Oncology University of Michigan Ann Arbor Michigan
| | - Steven W. Pipe
- Department of Pediatrics, Division of Hematology and Oncology University of Michigan Ann Arbor Michigan
- Department of Pathology University of Michigan Ann Arbor Michigan
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48
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Weyand AC, Hristov A, Tejasvi T, Walkovich K. A diagnosis of mycosis fungoides in a pediatric patient with recurrent Langerhans cell histiocytosis. Pediatr Blood Cancer 2018; 65. [PMID: 29080377 DOI: 10.1002/pbc.26835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Angela C Weyand
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Alexandra Hristov
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Kelly Walkovich
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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49
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Weyand AC, Mody RJ, Rabah RM, Opipari VP. PD-1 inhibition in congenital pigment synthesizing metastatic melanoma. Pediatr Blood Cancer 2018; 65. [PMID: 28675691 DOI: 10.1002/pbc.26702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/23/2017] [Accepted: 06/08/2017] [Indexed: 11/08/2022]
Abstract
A newborn female child was born with a congenital pigment synthesizing melanoma of the scalp. Further workup revealed metastatic disease within the liver, lungs, and left tibia. Whole exome sequencing was performed on multiple samples that revealed one somatic mutation, lysine methyltransferase 2C (KMT2C), at low allelic frequency but no v-Raf murine sarcoma viral oncogene homolog B (BRAF), NF-1 mutation. Programmed death ligand 1 was moderately expressed. Treatment was initiated with the programmed cell death protein 1 inhibitor nivolumab. The patient tolerated this treatment well with minimal toxicity. She is now over a year out from initial diagnosis, continuing on nivolumab, with stable disease.
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Affiliation(s)
- Angela C Weyand
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Rajen J Mody
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Raja M Rabah
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Valerie P Opipari
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
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50
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Abstract
Alopecia has been observed with many anticoagulants although the mechanism is unclear. A 20 year old female with recurrent DVTs developed alopecia with multiple anticoagulants, including heparin derivatives and the new oral anticoagulants. This resolved with discontinuation of the agents. The patient was ultimately able to be anticoagulated with fondaparinux long term without any alopecia. This case addresses the Key Clinical Question of management and recognition of anticoagulant induced alopecia. This side effect can result from almost any of the available agents and is quickly reversible, underlining the importance of tailoring treatment to the individual and their experiences.
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Affiliation(s)
- Angela C Weyand
- University of Michigan Medical School, Department of Pediatrics and Communicable Diseases, Division of Pediatric Hematology and Oncology, 8200 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, (ph) 734-615-8232
| | - Jordan A Shavit
- University of Michigan Medical School, Department of Pediatrics and Communicable Diseases, Division of Pediatric Hematology and Oncology, 8200 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, (ph) 734-615-8232, @clot1
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