1
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McLaughlin P, Hurley M, Chowdary P, Stephensen D, Khair K. The experiences and beliefs of people with severe haemophilia and healthcare professionals on pain management, and their views of using exercise as an aspect of intervention: a qualitative study. Disabil Rehabil 2022; 44:8420-8428. [PMID: 34951552 DOI: 10.1080/09638288.2021.2018054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To explore the experiences, views and beliefs of people with severe haemophilia and healthcare professionals (HCPs) on approaches for pain management, as well as their views on exercise being used as an aspect of management. METHODS Taking a qualitative inquiry approach using focus groups and semi-structured interviews, participants included people with severe haemophilia living with chronic pain and haemophilia HCPs. Data were analysed using reflexive thematic analysis. RESULTS Fourteen men with haemophilia with a median age of 47 (range 23-73) and six haemophilia HCPs agreed to participate. Of the people with haemophilia, 11 attended two focus groups and three were interviewed over telephone. Healthcare professionals were interviewed face-to-face. Two themes were conceptualised from the data: (i) haemophilia management and pain management is discordant (imbalance between good haemophilia care but poor pain management, historical medico-social influences on pain management, the need for trust); (ii) uncertain about exercise but clear on what matters (conflicting views on exercise, the need for proof of safety, personalised care). CONCLUSIONS Options for effective pain management remain limited and what is used is heavily influenced by beliefs and experience. Exercise as a treatment option in pain management is conceptually acceptable for people with haemophilia. Effective pain management requires understanding of individual beliefs and fears, and a personalised approach supported by knowledgeable, trusted clinicians.Implications for rehabilitationMusculoskeletal joint pain and its relationship with bleeding in people with haemophilia continues to be a management challenge.Current pain management strategies are of limited effectiveness with little evidence of an approach that reflects the multi-modal pain experience.Whilst exercise and rehabilitation approaches are conceptually possible for people with severe haemophilia, barriers remain regarding perception of overall safety and effectiveness.People with severe haemophilia may consider exercise as part of a pain management strategy if it is individualised, and they are supported to do it by clinicians who understand them and their haemophilia.
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Affiliation(s)
- P McLaughlin
- St George's University of London and Kingston University, London, UK.,Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - M Hurley
- St George's University of London and Kingston University, London, UK
| | - P Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - D Stephensen
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - K Khair
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID) Research Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Haemnet, London, UK
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2
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McLaughlin P, Hurley M, Chowdary P, Stephensen D, Khair K. How does a lifetime of painful experiences influence sensations and beliefs about pain in adults with severe haemophilia? A qualitative study. Disabil Rehabil 2022; 44:8412-8419. [PMID: 34951551 DOI: 10.1080/09638288.2021.2018053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To explore the life experiences of pain in people with severe haemophilia and understand how such experiences influence beliefs and sensation of pain in adulthood. METHODS A qualitative inquiry approach using focus groups and semi-structured individual interviews was used. Participants included people with severe haemophilia living with chronic pain. Data were analysed using reflexive thematic analysis. RESULTS Fourteen men with a median age of 47 (range 23-73) agreed to take part. Eleven participated in two focus groups and three were interviewed over telephone. Two themes were conceptualised from the data: (i) haemophilia and pain - an evolving life biography (the personal narrative, historical, social, and medical context, continuous adaptation of activity choices, surveillance of pain and its meaning); (ii) "My normal isn't normal" - identity and self-agency (pain as a feature of life and identify with severe haemophilia, loss of enjoyable activities balanced against staying active, barriers to participation). CONCLUSIONS Pain is a constantly evolving, lifetime feature for many adults with haemophilia and it is viewed as part of their identity with their condition. Healthcare professionals working in haemophilia should try to better understand the influence of an individuals lived experience with their haemophilia on beliefs and behaviours of pain.Implications for rehabilitationSevere haemophilia is a rare bleeding disorder that results in musculoskeletal joint disease.Adults with severe haemophilia have experienced multiple episodes of bleeding related musculoskeletal pain since childhood.Pain beliefs and behaviours in adulthood appear to be influenced by a lifetime of painful experiences associated with haemophilia.In order to better support people with haemophilia and chronic pain, healthcare professionals in haemophilia need to better understand how an individuals lived experience of pain helps inform their beliefs about it.
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Affiliation(s)
- P McLaughlin
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK.,Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - M Hurley
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
| | - P Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - D Stephensen
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - K Khair
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID) Research Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Haemnet, London, UK
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Wilding J, Zourikian N, Di Minno M, Khair K, Marquardt N, Benson G, Ozelo M, Hermans C. Obesity in the global haemophilia population: prevalence, implications and expert opinions for weight management. Obes Rev 2018; 19:1569-1584. [PMID: 30188610 DOI: 10.1111/obr.12746] [Citation(s) in RCA: 24] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/24/2018] [Indexed: 12/18/2022]
Abstract
Overweight and obesity may carry a significant disease burden for patients with haemophilia (PWH), who experience reduced mobility due to joint inflammation, muscle dysfunction and haemophilic arthropathy. This review aimed to define the prevalence and clinical impact of overweight/obesity in the global population of PWH. A detailed literature search pertaining to overweight/obesity in haemophilia in the last 15 years (2003-2018) was conducted, followed by a meta-analysis of epidemiological data. The estimated pooled prevalence of overweight/obesity in European and North American PWH was 31%. Excess weight in PWH is associated with a decreased range in motion of joints, accelerated loss of joint mobility and increase in chronic pain. Additionally, the cumulative disease burden of obesity and haemophilia may impact the requirement for joint surgery, occurrence of perioperative complications and the prevalence of anxiety and depression that associates with chronic illness. Best practice guidelines for obesity prevention and weight management, based on multidisciplinary expert perspectives, are considered for adult and paediatric PWH. Recommendations in the haemophilia context emphasize the importance of patient education and tailoring engagement in physical activity to avoid the risk of traumatic bleeding.
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Affiliation(s)
- J Wilding
- Obesity and Endocrinology Research Group, Institute of Ageing and Chronic Disease, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - N Zourikian
- Pediatric/Adult Comprehensive Hemostasis Center, CHU Sainte-Justine/Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - M Di Minno
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - K Khair
- Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children, London, UK
| | - N Marquardt
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - G Benson
- Northern Ireland Haemophilia Comprehensive Care Centre and Thrombosis Unit, Belfast City Hospital, Belfast, UK
| | - M Ozelo
- International Haemophilia Training Centre (IHTC) 'Claudio L.P. Correa', INCT do Sangue Hemocentro UNICAMP, University of Campinas, Campinas, Brazil
| | - C Hermans
- Division of Haematology, Haemostasis and Thrombosis Unit, Haemophilia Clinic, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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von Mackensen S, Hilberg T, Valentino LA, Kurnik K, Khair K. Validation of the Haemophilia & Exercise Project-Test-Questionnaire (HEP-Test-Q)-An instrument for the assessment of subjective physical functioning in children with haemophilia. Haemophilia 2018; 24:888-895. [PMID: 30004619 DOI: 10.1111/hae.13533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Contemporary haemophilia management recommends sport and physical activity in children with haemophilia. Assessment of subjective physical functioning requires standardized and validated instruments. AIMS To adapt and psychometrically test the adult Haemophilia & Exercise Project-Test-Questionnaire (HEP-Test-Q) for children (aged 6-17 years). METHODS In discussion rounds with children, single items of the adult HEP-Test-Q were reformulated to make them understandable without changing the item concept. The validation of the child-adapted version in children with haemophilia (n = 228) included pre-testing with feasibility testing, cognitive interviewing (n = 34), pilot-testing of the revised version in the EIS Study (n = 67) and field-testing in the SO-FIT Study (n = 127). RESULTS Pre-testing revealed a completion time of 8.2 ± 4.1 minutes and children liked the instrument. Cognitive interviews demonstrated that most items were easy to understand; 9 items were reformulated. Pilot-testing demonstrated good psychometric characteristics in terms of reliability (α = .94 Total Score) and validity. Convergent validity testing showed moderate correlations with the Haemo-QoL (r = -.491), but low correlations with the Petrini Score (r = -.293). Known groups' validity revealed significant differences in clinical subgroups; chronic pain (P < .002) and target joints (P < .021). Field-testing confirmed psychometric characteristics; Cronbach's alpha ranged from α = .80 ("endurance") to α = .94 (Total Score). The child-adapted HEP-Test-Q showed moderate correlations with the PedHAL (r = .634, P < .0001) and the Haemo-QoL SF (r = -.575, P < .0001). Known groups' validity testing proved that the HEP-Test-Q could discriminate between clinical subgroups. CONCLUSION The child-adapted HEP-Test-Q is a short, practical and acceptable instrument for the assessment of subjective physical functioning. Outcomes can be compared to adults because item concepts are identical to the adult version.
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Affiliation(s)
- S von Mackensen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | | | - K Kurnik
- Department of Paediatric Haemostasis, University Children's Hospital, Munich, Germany
| | - K Khair
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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Carpenter SL, Khair K, Gringeri A, Valentino LA. Prophylactic bypassing agent use before and during immune tolerance induction in patients with haemophilia A and inhibitors toFVIII. Haemophilia 2018; 24:570-577. [DOI: 10.1111/hae.13534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 01/11/2023]
Affiliation(s)
- S. L. Carpenter
- Hematology/OncologyUniversity of Missouri Kansas City School of Medicine Kansas City MO USA
- Kansas City Regional Hemophilia Treatment Center Kansas City MO USA
- Children's Mercy Hospital Kansas City MO USA
| | - K. Khair
- Great Ormond Street Hospital London UK
- London South Bank University London UK
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Khair K, Mazzucconi MG, Parra R, Santagostino E, Tsakiris DA, Hermans C, Oldenburg J, Spotts G, Steinitz-Trost K, Gringeri A. Pattern of bleeding in a large prospective cohort of haemophilia A patients: A three-year follow-up of the AHEAD (Advate in HaEmophilia A outcome Database) study. Haemophilia 2017; 24:85-96. [DOI: 10.1111/hae.13361] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/19/2023]
Affiliation(s)
- K. Khair
- Haemophilia Comprehensive Care Centre; Great Ormond Street Hospital for Children; NHS Foundation Trust; London UK
| | | | - R. Parra
- Unidad de Hemofilia-Banc de Sang i Teixits; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - E. Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Fondazione Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - D. A. Tsakiris
- Diagnostic Hematology; University Hospital; Basel Switzerland
| | - C. Hermans
- Haemophilia Clinic; Division of Haematology; St-Luc University Hospital; Brussels Belgium
| | - J. Oldenburg
- Institute for Experimental Hematology and Transfusion Medicine; Bonn University Clinic; Bonn Germany
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Khair K, Holland M, Bladen M, Griffioen A, McLaughlin P, von Mackensen S. Study of physical function in adolescents with haemophilia: The SO-FIT study. Haemophilia 2017; 23:918-925. [PMID: 28806864 DOI: 10.1111/hae.13323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Contemporary haemophilia care demands Patient-Reported Outcomes. SO-FIT is a UK multi-centre study, assessing self-reported function, health-related quality of life (HRQoL) and joint health in boys with severe haemophilia. METHODS Subjective physical function (PedHAL, HEP-Test-Q) and HRQoL (Haemo-QoL Short Form [SF]) were assessed alongside joint health using the objective Haemophilia Joint Health Score (HJHS v2.1). Demographic and clinical data were collected. RESULTS Data from 127 boys mean age 12.38 ± 2.5 (range 8-17) treated at 16 sites were analysed. One-hundred-and-thirteen had haemophilia A, 25/9 past/current inhibitor, 124 were treated prophylactically (46.8% primary) and three on-demand. In the preceding 6 months, boys reported median 0 joint bleeds (range 0-8) with a median HJHS score of 1 (range 0-30). Boys reported good physical functioning; HEP-Test-Q (M = 80.32 ± 16.1) showed the highest impairments in the domain "endurance" (72.53 ± 19.1), in PedHAL (M = 85.44 ± 18.9) highest impairments were in the domains "leisure activities & sports" (M = 82.43 ± 23.4) and "lying/sitting/kneeling/standing" (M = 83.22 ± 20.3). Boys reported generally good HRQoL in Haemo-QoL SF SF (M = 22.81 ± 15.0) with highest impairments in the domains "friends" (M = 28.81 ± 30.5) and "sports & school" (M = 26.14 ± 25.1). HJHS revealed low correlations with the Haemo-QoL SF (r = .251, P < .006), the PedHAL (r = -.397, P < .0001) and the HEP-Test-Q (r = -.323, P < .0001). A moderate correlation was seen between HEP-Test-Q and Haemo-QoL SF of r = -.575 (P < .0001) and between PedHAL and Haemo-QoL SFr = -.561 (P < .0001) implying that good perceived physical function is related to good HRQoL. CONCLUSIONS The SO-FIT study has demonstrated that children with severe haemophilia in the UK report good HRQoL and have good joint health as reflected in low HJHS scores.
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Affiliation(s)
- K Khair
- Haemophilia Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - M Bladen
- Haemophilia Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Griffioen
- Haemophilia Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - P McLaughlin
- Katharine Dormandy Haemophilia Centre & Thrombosis Unit, Royal Free NHS Foundation Trust, London, UK
| | - S von Mackensen
- Institute of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Khair K, Ranta S, Thomas A, Lindvall K. The impact of clinical practice on the outcome of central venous access devices in children with haemophilia. Haemophilia 2017; 23:e276-e281. [DOI: 10.1111/hae.13241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- K. Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - S. Ranta
- Karolinska University Hospital; Stockholm Sweden
| | - A. Thomas
- Royal Hospital for Sick Children; Edinburgh UK
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9
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von Mackensen S, Harrington C, Tuddenham E, Littley A, Will A, Fareh M, Hay CRM, Khair K. The impact of sport on health status, psychological well-being and physical performance of adults with haemophilia. Haemophilia 2016; 22:521-30. [DOI: 10.1111/hae.12912] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 12/16/2022]
Affiliation(s)
- S. von Mackensen
- Institute of Medical Psychology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - C. Harrington
- Katherine Dormandy Haemophilia Centre and Haemostasis Unit; Royal Free London NHS Foundation Trust; London UK
| | - E. Tuddenham
- Katherine Dormandy Haemophilia Centre and Haemostasis Unit; Royal Free London NHS Foundation Trust; London UK
| | - A. Littley
- Haemophilia Centre; Royal Manchester Children's Hospital; Central Manchester Foundation Trust; Manchester UK
| | - A. Will
- Haemophilia Centre; Royal Manchester Children's Hospital; Central Manchester Foundation Trust; Manchester UK
| | - M. Fareh
- University Dept of Haematology Manchester Royal Infirmary; Manchester UK
| | - C. R. M. Hay
- University Dept of Haematology Manchester Royal Infirmary; Manchester UK
| | - K. Khair
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
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10
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Bladen M, Main E, Khair K, Hubert N, Koutoumanou E, Liesner R. The incidence, risk and functional outcomes of intracranial haemorrhage in children with inherited bleeding disorders at one haemophilia center. Haemophilia 2016; 22:556-63. [DOI: 10.1111/hae.12938] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M. Bladen
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - E. Main
- Institute of Child Health; University College London; London UK
| | - K. Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - N. Hubert
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - E. Koutoumanou
- Institute of Child Health; University College London; London UK
| | - R. Liesner
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
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Rambod M, Forsyth K, Sharif F, Khair K. Assessment and management of pain in children and adolescents with bleeding disorders: a cross-sectional study from three haemophilia centres. Haemophilia 2015; 22:65-71. [DOI: 10.1111/hae.12765] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 12/24/2022]
Affiliation(s)
- M. Rambod
- Department of Medical Surgical; Community Based Psychiatric Care Research Center; School of Nursing and Midwifery; Shiraz University of Medical Sciences; Shiraz Iran
| | - K. Forsyth
- Clinical Nurse Specialist-Haemophilia; Royal London Hospital; London UK
| | - F. Sharif
- Department of Mental Health and Psychiatric Nursing; Community Based Psychiatric Care Research Center; School of Nursing and Midwifery; Shiraz University of Medical Sciences; Shiraz Iran
| | - K. Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
- Health and Social Care; London South Bank University; London UK
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12
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Bladen M, Khair K, Koutoumanou E, Leisner R, Hubert N, Main E. The incidence, risk and functional outcomes of intracranial haemorrhage in children with inherited bleeding disorders. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1776] [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: 11/25/2022]
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Kessler C, Oldenburg J, Ettingshausen CE, Tiede A, Khair K, Négrier C, Klamroth R. Spotlight on the human factor: building a foundation for the future of haemophilia A management. Haemophilia 2014; 21 Suppl 1:1-12. [DOI: 10.1111/hae.12582] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- C. Kessler
- Division of Hematology and Oncology; The Vincent Lombardi Comprehensive Cancer Center; Georgetown University Medical Center; Washington, DC USA
| | - J. Oldenburg
- The Institute of Experimental Haematology and Transfusion Medicine and the Haemophilia Centre at the University Clinic; Bonn Germany
| | | | - A. Tiede
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School; Hannover Germany
| | - K. Khair
- Great Ormond Street Hospital for Children NHS Trust; London UK
| | - C. Négrier
- Hematology Division; Director Hemophilia Comprehensive Care Center; Hôpital Edouard Herriot Pavillon E; Université Lyon; Lyon France
| | - R. Klamroth
- The Haemophilia Treatment Centre; Vivantes Klinikum im Friedrichshain; Berlin Germany
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14
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Affiliation(s)
- K. Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
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15
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Khair K, Batty P, Riat R, Bowles L, Burgess C, Chen YH, Hart D, Platton S, Pasi J, Liesner R. Wilate use in 47 children with von Willebrand disease: the North London paediatric haemophilia network experience. Haemophilia 2014; 21:e44-50. [DOI: 10.1111/hae.12497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- K. Khair
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - P. Batty
- The Royal London Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; London UK
| | - R. Riat
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - L. Bowles
- St Bartholome w's Hospital; Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; London UK
| | - C. Burgess
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - Y. -H. Chen
- The Royal London Haemophilia Centre London; Barts and The London School of Medicine and Dentistry; QMUL; London UK
| | - D. Hart
- Barts and The London School of Medicine and Dentistry; Haematology; The Royal London Hospital; London UK
| | - S. Platton
- The Royal London Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; London UK
| | - J. Pasi
- Barts and The London; Centre for Haematology ICMS; The Royal London Haemophilia Centre London; Barts and The London School of Medicine and Dentistry; QMUL; London UK
| | - R. Liesner
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
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Khair K, Holland M, Pollard D. The experience of girls and young Women with inherited bleeding disorders. Haemophilia 2013; 19:e276-81. [DOI: 10.1111/hae.12155] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- K. Khair
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London; UK
| | | | - D. Pollard
- Haemophilia Centre; Royal Free Hospital; London; UK
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Forrester C, Bielby H, Johns S, Efford J, Holland M, Khair K. Potential for development of haemophilia link nurse role within UK hospitals. Haemophilia 2013; 19:578-82. [DOI: 10.1111/hae.12144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- C. Forrester
- North Staffordshire Haemophilia Centre; University Hospital of North Staffordshire; Stoke On Trent; UK
| | - H. Bielby
- Department of Haematology; York Teaching Hospital NHS Foundation Trust; York; UK
| | - S. Johns
- Truro Haemophilia Centre; Royal Cornwall Hospitals; Truro; UK
| | - J. Efford
- The Haemophilia Centre; Great Ormond Street Hospital for Children NHS Trust; London; UK
| | | | - K. Khair
- The Haemophilia Centre; Great Ormond Street Hospital for Children NHS Trust; London; UK
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Bladen M, Main E, Hubert N, Koutoumanou E, Liesner R, Khair K. Factors affecting the Haemophilia Joint Health Score in children with severe haemophilia. Haemophilia 2013; 19:626-31. [PMID: 23534671 DOI: 10.1111/hae.12108] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2013] [Indexed: 11/30/2022]
Abstract
Joint damage from bleeding episodes leads to physical or functional limitations in people with haemophilia. Various factors may influence the frequency and severity of joint damage. This study examined whether age, prophylaxis, history of high-titre inhibitors (HTI) and bleeding events influenced the Haemophilia Joint Health Score (HJHS) in children. Medical and physiotherapy notes of boys with severe haemophilia, aged 4-18 years, were reviewed to identify factors associated with increased HJHS. The HJHS of 83 boys (median age: 11) ranged from 0 to 25, with 44/83 (53%) having a score of zero. The median HJHS was 0 (mean 2.6). In the non-HTI group, the HJHS for boys on late prophylaxis was 2.68 times higher than those who started early and the HJHS was on average 10% higher for every additional recent bleed. In this group the odds of having a zero score fell by 30% for every year increase in age. Boys with a history of HTI had higher HJHS scores than the non-HTI group, and age, number of recent bleeds and tolerized status were positively associated with HJHS. The score rose on average by 28% for every year of age and by 76% for non-tolerized boys. This study provides further evidence supporting early prophylaxis use and the importance of immune tolerance therapy. The HJHS is a useful tool for identifying and tracking changes in joint health with respect to therapy or disease progression. With improvements in haemophilia treatment, the disproportionate number of zero scores will continue to make interpretation of the HJHS challenging.
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Affiliation(s)
- M Bladen
- Haemophilia Centre, Great Ormond St Hospital for Children, NHS Foundation Trust, London, UK.
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Mathias M, Tunstall O, Khair K, Liesner R. Management of surgical procedures in children with severe FV deficiency: experience of 13 surgeries. Haemophilia 2012; 19:256-8. [DOI: 10.1111/hae.12053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/27/2022]
Affiliation(s)
- M. Mathias
- Great Ormond Street Hospital of Children NHS Foundation Trust; London; UK
| | - O. Tunstall
- Bristol Haemophilia Centre; Bristol Royal Hospital for Children; Bristol; UK
| | - K. Khair
- Great Ormond Street Hospital of Children NHS Foundation Trust; London; UK
| | - R. Liesner
- Great Ormond Street Hospital of Children NHS Foundation Trust; London; UK
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Affiliation(s)
- K. Khair
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Trust; London; UK
| | - A. Littley
- Haemophilia Centre; Central Manchester Foundation Trust; Manchester; UK
| | - A. Will
- Haemophilia Centre; Central Manchester Foundation Trust; Manchester; UK
| | - S. von Mackensen
- University Medical Centre; Institute of Medical Psychology; Hamburg; Germany
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Abstract
Purpura fulminans (PF) is a haematological emergency in which there is skin necrosis and disseminated intravascular coagulation. This may progress rapidly to multi-organ failure caused by thrombotic occlusion of small and medium-sized blood vessels. PF may complicate severe sepsis or may occur as an autoimmune response to otherwise benign childhood infections. PF may also be the presenting symptom of severe heritable deficiency of the natural anticoagulants protein C or protein S. Early recognition and treatment of PF is essential to reduce mortality and to prevent major long-term health sequelae. However, management strategies require accurate identification of the underlying cause. This review focuses on the clinical features, differential diagnosis and laboratory features of the range of PF disorders and includes expert consensus opinion about immediate and on-going management.
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Affiliation(s)
- E Chalmers
- Haemophilia Centre, Yorkhill Children's Hospital, Glasgow, UK
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22
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Abstract
Intracranial haemorrhages (ICH) in children with haemophilia are rare, and the outcome is variable, ranging from no apparent impairment to death. The aim of this investigation was to identify if children with haemophilia and ICH, have any long-term problems with motor function, visual motor integration or strengths and difficulties compared with a control group. A review of the Haemophilia Database at Great Ormond Street Hospital for Children NHS Trust was undertaken to identify boys with haemophilia and a history of ICH, as well as a control group of peers with no such history. Boys were born between January 1994 and December 2002. All boys were assessed using the movement Assessment Battery for Children, the Developmental Test of Visual Motor Integration and The Strengths and Difficulties Questionnaire as standardized assessments of motor competence, visual motor integration and behavioural difficulties. Six boys with haemophilia and ICH and 11 controls (mean age: 7 years; range: 4-12 years) were assessed. Children with ICH were significantly more likely to have problems with motor function and visual motor integration (Fisher's exact: P < 0.05). In addition, they had a tendency towards more problems with strengths and difficulties than their peer group (Fisher's exact: P = 0.06). Five of the six boys who had sustained an ICH were in mainstream schools; four requiring assistance with their education. The results of this small study suggest that ICH may signify long-term consequences for boys with haemophilia. The multidisciplinary team need to be aware of the rare but potentially important impact on motor function, visual motor integration and behaviour, which may inhibit the child from functioning optimally. An agreed comprehensive battery of assessments in collaboration with schools and healthcare workers is required to identify impairments to enable prompt interventions to be co-ordinated.
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Affiliation(s)
- M Bladen
- Haemophilia Centre, Great Ormond Street Hospital for Sick Children NHS Trust, London, UK.
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23
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Abstract
Glanzmann thrombasthenia (GT) is a rare autosomal recessive platelet function disorder. Stem cell transplantation (SCT) is curative, but it is only indicated in selected patients with a severe clinical phenotype or who develop anti-platelet antibodies. SCT have previously been limited to full intensity myeloablative conditioning regimens. This study details the successful outcome of SCT in five consecutive patients with GT, three of whom received reduced intensity conditioning (RIC) with stem cells from non-sibling donors. This is the first time RIC SCT has been reported in GT, and offers the possibility of curative therapy with reduced late effects.
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Affiliation(s)
- P Connor
- Department of Haematology, Central Middlesex Hospital, North West London NHS Trust, London, UK.
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Bladen M, Alderson L, Khair K, Liesner R, Green J, Main E. Can early subclinical gait changes in children with haemophilia be identified using the GAITRite�walkway. Haemophilia 2007; 13:542-7. [PMID: 17880441 DOI: 10.1111/j.1365-2516.2007.01429.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Development of haemophilic arthropathy has long-term implications for functional mobility in people with haemophilia, but early manifestations are often asymptomatic and difficult to identify. Earlier identification of joint damage may improve outcomes. The aim of this case note review was to determine whether the GAITRite system (electronic pressure sensitive walkway) could identify early changes in gait patterns in boys with haemophilia compared with their peers. Clinic data from medical and physiotherapy notes of boys with severe haemophilia were compared with data from age and leg length-matched controls. Data from two consecutive walks at preferred speed were collected on all participants using the GAITRite system. Clinic assessment notes from 26 boys (aged 7-17 years) with severe haemophilia were identified. Of these, 20 boys had no evidence of joint pathology on assessment and six boys had radiographic evidence of arthropathy. When these data were compared with normal controls, there were statistically significant increases in swing time, stance time, single support and double support in the asymptomatic group (P < 0.01) suggesting subtle early compensatory changes in gait pattern. The children with arthropathy had additional significant differences in their gait compared with matched controls. These differences included normalized velocity, step length, stride length, step time and base of support (P < 0.01). The GAITRite system appears sensitive enough to identify early subtle changes in gait and differentiate between asymptomatic boys with haemophilia and those with arthropathy in comparison with a matched control group. The electronic walkway is an accessible and portable means of providing quantitative gait analysis in the clinical environment. This is an important finding as early identification of gait changes may provide clinicians with the opportunity to intervene with the aim of arresting progression of joint damage.
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Affiliation(s)
- M Bladen
- Haemophilia Centre, Great Ormond St. Hospital, Great Ormond Street, London, UK.
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Khair K, Baker K, Mathias M, Burgess C, Liesner R. Intranasal desmopressin (OctimTM): a safe and efficacious treatment option for children with bleeding disorders. Haemophilia 2007; 13:548-51. [PMID: 17880442 DOI: 10.1111/j.1365-2516.2007.01519.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Desmopressin (1-deamino-8-D-arginine vasopressin (DDAVP)) has been shown to be an effective treatment option when administered both intravenously [1,2] and subcutaneously [3] to children with inherited bleeding disorders. We demonstrate here, both the efficacy and acceptability of a new intranasal DDAVP preparation, providing a cost effective treatment with good outcomes for children with bleed disorders.
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Affiliation(s)
- K Khair
- Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Abstract
Economic and political factors have led to the increased use of home therapy programmes for patients who have traditionally been treated in hospital. Many patients with hereditary angioedema (HAE) experience intermittent severe attacks that affect their quality of life and may be life-threatening. These attacks are treated with C1-inhibitor concentrate which, for most patients, is infused at the local hospital. Home therapy programmes for HAE are currently being established. This paper reviews the extent of use of these programmes and summarizes the advantages and potential disadvantages of the concept so far.
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Affiliation(s)
- H J Longhurst
- Barts and The London NHS Trust, Department of Immunopathology, London, UK.
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27
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Abstract
Alloimmune FVIII and FIX inhibitors are the most serious complication of haemophilia in the postviral contamination era and their optimal management remains controversial. We present 15 boys with severe haemophilia (14 with haemophilia A and 1 with haemophilia B) who have received immune tolerance at our centre over a 9-year period. Twelve of them (80%) were successfully tolerized with varying dose intensities, but three of them (including the boy with haemophilia B) failed tolerization. The factors, which were associated with successful tolerance in our group, were a low maximum inhibitor titre and a short interval between diagnosis of the inhibitor and the start of immune tolerance. The time taken to achieve immune tolerance varied from 1 to 27 months and none of the inhibitors have recurred. Two of the three boys who failed immune tolerance had had their inhibitor for 72 and 69 months, respectively before tolerance was attempted.
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Affiliation(s)
- M Mathias
- Haemophilia Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
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28
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Abstract
Children born with severe homozygous protein C deficiency do not survive beyond the neonatal period unless they receive protein C replacement. Protein C concentrate (Baxter Biosciences, Vienna) is usually given intravenously via a central venous catheter The authors describe 2 children in whom protein C concentrate was successfully administered by subcutaneous infusion after they had had recurrent central line infections. Alternate daily doses of 250-350 IU/kg resulted in trough protein C levels of > 25 IU/dL. In the follow-up period of 1-2 years neither child has had a thrombotic episode or purpuric skin lesions, and infusions are managed in the home by their parents.
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Affiliation(s)
- M Mathias
- Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Poon MC, D'Oiron R, Von Depka M, Khair K, Négrier C, Karafoulidou A, Huth-Kuehne A, Morfini M. Prophylactic and therapeutic recombinant factor VIIa administration to patients with Glanzmann's thrombasthenia: results of an international survey. J Thromb Haemost 2004; 2:1096-103. [PMID: 15219192 DOI: 10.1111/j.1538-7836.2004.00767.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antibodies to glycoprotein (GP) IIb-IIIa and/or HLA may render platelet transfusions ineffective to stop bleeding or to cover surgery in patients with Glanzmann's thrombasthenia (GT). Anecdotal reports suggest recombinant factor (rF)VIIa might be a therapeutic alternative in these situations. OBJECTIVES An international survey was conducted to evaluate further the efficacy and safety of rFVIIa in GT patients. PATIENTS We analyzed the use of rFVIIa during 34 surgical/invasive procedures and 108 bleeding episodes in 59 GT patients including 29 with current or previous antiplatelet antibodies, and 23 with a history of refractoriness to platelet transfusion. RESULTS rFVIIa was effective in 29 of the 31 evaluable procedures, and in 77 of the 103 evaluable bleeding episodes of which eight had a recurrence. A significantly higher success rate was observed in severe bleeding episodes when an arbitrarily defined 'optimal regimen' derived from the Canadian pilot study results (> or = 80 micro g kg(-1) rFVIIa/injection, dosing interval < or = 2.5 h, three or more doses before failure declaration) was used compared with other regimens (77%; 24/31 vs. 48%, 19/40; chi(2), P = 0.010). Patients given maintenance doses had significantly fewer recurrences within 48 h of bleed cessation compared with those not given any (Fisher's exact test, P = 0.022). One thromboembolic event and one blood clot in the ureter occurring in surgical patients following prolonged continuous infusion of high-dose rFVIIa and antifibrinolytic drug use have been previously reported. CONCLUSION rFVIIa seems a potential alternative to platelet transfusion in GT patients, particularly in those with antiplatelet antibodies and/or platelet refractoriness.
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Affiliation(s)
- M-C Poon
- Centre d'Hémophiles, AP-HP Hôpital Bicêtre, Le Kremlin Bicêtre, France.
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30
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Gringeri A, von Mackensen S, Auerswald G, Bullinger M, Perez Garrido R, Kellermann E, Khair K, Lenk H, Vicariot M, Villar A, Wermes C. Health status and health-related quality of life of children with haemophilia from six West European countries. Haemophilia 2004; 10 Suppl 1:26-33. [PMID: 14987246 DOI: 10.1111/j.1355-0691.2004.00876.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A multicentre, international, cross-sectional study was carried out in the frame of field testing of the first haemophilia-specific quality-of-life (QoL) questionnaire (Haemo-QoL). The aim of this paper is to describe health status and health care and their impact on QoL in haemophilic children in Western Europe. Children aged 4-16 years with severe haemophilia without inhibitors were enrolled by 20 centres in France, Germany, Italy, the Netherlands, Spain and the United Kingdom. Clinical information was collected by the physicians with a medical documentation form. Health-related QoL (HRQoL) of children was assessed with Haemo-QoL, available for three age groups. Clinical data were available in 318 patients, 85.5% with haemophilia A. The mean age at first bleeding was 11 months, at first joint bleed 25 months. Functional joint impairments were found in 11.3%. Prophylaxis treatment was given to 66.7% of children in whom breakthrough bleeds occurred 0.4 times a month compared to 1.1 bleeds in children receiving on-demand treatment. A significantly higher factor consumption was found only in the two younger age groups of prophylaxis patients compared to on-demand patients. HRQoL was satisfactory in this cohort: young children were impaired mainly in the dimension 'family' and 'treatment', whereas older children had higher impairments in the so-called 'social' dimensions, such as 'perceived support' and 'friends'. Health care of children in Western Europe is progressively improving with a large diffusion of home treatment and prophylaxis. This provides a high level of health status and HRQoL, being better in haemophilic adolescents on prophylaxis.
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Affiliation(s)
- A Gringeri
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Internal Medicine, IRCCS Maggiore Hospital and University of Milan, Milan, Italy.
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31
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Abstract
Factor XIII deficiency is a rare inherited bleeding disorder that is often difficult to diagnose. The standard screening tests are normal in these patients and their bleeding phenotype may be variable. We report the case of a 3-year-old girl who presented with an intracranial haemorrhage. Several confounding factors, such as the suspicion of an arteriovenous malformation and the development of a deep venous thrombosis, led to a delay in the diagnosis of factor XIII deficiency. Subsequently, her brother was also found to have severe factor XIII deficiency. This case highlights the importance of a detailed history and of screening families in which index cases have been identified. It should also remind physicians that bleeding disorders may have unusual presentations and should be sought when investigating unexplained bleeding.
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Affiliation(s)
- A Almeida
- Department of Haematology, Great Ormond Street Hospital, Great Ormond Street, London, UK
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Harrison P, Robinson M, Liesner R, Khair K, Cohen H, Mackie I, Machin S. The PFA-100: a potential rapid screening tool for the assessment of platelet dysfunction. Clin Lab Haematol 2002; 24:225-32. [PMID: 12181026 DOI: 10.1046/j.1365-2257.2002.00451.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The PFA-100 is a device that simulates high shear dependent platelet function in vitro and thus is particularly useful for screening for von Willebrand's disease (VWD). The aim of this study was to assess the overall potential of the PFA-100 as a primary clinical screening tool using the wide spectrum of clinical samples assessed for platelet function within our institution. The PFA-100 test was performed using both collagen/ADP (CADP) and collagen/epinephrine (CEPI) cartridges on samples from 337 patients with a wide variety of haemostatic defects. One hundred and eighty-two patients were defined as having normal platelet function based on classical laboratory tests and von Willebrand factor levels. The overall clinical sensitivity of the PFA-100 for platelet abnormalities (including VWD) was 81% for CADP and 86% for CEPI. The overall specificity was found to be 82% for CADP and 80% for CEPI. When utilizing both cartridges in combination (with both results either higher or lower than the upper cutoff of the normal ranges), the overall false positive and false negative rates were 12% and 6%, respectively. The PFA-100 proved to be sensitive in detecting classical defects by giving prolonged closure times in samples from patients with major platelet function defects (e.g. von Willebrand's disease, Glanzmann's thrombasthenia and Bernard Soulier syndrome). However, there were a small number of false negative results (6%) obtained with various milder platelet defects (e.g. Hermansky Pudlak syndrome, storage pool and release defects, type I VWD and macrothrombocytopenia). The PFA-100 test provides a useful rapid screening tool and should increase the efficiency and reduce the cost of the routine diagnosis of platelet dysfunction.
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Affiliation(s)
- Paul Harrison
- Haemostasis Research, Department of Haematology, University College Hospital, London, UK.
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Harrison C, Khair K, Baxter B, Russell-Eggitt I, Hann I, Liesner R. Hermansky-Pudlak syndrome: infrequent bleeding and first report of Turkish and Pakistani kindreds. Arch Dis Child 2002; 86:297-301. [PMID: 11919112 PMCID: PMC1719163 DOI: 10.1136/adc.86.4.297] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [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: 11/03/2022]
Abstract
Hermansky-Pudlak syndrome (HPS) is a rare disorder characterised by oculocutaneous albinism, a bleeding tendency, and lipofuscinosis. This retrospective study reviews the clinical history and haematological features of 23 cases of HPS. Information was gathered from patient notes and by direct interview. Thirteen of the 23 children were of Turkish origin, 12 being members of four kindreds from the Turkish/Kurdish border. Four children originated from Pakistan. Haemorrhage was uncommon; two experienced significant bleeding (intracranial and retinal haemorrhage in one and menorrhagia in another), and twelve minor symptoms. Results of laboratory evaluation of platelet function were not predictive of bleeding; in particular the PFA-100 analyser was not sensitive to the HPS defect. The most sensitive test of platelet fuction was quantitation of platelet nucleotides. The occurrence of Turkish and Pakistani kindreds with HPS is novel and follow up for long term complications described in Puerto Rican patients as well as genetic analysis is ongoing.
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Affiliation(s)
- C Harrison
- Department of Haematology and Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital NHS Trust, London WC1E 3JH, UK.
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Bullinger M, von Mackensen S, Fischer K, Khair K, Petersen C, Ravens-Sieberer U, Rocino A, Sagnier P, Tusell JM, van den Berg M, Vicariot M. Pilot testing of the 'Haemo-QoL' quality of life questionnaire for haemophiliac children in six European countries. Haemophilia 2002; 8 Suppl 2:47-54. [PMID: 11966854 DOI: 10.1046/j.1351-8216.2001.114.doc.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a multinational working group, an instrument (Haemo-QoL) to assess quality of life in children/adolescents with haemophilia and their parents has been developed. In co-operation with haemophilia treatment centres in six European countries, approximately 10 children/adolescents with haemophilia per country and their parents were asked to participate in the pilot-testing. Both self-reported and parent-reported questionnaires were provided for two age-groups of children (4-16 years). Medical data was collected from physicians from patient files. Answers to open questions from participants (58 children and 57 parents) confirmed the content of 116 of the preliminary items. Cognitive debriefing revealed that the majority of the Haemo-QoL was rated favourably, but 29 questions were recommended to be omitted and several items to be reformulated. Preliminary psychometric testing of the revised 77 item questionnaire in the same sample showed acceptable reliability and validity, which will be examined in a subsequent study with a larger patient sample.
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Affiliation(s)
- M Bullinger
- Department of Medical Psychology, University of Hamburg, Institute for Medical Psychology, University of Munich, Germany.
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35
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Madge S, Khair K. 'A higher level of practice': what is it and what does it involve? Paediatr Nurs 2001; 13:31-2. [PMID: 12025698 DOI: 10.7748/paed2001.07.13.6.31.c754] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S Madge
- Great Ormond Street Hospital for Children, London
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36
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Russell-Eggitt IM, Thompson DA, Khair K, Liesner R, Hann IM. Hermansky-Pudlak syndrome presenting with subdural haematoma and retinal haemorrhages in infancy. J R Soc Med 2000; 93:591-2. [PMID: 11198692 PMCID: PMC1298152 DOI: 10.1177/014107680009301110] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- I M Russell-Eggitt
- Department of Ophthalmology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
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37
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McMahon C, Smith J, Khair K, Liesner R, Hann IM, Smith OP. Central venous access devices in children with congenital coagulation disorders: complications and long-term outcome. Br J Haematol 2000; 110:461-8. [PMID: 10971409 DOI: 10.1046/j.1365-2141.2000.02184.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Reliable venous access is essential to facilitate the administration of prophylactic factor concentrate or blood products in children with congenital coagulation disorders and immune tolerance therapy (ITT) regimens in those who develop high responding inhibitors. Poor venous access is even more problematic in very young children, the vast majority of whom will require the insertion of central venous access devices (CVADs). Previous studies have suggested that infection rates are low and that there are few long-term complications associated with CVAD usage. We have reviewed 86 CVADs that have been inserted, since 1988, in 58 children with congenital bleeding disorders, aged 6 d to 16.5 years, attending Great Ormond Street Hospital, London, and the National Children's Hospital, Dublin. The devices have remained in situ for 2 weeks to 92 months (median 22.5 months). Early (0-2 weeks) complications of CVAD insertion included nine bleeding episodes, one extravasation of factor concentrate, three allergic reactions to factor concentrate and five catheter infections. Overall, CVAD infection was the commonest problem encountered, with 52 devices (60%) becoming infected. Twenty-seven CVADs (31%) required removal. Infection rates in children without inhibitors (29/68) were 1/20 patient-months or 1. 6 infections/1000 patient-days, but infection rates for those with inhibitors were 1/8.5 patient-months or 4.3/1000 patient-days. Staphylococcus epidermidis was the predominant organism (25/52) isolated. Blockage of CVAD (four) and catheter disconnection (four) were the most frequently occurring non-infectious long-term complications. Skin erosion of the port was also seen in three children, in one child at 20 months, in one at 29 months and in one at 34 months after insertion. This study demonstrates a high CVAD infection rate and highlights the long-term complications of CVAD usage.
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Affiliation(s)
- C McMahon
- National Paediatric Centre for Inherited Coagulation Disorders, National Children's Hospital, Tallaght, Dublin 24, Ireland
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38
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Abstract
Creating a team requires a clear strategy with objectives and boundaries. Teams succeed or fail depending on the enthusiasm and dedication of the members. Important points to consider in maintaining effectiveness include team philosophy, leadership, dynamics, communication, and workload. Members provide a unique contribution that must be valued and respected. Maintaining a productive and friendly team can become difficult. Issues such as uncertainty of the team's position in the overall service, caseload, poor coordination between team members, and uneven work distribution may cause disruption. To ensure a functioning and useful team, members must be constantly aware of their working relationships with each other and the impact they have on patients, families, and colleagues.
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Affiliation(s)
- S Madge
- Respiratory Unit, Great Ormond Street Hospital for Children, London, UK.
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39
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Abstract
We report a case of severe factor V (FV) deficiency (<1%) associated with multiple episodes of intracranial bleeding which presented at birth. The clinical course was further complicated by the development of an inhibitor, episodes of sepsis and cardiac failure. The management using virally inactivated FFP and platelets is discussed.
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Affiliation(s)
- N Salooja
- Great Ormond Street Hospital for children, London, UK
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40
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Ancliff P, Liesner R, Khair K, Hann I. The use of recombinant factor VIIa in a patient with severe Glanzmann's thrombasthenia to facilitate insertion of a Port-a-Cath. Blood Coagul Fibrinolysis 1999; 10:447-8. [PMID: 10695773 DOI: 10.1097/00001721-199910000-00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Robinson MS, Mackie IJ, Khair K, Liesner R, Goodall AH, Savidge GF, Machin SJ, Harrison P. Flow cytometric analysis of reticulated platelets: evidence for a large proportion of non-specific labelling of dense granules by fluorescent dyes. Br J Haematol 1998; 100:351-7. [PMID: 9488626 DOI: 10.1046/j.1365-2141.1998.00563.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The labelling of platelets with thiazole orange (TO) has been utilized by various laboratories to determine the percentage of reticulated platelets within whole blood or platelet-rich plasma (PRP). A proportion of TO labelling, however, is not entirely mRNA specific and remains to be fully defined. Almost half of the total TO-positive signal within normal platelets (n = 5) was shown to be abrogated upon degranulation with 80 microM thrombin receptor activating peptide (TRAP) (P = 0.006), strongly suggesting that platelet granules are non-specifically labelling with dye. We have confirmed this hypothesis by studying TO labelling of platelets within whole blood from dense granule deficient patients, e.g. Hermansky-Pudlak syndrome (HPS) (n = 5) and storage pool disease (SPD) (n = 4). The levels of TO-positive platelets were found to be significantly lower than normal (P = 0.0003 and P = 0.0002 respectively), but not significantly different from TRAP degranulated platelets. Upon degranulation of HPS and SPD platelets there was very little further reduction in the TO signal. Incubation of normals and SPD whole blood with different concentrations of either TO or coriphosphine-O confirmed that dense granules were non-specifically labelling even at high concentrations of both dyes. These findings suggest that although TO labelling is in part RNA specific, the dense granular pool of nucleotides appears to cause a substantial amount (approximately 50%) of non-specific labelling observed under these conditions of assay. This can easily be controlled for by a degranulation step with a non-enzymatic platelet agonist such as TRAP, and may have important consequences for the eventual standardization. clinical utilization and automation of reticulated platelet assays.
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Affiliation(s)
- M S Robinson
- Department of Haematology, University College Hospital, London
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Smith MP, Rice KM, Bromidge ES, Lawn M, Beresford-Webb R, Spence K, Khair K, Hann I, Savidge GF. Continuous infusion therapy with very high purity von Willebrand factor concentrate in patients with severe von Willebrand disease. Blood Coagul Fibrinolysis 1997; 8:6-12. [PMID: 9105631 DOI: 10.1097/00001721-199701000-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Five patients with severe (type III) von Willebrand disease received, by continuous infusion, a solvent-detergent treated von Willebrand factor high purity concentrate to control haemostasis. The clinical indications for treatment included prophylaxis prior to orthopaedic, abdominal and tympanic membrane surgery, and treatment of epistaxis and trauma-related bleeding. Plasma vWf antigen and activity were normalized sooner than factor VIII:C levels after initial bolus followed by infusion of the concentrate. Haemostasis was established in all five patients. The degree of shortening of the bleeding time correlated with concentrate infusion rate and, therefore, with administered dose of high molecular weight multimers. Concentrate clearance decreased over time with continued infusion. The product was shown to be stable and sterile at 24 h after reconstitution with no evidence of neoantigen expression. This report illustrates the effectiveness of high purity vWf concentrate administered by continuous infusion and shows that high-molecular-weight multimers are required to shorten the bleeding time to within the normal range.
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Affiliation(s)
- M P Smith
- Haemophilia Centre, St Thomas' Hospital, London, UK
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Abstract
Twenty-seven children with severe haemophilia receiving regular prophylactic factor concentrate were evaluated to examine the overall effectiveness of prophylaxis in modern haemophilia care. The median age at the start of prophylaxis was 6.2 years (range 1.3-15.9 years) and the cumulative length of follow-up was 808 months (mean 30, rang 7-76 months). Nine patients required a central venous catheter for venous access (age range 1.3-5.2 years), eight boys could cannulate themselves and in 10 the parents performed regular venepuncture. The mean dose of concentrate given at the time of study was 31.8 U/kg three times weekly (range 12.5.6 U/kg) or 4900 U/kg/year (range 1900-8200). None developed an inhibitor on prophylaxis, though four had previously had an antibody. The median average annual number of bleeds in the 27 patients prior to prophylaxis was 14.7 (range 3.7-35.4). On prophylaxis this fell to 1.5 (range 0-12.5) (P<0.001) and in the group as a whole the frequency of bleeds diminished in successive years on prophylaxis. All 20 children with evidence of arthropathy improved on prophylaxis and eight had reversal of chronic damage such that their joints appeared normal at the time of study. There were reductions in the need for walking aids, in hospital admissions, and in numbers of school days lost for bleeding episodes. All families feel that prophylaxis has brought about an improvement in quality of life.
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Affiliation(s)
- R J Liesner
- The Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children NHS Trust, London
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Chan T, Khair K, Jing L, Ahola M, Noorishad J, Vuillod E. International comparison of coupled thermo-hydro-mechanical models of a multiple-fracture bench mark problem: DECOVALEX phase I, bench mark test 2. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/0148-9062(95)00034-e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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