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Gallastegui N, Steiner BUK, Aguero P, Bailey C, Kruse-Jarres R, Quon DV, Hanacek C, Volland LM, Barnes RFW, von Drygalski A. The role of point-of-Care Musculoskeletal Ultrasound for Routine Joint evaluation and management in the Hemophilia Clinic - A Real World Experience. BMC Musculoskelet Disord 2022; 23:1111. [PMID: 36539778 PMCID: PMC9768915 DOI: 10.1186/s12891-022-06042-w] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The use of musculoskeletal ultrasound (MSKUS) for point-of-care (POC) evaluation of hemophilic arthropathy is growing rapidly. However, the extent to which MSKUS influences clinical treatment decisions is unknown. METHODS We conducted a three-year, prospective, multi-center study at three hemophilia treatment centers in the United States to evaluate the utilization of POC-MSKUS for routine clinical decision-making in adult persons with hemophilic arthropathy. Bilateral elbows, knees and ankles were assessed clinically [Hemophilia Joint Health Score (HJHS)] and with POC-MSKUS by the Joint TissueActivity and Damage Exam (JADE) protocol at baseline and approximately annually for two additional times. Treatment decisions, including physical therapy (PT) and "medical" (joint injections/aspirations, referrals to orthopedics, changes/adjustments of hemostatic plans, and use of oral anti-inflammatory medications) were recorded in relation to POC-MSKUS. RESULTS Forty-four persons [median age 37 years (IQR 29, 51)], mostly with severe Hemophilia A on clotting factor prophylaxis, completed 129 visits, yielding 792 joint exams by POC-MSKUS and HJHS [median at baseline 27 (IQR 18, 42)] over a median follow up of 584 days (range: 363 to 1072). Among 157 management decisions, 70% were related to PT plans (n = 110) and 30% were "medical". Point-of-care MSKUS influenced 47/110 (43%) PT plans, mostly informing treatment of specific arthropathic joints (45/47 plans) in patients with high HJHS. Physical therapy plans influenced by POC-MSKUS directed more manual therapy/therapeutic exercises, while plans based on physical exam were focused more on global exercises and wellness. Treatment decisions were mostly based on the identification of specific musculoskeletal abnormalities visualized by POC-MSKUS. Of note 20/47 (43%) POC-MSKUS plans included de-escalation strategies, thereby reducing exercise intensity, mostly for joint instability and subclinical hemarthroses. Point-of-care MSKUS also informed 68% (32/47) of "medical" decisions, surprisingly mostly for injections/aspirations and referrals to orthopedics, and not for adjustments of hemostatic treatment. Although not formally studied, ultrasound images were used frequently for patient education. CONCLUSION Routine joint evaluations with POC-MSKUS resulted in few changes regarding medical management decisions but had a profound effect on the formulation of PT plans. Based on these findings, new studies are essential to determine the benefit of MSKUS-informed management plans on joint health outcomes.
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Affiliation(s)
- N Gallastegui
- grid.266100.30000 0001 2107 4242Department of Medicine, Division of Hematology/Oncology, University of California San Diego, CA San Diego, USA ,grid.261331.40000 0001 2285 7943Department of Medicine, Division of Hematology, The Ohio State University, OH Columbus, USA
| | - BUK Steiner
- Washington Center for Bleeding Disorders, WA Seattle, USA
| | - P Aguero
- grid.266100.30000 0001 2107 4242Department of Medicine, Division of Hematology/Oncology, University of California San Diego, CA San Diego, USA
| | - C Bailey
- grid.489149.90000 0004 5900 1331The Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children, Los Angeles California, USA
| | - R Kruse-Jarres
- Washington Center for Bleeding Disorders, WA Seattle, USA
| | - DV Quon
- grid.489149.90000 0004 5900 1331The Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children, Los Angeles California, USA
| | - C Hanacek
- grid.266100.30000 0001 2107 4242Department of Medicine, Division of Hematology/Oncology, University of California San Diego, CA San Diego, USA ,Department of General Medical Education, KPC Health. Hemet, CA, USA 1810 Cannon Drive, Suite 1150E, OH Columbus, USA
| | - LM Volland
- grid.266100.30000 0001 2107 4242Department of Medicine, Division of Hematology/Oncology, University of California San Diego, CA San Diego, USA ,grid.422264.40000 0004 0542 3790National Hemophilia Foundation, NYC NY, USA
| | - RFW Barnes
- grid.266100.30000 0001 2107 4242Department of Medicine, Division of Hematology/Oncology, University of California San Diego, CA San Diego, USA
| | - A von Drygalski
- grid.266100.30000 0001 2107 4242Department of Medicine, Division of Hematology/Oncology, University of California San Diego, CA San Diego, USA
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Zhou JY, Rappazzo KC, Volland L, Barnes RFW, Brackman M, Steiner B, Kruse-Jarres R, Quon DV, Bailey C, Chang EY, von Drygalski A. Pocket handheld ultrasound for evaluation of the bleeding haemophilic joint: A novel and reliable way to recognize joint effusions. Haemophilia 2018; 24:e77-e80. [PMID: 29436079 DOI: 10.1111/hae.13429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J Y Zhou
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - K C Rappazzo
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - L Volland
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - R F W Barnes
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - M Brackman
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - B Steiner
- Washington Center for Bleeding Disorders at BloodWorks NW, Seattle, WA, USA
| | - R Kruse-Jarres
- Washington Center for Bleeding Disorders at BloodWorks NW, Seattle, WA, USA
| | - D V Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children, Los Angeles, CA, USA
| | - C Bailey
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children, Los Angeles, CA, USA
| | - E Y Chang
- VA San Diego Healthcare System, Radiology Service, San Diego, CA, USA
| | - A von Drygalski
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, San Diego, CA, USA.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
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Shatzel JJ, Azar S, Scherber R, Gay N, Deloughery TG, VanSandt A, Kruse-Jarres R, Recht M, Taylor JA. Unexpected pharmacokinetics of recombinant porcine factor VIII in a patient with acquired factor VIII deficiency and spontaneous epidural haematoma. Haemophilia 2017; 23:e453-e456. [PMID: 28664642 DOI: 10.1111/hae.13247] [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] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J J Shatzel
- Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - S Azar
- Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - R Scherber
- Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - N Gay
- Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - T G Deloughery
- Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA.,Department of Pathology, Oregon Health & Science University, Portland, OR, USA.,The Hemophilia Center at Oregon Health & Science University, Portland, OR, USA
| | - A VanSandt
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA.,The Hemophilia Center at Oregon Health & Science University, Portland, OR, USA
| | - R Kruse-Jarres
- Washington Center for Bleeding Disorders at BloodWorks Northwest, University of Washington, Seattle, WA, USA
| | - M Recht
- The Hemophilia Center at Oregon Health & Science University, Portland, OR, USA
| | - J A Taylor
- Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA.,The Hemophilia Center at Oregon Health & Science University, Portland, OR, USA.,VA Medical Center, Portland, OR, USA
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Abstract
The development of inhibitors to factor VIII (FVIII) or factor IX (FIX) remains a major treatment complication encountered in the treatment of haemophilia. Not all patients with even the same severity and genotype develop inhibitors suggesting an underlying mechanism of tolerance against FVIII- or FIX-related immunity. One mechanism may be central tolerance observed in patients in whom the FVIII mutation enables some production of the protein. The other is a peripheral tolerance mechanism which may be evident in patients with null mutation. Recently, recombinant porcine FVIII (rpFVIII, Obixur, OBI-1, BAX801) has been developed for the haemostatic treatment of both congenital haemophilia with inhibitor (CHAWI) and acquired haemophilia A (AHA). In 28 subjects with AHA with life-/limb-threatening bleeding, rpFVIII reduced or stopped bleeding in all patients within 24 h. The cross-reactivity of anti-human FVIII antibodies to rpFVIII remains around 30-50%. Recently, new therapeutics based on the quite novel concepts have been developed and clinical studies are ongoing. These are humanized asymmetric antibody mimicking FVIIIa function by maintaining a suitable interaction between FIXa and FX (Emicizumab, ACE910), and small interfering RNAs (siRNA, ALN-AT3) suppress liver production of AT through post-transcriptional gene silencing and a humanized anti-TFPI monoclonal antibody (Concizumab). Their main advantages are longer half-life, subcutaneous applicability and efficacy irrespective of the presence of inhibitors which will make it easier to initiate more effective treatment especially early childhood.
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Affiliation(s)
- M Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - D Lillicrap
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - R Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks NW, University of Washington, Seattle, WA, USA
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5
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Antun A, Monahan PE, Manco-Johnson MJ, Callaghan MU, Kanin M, Knoll C, Carpenter SL, Davis JA, Guerrera MF, Kruse-Jarres R, Ragni MV, Witmer C, McCracken CE, Kempton CL. Inhibitor recurrence after immune tolerance induction: a multicenter retrospective cohort study. J Thromb Haemost 2015; 13:1980-8. [PMID: 26382916 PMCID: PMC4639409 DOI: 10.1111/jth.13143] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 04/13/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Immune tolerance induction (ITI) in patients with congenital hemophilia A is successful in up to 70%. Although there is growing understanding of predictors of response to ITI, the probability and predictors of inhibitor recurrence after successful ITI are not well understood. OBJECTIVES To determine the association of clinical characteristics, particularly adherence to factor VIII (FVIII) prophylaxis after ITI, with inhibitor recurrence in patients with hemophilia A who were considered tolerant after ITI. METHODS In this multicenter retrospective cohort study, 64 subjects with FVIII level < 2% who were considered successfully tolerant after ITI were analyzed to estimate the cumulative probability of inhibitor recurrence using the Kaplan-Meier method. The association of clinical characteristics with inhibitor recurrence was assessed using logistic regression. RESULTS A recurrent inhibitor titer ≥ 0.6 BU mL(-1) occurred at least once in 19 (29.7%) and more than once in 12 (18.8%). The probability of any recurrent inhibitor at 1 and 5 years was 12.8% and 32.5%, respectively. Having a recurrent inhibitor was associated with having received immune modulation during ITI (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.2-22.4) and FVIII recovery of < 85% at the end of ITI (OR 2.6, 95% CI 1.3-5.9) but was not associated with adherence to post-ITI prophylactic FVIII infusion (OR 0.5, 95% CI 0.06-4.3). CONCLUSIONS The use of immune modulation therapy during ITI and lower FVIII recovery at the end of ITI appear to be associated with an increased risk of inhibitor recurrence after successful ITI. Adherence to post-ITI prophylactic FVIII infusions is not a major determinant of recurrence.
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Affiliation(s)
- A Antun
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - P E Monahan
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - M J Manco-Johnson
- Hemophilia and Thrombosis Center and Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | | | - M Kanin
- Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - C Knoll
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | - J A Davis
- Department of Pediatrics, University of Miami, Miami, FL, USA
| | - M F Guerrera
- Children's National Medical Center, Washington, DC, USA
| | - R Kruse-Jarres
- Department of Medicine, Tulane University, New Orleans, LA, USA
| | - M V Ragni
- Department of Medicine, University of Pittsburgh Medical Center and Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA
| | - C Witmer
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - C E McCracken
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - C L Kempton
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
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6
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Valentino LA, Kempton CL, Kruse-Jarres R, Mathew P, Meeks SL, Reiss UM. US Guidelines for immune tolerance induction in patients with haemophilia a and inhibitors. Haemophilia 2015; 21:559-67. [DOI: 10.1111/hae.12730] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 01/19/2023]
Affiliation(s)
| | - C. L. Kempton
- Emory University School of Medicine; Atlanta GA USA
- Aflac Cancer and Blood Disorders Center; Emory University/Children's Healthcare of Atlanta; Atlanta GA USA
| | - R. Kruse-Jarres
- Puget Sound Blood Center/University of Washington; Seattle WA USA
| | - P. Mathew
- University of New Mexico; Albuquerque NM USA
| | - S. L. Meeks
- Aflac Cancer and Blood Disorders Center; Emory University/Children's Healthcare of Atlanta; Atlanta GA USA
| | - U. M. Reiss
- St. Jude Children's Research Hospital; Memphis TN USA
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Fogarty PF, Mancuso ME, Kasthuri R, Bidlingmaier C, Chitlur M, Gomez K, Holme PA, James P, Kruse-Jarres R, Mahlangu J, Mingot-Castellano ME, Soni A. Presentation and management of acute coronary syndromes among adult persons with haemophilia: results of an international, retrospective, 10-year survey. Haemophilia 2015; 21:589-97. [DOI: 10.1111/hae.12652] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 01/01/2023]
Affiliation(s)
- P. F. Fogarty
- Penn Comprehensive Hemophilia and Thrombosis Program; Philadelphia PA USA
| | - M. E. Mancuso
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - R. Kasthuri
- Division of Hematology and Oncology; Hemophilia and Thrombosis Center; University of North Carolina; Chapel Hill NC USA
| | | | - M. Chitlur
- Children's Hospital of Michigan; Detroit MI USA
| | | | - P. A. Holme
- Department of Haematology; Oslo University Hospital, Rikshospitalet; Oslo Norway
| | - P. James
- Queen's University; Kingston ON Canada
| | | | - J. Mahlangu
- Faculty of Health Sciences; University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital; Johannesburg South Africa
| | | | - A. Soni
- Children's Hospital of Orange County; Orange CA USA
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8
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Kruse-Jarres R, Gilsenan A, Spears J, Kaye JA. Prospective, observational study of plasma-derived factor VIII/von Willebrand factor in immune tolerance induction: the PRISM registry. Haemophilia 2015; 21:e122-e124. [PMID: 25623889 DOI: 10.1111/hae.12590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 01/19/2023]
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9
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Affiliation(s)
- R. Kruse-Jarres
- School of Medicine Section of Hematology/Oncology; Tulane University; New Orleans LA USA
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10
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Leissinger C, Josephson CD, Granger S, Konkle BA, Kruse-Jarres R, Ragni MV, Journeycake JM, Valentino L, Key NS, Gill JC, McCrae KR, Neufeld EJ, Manno C, Raffini L, Saxena K, Torres M, Marder V, Bennett CM, Assmann SF. Rituximab for treatment of inhibitors in haemophilia A. A Phase II study. Thromb Haemost 2014; 112:445-58. [PMID: 24919980 DOI: 10.1160/th14-01-0078] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/22/2014] [Indexed: 01/19/2023]
Abstract
The development of antibodies against infused factor VIII (FVIII) in patients with haemophilia A is a serious complication leading to poorly controlled bleeding and increased morbidity. No treatment has been proven to reduce high titre antibodies in patients who fail immune tolerance induction or are not candidates for it. The Rituximab for the Treatment of Inhibitors in Congenital Hemophilia A (RICH) study was a phase II trial to assess whether rituximab can reduce anamnestic FVIII antibody (inhibitor) titres. Male subjects with severe congenital haemophilia A and an inhibitor titre ≥5 Bethesda Units/ml (BU) following a FVIII challenge infusion received rituximab 375 mg/m² weekly for weeks 1 through 4. Post-rituximab inhibitor titres were measured monthly from week 6 through week 22 to assess treatment response. Of 16 subjects who received at least one dose of rituximab, three (18.8%) met the criteria for a major response, defined as a fall in inhibitor titre to <5 BU, persisting after FVIII re-challenge. One subject had a minor response, defined as a fall in inhibitor titre to <5 BU, increasing to 5-10 BU after FVIII re-challenge, but <50% of the original peak inhibitor titre. Rituximab is useful in lowering inhibitor levels in patients, but its effect as a solo treatment strategy is modest. Future studies are indicated to determine the role of rituximab as an adjunctive therapy in immune tolerisation strategies.
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Affiliation(s)
| | | | - S Granger
- Suzanne Granger, MS, New England Research Institutes, Inc., 480 Pleasant St., Watertown, MA 02472, USA, Tel.: +1 617 972 3319, Fax: +1 617 926 8246, E-mail:
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11
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Abstract
Development of alloantibodies against infused factor VIII (FVIII) is the most significant complication of haemophilia care today. Antibodies inactivate the procoagulant activity of FVIII and inhibit patients' response to replacement therapy. As inhibitors tend to develop early in the course of FVIII treatment, the challenge is to bring patients through the critical early phase of FVIII exposure without inhibitor development as the subsequent risk is much lower. Disease severity, major FVIII gene defects, family history and non-Caucasian race are major risk factors for inhibitor development. Other variables thought to play a role in inhibitor formation include age at first treatment, intensity of early treatment, use of prophylaxis and product choice [especially recombinant vs. plasma-derived von Willebrand factor (VWF)-containing concentrates]. As these treatment-related variables are modifiable, they provide opportunity to minimize inhibitor incidence at the clinical level. At present, most data regarding inhibitor development derive from retrospective studies, registry reviews, small case series and uncontrolled studies. Findings have often been conflicting, which precludes drawing definitive conclusions. Nevertheless, some clarity is beginning to emerge. Intensity of early treatment appears to be a stronger risk factor for inhibitor development than timing of first treatment. Controlled early antigen presentation via prophylaxis looks promising, particularly in conjunction with strategies to avoid immunological danger signals, but the timing of introduction and optimal regimen are not yet known. Several reports suggest that plasma-derived VWF-containing FVIII concentrates are less immunogenic than recombinant or VWF-free plasma-derived concentrates, but this is awaiting confirmation in the ongoing prospective Survey of Inhibitors in Plasma-Product Exposed Toddlers study.
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Affiliation(s)
- R Kruse-Jarres
- School of Medicine Section of Hematology/Oncology, Tulane University, New Orleans, LA, USA.
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von Drygalski A, Kolaitis NA, Bettencourt R, Bergstrom J, Kruse-Jarres R, Quon DV, Wassel C, Li MC, Waalen J, Elias DJ, Mosnier LO, Allison M. Prevalence and risk factors for hypertension in hemophilia. Hypertension 2013; 62:209-15. [PMID: 23630949 DOI: 10.1161/hypertensionaha.113.01174] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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: 01/11/2023]
Abstract
Hypertension (HTN) is a major risk factor for intracranial hemorrhage. We, therefore, investigated the prevalence, treatment, and control of HTN in adult patients with hemophilia (PWH). PWH≥18 years (n=458) from 3 geographically different cohorts in the United States were evaluated retrospectively for HTN and risk factors. Results were compared with the nationally representative sample provided by the contemporary National Health and Nutrition Examination Survey (NHANES). PWH had a significantly higher prevalence of HTN compared with NHANES. Overall, the prevalence of HTN was 49.1% in PWH compared with 31.7% in NHANES. At ages 18 to 44, 45 to 64, 65 to 74, and ≥75 years, the prevalence of HTN for PWH was 31.8%, 72.6%, 89.7%, and 100.0% compared with 12.5%, 41.2%, 64.1%, and 71.7% in NHANES, respectively. Of treated hypertensive PWH, only 27.1% were controlled, compared with 47.7% in NHANES (all P<0.05). Age, body mass index, diabetes mellitus, and renal function were independently associated with HTN. Among patients with moderate or severe hemophilia there was a trend (≈1.5-fold) for higher odds of having HTN compared with patients with mild hemophilia. On the basis of these results, new care models for adult PWH and further studies for the causes of HTN in hemophilia are recommended.
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Affiliation(s)
- Annette von Drygalski
- Division of Hematology/Oncology, Department of Medicine, University of California, San Diego, CA, USA.
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13
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Chang T, Albright K, Kruse-Jarres R, Leissinger C, Martin-Schild S. Elevated Factor VIII Is Common in the Acute Phase of Ischemic Stroke and Is Associated with African American Race and Poor Outcomes (S43.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s43.007] [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: 11/15/2022] Open
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14
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Goldenberg NA, Kruse-Jarres R, Frick N, Pipe SW, Leissinger CA, Kessler CM. Outcomes of mentored, grant-funded fellowship training in haemostasis /thrombosis: findings from a nested case-control survey study. Haemophilia 2011; 18:326-31. [PMID: 21899663 DOI: 10.1111/j.1365-2516.2011.02626.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Successful strategies by which to effectively recruit and retain academic subspecialists in benign haematology have not been established. To evaluate the effectiveness of a grant-funded, mentored fellowship with respect to retention and early career goals in haemostasis/thrombosis, we sought to compare outcomes for graduates of a grant-funded, mentored fellowship training programme in haemostasis/thrombosis [the National Hemophilia Foundation (NHF)-Baxter Clinical Fellowship Award] during conventional haematology/oncology fellowship training (cases), vs. their training peers who were graduates of conventional haematology/oncology fellowship training alone (controls), via a nested case-control survey study. Survey response rate was 85% (11/13) for cases and 90% (9/10) for controls. All respondents had pursued careers in academic haematology/oncology. Median (range) percent time spent in benign haematology postfellowship was 98% (70-100%) for cases vs. 0% (0-20%) for controls. Time spent in research was significantly greater among cases than controls (median 80% [range: 42-90%] vs. 55% [10-80%], respectively; P = 0.01). By years 3-4 postfellowship, median annual number of peer-reviewed publications was higher for cases than controls (3.5 vs. 1.0; P = 0.01). Cases were also more successful in grant funding (including K-awards). These data suggest that a grant-funded, mentored fellowship training programme in haemostasis/thrombosis may be superior to conventional haematology/oncology fellowship training alone with respect to outcomes of retention in clinical care/research, early-career grant funding and publication productivity.
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Affiliation(s)
- N A Goldenberg
- Section of Hematology/Oncology/Bone Marrow Transplantation and the Mountain States Regional Hemophilia and Thrombosis Center, Department of Pediatrics, University of Colorado, Aurora, CO 80045-0507, USA.
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15
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Sheen MA, Lang-Mims G, Leissinger CA, Kruse-Jarres R, Barnhill M, Blaya M. Re-establishing oncologic care after a major disaster. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16541] [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: 11/20/2022] Open
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16
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Kruse-Jarres R, Hadi CM, Leissinger CA. Inhibitor development and successful immune tolerance in an HIV-infected patient with haemophilia A and after immune reconstitution with HAART. Haemophilia 2007; 13:707-11. [PMID: 17973846 DOI: 10.1111/j.1365-2516.2007.01543.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This is the case of a 28-year-old man with severe congenital haemophilia A, who had a relatively mild bleeding course during early childhood, with limited factor VIII (FVIII) exposure. He was infected with HIV before the age of 7 years, and demonstrated profound immunodeficiency from childhood, with very low CD4+ cell counts for more than a decade. Following initiation of highly active anti-retroviral therapy (HAART) and gradually increasing CD4+ cells, he presented for the first time with a high-titre inhibitor at age 26, despite over 1000 previous FVIII exposures. Subsequently, his inhibitor was successfully eradicated with a standard immune tolerance protocol. It is likely that the effects of chronic HIV infection on T-lymphocyte pathways, and the partial immune reconstitution resulting from HAART, led to this patient's unusual inhibitor course. Such a case serves to augment knowledge gained in animal studies about the immunobiology of FVIII inhibitors.
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Affiliation(s)
- R Kruse-Jarres
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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17
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