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Weimar C, Beyer-Westendorf J, Bohmann FO, Hahn G, Halimeh S, Holzhauer S, Kalka C, Knoflach M, Koennecke HC, Masuhr F, Mono ML, Nowak-Göttl U, Scherret E, Schlamann M, Linnemann B. New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline. Neurol Res Pract 2024; 6:23. [PMID: 38637841 PMCID: PMC11027218 DOI: 10.1186/s42466-024-00320-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Over the last years, new evidence has accumulated on multiple aspects of diagnosis and management of cerebral venous and dural sinus thrombosis (CVT) including identification of new risk factors, studies on interventional treatment as well as treatment with direct oral anticoagulants. Based on the GRADE questions of the European Stroke Organization guideline on this topic, the new German guideline on CVT is a consensus between expert representatives of Austria, Germany and Switzerland. New recommendations include:• CVT occurring in the first weeks after SARS-CoV-2 vaccination with vector vaccines may be associated with severe thrombocytopenia, indicating the presence of a prothrombotic immunogenic cause (Vaccine-induced immune thrombotic thrombocytopenia; VITT).• D-dimer testing to rule out CVT cannot be recommended and should therefore not be routinely performed.• Thrombophilia screening is not generally recommended in patients with CVT. It should be considered in young patients, in spontaneous CVT, in recurrent thrombosis and/or in case of a positive family history of venous thromboembolism, and if a change in therapy results from a positive finding.• Patients with CVT should preferably be treated with low molecular weight heparine (LMWH) instead of unfractionated heparine in the acute phase.• On an individual basis, endovascular recanalization in a neurointerventional center may be considered for patients who deteriorate under adequate anticoagulation.• Despite the overall low level of evidence, surgical decompression should be performed in patients with CVT, parenchymal lesions (congestive edema and/or hemorrhage) and impending incarceration to prevent death.• Following the acute phase, oral anticoagulation with direct oral anticoagulants instead of vitamin K antagonists should be given for 3 to 12 months to enhance recanalization and prevent recurrent CVT as well as extracerebral venous thrombosis.• Women with previous CVT in connection with the use of combined hormonal contraceptives or pregnancy shall refrain from continuing or restarting contraception with oestrogen-progestagen combinations due to an increased risk of recurrence if anticoagulation is no longer used.• Women with previous CVT and without contraindications should receive LMWH prophylaxis during pregnancy and for at least 6 weeks post partum.Although the level of evidence supporting these recommendations is mostly low, evidence from deep venous thrombosis as well as current clinical experience can justify the new recommendations.This article is an abridged translation of the German guideline, which is available online.
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Affiliation(s)
- C Weimar
- BDH Klinik Elzach und Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany.
| | - J Beyer-Westendorf
- Department of Medicine I; Division "Thrombosis & Hemostasis ", Dresden University Hospital "Carl Gustav Caris; Technical University Dresden, Dresden, Germany
| | - F O Bohmann
- Department of Neurology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - G Hahn
- Department of Pediatric Radiology, University Children`s Hospital Basel UKBB, Basel, Switzerland
| | - S Halimeh
- Universitätsklinikum Essen, gerinnungszentrum rhein-ruhr, Duisburg, Germany
| | - S Holzhauer
- Klinik für Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Kalka
- Vascular Institute Central Switzerland, Aarau, Switzerland and University of Cologne, Cologne, Germany
| | - M Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - H-C Koennecke
- Klinik für Neurologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - F Masuhr
- Abteilung für Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - M-L Mono
- Abteilung für Neurologie, Stadtspital Triemli, Zürich, Switzerland
| | - U Nowak-Göttl
- Gerinnungszentrum UKSH (Campus Kiel und Lübeck), Institut für Klinische Chemie, Kiel, Germany
| | - E Scherret
- Klinik für Neurologie der Charité - , Universitätsmedizin Berlin, Berlin, Germany
| | - M Schlamann
- Sektion Neuroradiologie, Institut für Diagnostische und Interventionelle Radiologie, Klinikum der Universität zu Köln, Cologne, Germany
| | - B Linnemann
- Klinik für Kardiologie III - Angiologie, Universitätsmedizin Mainz, Mainz, Germany
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2
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Zaninetti C, Baschin M, Vater L, Karastaneva A, Holzhauer S, Leinøe E, Ørslev Rasmussen A, Wesche J, Freyer C, Seidel MG, Greinacher A. Platelet expression of the transcription factor ETV6 associates with ETV6-related thrombocytopenia and can be detected by immunofluorescence on the blood film. Br J Haematol 2024; 204:710-714. [PMID: 37985135 DOI: 10.1111/bjh.19211] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Carlo Zaninetti
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Marcel Baschin
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
- Pädiatrischen Onkologie und Hämatologie der Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Leonard Vater
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Anna Karastaneva
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Holzhauer
- Klinik für Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Leinøe
- Department of Haematology and Department of Genomic Medicine, Rigshospitalet University Hospital, Copenhagen, Denmark
| | | | - Jan Wesche
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Carmen Freyer
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Markus G Seidel
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Greinacher
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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3
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Lehrnbecher T, Ahlmann M, Albert M, Barnbrock AE, Beutel K, Bochennek K, Classen CF, Holzhauer S, Hutter C, Lakatos K, Meisel R, Porto L, Vokuhl C, Vraetz T, Minkov M. [Updated AWMF Guideline on the Diagnosis and Treatment of Langerhans cell Histiocytosis in Children and Adolescents]. Klin Padiatr 2023; 235:322-330. [PMID: 37666270 DOI: 10.1055/a-2135-3175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Langerhans cell Histiocytosis is a rare neoplastic disease, which occurs mainly in children and adolescents. The disease may affect any organ, and therefore, the clinical symptoms vary widely. Some patients have a spontaneous remission of the disease, whereas others experience a rapid and potentially lethal clinical course. The therapeutic approach depends on the extent of the disease, and reaches from a watch-and-wait strategy to chemotherapy with the standard drugs vinblastine and prednisone. The identification of mutations in the MAPK-pathway resulted in growing interest in targeted therapy using compounds such as the BRAF inhibitors. Chronic relapses and permanent sequelae are important problems of LCH and are the focus of current research.
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Affiliation(s)
- Thomas Lehrnbecher
- Pädiatrische Hämatologie, Onkologie und Hämostaseologie, Klinik für Kinder- und Jugendmedizin, Goethe-Universität, Frankfurt, Germany
| | - Martina Ahlmann
- Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster, Munster, Germany
| | - Michael Albert
- Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München Medizinische Fakultät, Munchen, Germany
| | - Anke Elisabeth Barnbrock
- Pädiatrische Hämatologie, Onkologie und Hämostaseologie, Klinik für Kinder- und Jugendmedizin, Goethe-Universität, Frankfurt, Germany
| | - Karin Beutel
- Kinderklinik München-Schwabing, Städtische Kliniken München, München, Germany
| | - Konrad Bochennek
- Pädiatrische Hämatologie, Onkologie und Hämostaseologie, Klinik für Kinder- und Jugendmedizin, Goethe-Universität, Frankfurt, Germany
| | | | - Susanne Holzhauer
- Pädiatrische Hämatologie und Onkologie, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Caroline Hutter
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Medizinische Universität Wien, Wien, Austria
| | - Karoly Lakatos
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Medizinische Universität Wien, Wien, Austria
| | - Roland Meisel
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Luciana Porto
- Pädiatrische Neuroradiologie, Goethe-Universitat Frankfurt am Main Fachbereich 16 Medizin, Frankfurt am Main, Germany
| | | | - Thomas Vraetz
- Pädiatrische Hämatologie und Onkologie, Universität Freiburg Abteilung Medizin, Freiburg, Germany
| | - Milen Minkov
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Medizinische Universität Wien, Wien, Austria
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Schifferli A, Moulis G, Godeau B, Leblanc T, Aladjidi N, Michel M, Leverger G, Elalfy M, Grainger J, Chitlur M, Heiri A, Holzhauer S, Le Gavrian G, Imbach P, Kühne T. Adolescents and young adults with newly diagnosed primary immune thrombocytopenia. Haematologica 2023; 108:2783-2793. [PMID: 37051753 PMCID: PMC10542823 DOI: 10.3324/haematol.2022.282524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Current immune thrombocytopenia (ITP) guidelines target children and adults, leading to oversimplification. Adolescents and young adults (AYAS) comprise a separate group with distinct health and psychosocial issues. This study aimed to describe the clinical presentation and therapeutic strategies of ITP among AYAS. We analyzed data from two large ITP registries (PARC-ITP; CARMEN-France) and included newly diagnosed ITP patients (aged 12-25 years) with an initial platelet counts of <100×109/L. Patients with secondary ITP or non-immune thrombocytopenia (n=57) and pregnant women (n=10) were excluded. Of the 656 cases of AYAS with primary ITP registered from 2004 up to 2021, 12-month follow-up data were available for 72%. The initial median platelet count was 12×109/L. In 109 patients (17%), the diagnosis was incidental, without documented bleeding. Apart from gynecological bleeding, the clinical and therapeutical characteristics of females and males were similar. Platelet-enhancing drugs were reported in 66%, 45%, and 30% of patients at diagnosis, 1-6 months, and 6-12 months after diagnosis, respectively. Corticosteroids were the preferred treatment at all time points. At 12 months, 50% of all patients developed chronic ITP. In the subgroup of patients with initial severe thrombocytopenia (<20×109/L), those receiving frontline treatment had a higher remission rate at 1 year than those who followed an initial watch-and-wait strategy (53% and 32%; P<0.05). Our analysis indicates that the remission rate at 1 year may be associated with the initial treatment strategy. This hypothesis must be confirmed in prospective studies.
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Affiliation(s)
- Alexandra Schifferli
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland.
| | - Guillaume Moulis
- Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre d'Investigation Clinique 1436, équipe PEPSS, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Reference Center for Adult Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hopitaux de Paris, Université Paris-Est Créteil, France
| | - Thierry Leblanc
- Department of Hematology, APHP-Robert Debré Hospital, Paris, France
| | - Nathalie Aladjidi
- Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), Pediatric Hematologic Unit, Centre d'Investigation Clinique Plurithématique (CICP) INSERM 1401, University Hospital of Bordeaux, Bordeaux, France
| | - Marc Michel
- Department of Internal Medicine, National Reference Center for Adult Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hopitaux de Paris, Université Paris-Est Créteil, France
| | - Guy Leverger
- Hôpital Armand-Trousseau AP-HP, Sorbonne université, service d'hémato-oncologie pédiatrique, Paris, France
| | - Mohsen Elalfy
- Department of Pediatric Hematology/Oncology, Ain Shams University, Cairo, Egypt
| | - John Grainger
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Meera Chitlur
- Carmen and Ann Adams Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Andrea Heiri
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
| | - Susanne Holzhauer
- Department of Pediatric Hematology and Oncology, Charité, Berlin, Germany
| | - Gautier Le Gavrian
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
| | - Paul Imbach
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
| | - Thomas Kühne
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
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5
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Matzdorff A, Alesci SR, Gebhart J, Holzhauer S, Hütter-Krönke ML, Kühne T, Meyer O, Ostermann H, Pabinger I, Rummel M, Sachs UJ, Stauch T, Trautmann-Grill K, Wörmann B. Expert Report on Immune Thrombocytopenia: Current Diagnostics and Treatment - Recommendations from an Expert Group from Austria, Germany, and Switzerland. Oncol Res Treat 2023; 46 Suppl 2:5-44. [PMID: 36787705 DOI: 10.1159/000529662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Axel Matzdorff
- Department of Medicine II, Asklepios Clinic Uckermark, Schwedt, Germany
| | | | - Johanna Gebhart
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Susanne Holzhauer
- Department of Paediatric Haematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Marie Luise Hütter-Krönke
- Department of Medicine, Hematology, Oncology, and Tumor Immunology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Kühne
- Department of Oncology/Hematology, University Children's Hospital Basel, Basel, Switzerland
| | | | | | - Ingrid Pabinger
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Mathias Rummel
- Department of Hematology, Clinic for Haematology and Medical Oncology, Justus Liebig University Hospital, Giessen, Germany
| | - Ulrich J Sachs
- Institute for Clinical Immunology, Transfusion Medicine and Hemostasis, Justus-Liebig-University, Giessen, Germany
| | - Thomas Stauch
- Department of Internal Medicine II, Hematology and Oncology, University Hospital Jena, Jena, Germany
| | | | - Bernhard Wörmann
- Department of Medicine, Hematology, Oncology, and Tumor Immunology, Charite-Universitätsmedizin Berlin, Berlin, Germany
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Matzdorff A, Alesci SR, Gebhart J, Holzhauer S, Hütter-Krönke ML, Kühne T, Meyer O, Ostermann H, Pabinger I, Rummel M, Sachs UJ, Stauch T, Trautmann-Grill K, Wörmann B. [Expertenreport Immunthrombozytopenie - Aktuelle Diagnostik und Therapie]. Oncol Res Treat 2022; 46 Suppl 1:7-53. [PMID: 36572012 DOI: 10.1159/000528819] [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] [Received: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Axel Matzdorff
- Medizinische Klinik II, Asklepios Klinikum Uckermark, Schwedt, Deutschland
| | - Sonja R Alesci
- IMD Gerinnungszentrum Hochtaunus, Bad Homburg, Deutschland
| | - Johanna Gebhart
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Susanne Holzhauer
- Klinik für Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Marie Luise Hütter-Krönke
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Campus Virchow Klinikum, Berlin, Deutschland
| | - Thomas Kühne
- Universitäts-Kinderspital beider Basel, Basel, Schweiz
| | - Oliver Meyer
- Blutspendedienst der Landesverbände des DRK Niedersachsen, Sachsen-Anhalt, Thüringen, Oldenburg und Bremen gGmbH, Springe, Deutschland
| | | | - Ingrid Pabinger
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Mathias Rummel
- Medizinische Klinik IV, Klinikum der Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Ulrich J Sachs
- Institut für Klinische Immunologie, Transfusionsmedizin und Hämostaseologie, Justus-Liebig-Universität Gießen und Sektion Hämostaseologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Thomas Stauch
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Karolin Trautmann-Grill
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Deutschland
| | - Bernhard Wörmann
- Ambulantes Gesundheitszentrum der Charité, Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Berlin, Deutschland
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Miesbach W, Oldenburg J, Klamroth R, Eichler H, Koscielny J, Holzhauer S, Holstein K, Hovinga JAK, Alberio L, Olivieri M, Knöfler R, Male C, Tiede A. Erratum: Gentherapie der Hämophilie: Empfehlung der Gesellschaft für Thrombose- und Hämostaseforschung (GTH). Hamostaseologie 2022. [PMID: 36543250 DOI: 10.1055/s-0042-1760262] [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] [Indexed: 12/24/2022] Open
Affiliation(s)
- Wolfgang Miesbach
- Medizinische Klinik 2, Institut für Transfusionsmedizin, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Deutschland
| | - Robert Klamroth
- Klinik für Innere Medizin - Angiologie und Hämostaseologie, Zentrum für Gefäßmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Hermann Eichler
- Institut für Klinische Hämostaseologie und Transfusionsmedizin, Universität und Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Jürgen Koscielny
- Gerinnungsambulanz mit Hämophiliezentrum, Charité, Berlin, Deutschland
| | - Susanne Holzhauer
- Klinik für Pädiatrie m. S. Onkologie und Hämatologie, Charité, Universitätsmedizin, Berlin, Deutschland
| | - Katharina Holstein
- II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Johanna A Kremer Hovinga
- Universitätsklinik für Hämatologie und Hämatologische Zentrallabor, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Lorenzo Alberio
- Division of Haematology and Haematology Central Laboratory, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Olivieri
- Hämophiliezentrum LMU Klinikum - Bereich Pädiatrie, Dr. von Haunerschen Kinderspital, LMU München, München, Deutschland
| | - Ralf Knöfler
- Universitätsklinikum Dresden Klinik/Poliklinik für Kinder- und Jugendmedizin Bereich Hämatologie, Dresden, Deutschland
| | - Christoph Male
- Abteilung für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Österreich
| | - Andreas Tiede
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Deutschland
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Miesbach W, Oldenburg J, Klamroth R, Eichler H, Koscielny J, Holzhauer S, Holstein K, Hovinga JAK, Alberio L, Olivieri M, Knöfler R, Male C, Tiede A. Gene therapy of Hemophilia: Recommendations from the German, Austrian, and Swiss Society for Thrombosis and Haemostasis Research (GTH). Hamostaseologie 2022. [PMID: 36516966 DOI: 10.1055/a-1957-4477] [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: 12/23/2022] Open
Abstract
Gene therapy has recently become a realistic treatment perspective for patients with hemophilia. Reviewing the literature and our personal experience from clinical trials, we discuss key aspects of hemophilia A and B gene therapy with vectors derived from adeno-associated virus, including predictable results, risks, adverse events, and patient-reported outcomes. Patient selection, informed consent, administration, and monitoring of gene therapy as well as data collection are explained. We also discuss the need for interdisciplinary cooperation with hepatology and other specialties. We emphasize structural and organizational requirements for treatment centers according to the hub-and-spoke model and recommend the use of electronic diaries to ensure safe and timely collection and exchange of data. Electronic diaries will play a key role as a primary source of data for pharmacovigilance, postmarketing clinical studies, national and international registries, as well as health technology and benefit assessment. Reimbursement aspects and the future of gene therapy in adolescents and children are also considered. In a rapidly evolving scientific environment, these recommendations aim to support treatment providers and payers to prepare for the implementation of gene therapy following marketing authorization.
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Affiliation(s)
- Wolfgang Miesbach
- Medizinische Klinik 2, Institut für Transfusionsmedizin, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Deutschland
| | - Robert Klamroth
- Klinik für Innere Medizin - Angiologie und Hämostaseologie, Zentrum für Gefäßmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Hermann Eichler
- Institut für Klinische Hämostaseologie und Transfusionsmedizin, Universität und Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Jürgen Koscielny
- Gerinnungsambulanz mit Hämophiliezentrum, Charité, Berlin, Deutschland
| | - Susanne Holzhauer
- Klinik für Pädiatrie m. S. Onkologie und Hämatologie, Charité, Universitätsmedizin, Berlin, Deutschland
| | - Katharina Holstein
- II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Johanna A Kremer Hovinga
- Universitätsklinik für Hämatologie und Hämatologische Zentrallabor, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Lorenzo Alberio
- Division of Haematology and Haematology Central Laboratory, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Olivieri
- Hämophiliezentrum LMU Klinikum - Bereich Pädiatrie, Dr. von Haunerschen Kinderspital, LMU München, München, Deutschland
| | - Ralf Knöfler
- Universitätsklinikum Dresden Klinik/Poliklinik für Kinder- und Jugendmedizin Bereich Hämatologie, Dresden, Deutschland
| | - Christoph Male
- Abteilung für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Österreich
| | - Andreas Tiede
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Deutschland
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9
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Miesbach W, Eichler H, Holstein K, Holzhauer S, Klamroth R, Knöfler R, Male C, Olivieri M, Oldenburg J, Tiede A. Electronic diaries in the management of haemophilia gene therapy: Perspective of an expert group from the German, Austrian and Swiss Society on Thrombosis and Haemostasis (GTH). Haemophilia 2022; 28:264-269. [PMID: 35182445 DOI: 10.1111/hae.14516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Gene therapy (GT) is becoming a realistic treatment option for patients with haemophilia. Outside clinical trials, the complexity and potential complications of GT will pose unprecedented challenges to haemophilia care centres. AIM To explore the potential use of electronic tools to improve the delivery of GT under real-world conditions. METHODS Considering the hub-and-spoke model, the GTH working group on GT considered the entire patient pathway and reached consensus on requirements for an integrative software tool to secure documenting and sharing information between treaters, pharmacies and patients. RESULTS Six steps of the gene therapy process were identified, each requiring completion of the previous step as a prerequisite for entry. The responsibilities of GT dosing and follow-up treatment centres, read/write access rules, and the minimum data set were outlined. Data contributed by patients through mobile devices was also considered. CONCLUSION Important information needs to be shared between patients and treatment centres in a real-world GT hub-and-spoke model. Collecting and sharing this information in well-organised electronic applications will not only improve patient care but also enable national and international data collection in clinical registries.
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Affiliation(s)
- Wolfgang Miesbach
- Department of Haemostaseology and Haemophilia Centre, Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Hermann Eichler
- Institute of Clinical Haemostaseology and Transfusion Medicine, Saarland University and University Hospital, Homburg/Saar, Germany
| | - Katharina Holstein
- Haemophilia Center, II. Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Holzhauer
- Pediatric Hematology and Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Robert Klamroth
- Department for Internal Medicine - Vascular medcine and Haemostaseology, Haemophilia Centre, Vivantes Clinic imFriedrichshain, Berlin, Germany
| | - Ralf Knöfler
- Department of Paediatric Haemostaseology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Christoph Male
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Martin Olivieri
- Paediatric Haemostasis and Thrombosis Unit, Paediatric Haemophilia Center, Department of Paediatrics, LMU, Dr. von Hauner Children's Hospital, University Hospital, Munich, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, Medical Faculty, University Hospital Bonn, University of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University Clinic Bonn, Bonn, Germany
| | - Andreas Tiede
- Hannover Medical School, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
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Abstract
Iron deficiency anemia has a high prevalence in children and has repeatedly been implicated as a risk factor for arterial and venous thrombosis. As an effective therapy for iron deficiency anemia is available, understanding the association between this form of anemia and the potentially severe thrombosis phenotype is of major clinical interest. Recent findings shed light on pathophysiology of hypercoagulability resulting from iron-restricted erythropoiesis. Specifically, an animal model of induced iron deficiency allowed identifying multiple mechanisms, by which iron deficiency anemia results in increased thrombus formation and thrombus progression both in arterial and venous thrombosis. These findings complement and support conclusions derived from clinical data. The purpose of this mini review is to summarize current evidence on the association of iron deficiency anemia and thrombosis. We want to increase the awareness of iron deficiency as a risk factor for thrombosis in the pediatric population. We discuss how novel pathophysiological concepts can be translated into the clinical settings and suggest clinical studies on prevention and treatment strategies in high-risk patient groups.
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Affiliation(s)
- Hannah Kalff
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Susanne Holzhauer
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
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11
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Cuntz F, Deubzer HE, Schulte JH, Nimtz-Talaska A, Eggert A, Holzhauer S. Hemostatic Management in an Infant With Neuroblastoma and Severe Hemophilia B With Extended Half-life Recombinant Factor IX Fusion Protein. J Pediatr Hematol Oncol 2022; 44:e246-e249. [PMID: 33661164 DOI: 10.1097/mph.0000000000002109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022]
Abstract
In the rare co-occurrence of childhood cancer and severe hemophilia, hemostatic management is of paramount therapeutic importance. We present the case of an 11-month-old boy with severe congenital hemophilia B, who was diagnosed with metastatic high-risk neuroblastoma. He consequently developed paraneoplastic coagulopathy with life-threatening tumor hemorrhage and intracranial hemorrhage, showing central nervous system relapse. Management consisted of factor IX replacement with extended half-life factor IX fusion protein, adjusted to bleeding risk. Additional interventions included factor XIII, fibrinogen, fresh frozen plasma, tranexamic acid, and platelet transfusions. The half-life of factor IX products was markedly reduced requiring close factor IX monitoring and adequate replacement. This intensified treatment allowed chemotherapy, autologous stem cell transplantation, and GD2 antibody immune therapy without bleeding or thrombosis.
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Affiliation(s)
- Franziska Cuntz
- Department of Pediatric Hematology and Oncology, Charité University Medicine
| | - Hedwig E Deubzer
- Department of Pediatric Hematology and Oncology, Charité University Medicine
- Experimental and Clinical Research Center (ECRC), Charité and Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin
| | - Johannes H Schulte
- Department of Pediatric Hematology and Oncology, Charité University Medicine
| | | | - Angelika Eggert
- Department of Pediatric Hematology and Oncology, Charité University Medicine
| | - Susanne Holzhauer
- Department of Pediatric Hematology and Oncology, Charité University Medicine
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12
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Holzhauer S. 4/w – Nasenbluten und blaue Flecken. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01290-x] [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: 01/19/2023]
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13
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Chonat S, Eber SW, Holzhauer S, Kollmar N, Morton DH, Glader B, Neufeld EJ, Yaish HM, Rothman JA, Sharma M, Ravindranath Y, Wang H, Breakey VR, Sheth S, Bradeen HA, Al-Sayegh H, London WB, Grace RF. Pyruvate kinase deficiency in children. Pediatr Blood Cancer 2021; 68:e29148. [PMID: 34125488 DOI: 10.1002/pbc.29148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pyruvate kinase deficiency (PKD) is a rare, autosomal recessive red blood cell enzyme disorder, which leads to lifelong hemolytic anemia and associated complications from the disease and its management. METHODS An international, multicenter registry enrolled 124 individuals younger than 18 years old with molecularly confirmed PKD from 29 centers. Retrospective and prospective clinical data were collected. RESULTS There was a wide range in the age at diagnosis from 0 to 16 years. Presentation in the newborn period ranged from asymptomatic to neonatal jaundice to fulminant presentations of fetal distress, myocardial depression, and/or liver failure. Children <5 years old were significantly more likely to be transfused than children >12 to <18 years (53% vs. 14%, p = .0006), which correlated with the timing of splenectomy. Regular transfusions were most common in children with two severe PKLR variants. In regularly transfused children, the nadir hemoglobin goal varied considerably. Impact on quality of life was a common reason for treatment with regular blood transfusions and splenectomy. Splenectomy increased the hemoglobin and decreased transfusion burden in most children but was associated with infection or sepsis (12%) and thrombosis (1.3%) even during childhood. Complication rates were high, including iron overload (48%), perinatal complications (31%), and gallstones (20%). CONCLUSIONS There is a high burden of disease in children with PKD, with wide practice variation in monitoring and treatment. Clinicians must recognize the spectrum of the manifestations of PKD for early diagnostic testing, close monitoring, and management to avoid serious complications in childhood.
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Affiliation(s)
- Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Stefan W Eber
- Schwerpunktpraxis für Pädiatrische Hämatologie-Onkologie, Munich, Germany
| | - Susanne Holzhauer
- Charité, University Medicine, Pediatric Hematology and Oncology, Berlin, Germany
| | | | - D Holmes Morton
- Central Pennsylvania Clinic for Special Children & Adults, Belleville, Pennsylvania, USA.,Lancaster General Hospital, Lancaster, Pennsylvania, USA
| | - Bertil Glader
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Ellis J Neufeld
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Hassan M Yaish
- Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | | | - Mukta Sharma
- Children's Mercy, School of Medicine University of Missouri, Kansas City, Missouri, USA
| | - Yaddanapudi Ravindranath
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Heng Wang
- DDC Clinic for Special Needs Children, Middlefield, Ohio, USA
| | | | - Sujit Sheth
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Heather A Bradeen
- The University of Vermont Children's Hospital, Burlington, Vermont, USA
| | - Hasan Al-Sayegh
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts, USA
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts, USA
| | - Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts, USA
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14
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van Ommen CH, Albisetti M, Bhatt M, Bonduel M, Branchford B, Chalmers E, Chan A, Goldenberg NA, Holzhauer S, Monagle P, Nowak‐Göttl U, Revel‐Vilk S, Sciuccatie G, Sirachainan N, Male C. International pediatric thrombosis network to advance pediatric thrombosis research: Communication from the ISTH SSC subcommittee on pediatric and neonatal thrombosis and hemostasis. J Thromb Haemost 2021; 19:1123-1129. [PMID: 33792176 PMCID: PMC8252713 DOI: 10.1111/jth.15260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 01/16/2023]
Abstract
Pediatric thromboembolism is a rare and heterogenous disease. As a result, there is a paucity of knowledge with regard to natural history, management, and outcomes of most types of pediatric venous and arterial thromboembolism. International research collaboration is needed to fill these knowledge gaps. Not only randomized controlled trials, but also representative observational studies are required to answer all research questions. Therefore, the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis initiated the International Pediatric Thrombosis Network (IPTN). The aims of the IPTN include (1) development of the Throm-PED registry to facilitate international prospective observational studies, and (2) establishment of a network of pediatric thrombosis centers experienced in effectively conducting clinical trials and observational studies. The IPTN needs dedicated clinicians all over the world and several funding sources to obtain high-quality research data to reach its ultimate goal of improving care in children with thrombosis. The aim of this communication is to call for active participation in the IPTN to all physicians taking care of children with thrombosis worldwide.
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Affiliation(s)
- C. Heleen van Ommen
- Department of Pediatric Hematology‐OncologyErasmus MC Sophia Children's HospitalRotterdamthe Netherlands
| | - Manuela Albisetti
- Division of HematologyUniversity Children's HospitalZurichSwitzerland
| | - Mohir Bhatt
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Marianne Bonduel
- Servicio de Hematología y OncologíaHospital de Pediatría Prof. Dr. Juan P. GarrahanBuenos AiresArgentina
| | - Brian Branchford
- Department of PediatricsUniversity of Colorado Anschutz Medical CampusDenverColoradoUSA
| | | | - Anthony Chan
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Neil A. Goldenberg
- Departments of Pediatrics and MedicineDivision of HematologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Thrombosis and Stroke ProgramsJohns Hopkins All Children's Hospital, and Johns Hopkins All Children's Institute for Clinical and Translational ResearchSt. PetersburgFloridaUSA
| | | | - Paul Monagle
- Department of PediatricsHematology Research GroupMurdoch Children's Research InstituteThe University of MelbourneMelbourneAustralia
- Department of Clinical HematologyThe Royal Children's HospitalMelbourneAustralia
| | - Ulrike Nowak‐Göttl
- Department of Pediatric Hematology‐OncologyMünster and Institute of Clinical ChemistryUniversity Hospital Kiel‐LübeckUniversity of MünsterKielGermany
| | - Shoshana Revel‐Vilk
- Pediatric Hematology/Oncology UnitShaare‐Zedek Medical CenterHebrew UniversityJerusalemIsrael
| | - Gabriela Sciuccatie
- Servicio de Hematología y OncologíaHospital de Pediatría Prof. Dr. Juan P. GarrahanBuenos AiresArgentina
| | - Nongnuch Sirachainan
- Department of PediatricsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Christoph Male
- Department of PediatricsMedical University of ViennaViennaAustria
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15
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Al-Samkari H, van Beers EJ, Morton DH, Barcellini W, Eber SW, Glader B, Yaish HM, Chonat S, Kuo KHM, Kollmar N, Despotovic JM, Pospíšilová D, Knoll CM, Kwiatkowski JL, Pastore YD, Thompson AA, Wlodarski MW, Ravindranath Y, Rothman JA, Wang H, Holzhauer S, Breakey VR, Verhovsek MM, Kunz J, Sheth S, Sharma M, Rose MJ, Bradeen HA, McNaull MN, Addonizio K, Al-Sayegh H, London WB, Grace RF. Characterization of the severe phenotype of pyruvate kinase deficiency. Am J Hematol 2020; 95:E281-E285. [PMID: 32619047 DOI: 10.1002/ajh.25926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - D Holmes Morton
- Central Pennsylvania Clinic for Special Children & Adults, Belleville, Pennsylvania
- Lancaster General Hospital, Lancaster, Pennsylvania
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefan W Eber
- Schwerpunktpraxis für Pädiatrische Hämatologie-Onkologie and Children's Hospital, Technical University, Munich, Germany
| | - Bertil Glader
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Hassan M Yaish
- Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Satheesh Chonat
- Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kevin H M Kuo
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | | | - Jenny M Despotovic
- Texas Children's Hematology Center, Baylor College of Medicine, Houston, Texas
| | | | | | - Janet L Kwiatkowski
- Children's Hospital of Philadelphia and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Alexis A Thompson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Marcin W Wlodarski
- St. Jude Children's Research Hospital, Memphis, Tennessee
- University of Freiburg, Freiburg, Germany
| | | | | | - Heng Wang
- DDC Clinic for Special Needs Children, Middlefield, Ohio
| | | | | | | | - Joachim Kunz
- Zentrum für Kinder-und Jugendmedizin, Heidelberg, Germany
| | - Sujit Sheth
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Mukta Sharma
- Children's Mercy, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Melissa J Rose
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | | | | | - Kathryn Addonizio
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, Massachusetts
| | - Hasan Al-Sayegh
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, Massachusetts
| | - Wendy B London
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, Massachusetts
| | - Rachael F Grace
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, Massachusetts
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16
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Young G, Lensing AWA, Monagle P, Male C, Thelen K, Willmann S, Palumbo JS, Kumar R, Nurmeev I, Hege K, Bajolle F, Connor P, Hooimeijer HL, Torres M, Chan AKC, Kenet G, Holzhauer S, Santamaría A, Amedro P, Beyer-Westendorf J, Martinelli I, Massicotte MP, Smith WT, Berkowitz SD, Schmidt S, Price V, Prins MH, Kubitza D. Rivaroxaban for treatment of pediatric venous thromboembolism. An Einstein-Jr phase 3 dose-exposure-response evaluation. J Thromb Haemost 2020; 18:1672-1685. [PMID: 32246743 DOI: 10.1111/jth.14813] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, the randomized EINSTEIN-Jr study showed similar efficacy and safety for rivaroxaban and standard anticoagulation for treatment of pediatric venous thromboembolism (VTE). The rivaroxaban dosing strategy was established based on phase 1 and 2 data in children and through pharmacokinetic (PK) modeling. METHODS Rivaroxaban treatment with tablets or the newly developed granules-for-oral suspension formulation was bodyweight-adjusted and administered once-daily, twice-daily, or thrice-daily for children with bodyweights of ≥30, ≥12 to <30, and <12 kg, respectively. Previously, these regimens were confirmed for children weighing ≥20 kg but only predicted in those <20 kg. Based on sparse blood sampling, the daily area under the plasma concentration-time curve [AUC(0-24)ss ] and trough [Ctrough,ss ] and maximum [Cmax,ss ] steady-state plasma concentrations were derived using population PK modeling. Exposure-response graphs were generated to evaluate the potential relationship of individual PK parameters with recurrent VTE, repeat imaging outcomes, and bleeding or adverse events. A taste-and-texture questionnaire was collected for suspension-recipients. RESULTS Of the 335 children (aged 0-17 years) allocated to rivaroxaban, 316 (94.3%) were evaluable for PK analyses. Rivaroxaban exposures were within the adult exposure range. No clustering was observed for any of the PK parameters with efficacy, bleeding, or adverse event outcomes. Results were similar for the tablet and suspension formulation. Acceptability and palatability of the suspension were favorable. DISCUSSION Based on this analysis and the recently documented similar efficacy and safety of rivaroxaban compared with standard anticoagulation, we conclude that bodyweight-adjusted pediatric rivaroxaban regimens with either tablets or suspension are validated and provide for appropriate treatment of children with VTE.
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Affiliation(s)
- Guy Young
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Paul Monagle
- Department of Clinical Haematology, Royal Children's Hospital, Haematology Research Murdoch Children's Research Institute, Parkville, Vic., Australia
- Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - Christoph Male
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | | | | | - Joseph S Palumbo
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Riten Kumar
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | | | - Kerry Hege
- Riley Hospital For Children at IU Health, Indianapolis, IN, USA
| | - Fanny Bajolle
- M3C-Necker Enfants malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Philip Connor
- The Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Hélène L Hooimeijer
- Department of Hematology and Oncology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcela Torres
- Department of Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX, USA
| | | | - Gili Kenet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Israeli National Hemophilia Center and Thrombosis Unit, The Amalia Biron Thrombosis Research Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Susanne Holzhauer
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Amparo Santamaría
- Hemostasis and Thrombosis Unit, Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Jan Beyer-Westendorf
- Division of Haematology and Haemostaseology, Department of Medicine I, Department of Haematology, University Hospital "Carl Gustav Carus" Dresden, King's Thrombosis Service, King's College London, London, UK
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | - Stephan Schmidt
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, University of Florida, OR, USA
| | - Victoria Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Martin H Prins
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
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17
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Bianchi P, Fermo E, Lezon‐Geyda K, Beers EJ, Morton HD, Barcellini W, Glader B, Chonat S, Ravindranath Y, Newburger PE, Kollmar N, Despotovic JM, Verhovsek M, Sharma M, Kwiatkowski JL, Kuo KHM, Wlodarski MW, Yaish HM, Holzhauer S, Wang H, Kunz J, Addonizio K, Al‐Sayegh H, London WB, Andres O, Wijk R, Gallagher PG, Grace RFF. Genotype-phenotype correlation and molecular heterogeneity in pyruvate kinase deficiency. Am J Hematol 2020; 95:472-482. [PMID: 32043619 DOI: 10.1002/ajh.25753] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 01/19/2023]
Abstract
Pyruvate kinase (PK) deficiency is a rare recessive congenital hemolytic anemia caused by mutations in the PKLR gene. This study reports the molecular features of 257 patients enrolled in the PKD Natural History Study. Of the 127 different pathogenic variants detected, 84 were missense and 43 non-missense, including 20 stop-gain, 11 affecting splicing, five large deletions, four in-frame indels, and three promoter variants. Within the 177 unrelated patients, 35 were homozygous and 142 compound heterozygous (77 for two missense, 48 for one missense and one non-missense, and 17 for two non-missense variants); the two most frequent mutations were p.R510Q in 23% and p.R486W in 9% of mutated alleles. Fifty-five (21%) patients were found to have at least one previously unreported variant with 45 newly described mutations. Patients with two non-missense mutations had lower hemoglobin levels, higher numbers of lifetime transfusions, and higher rates of complications including iron overload, extramedullary hematopoiesis, and pulmonary hypertension. Rare severe complications, including lower extremity ulcerations and hepatic failure, were seen more frequently in patients with non-missense mutations or with missense mutations characterized by severe protein instability. The PKLR genotype did not correlate with the frequency of complications in utero or in the newborn period. With ICCs ranging from 0.4 to 0.61, about the same degree of clinical similarity exists within siblings as it does between siblings, in terms of hemoglobin, total bilirubin, splenectomy status, and cholecystectomy status. Pregnancy outcomes were similar across genotypes in PK deficient women. This report confirms the wide genetic heterogeneity of PK deficiency.
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Affiliation(s)
- Paola Bianchi
- U.O.C. EmatologiaU.O.S. Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | - Elisa Fermo
- U.O.C. EmatologiaU.O.S. Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | | | - Eduard J. Beers
- Division Internal Medicine and DermatologyVan Creveldkliniek, University Medical Center Utrecht Utrecht The Netherlands
| | - Holmes D. Morton
- Central Pennsylvania Clinic for Special Children & AdultsBelleville, PA; Lancaster General Hospital Lancaster PA
| | - Wilma Barcellini
- U.O.C. EmatologiaU.O.S. Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | - Bertil Glader
- Lucile Packard Children's HospitalStanford University Palo Alto CA
| | - Satheesh Chonat
- Department of PediatricsEmory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta Atlanta GA
| | - Yaddanapudi Ravindranath
- School of MedicinePediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine Detroit MI
| | - Peter E. Newburger
- Department of PediatricsUniversity of Massachusetts Medical School Worcester MA
| | - Nina Kollmar
- Department of Pediatric Hematology/OncologyKlinikum Kassel GmbH Kassel Germany
| | | | | | - Mukta Sharma
- Department of PediatricsChildren's Mercy, School of Medicine University of Missouri Kansas City MO
| | - Janet L. Kwiatkowski
- Division of HematologyChildren's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Kevin H. M. Kuo
- Division of Hematology, Department of MedicineUniversity Health Network, University of Toronto Toronto Ontario Canada
| | | | - Hassan M. Yaish
- Primary Children's HospitalUniversity of Utah Salt Lake City UT
| | - Susanne Holzhauer
- CharitéUniversity Medicine, Pediatric Hematology and Oncology Berlin Germany
| | - Heng Wang
- DDC Clinic for Special Needs Children Middlefield OH
| | - Joachim Kunz
- Zentrumfür Kinder‐und Jugendmedizin Heidelberg Germany
| | - Kathryn Addonizio
- Dana‐Farber/Boston Children's Cancer and Blood Disorder Center Boston MA
| | - Hasan Al‐Sayegh
- Dana‐Farber/Boston Children's Cancer and Blood Disorder Center Boston MA
| | - Wendy B. London
- Dana‐Farber/Boston Children's Cancer and Blood Disorder Center Boston MA
| | - Oliver Andres
- Department of PediatricsUniversity of Würzburg Würzburg Germany
| | - Richard Wijk
- Central Diagnostic LaboratoryUniversity Medical Center Utrecht Utrecht The Netherlands
| | - Patrick G. Gallagher
- Department of Pediatrics, Department of Genetics, Department of PathologyYale University School of Medicine New Haven CT
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18
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Guilliams KP, Kirkham FJ, Holzhauer S, Pavlakis S, Philbrook B, Amlie-Lefond C, Noetzel MJ, Dlamini N, Sharma M, Carpenter JL, Fox CK, Torres M, Ichord RN, Jordan LC, Dowling MM. Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management. Stroke 2020; 50:1089-1094. [PMID: 31009343 DOI: 10.1161/strokeaha.118.022800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Sickle cell disease (SCD) and arteriopathy are pediatric stroke risk factors that are not mutually exclusive. The relative contributions of sickled red blood cells and arteriopathy to stroke risk are unknown, resulting in unclear guidelines for primary and secondary stroke prevention when both risk factors are present. We hypothesized that despite similarities in clinical presentation and radiographic appearance of arteriopathies, stroke evaluation and management differ in children with SCD compared with those without SCD. Methods- We compared presentation and management of children with and without SCD enrolled in the IPSS (International Pediatric Stroke Study) with acute arterial ischemic stroke, according to SCD and arteriopathy status. Regression modeling determined relative contribution of SCD and arteriopathy in variables with significant frequency differences. Results- Among 930 childhood arterial ischemic strokes, there were 98 children with SCD, 67 of whom had arteriopathy, and 466 without SCD, 392 of whom had arteriopathy. Arteriopathy, regardless of SCD status, increased likelihood of hemiparesis (odds ratio [OR], 1.94; 95% CI, 1.46-2.56) and speech abnormalities (OR, 1.67; 95% CI, 1.29-2.19). Arteriopathy also increased likelihood of headache but only among those without SCD (OR, 1.89; 95% CI, 1.40-2.55). Echocardiograms were less frequently obtained in children with SCD (OR, 0.58; 95% CI, 0.37-0.93), but the frequency of identified cardiac abnormalities was similar in both groups ( P=0.57). Children with SCD were less likely to receive antithrombotic therapy, even in the presence of arteriopathy (OR, 0.14; 95% CI, 0.08-0.22). Arteriopathy was associated with a significantly higher likelihood of antithrombotic therapy in children without SCD (OR, 5.36; 95% CI, 3.55-8.09). Conclusions- Arteriopathy, and not SCD status, was most influential of stroke presentation. However, SCD status influenced stroke management because children with SCD were less likely to have echocardiograms or receive antithrombotic therapy. Further work is needed to determine whether management differences are warranted.
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Affiliation(s)
- Kristin P Guilliams
- From the Departments of Neurology and Pediatrics, Washington University School of Medicine, St Louis, MO (K.P.G., M.J.N.)
| | - Fenella J Kirkham
- Developmental Neurosciences and Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, London and Clinical and Experimental Sciences, University of Southampton, United Kingdom (F.J.K.)
| | - Susanne Holzhauer
- Department of Pediatric Hematology and Oncology Charité University Medicine, Berlin, Germany (S.H.)
| | - Steven Pavlakis
- Department of Pediatrics and Neurology, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY (S.P.)
| | - Bryan Philbrook
- Department of Pediatrics, Pediatric Neurology, Emory University, Children's Healthcare of Atlanta, GA (B.P.)
| | - Catherine Amlie-Lefond
- Department of Neurology, Seattle Children's Hospital, University of Washington, Seattle (C.A.-L.)
| | - Michael J Noetzel
- From the Departments of Neurology and Pediatrics, Washington University School of Medicine, St Louis, MO (K.P.G., M.J.N.)
| | - Nomazulu Dlamini
- Department of Neurology, The Hospital for Sick Children, Toronto, Canada (N.D.)
| | - Mukta Sharma
- Department of Pediatric Hematology Oncology, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine (M.S.)
| | - Jessica L Carpenter
- Department of Pediatrics, Neurology, and Neuroscience, George Washington University, Children's National Medical Center, Washington DC (J.L.C.)
| | - Christine K Fox
- Departments of Neurology and Pediatrics, University of California San Francisco (C.K.F.)
| | - Marcela Torres
- Department of Pediatric Hematology Oncology, Cook Children's Medical Center, Fort Worth, TX (M.T.)
| | - Rebecca N Ichord
- Departments of Neurology and Pediatrics, Perlman School of Medicine at the University of Pennsylvania, Philadelphia (R.N.I.)
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN (L.C.J.)
| | - Michael M Dowling
- Departments of Pediatrics, Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas and Children's Health Dallas (M.M.D.)
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19
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Mahn R, Schilling K, Klamroth R, Kentouche K, Aumann V, Fischer L, Holzhauer S, Sirb H, Scholz U, Trautmann K, Halm-Heinrich I, Krammer-Steiner B, Knöfler R, Pfrepper C. Veränderungen in der Hämophiliebehandlung im Osten Deutschlands in den letzten 10 Jahren – eine Untersuchung des Kompetenznetzes Hämorrhagische Diathese Ost (KHDO). Hamostaseologie 2019. [DOI: 10.1055/s-0039-3400727] [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] [Indexed: 10/25/2022] Open
Affiliation(s)
- Rebecca Mahn
- Abteilung für Hämostaseologie, Universitätsklinikum Leipzig
| | | | - Robert Klamroth
- Klinik für Angiologie und Hämostaseologie, Vivantes Klinikum Friedrichshain, Berlin
| | - Karim Kentouche
- Klinik für Kinderund Jugendmedizin, Universitätsklinikum Jena
| | | | - Lars Fischer
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Leipzig
| | - Susanne Holzhauer
- Klinik für Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité, Berlin
| | - Harry Sirb
- Klinik für Kinder- und Jugendmedizin, DRK Krankenhaus Lichtenstein
| | - Ute Scholz
- Zentrum für Blutgerinnungsstörungen Leipzig
| | | | | | | | - Ralf Knöfler
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Dresden
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20
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Hoppe PA, Holzhauer S, Lala B, Bührer C, Gratopp A, Hanitsch LG, Humme D, Kieslich M, Kallinich T, Lau S, Leistner R, Niebank M, Pokrywka A, Ringe H, Schaper AS, Schröder JT, Schwarz C, Staab D, Stegemann MS, Thee S, Varnholt V, von Bernuth H, Weber-Carstens S, Wendt A, Krüger R. Severe infections of Panton-Valentine leukocidin positive Staphylococcus aureus in children. Medicine (Baltimore) 2019; 98:e17185. [PMID: 31567961 PMCID: PMC6756729 DOI: 10.1097/md.0000000000017185] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA) mostly present as recurrent skin abscesses and furunculosis. However, life-threatening infections (eg, necrotizing pneumonia, necrotizing fasciitis, and osteomyelitis) caused by PVL-SA have also been reported.We assessed the clinical phenotype, frequency, clinical implications (surgery, length of treatment in hospitals/intensive care units, and antibiotic treatments), and potential preventability of severe PVL-SA infections in children.Total, 75 children treated for PVL-SA infections in our in- and outpatient units from 2012 to 2017 were included in this retrospective study.Ten out of 75 children contracted severe infections (PVL-methicillin resistant S aureus n = 4) including necrotizing pneumonia (n = 4), necrotizing fasciitis (n = 2), pyomyositis (n = 2; including 1 patient who also had pneumonia), mastoiditis with cerebellitis (n = 1), preorbital cellulitis (n = 1), and recurrent deep furunculosis in an immunosuppressed patient (n = 1). Specific complications of PVL-SA infections were venous thrombosis (n = 2), sepsis (n = 5), respiratory failure (n = 5), and acute respiratory distress syndrome (n = 3). The median duration of hospital stay was 14 days (range 5-52 days). In 6 out of 10 patients a history suggestive for PVL-SA colonization in the patient or close family members before hospital admission was identified.PVL-SA causes severe to life-threatening infections requiring lengthy treatments in hospital in a substantial percentage of symptomatic PVL-SA colonized children. More than 50% of severe infections might be prevented by prompt testing for PVL-SA in individuals with a history of abscesses or furunculosis, followed by decolonization measures.
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Affiliation(s)
- Pia-Alice Hoppe
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | | | | | | | - Daniel Humme
- Department of Dermatology, Venerology and Allergy
| | | | | | - Susanne Lau
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | | | - Hannelore Ringe
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | - Carsten Schwarz
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Doris Staab
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | - Stephanie Thee
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Verena Varnholt
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Horst von Bernuth
- Department of Pediatric Pneumology, Immunology and Intensive Care
- Department of Immunology, Labor Berlin Charité-Vivantes GmbH
- Berlin-Brandenburg Center for Regenerative Therapies
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine Campus Mitte and Campus-Virchow Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anke Wendt
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Renate Krüger
- Department of Pediatric Pneumology, Immunology and Intensive Care
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21
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Monagle P, Lensing AWA, Thelen K, Martinelli I, Male C, Santamaría A, Samochatova E, Kumar R, Holzhauer S, Saracco P, Simioni P, Robertson J, Grangl G, Halton J, Connor P, Young G, Molinari AC, Nowak-Göttl U, Kenet G, Kapsa S, Willmann S, Pap AF, Becka M, Twomey T, Beyer-Westendorf J, Prins MH, Kubitza D. Bodyweight-adjusted rivaroxaban for children with venous thromboembolism (EINSTEIN-Jr): results from three multicentre, single-arm, phase 2 studies. Lancet Haematol 2019; 6:e500-e509. [PMID: 31420317 DOI: 10.1016/s2352-3026(19)30161-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rivaroxaban has been shown to be efficacious for treatment of venous thromboembolism in adults, and has a reduced risk of bleeding compared with standard anticoagulants. We aimed to develop paediatric rivaroxaban regimens for the treatment of venous thromboembolism in children and adolescents. METHODS In this phase 2 programme, we did three studies to evaluate rivaroxaban treatment in children younger than 6 months, aged 6 months to 5 years, and aged 6-17 years. Our studies used a multicentre, single-arm design at 54 sites in Australia, Europe, Israel, Japan, and north America. We included children with objectively confirmed venous thromboembolism previously treated with low-molecular weight heparin, fondaparinux, or a vitamin K antagonist for at least 2 months or, in children who had catheter-related venous thromboembolism for at least 6 weeks. We administered rivaroxaban orally in a bodyweight-adjusted 20 mg-equivalent dose, based on physiologically-based pharmacokinetic modelling predictions and EINSTEIN-Jr phase 1 data in young adults, in either a once-daily (tablets; for those aged 6-17 years), twice-daily (in suspension; for those aged 6 months to 11 years), or three times-daily (in suspension; for those younger than 6 months) dosing regimen for 30 days (or 7 days for those younger than 6 months). The primary aim was to define rivaroxaban treatment regimens that match the target adult exposure range. The principal safety outcome was major bleeding and clinically relevant non-major bleeding. Analyses were per-protocol. The predefined efficacy outcomes were symptomatic recurrent venous thromboembolism, asymptomatic deterioration on repeat imaging at the end of the study treatment period. These trials are registered at ClinicalTrials.gov, numbers NCT02564718, NCT02309411, and NCT02234843. FINDINGS Between Feb 11, 2013, and Dec 20, 2017, we enrolled 93 children (ten children younger than 6 months; 15 children aged 6 months to 1 year; 25 children aged 2-5 years; 32 children aged 6-11 years; and 11 children aged 12-17 years) into our study. 89 (96%) children completed study treatment (30 days of treatment, or 7 days in those younger than 6 months), and 93 (100%) children received at least one dose of study treatment and were evaluable for the primary endpoints. None of the children had a major bleed, and four (4%, 95% CI 1·2-10·6) of these children had a clinically relevant non-major bleed (three children aged 12-17 years with menorrhagia and one child aged 6-11 years with gingival bleeding). We found no symptomatic recurrent venous thromboembolism in any patients (0%, 0·0-3·9). 24 (32%) of 75 patients with repeat imaging had their thrombotic burden resolved, 43 (57%) patients improved, and eight (11%) patients were unchanged. No patient deteriorated. We confirmed therapeutic rivaroxaban exposures with once-daily dosing in children with bodyweights of at least 30 kg and with twice-daily dosing in children with bodyweights of at least 20 kg and less than 30 kg. Children with low bodyweights (<20 kg, particularly <12 kg) showed low exposures so, for future studies, rivaroxaban dosages were revised for these weight categories, to match the target adult exposure range. 61 (66%) of 93 children had adverse events during the study. Pyrexia was the most common adverse event (ten [11%] events), and anaemia and neutropenia or febrile neutropenia were the most frequent grade 3 or worse events (four [4%] events each). No children died or were discontinued from rivaroxaban because of adverse events. INTERPRETATION Treatment with bodyweight-adjusted rivaroxaban appears to be safe in children. The treatment regimens that we confirmed in children with bodyweights of at least 20 kg and the revised treatment regimens that we predicted in those with bodyweights less than 20 kg will be evaluated in the EINSTEIN-Jr phase 3 trial in children with acute venous thromboembolism. FUNDING Bayer AG, Janssen Research and Development.
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Affiliation(s)
- Paul Monagle
- Department of Clinical Haematology, Royal Children's Hospital, Haematology Research Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, VIC, Australia
| | | | | | - Ida Martinelli
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christoph Male
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Amparo Santamaría
- Department of Thrombosis and Haemostasis, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Elena Samochatova
- Federal Research and Clinical Centre of Paediatric Haematology, Oncology and Immunology, Moscow, Russia
| | - Riten Kumar
- Division of Pediatric Hematology and Oncology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Susanne Holzhauer
- Department of Paediatric Haematology and Oncology, Charité-Universitätsmedizin, Berlin, Germany
| | - Paola Saracco
- Department of Paediatrics, Haematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza Torino, Turin, Italy
| | - Paolo Simioni
- Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padova University Hospital, Padova, Italy
| | - Jeremy Robertson
- Haematology Service, Division of Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Gernot Grangl
- Department of Paediatrics and Adolescence Medicine, Division of Paediatric Cardiology, Medical University of Graz, Graz, Austria
| | - Jacqueline Halton
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Phillip Connor
- The Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Guy Young
- Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Angelo C Molinari
- Thrombosis and Haemostasis Unit, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Ulrike Nowak-Göttl
- Thrombosis and Haemostasis Treatment Centre, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Gili Kenet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israeli National Haemophilia Centre and Thrombosis Unit and The Amalia Biron Thrombosis Research Institute, Sheba Medical Centre, Tel Hashomer, Israel
| | | | | | | | | | | | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Haematology and Haemostaseology, University Hospital Carl Gustav Carus, Dresden, Germany; King's Thrombosis Service, Department of Haematology, King's College London, London, UK
| | - Martin H Prins
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
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22
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Usuba K, Price VE, Blanchette V, Abad A, Altisent C, Buchner‐Daley L, Carneiro JDA, Feldman BM, Fischer K, Grainger J, Holzhauer S, Luke K, Meunier S, Ozelo M, Tang L, Antunes SV, Villaça P, Wakefield C, Wharfe G, Wu R, Young NL. Impact of prophylaxis on health-related quality of life of boys with hemophilia: An analysis of pooled data from 9 countries. Res Pract Thromb Haemost 2019; 3:397-404. [PMID: 31294327 PMCID: PMC6611476 DOI: 10.1002/rth2.12202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prophylaxis reduces the frequency of bleeds in boys with severe hemophilia and is the standard care for their management in resource-abundant countries. The effect of prophylaxis on Health-Related Quality of Life (HRQoL) has not been established, because the sample sizes of most studies are too small to explore the relationship of multiple factors that influence HRQoL. METHODS The aim of this study was to assess the impact of hemophilia severity and treatment regimen on HRQoL and to establish the minimum important difference (MID) using the international level of score distributions. HRQoL data were pooled from 7 studies across 9 countries. HRQoL was measured using the Canadian Hemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT). A mixed-effect linear regression analysis was employed to assess the impact of prophylaxis on the CHO-KLAT score. RESULTS Data from 401 boys with hemophilia were analyzed (57.6% severe hemophilia and 57.6% receiving prophylaxis). The model revealed that receiving prophylaxis was significantly associated with higher HRQoL (regression coefficient 8.5, 95% confidence interval [CI] 3.9-13.1). Boys with severe hemophilia had a significantly lower HRQoL as compared to boys with moderate and mild hemophilia whose CHO-KLAT scores were 7.0 and 6.6 points higher, respectively. There was a significant interaction between treatment and disease severity (P = 0.023), indicating prophylaxis has the most significant impact in boys with severe hemophilia. Based on these pooled data, the MID of the CHO-KLAT was established at 6.5. CONCLUSIONS This study confirms the positive effect of prophylaxis on HRQoL in boys with hemophilia in a real-world setting and provides initial benchmarks for interpreting HRQoL scores based on use of the CHO-KLAT instrument.
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Affiliation(s)
- Koyo Usuba
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
- Evaluating Children's Health Outcomes Research CentreLaurentian UniversitySudburyOntarioCanada
| | - Victoria E. Price
- Division of Pediatric Hematology/OncologyDepartment of PediatricsIWK Health CentreDalhousie UniversityHalifaxNova ScotiaCanada
| | - Victor Blanchette
- Division of Hematology/OncologyDepartment of PediatricsThe Hospital for Sick Children (SickKids)University of TorontoTorontoOntarioCanada
| | - Audrey Abad
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
| | | | | | - Jorge D. A. Carneiro
- Centro de Hemofilia e Instituto da CriançaHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Brian M. Feldman
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoOntarioCanada
- Institute of Health PolicyManagement & Evaluation, the Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Susanne Holzhauer
- Department of Pediatric Hematology and OncologyCharité University MedicineBerlinGermany
| | - Koon‐Hung Luke
- Department of PediatricsLaboratory Medicine and PathologyUniversity of OttawaOttawaOntarioCanada
| | - Sandrine Meunier
- Hemostase CliniqueGroupement Hospitalier Universitaire EstHospices Civils de LyonBronFrance
| | - Margareth Ozelo
- Unit of Hemophilia IHTCCláudio L.P. CorreaHemocentro UnicampINCT do SangueUniversity of CampinasCampinasBrazil
| | - Ling Tang
- Hematology/Oncology CenterBeijing Children's Hospital, Capital Medical UniversityBeijingChina
| | - Sandra V. Antunes
- Department of HematologyUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Paula Villaça
- Service of HematologyHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Cindy Wakefield
- Department of NursingThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
| | - Gilian Wharfe
- Department of PathologyUniversity of the West Indies (UWI)MonaJamaica
| | - Runhui Wu
- Hematology/Oncology CenterBeijing Children's Hospital, Capital Medical UniversityBeijingChina
| | - Nancy L. Young
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
- Evaluating Children's Health Outcomes Research CentreLaurentian UniversitySudburyOntarioCanada
- School of Rural and Northern HealthLaurentian UniversitySudburyOntarioCanada
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23
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Weimar C, Holzhauer S, Knoflach M, Koennecke HC, Masuhr F, Mono ML, Niederstadt T, Nowak-Göttl U, Schellong SM, Kurth T. [Cerebral venous and sinus thrombosis : S2k guidelines]. Nervenarzt 2019; 90:379-387. [PMID: 30758512 DOI: 10.1007/s00115-018-0654-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christian Weimar
- Neurologische Universitätsklinik, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Susanne Holzhauer
- Klinik für Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité Universitätsmedizin, Berlin, Deutschland
| | - Michael Knoflach
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | | | - Florian Masuhr
- Abteilung für Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | | | - Thomas Niederstadt
- Institut für Klinische Radiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Ulrike Nowak-Göttl
- Institut für Klinische Chemie, Gerinnungszentrum UKSH (Campus Kiel und Lübeck), Kiel, Deutschland
| | | | - Tobias Kurth
- Institut für Public Health, Charité Universitätsmedizin, Berlin, Deutschland
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24
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van Beers EJ, van Straaten S, Morton DH, Barcellini W, Eber SW, Glader B, Yaish HM, Chonat S, Kwiatkowski JL, Rothman JA, Sharma M, Neufeld EJ, Sheth S, Despotovic JM, Kollmar N, Pospíšilová D, Knoll CM, Kuo K, Pastore YD, Thompson AA, Newburger PE, Ravindranath Y, Wang WC, Wlodarski MW, Wang H, Holzhauer S, Breakey VR, Verhovsek M, Kunz J, McNaull MA, Rose MJ, Bradeen HA, Addonizio K, Li A, Al-Sayegh H, London WB, Grace RF. Prevalence and management of iron overload in pyruvate kinase deficiency: report from the Pyruvate Kinase Deficiency Natural History Study. Haematologica 2018; 104:e51-e53. [PMID: 30213831 DOI: 10.3324/haematol.2018.196295] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Eduard J van Beers
- Van Creveldkliniek, University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Stephanie van Straaten
- Van Creveldkliniek, University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - D Holmes Morton
- Central Pennsylvania Clinic for Special Children & Adults, Belleville, PA, USA Lancaster General Hospital, Lancaster, PA, USA
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefan W Eber
- Schwerpunktpraxis für Pädiatrische Hämatologie-Onkologie and Children's Hospital, Technical University, Munich, Germany
| | - Bertil Glader
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Hassan M Yaish
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Satheesh Chonat
- Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA, USA
| | - Janet L Kwiatkowski
- Children's Hospital of Philadelphia and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mukta Sharma
- Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA
| | | | - Sujit Sheth
- Weill Cornell Medical College, New York Presbyterian Hospital, NY, USA
| | - Jenny M Despotovic
- Texas Children's Hematology Center, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | - Kevin Kuo
- University of Toronto, University Health Network, ON, Canada
| | | | - Alexis A Thompson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | | | | | - Marcin W Wlodarski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Heng Wang
- DDC Clinic for Special Needs Children, Middlefield, OH, USA
| | | | | | | | - Joachim Kunz
- Zentrum für Kinder-und Jugendmedizin,University of Heidelberg, Heidelberg, Germany
| | | | - Melissa J Rose
- Nationwide Children's Hospital,The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Kathryn Addonizio
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Anran Li
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Hasan Al-Sayegh
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Wendy B London
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Rachael F Grace
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
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Schifferli A, Holbro A, Chitlur M, Coslovsky M, Imbach P, Donato H, Elalfy M, Graciela E, Grainger J, Holzhauer S, Riccheri C, Rodeghiero F, Ruggeri M, Tamary H, Uglova T, Wu R, Kühne T. A comparative prospective observational study of children and adults with immune thrombocytopenia: 2-year follow-up. Am J Hematol 2018. [PMID: 29516627 DOI: 10.1002/ajh.25086] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Comparative clinical studies of children and adults with immune thrombocytopenia (ITP) are poorly covered in the literature. However, the accepted classification of ITP-childhood ITP and adult ITP-results in considerable differences in treatment protocols and practice guidelines. The analysis of the Pediatric and Adult Registry on Chronic ITP (PARC-ITP) of patients at first presentation demonstrated fewer differences in clinical and laboratory findings at initial diagnosis between children and adults than expected. The present report of 2-year follow-up data supports the hypothesis that there are common aspects of childhood and adult ITP. Data of 3360 children and 420 adults were collected during the time of 2004 until 2015 at initial diagnosis. Follow-up information was available for 51% and 33% of children and 66% and 49% of adults at 12- and 24-months, respectively. Similarities were found in unexpected areas of ITP, such as the rate of late remission at 12 and 24 months, reported bleeding sites, platelet count in bleeders, and the frequency of treated patients with persistent or chronic ITP. Differences were confirmed for the overall rate of remission and treatment modalities. Unexpected differences were found in the percentage of nonbleeders, with more adults in the nonbleeder group. More studies are needed to investigate different age groups with the aim to optimize their management.
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Affiliation(s)
- Alexandra Schifferli
- Department of Hematology/OncologyUniversity Children's Hospital BaselBasel Switzerland
| | - Andreas Holbro
- Department of HematologyUniversity Hospital BaselBasel Switzerland
| | - Meera Chitlur
- Carmen and Ann Adams Department of Pediatrics, Division of Hematology/OncologyChildren's Hospital of Michigan, Wayne State UniversityDetroit Michigan
| | | | - Paul Imbach
- Chairperson Intercontinental Cooperative ITP Study Group (ICIS)Basel Switzerland
| | - Hugo Donato
- Hematology/Oncology, Hospital del Niño de San Justo, San JustoBuenos Aires Argentina
| | - Mohsen Elalfy
- Pediatric Hematology and OncologyPediatric Hospital Ain Shams UniversityCairo Egypt
| | - Elena Graciela
- Department of Hemalogy‐Oncology Pedro de ElizaldeChildren Hospital Buenos AiresBuenos Aires Argentina
| | - John Grainger
- Department of HaematologyRoyal Manchester Children's HospitalManchester United Kingdom
| | - Susanne Holzhauer
- Department of Pediatric Hematology and OncologyCharité Berlin Germany
| | - Cecilia Riccheri
- Servicio de Pediatria Hospital Alejandro Posadas Buenos AiresBuenos Aires Argentina
| | | | - Marco Ruggeri
- Hematology DepartmentSan Bortolo HospitalVicenza Italy
| | - Hannah Tamary
- Hematology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Sackler Faculty of MedicineTel Aviv UniversityTel Aviv Israel
| | - Tatjana Uglova
- Department of Clinical ResearchBelarusian Research Center of Pediatric Oncology, Hematology and ImmunologyMinsk Belarus
| | - Runhui Wu
- Hematology Oncology Center, Beijing Children's Hospital CapitalBeijing China
| | - Thomas Kühne
- Department of Hematology/OncologyUniversity Children's Hospital BaselBasel Switzerland
- Chairperson Intercontinental Cooperative ITP Study Group (ICIS)Basel Switzerland
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Holzhauer S, Sitaru AG, Ebell W, Schindler D, Hanenberg H, Wirbelauer J, Walter U, Grossmann R. Decreased platelet reactivity identified by whole blood flow cytometry in Fanconi anaemia patients. Thromb Haemost 2017. [DOI: 10.1160/th07-06-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Summarydisorder characterized by congenital anomalies and a high risk for bone marrow failure and cancer. Bleeding is a frequent complication in FA, leading to substantial morbidity and mortality. Thrombocytopenia is a major factor leading to this complication, but the bleeding tendency of FA patients often exceeds what one might expect based on their platelet counts. We therefore investigated if alterations of platelet function contribute to the bleeding tendency of FA patients. We assessed platelet function in 11 FA patients and 23 controls with whole blood flow cytometry. We analyzed the expression of platelet membrane glycoprotein receptors, reactivity of platelets to physiologic agonists and the proportion of young platelets. In FA patients platelet PAC-1 after stimulation with thrombin receptor activating peptide (TRAP) and adenosine diphosphate (ADP) were 15–70% lower than in controls. We found no or only minor differences of platelet glycoprotein receptor expression between groups. While the proportion of reticulated platelets was not different, the absolute number of reticulated platelets was markedly lower in FA patients. Our data show that FA is associated with reduced platelet reactivity, which may contribute to the high bleeding tendency in FA patients. Whole blood flow cytometry is a suitable method for analysis of platelet function in FA patients.
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Kenet G, Kurnik K, Gelas MA, Finckh U, Junker R, Heller C, Zieger B, Knöfler R, Holzhauer S, Mesters R, Krümpel A, Klostermeier UC, Limperger V, Nowak-Göttl U. Role of protein S deficiency in children with venous thromboembolism. Thromb Haemost 2017; 113:426-33. [DOI: 10.1160/th14-06-0533] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/28/2014] [Indexed: 11/05/2022]
Abstract
SummaryVenous thromboembolism [TE] is a multifactorial disease, and protein S deficiency [PSD] constitutes a major risk factor. In the present study the prevalence of PSD and the clinical presentation at TE onset in a cohort of children is reported. In 367 unselected paediatric patients with TE (age 0.1–18 years) recruited between July 1996 and December 2013, a comprehensive thrombophilia screening was performed along with recording of anamnestic data. Thirty of 367 paediatric patients (8.2 %) derived from 27 families had PSD. Mean age at first TE onset was 14.5 years (range 0.1 to 18). Thrombotic locations were cerebral veins (n=8), calf vein TE (n=3) deep veins (DVT) of the leg (n=12), DVT & pulmonary embolism (n=5) and intra-cardiac veins (n=1) or purpura fulminans (n=1). PSD co-occurred with the factor 5 mutation at rs6025 or the homozygous factor 2 susceptibility variant at rs1799963 in one case each. The Heerlen polymorphism detected in five children presented with milder PSD. In 18 patients (60 %) a concomitant risk factor for TE was identified. A second TE event within primarily healthy siblings occurred in three of 27 PSD families (11.0 %). In this cohort of children with symptomatic TE, the prevalence of PSD adjusted for family status was 7.4 %. Given its clinical implication for patients and family members, thrombophilia testing should be performed and the benefit of medical or educational interventions should be evaluated in this high-risk population.
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Elisa Mancuso M, Santagostino E, Kenet G, Elalfy M, Holzhauer S, Bidlingmaier C, Escuriola Ettingshausen C, Iorio A, Nowak-Göttl U, Marcucci M. Type and intensity of FVIII exposure on inhibitor development in PUPs with haemophilia A. Thromb Haemost 2017; 113:958-67. [DOI: 10.1160/th14-07-0621] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/18/2014] [Indexed: 01/13/2023]
Abstract
SummaryThe impact of treatment-related factors on inhibitor development in previously untreated patients (PUPs) with haemophilia A is still debated. We present the results of a collaborative, individual patient data meta-analytic project. Eligible data sources were published cohorts of PUPs for which patient-level data were available. The exposures of interest were factor (F)VIII type (recombinant [rFVIII] vs plasma-derived [pdFVIII]) and treatment intensity (≥ vs < 150 IU/kg/week) at first treatment. Family history of inhibitors, F8 mutations, age, treatment regimen (on-demand vs prophylaxis), secular trend and surgery were analysed as putative confounders using different statistical approaches (multivariable Cox regression, propensity score analyses, CART). Analyses accounted for the multi-centre origin of the data. We included 761 consecutive, unselected PUPs with moderate to severe haemophilia A from 10 centres in Egypt, Germany, Israel and Italy. A total of 27 % of patients developed inhibitors; 40 % and 22 % of patients treated with rFVIII and pdFVIII (unadjusted HR 2.2, 95 % CI 1.6–2.9), respectively; 51 % and 24 % of patients receiving high-and low-intensity treatment (unadjusted HR 2.9, 95 % CI 2.0–4.2), respectively. In adjusted analyses, only treatment intensity remained an independent predictor; the effect of FVIII type was largely due to confounding, but with a significant interaction between FVIII type and treatment intensity. This patient-level meta-analysis confirms, across different statistical approaches, that high-intensity treatment is a strong risk factor for inhibitor development. The possible role of FVIII type in subgroups is suggested by the test for interactions but could not be proven because of the limited subgroups sample sizes.
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Limperger V, Kenet G, Goldenberg NA, Heller C, Holzhauer S, Junker R, Klostermeier UC, Knoefler R, Kurnik K, Krümpel A, Mesters R, Stach M, Young G, Nowak-Göttl U. Impact of high-risk thrombophilia status on recurrence among children with a first non-central-venous-catheter-associated VTE: an observational multicentre cohort study. Br J Haematol 2016; 175:133-40. [PMID: 27329967 DOI: 10.1111/bjh.14192] [Citation(s) in RCA: 16] [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] [Received: 02/16/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
Deficiency of antithrombin (AT), protein C (PC) or protein S (PS) constitutes a major risk factor for venous thromboembolism (VTE). Individuals at high risk for recurrence who benefit from screening need to be identified. The primary study objective was to determine the individual recurrence risk among children with a first non-central-venous-catheter-associated VTE with respect to their thrombophilia status and to evaluate if the clinical presentation at first VTE onset differs between children with AT, PC or PS deficiency versus no thrombophilia. We calculated the absolute risk of VTE recurrence and event-free-survival adjusted for thrombophilia, age, sex and positive family VTE history in 161 consecutively enrolled paediatric VTE patients. The presence of a deficiency relative to no thrombophilia was evaluated as a potential predictor of recurrence. Predictors for recurrence were AT deficiency (hazard ratio/95% CI: 6·5/2·46-17·2) and female gender (2·6/1·1-6·35). The annual recurrence rates (95% CIs) were 5·4% (2·6-10) in AT-deficient children, 1·3% (0·3-3·8) in patients with PC deficiency, 0·7% (0·08-2·4) in the PS-deficient cohort and 0·9% (0·4-1·8) in patients with no thrombophilia. Positive family VTE history or combined thrombophilias did not predict recurrence. Given the overall annual incidence rate of recurrence of 1·5% we suggest screening for AT deficiency in children with VTE.
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Affiliation(s)
- Verena Limperger
- Institute of Clinical Chemistry, University Hospital Kiel, Kiel, Germany
| | - Gili Kenet
- Thrombosis Unit, National Haemophilia Centre, Tel Hashomer and the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Neil A Goldenberg
- All Children's Hospital Johns Hopkins Medicine and All Children's Research Institute, St. Petersburg, FL, USA.,Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Susanne Holzhauer
- Department of Paediatric Haematology/Oncology, Charité, Berlin, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry, University Hospital Kiel, Kiel, Germany
| | | | - Ralf Knoefler
- Department of Paediatric Haemostaseology, Dresden, Germany
| | - Karin Kurnik
- Department of Paediatrics, University Children Hospital Munich, Munich, Germany
| | - Anne Krümpel
- Department of Paediatric Haematology/Oncology, University Children Hospital Münster, Münster, Germany
| | - Rolf Mesters
- Department of Medicine/Haematology & Oncology, Univ. Hospital Münster, Münster, Germany
| | - Michael Stach
- IT Service Centre, University Hospital of Münster, Münster, Germany
| | - Guy Young
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ulrike Nowak-Göttl
- Institute of Clinical Chemistry, University Hospital Kiel, Kiel, Germany. .,Department of Paediatric Haematology/Oncology, University Children Hospital Münster, Münster, Germany.
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Grainger JD, Locatelli F, Chotsampancharoen T, Donyush E, Pongtanakul B, Komvilaisak P, Sosothikul D, Drelichman G, Sirachainan N, Holzhauer S, Lebedev V, Lemons R, Pospisilova D, Ramenghi U, Bussel JB, Bakshi KK, Iyengar M, Chan GW, Chagin KD, Theodore D, Marcello LM, Bailey CK. Eltrombopag for children with chronic immune thrombocytopenia (PETIT2): a randomised, multicentre, placebo-controlled trial. Lancet 2015; 386:1649-58. [PMID: 26231455 DOI: 10.1016/s0140-6736(15)61107-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The thrombopoietin receptor agonist eltrombopag has been shown to be safe, tolerable, and effective for adults with chronic immune thrombocytopenia. We aimed to investigate the safety and efficacy of eltrombopag for children with chronic immune thrombocytopenia. METHODS PETIT2 was a two part, randomised, multicentre, placebo-controlled study done at 38 centres in 12 countries (Argentina, Czech Republic, Germany, Hong Kong, Israel, Italy, Russia, Spain, Taiwan, Thailand, UK, and USA). Paediatric patients aged 1-17 years who had chronic immune thrombocytopenia and platelet counts less than 30 × 10(9) per L were randomly assigned (2:1) to receive eltrombopag or placebo. We stratified patients by age into three cohorts (patients aged 12-17 years, 6-11 years, and 1-5 years) before randomly entering them into a 13 week, double-blind period. Randomisation was done by the GlaxoSmithKline Registration and Medication Ordering System and both patients and study personnel were masked to treatment assignments. Patients who were allocated eltrombopag received tablets (except for those aged 1-5 years who received an oral suspension formulation) once per day for 13 weeks. Starting doses for patients aged 6-17 were based on bodyweight, and ethnic origin and ranged between 50 mg/day and 25 mg/day (starting dose for patients aged 1-5 years was 1·2 mg/kg/day or 0·8 mg/kg/day for east Asian patients). Patients who completed the double-blind period entered a 24 week open-label treatment period in which all patients received eltrombopag at either the starting dose (if they were formerly on placebo) or their established dose. The primary outcome was the proportion of patients achieving platelet counts of at least 50 × 10(9) per L in the absence of rescue therapy for 6 or more weeks from weeks 5 to 12 of the double-blind period. The intention-to-treat population included in the efficacy assessment consisted of all patients who were randomly assigned to one of the treatment groups, and the safety population included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT01520909. FINDINGS Beginning in March 15, 2012, 92 patients were enrolled, and the trial was completed on Jan 2, 2014. 63 patients were assigned to receive eltrombopag and 29 were assigned to receive placebo. In the double-blind period, three patients discontinued treatment because of adverse events: two patients in the eltrombopag group withdrew because of increased liver aminotransferases and one in the placebo group withdrew because of abdominal haemorrhage. 25 (40%) patients who received eltrombopag compared with one (3%) patient who received placebo achieved the primary outcome of platelet counts of at least 50 × 10(9) per L for 6 of the last 8 weeks of the double-blind period (odds ratio 18·0, 95% CI, 2·3-140·9; p=0·0004). Responses were similar in all cohorts (eltrombopag vs placebo: 39% vs 10% for patients aged 12-17 years, 42% vs 0% for patients aged 6-11 years, and 36% vs 0% for patients aged 1-5 years). Proportionately fewer patients who received eltrombopag (23 [37%] of 63 patients) had WHO grades 1-4 bleeding at the end of the double-blind period than did those who received placebo (16 [55%] of 29 patients); grades 2-4 bleeding were similar (three [5%] patients who received eltrombopag vs two [7%] patients who received placebo). During the 24-week open-label treatment period, 70 [80%] of 87 patients achieved platelet counts of 50 × 10(9) per L or more at least once. Adverse events that occurred more frequently with eltrombopag than with placebo included nasopharyngitis (11 [17%] patients), rhinitis (10 [16%] patients), upper respiratory tract infection (7 [11%] patients), and cough (7 [11%] patients). Serious adverse events occurred in five (8%) patients who received eltrombopag and four (14%) who received placebo. Safety was consistent between the open-label and double-blind periods. No deaths, malignancies, or thromboses occurred during the trial. INTERPRETATION Eltrombopag, which produced a sustained platelet response in 40% of patients with chronic immune thrombocytopenia, is a suitable therapeutic option for children with chronic symptomatic immune thrombocytopenia. We identified no new safety concerns and few patients discontinued treatment because of adverse events. FUNDING GlaxoSmithKline.
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Affiliation(s)
- John D Grainger
- Department of Haematology, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK; Central Manchester Hospitals NHS Foundation Trust, NIHR/Wellcome Trust Manchester CRF, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - Franco Locatelli
- IRCCS Ospedale Pediatrico Bambino Gesú, University of Pavia, Rome, Italy
| | | | - Elena Donyush
- Izmaylovskaya Children's City Clinical Hospital, Moscow Board of Health, Moscow, Russia
| | | | | | | | | | | | | | | | - Richard Lemons
- Primary Children's Medical Center, Salt Lake City, UT, USA
| | | | - Ugo Ramenghi
- Regina Margherita Children's Hospital, Turin, Italy
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Streif W, Knöfler R, Eberl W, Andres O, Bakchoul T, Bergmann F, Beutel K, Dittmer R, Gehrisch S, Gottstein S, Halimeh S, Haselböck J, Hassenpflug WA, Heine S, Holzhauer S, King S, Kirchmaier CM, Krause M, Kreuz W, Lösche W, Mahnel R, Maurer M, Nimtz-Talaska A, Olivieri M, Rott H, Schambeck CM, Schedel A, Schilling FH, Schmugge M, Schneppenheim R, Scholz U, Scholz T, Schulze H, Siegemund A, Strauß G, Sykora KW, Wermes C, Wiegering V, Wieland I, Zieger B, Zotz RB. [Therapy of inherited diseases of platelet function. Interdisciplinary S2K guideline of the Permanent Paediatric Committee of the Society of Thrombosis and Haemostasis Research (GTH e. V.)]. Hamostaseologie 2015; 34:269-75, quiz 276. [PMID: 25370176 DOI: 10.5482/hamo-2014040001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 07/02/2014] [Indexed: 11/05/2022] Open
Abstract
Inherited disorders of platelet function are a heterogeneous group. For optimal prevention and management of bleeding, classification and diagnosis of the underlying defect are highly recommended. An interdisciplinary guideline for a diagnostic approach has been published (AWMF # 086-003 S2K; Hämostaseologie 2014; 34: 201-212). Underlying platelet disorder, platelet count, age and clinical situation modify treatment. Exclusive transfusion of platelet concentrates may be inappropriate as potentially adverse effects can outweigh its benefit. A stepwise and individually adjusted approach for restitution and maintenance of haemostasis is recommended. Administration of antifibrinolytics is generally endorsed, but is of particular use in Quebec disease. Restricted to older children, desmopressin is favourable in storage pool disease and unclassified platelet disorders. Although licensed only for patients with Glanzmann thrombasthenia and alloantibodies, in clinical practice rFVIIa is widely used in inherited platelet disorders with severe bleeding tendency. This guideline aims at presenting the best available advice for the management of patients with inherited platelet function disorders.
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Affiliation(s)
| | - R Knöfler
- Priv.-Doz. Dr. med. Ralf Knöfler, Universitätsklinikum Carl Gustav Carus Dresden Klinik und Poliklinik für Kinder- und Jugendmedizin, Bereich Hämostaseologie, Fetscherstr. 74, 01307 Dresden, Tel. 03 51/458 47 99, Fax 03 51/458 57 88, E-Mail:
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McCusker PJ, Fischer K, Holzhauer S, Meunier S, Altisent C, Grainger JD, Blanchette VS, Burke TA, Wakefield C, Young NL. International cross-cultural validation study of the Canadian haemophilia outcomes: kids' life assessment tool. Haemophilia 2014; 21:351-357. [PMID: 25471939 DOI: 10.1111/hae.12597] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 10/30/2014] [Indexed: 11/30/2022]
Abstract
Health-related quality of life (HRQoL) assessment is recognized as an important outcome in the evaluation of different therapeutic regimens for persons with haemophilia. The Canadian Haemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT) is a disease-specific measure of HRQoL for 4 to 18-year-old boys with haemophilia. The purpose of this study was to extend this disease-specific, child-centric, outcome measure for use in international clinical trials. We adapted the North American English CHO-KLAT version for use in five countries: France, Germany, the Netherlands, Spain and the United Kingdom (UK). The process included four stages: (i) translation; (ii) cognitive debriefing; (iii) validity assessment relative to the PedsQL (generic) and the Haemo-QoL (disease-specific) and (iv) assessment of inter and intra-rater reliability. Cognitive debriefing was performed in 57 boys (mean age 11.4 years), validation was performed in 144 boys (mean age 11.0 years) and reliability was assessed for a subgroup of 64 boys (mean age 12.0 years). Parents also participated. The mean scores reported by the boys were high: CHO-KLAT 77.0 (SD = 11.2); PedsQL 83.8 (SD = 11.9) and Haemo-QoL 79.6 (SD = 11.5). Correlations between the CHO-KLAT and PedsQL ranged from 0.63 in Germany to 0.39 in the Netherlands and Spain. Test-retest reliability (concordance) for child self-report was 0.67. Child-parent concordance was slightly lower at 0.57. The CHO-KLAT has been fully culturally adapted and validated for use in five different languages and cultures (in England, the Netherlands, France, Germany and Spain) where treatment is readily available either on demand or as prophylaxis.
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Limperger V, Klostermeier UC, Kenet G, Holzhauer S, Alhenc Gelas M, Finckh U, Junker R, Heller C, Zieger B, Kurnik K, Knöfler R, Mesters R, Halimeh S, Nowak-Göttl U. Clinical and laboratory characteristics of children with venous thromboembolism and protein C-deficiency: an observational Israeli-German cohort study. Br J Haematol 2014; 167:385-93. [DOI: 10.1111/bjh.13039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Verena Limperger
- Institute of Clinical Chemistry; University Hospital of Kiel & Lübeck; Lübeck Germany
| | | | - Gili Kenet
- Thrombosis Unit; National Haemophilia Centre; Tel Hashomer and the Sackler Medical School; Tel Aviv University; Tel-Hashomer Israel
| | - Susanne Holzhauer
- Department of Paediatric Haematology/Oncology; Charité- Charité - Universitaetsmedizin Berlin; Berlin Germany
| | - Martine Alhenc Gelas
- Service d'hématologie biologique; AP-HP, Hôpital Europeen Georges Pompidou; Paris France
| | - Ulrich Finckh
- Medizinisches Versorgungszentrum Eberhard & Partner; Dortmund Germany
| | - Ralf Junker
- Institute of Clinical Chemistry; University Hospital of Kiel & Lübeck; Lübeck Germany
| | - Christine Heller
- University Hospital; Department of Paediatric Hemostaseology; Frankfurt Germany
| | - Barbara Zieger
- Department Paediatrics; University Children Hospital Freiburg; Freiburg Germany
| | - Karin Kurnik
- Department of Paediatrics; University Children Hospital Munich; Munich Germany
| | - Ralf Knöfler
- Department of Paediatric Hemostaseology; University Hospital Dresden; Dresden Germany
| | - Rolf Mesters
- Department of Medicine/Haematology & Oncology; University Hospital of Münster; Münster Germany
| | - Susan Halimeh
- Coagulation Centre Rhine-Ruhr; Duisburg Germany
- University Children Hospital; Münster Germany
| | - Ulrike Nowak-Göttl
- University Children Hospital; Münster Germany
- Centre of Thrombosis and Haemostasis; Department of Clinical Chemistry; University Hospital of Kiel & Lübeck; Kiel Germany
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Limperger V, Franke A, Kenet G, Holzhauer S, Picard V, Junker R, Heller C, Gille C, Manner D, Kurnik K, Knoefler R, Mesters R, Halimeh S, Nowak-Göttl U. Clinical and laboratory characteristics of paediatric and adolescent index cases with venous thromboembolism and antithrombin deficiency. An observational multicentre cohort study. Thromb Haemost 2014; 112:478-85. [PMID: 24966143 DOI: 10.1160/th14-02-0149] [Citation(s) in RCA: 20] [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] [Received: 02/18/2014] [Accepted: 04/02/2014] [Indexed: 11/05/2022]
Abstract
Venous thromboembolism [TE] is a multifactorial disease and antithrombin deficiency [ATD] constitutes a major risk factor. In the present study the prevalence of ATD and the clinical presentation at TE onset in a cohort of paediatric index cases are reported. In 319 unselected paediatric patients (0.1-18 years) from 313 families, recruited between July 1996 and December 2013, a comprehensive thrombophilia screening was performed along with recording of anamnestic data. 21 of 319 paediatric patients (6.6%), corresponding to 16 of 313 families (5.1%), were AT-deficient with confirmed underlying AT gene mutations. Mean age at first TE onset was 14 years (range 0.1 to 17). Thrombotic locations were renal veins (n=2), cerebral veins (n=5), deep veins (DVT) of the leg (n=9), DVT & pulmonary embolism (n=4) and pelvic veins (n=1). ATD co-occurred with the factor-V-Leiden mutation in one and the prothrombin G20210A mutation in two children. In 57.2% of patients a concomitant risk factor for TE was identified, whereas 42.8% of patients developed TE spontaneously. A second TE event within primarily healthy siblings occurred in three of 313 families and a third event among siblings was observed in one family. In an unselected cohort of paediatric patients with symptomatic TE, the prevalence of ATD adjusted for family status was 5.1%. Given its clinical implication for patients and family members, thrombophilia testing should be performed and the benefit of medical or educational interventions should be evaluated in this high risk population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - U Nowak-Göttl
- Ulrike Nowak-Göttl, Center of Thrombosis & Hemostasis, Institute of Clinical Chemistry, Univ. Hospital Kiel, Arnold-Heller-Str. 3, Building 17, 24105 Kiel, Germany, E-mail:
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Kenet G, Bidlingmaier C, Bogdanova N, Ettingshausen CE, Goldenberg N, Gutsche S, Halimeh S, Holzhauer S, Kurnik K, Limperger V, Junker R, Nowak-Göttl U. Influence of factor 5 rs6025 and factor 2 rs1799963 mutation on inhibitor development in patients with hemophilia A - an Israeli-German multicenter database study. Thromb Res 2014; 133:544-9. [DOI: 10.1016/j.thromres.2014.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/02/2014] [Accepted: 01/03/2014] [Indexed: 01/15/2023]
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Klamroth R, Holzhauer S, Zimmermann R, Heller C, Kurnik K. Beriate® P in the treatment of patients with haemophilia A: results of a long-term pharmacovigilance study. Thromb Res 2014; 134 Suppl 1:S16-21. [PMID: 24418255 DOI: 10.1016/j.thromres.2013.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The German Beriate(®) P pharmacovigilance study started in 2003 and is planned to run until December 2013. MATERIALS AND METHODS This analysis included data from 84 haemophilia A patients treated with the high-purity, plasma-derived coagulation factor VIII concentrate Beriate(®) P. Prior to study start, 69 of the 80 patients for whom data were available had received previous treatment with Beriate(®) P (mean treatment period 7.1 ± 5.4 years). The mean study duration from the start of pharmacovigilance was 43.3 ± 30.3 months (median 43.5 months; range 0-101.9months). The most common treatment at the last visit was prophylaxis (65.7% of patients), which was most commonly administered at a frequency of three infusions/week in 47.3% of patients. RESULTS Most patients experienced up to six minor bleeds/year. For 1,311 bleeding episodes, a median of one infusion/bleed was administered (mean 2.8 ± 4.7; range 0-83). The clinical response to Beriate(®) P was rated "excellent"/"good" in 94% of 32 visits of patients with major bleeding. The clinical response for patients with minor bleeding was rated "excellent"/"good" in 98.5% of 377 visits. One clinically relevant inhibitor in a previously untreated patient was documented during the study course. There were no reports of virus transmissions suspected to be caused by Beriate(®) P prior to the study start or during the study. CONCLUSIONS These findings confirm the excellent efficacy, safety, and tolerability of Beriate(®) P in the treatment of a wide spectrum of previously untreated patients up to adult patients with haemophilia A.
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Affiliation(s)
- Robert Klamroth
- Hämophiliezentrum, Klinik für Innere Medizin - Angiologie, Hämostaseologie und Pneumologie, Vivantes-Klinikum im Friedrichshain, Berlin, Germany
| | - Susanne Holzhauer
- Klinik für Pädiatrische Hämatologie und Onkologie, Campus Virchow Klinikum, Universitätsklinikum Charité Berlin, Berlin, Germany
| | - Rainer Zimmermann
- Hämophiliezentrum, Abteilung für. Innere Medizin, SRH Kurpfalzkrankenhaus, Heidelberg, Germany
| | - Christine Heller
- Pädiatrische Hämostaseologie, Klinik für Kinderheilkunde-und Jugendmedizin, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Germany
| | - Karin Kurnik
- Zentrum für Pädiatrische Hämostaseologie, Ludwig-Maximilian Universität, Klinikum der Universität, Campus Innenstadt, Munich, Germany.
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Kenet G, Aronis S, Berkun Y, Bonduel M, Chan A, Goldenberg NA, Holzhauer S, Iorio A, Journeycake J, Junker R, Male C, Manco-Johnson M, Massicotte P, Mesters R, Monagle P, van Ommen H, Rafini L, Simioni P, Young G, Nowak-Göttl U. Impact of persistent antiphospholipid antibodies on risk of incident symptomatic thromboembolism in children: a systematic review and meta-analysis. Semin Thromb Hemost 2011; 37:802-9. [PMID: 22187403 DOI: 10.1055/s-0031-1297171] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The aim of this study was to estimate the impact of antiphospholipid (aPL) antibodies on the risk of incident thromboembolism (TE; arterial and venous) in children via meta-analysis of published observational studies. A systematic search of electronic databases (Medline, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1966 to 2010 was conducted using keywords in combination both as MeSH terms and text words. Two authors independently screened citations and those meeting the a priori defined inclusion criteria were retained. Data on year of publication, study design, country of origin, number of patients/controls, ethnicity, TE type, and frequency of recurrence were abstracted. Heterogeneity across studies was evaluated, and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using either fixed-effects or random-effects models. Of 504, 16 pediatric studies met the inclusion criteria. In total 1403 patients and 1667 population-based controls ≤18 years were enrolled. No significant heterogeneity was discerned across studies, and no publication bias was detected. Thus, data from arterial and venous TE were analyzed together. In addition, meta-regression analysis did not reveal statistically significant differences between site of TE, age at first TE, country, or publication year. A statistically significant association with a first TE was demonstrated for persistent aPL antibodies, with an overall summary ORs/CI of 5.9/3.6-9.7 (arterial 6.6/3.5-12.4; deep vein thrombosis 4.9/2.2-10.9). The present meta-analysis indicates that detection of persistent aPL is clinically meaningful in children with, or at risk for, TE and underscores the importance of pediatric thrombophilia screening programs.
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Affiliation(s)
- Gili Kenet
- The Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel
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Abstract
Thrombocytopenia is the most common haematological abnormality in newborns admitted to neonatal care units and serves as an important indicator of underlying pathological processes of mother or child. In most cases thrombocytopenia is mild to moderate and resolves within the first weeks of life without any intervention. However, in some neonates thrombocytopenia is severe or may reflect an inborn platelet disorder. As clinical course and outcome of thrombocytopenia depend on the aetiology of thrombocytopenia, an appropriate work-up is essential to guide therapy in neonates with thrombocytopenia and to avoid severe bleeding.
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Affiliation(s)
- Susanne Holzhauer
- Department of Paediatric Oncology and Haematology, Charité - University of Berlin, Berlin, Germany
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Iorio A, Halimeh S, Holzhauer S, Goldenberg N, Marchesini E, Marcucci M, Young G, Bidlingmaier C, Brandao LR, Ettingshausen CE, Gringeri A, Kenet G, Knöfler R, Kreuz W, Kurnik K, Manner D, Santagostino E, Mannucci PM, Nowak-Göttl U. Rate of inhibitor development in previously untreated hemophilia A patients treated with plasma-derived or recombinant factor VIII concentrates: a systematic review. J Thromb Haemost 2010; 8:1256-65. [PMID: 20345722 DOI: 10.1111/j.1538-7836.2010.03823.x] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [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: 12/18/2022]
Abstract
BACKGROUND Different rates of inhibitor development after either plasma-derived (pdFVIII) or recombinant (rFVIII) FVIII have been suggested. However, conflicting results are reported in the literature. OBJECTIVES To systematically review the incidence rates of inhibitor development in previously untreated patients (PUPs) with hemophilia A treated with either pdFVIII or rFVIII and to explore the influence of both study and patient characteristics. METHODS Summary incidence rates (95% confidence interval) from all included studies for both pdFVIII and rFVIII results were recalculated and pooled. Sensitivity analysis was used to investigate the effect of study design, severity of disease and inhibitor characteristics. Meta-regression and analysis-of-variance were used to investigate the effect of covariates (testing frequency, follow-up duration and intensity of treatment). RESULTS Two thousand and ninety-four patients (1965 treated with pdFVIII, 887 with rFVIII; median age, 9.6 months) from 24 studies were investigated and 420 patients were observed to develop inhibitors. Pooled incidence rate was 14.3% (10.4-19.4) for pdFVIII and 27.4% (23.6-31.5) for rFVIII; high responding inhibitor incidence rate was 9.3% (6.2-13.7) for pdFVIII and 17.4% (14.2-21.2) for rFVIII. In the multi-way anova study design, study period, testing frequency and median follow-up explained most of the variability, while the source of concentrate lost statistical significance. It was not possible to analyse the effect of intensity of treatment or trigger events such as surgery, and to completely exclude multiple reports of the same patient or changes of concentrate. CONCLUSIONS These findings underscore the need for randomized controlled trials to address whether or not the risk of inhibitor in PUPs with hemophilia A differs between rFVIII and pdFVIII.
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Affiliation(s)
- A Iorio
- Internal and Vascular Medicine &Hemophilia Centre, University of Perugia, Perugia, Italy.
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Durmuş B, Mook-Kanamori DO, Holzhauer S, Hofman A, van der Beek EM, Boehm G, Steegers EAP, Jaddoe VWV. Growth in foetal life and infancy is associated with abdominal adiposity at the age of 2 years: the generation R study. Clin Endocrinol (Oxf) 2010; 72:633-40. [PMID: 19769622 DOI: 10.1111/j.1365-2265.2009.03708.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [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: 11/28/2022]
Abstract
OBJECTIVE Early weight gain is associated with an increased risk of obesity. It is not known whether rapid weight gain in foetal life and infancy is also associated with increased abdominal adiposity. We examined the associations of foetal and postnatal growth characteristics with abdominal fat mass at the age of 2 years. DESIGN This study was performed in 481 children participating in a prospective cohort study from early foetal life onward. MEASUREMENTS Foetal and postnatal growth characteristics in second and third trimester, at birth and at the age of 2 years were related to abdominal fat mass (subcutaneous distance and area, preperitoneal distance and area) measured by ultrasound at the age of 2 years. RESULTS Foetal and birth weight were not associated with abdominal subcutaneous fat mass. Estimated foetal weight in second trimester of pregnancy was inversely associated with preperitoneal fat area [-3.73% (95% confidence interval -7.23, -0.10)] per standard deviation score increase in weight. Weight gain from birth to the age of 2 years was positively associated with preperitoneal fat mass measures. These associations remained significant after adjustment for age, sex, breastfeeding and body mass index. Positive associations were found between catch-up growth in weight and abdominal fat mass measures. CONCLUSIONS Our results suggest that rapid growth rates during foetal life and infancy are associated with increased abdominal subcutaneous and preperitoneal fat mass in healthy children. Further studies need to explore whether these associations persist in later life and are related to metabolic syndrome outcomes.
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Affiliation(s)
- Büşra Durmuş
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
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Kenet G, Lütkhoff LK, Albisetti M, Bernard T, Bonduel M, Brandao L, Chabrier S, Chan A, deVeber G, Fiedler B, Fullerton HJ, Goldenberg NA, Grabowski E, Günther G, Heller C, Holzhauer S, Iorio A, Journeycake J, Junker R, Kirkham FJ, Kurnik K, Lynch JK, Male C, Manco-Johnson M, Mesters R, Monagle P, van Ommen CH, Raffini L, Rostásy K, Simioni P, Sträter RD, Young G, Nowak-Göttl U. Impact of Thrombophilia on Risk of Arterial Ischemic Stroke or Cerebral Sinovenous Thrombosis in Neonates and Children. Circulation 2010; 121:1838-47. [DOI: 10.1161/circulationaha.109.913673] [Citation(s) in RCA: 325] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Gili Kenet
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Lisa K. Lütkhoff
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Manuela Albisetti
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Timothy Bernard
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Mariana Bonduel
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Leonardo Brandao
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Stephane Chabrier
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Anthony Chan
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Gabrielle deVeber
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Barbara Fiedler
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Heather J. Fullerton
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Neil A. Goldenberg
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Eric Grabowski
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Gudrun Günther
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Christine Heller
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Susanne Holzhauer
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Alfonso Iorio
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Janna Journeycake
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Ralf Junker
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Fenella J. Kirkham
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Karin Kurnik
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - John K. Lynch
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Christoph Male
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Marilyn Manco-Johnson
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Rolf Mesters
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Paul Monagle
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - C. Heleen van Ommen
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Leslie Raffini
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Kevin Rostásy
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Paolo Simioni
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Ronald D. Sträter
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Guy Young
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
| | - Ulrike Nowak-Göttl
- From the Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel (G.K.); Department of Pediatric Hematology/Oncology, University Hospital of Münster, Münster, Germany (L.K.L., R.D.S., U.N.-G.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Department of Pediatrics, Hematology/Oncology/BMT, and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, and Children’s Hospital, Denver/Aurora, Colo (T.B., N.A.G.,
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Halimeh S, Bidlingmaier C, Brandao L, Ettingshausen C, Holzhauer S, Kenet G, Knöfler R, Kreuz W, Kurnik K, Manner D, Nowak-Göttl U. Inhibitors in children with severe haemophilia A treated with recombinant and plasmatic FVIII products. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619096] [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: 10/17/2022] Open
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Mook-Kanamori DO, Holzhauer S, Hollestein LM, Durmus B, Manniesing R, Koek M, Boehm G, van der Beek EM, Hofman A, Witteman JCM, Lequin MH, Jaddoe VWV. Abdominal fat in children measured by ultrasound and computed tomography. Ultrasound Med Biol 2009; 35:1938-1946. [PMID: 19800165 DOI: 10.1016/j.ultrasmedbio.2009.07.002] [Citation(s) in RCA: 51] [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] [Received: 02/16/2009] [Revised: 05/28/2009] [Accepted: 07/14/2009] [Indexed: 05/28/2023]
Abstract
The prevalence of childhood obesity is increasing rapidly. Visceral fat plays an important role in the pathogenesis of metabolic and cardiovascular diseases. Currently, computed tomography (CT) is broadly seen as the most accurate method of determining the amount of visceral fat. The main objective was to examine whether measures of abdominal visceral fat can be determined by ultrasound in children and whether CT can be replaced by ultrasound for this purpose. To assess whether preperitoneal fat thickness and area are good approximations of visceral fat at the umbilical level, we first retrospectively examined 47 CT scans of nonobese children (body mass index <30kg/m(2); median age 7.9 y [95% range 1.2 to 16.2]). Correlation coefficients between visceral and preperitoneal fat thickness and area were 0.58 (p<0.001) and 0.76 (p<0.001), respectively. Then, to assess how preperitoneal and subcutaneous fat thicknesses and areas measured by ultrasound compare with these parameters in CT, we examined 34 nonobese children (median age 9.5 [95% range 0.3 to 17.0]) by ultrasound and CT. Ultrasound measurements of preperitoneal and subcutaneous fat were correlated with CT measurements, with correlation coefficients ranging from 0.75-0.97 (all p<0.001). Systematic differences of up to 24.0cm(2) for preperitoneal fat area (95% confidence interval -29.9 to 77.9cm(2)) were observed when analyzing the results described by the Bland-Altman method. Our findings suggest that preperitoneal fat can be used as an approximation for visceral fat in children and that measuring abdominal fat with ultrasound in children is a valid method for epidemiological and clinical studies. However, the exact agreement between the ultrasound and CT scan was limited, which indicates that ultrasound should be used carefully for obtaining exact fat distribution measurements in individual children.
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Affiliation(s)
- D O Mook-Kanamori
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
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Rossberg S, Schwarz K, Meisel C, Holzhauer S, Kühl J, Ebell W, Wahn V, Bernuth HV. Delayed Onset of (Severe) Combined Immunodeficiency (S)CID (T-B+NK+): Complete IL-7 Receptor Deficiency in a 22 Months Old Girl. Klin Padiatr 2009; 221:339-43. [DOI: 10.1055/s-0029-1239537] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Holzhauer S, Zwijsen RML, Jaddoe VWV, Boehm G, Moll HA, Mulder PG, Kleyburg-Linkers VA, Hofman A, Witteman JCM. Sonographic assessment of abdominal fat distribution in infancy. Eur J Epidemiol 2009; 24:521-9. [PMID: 19639387 PMCID: PMC2744780 DOI: 10.1007/s10654-009-9368-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 06/30/2009] [Indexed: 11/28/2022]
Abstract
There is growing evidence that not only the total amount of fat, but also the distribution of body fat determines risks for metabolic and cardiovascular disease. Developmental studies on factors influencing body fat distribution have been hampered by a lack of appropriate techniques for measuring intraabdominal fat in early life. Sonography, which is an established method for assessing abdominal fat distribution in adults, has not yet been evaluated in infants. To adapt the sonographic measurement of abdominal fat distribution to infants and study its reliability. The Generation R study, a population-based prospective cohort study. We included 212 one- and 227 two-year old Dutch infants in the present analysis. Sixty-two infants underwent replicate measurements to assess reproducibility. We developed a standardized protocol to measure the thickness of (1) subcutaneous and (2) preperitoneal fat in the upper abdomen of infants. To this end we defined infancy specific measurement areas to quantify fat thickness. Reproducibility of fat measurements was good to excellent with intraclass correlation coefficients of 0.93–0.97 for intra-observer agreement and of 0.89–0.95 for inter-observer agreement. We observed a pronounced increase in preperitoneal fat thickness in the second year of life while subcutaneous fat thickness increased only slightly, resulting in an altered body fat distribution. Gender did not significantly influence fat distribution in the first two years of life. Our age specific protocol for the sonographic measurement of central subcutaneous and preperitoneal fat is a reproducible method that can be instrumental for investigating fat distribution in early life.
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Affiliation(s)
- Susanne Holzhauer
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
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Oswald O, Holzhauer S, Henrich W, Krings G, Bührer C, Czernik C. Diamond-Blackfan-Syndrom als seltene Ursache eines Hydrops fetalis. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223058] [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: 10/20/2022]
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Holzhauer S, Sitaru AG, Ebell W, Schindler D, Hanenberg H, Wirbelauer J, Walter U, Grossmann R. Decreased platelet reactivity identified by whole blood flow cytometry in Fanconi anaemia patients. Thromb Haemost 2007; 98:1291-1297. [PMID: 18064327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Fanconi anaemia (FA) is a rare inherited chromosome instability disorder characterized by congenital anomalies and a high risk for bone marrow failure and cancer. Bleeding is a frequent complication in FA, leading to substantial morbidity and mortality. Thrombocytopenia is a major factor leading to this complication, but the bleeding tendency of FA patients often exceeds what one might expect based on their platelet counts. We therefore investigated if alterations of platelet function contribute to the bleeding tendency of FA patients. We assessed platelet function in 11 FA patients and 23 controls with whole blood flow cytometry. We analyzed the expression of platelet membrane glycoprotein receptors, reactivity of platelets to physiologic agonists and the proportion of young platelets. In FA patients platelet reactivity was decreased: Expression of P-selectin and binding of PAC-1 after stimulation with thrombin receptor activating peptide (TRAP) and adenosine diphosphate (ADP) were 15-70% lower than in controls. We found no or only minor differences of platelet glycoprotein receptor expression between groups. While the proportion of reticulated platelets was not different, the absolute number of reticulated platelets was markedly lower in FA patients. Our data show that FA is associated with reduced platelet reactivity, which may contribute to the high bleeding tendency in FA patients. Whole blood flow cytometry is a suitable method for analysis of platelet function in FA patients.
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Kuehner C, Holzhauer S, Huffziger S. Decreased cortisol response to awakening is associated with cognitive vulnerability to depression in a nonclinical sample of young adults. Psychoneuroendocrinology 2007; 32:199-209. [PMID: 17291694 DOI: 10.1016/j.psyneuen.2006.12.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 11/28/2006] [Accepted: 12/09/2006] [Indexed: 11/29/2022]
Abstract
Due to its high intraindividual stability, the cortisol awakening response (CAR) may be regarded as a trait measure of the dynamics of the HPA-axis activity. The present study aimed at investigating associations of the CAR with rumination as a cognitive vulnerability marker for depression assessed by both a trait measure and by experimental manipulation. After induction of sad mood by viewing a sad sequence of a movie, 42 healthy university students were randomly induced to either ruminatively self-focus on their feelings or to distract themselves from their mood by concentrating on respective text cards for 8min. Trait rumination and distraction were measured by the Response Styles Questionnaire (RSQ) at baseline (T0), while current mood was recorded before (T1) and after (T2) the mood induction as well as after the rumination/distraction induction (T3) using the Positive and Negative Affect Schedule (PANAS). Basal saliva cortisol levels were measured independently on a different day. After mood induction, levels of mood were lowered significantly. Participants subsequently induced to ruminate kept their negative mood whereas participants induced to distract themselves showed a reduction in negative mood. Self-focused trait rumination amplified low mood in both induction conditions. A decreased CAR was associated with self-focused rumination and with less improvement of sad mood after induced distraction. We conclude that the two variables apparently share specific vulnerability qualities towards depression by hampering the adaptive shift of attention to external cues during dysphoric moods, probably involving lowered disinhibition of task-irrelevant negative emotional processing. The present study provided first indications of a possible relationship between a cognitive vulnerability marker for depression and characteristics of basal neuroendocrine activity regarding their association with the course of experimentally induced dysphoric mood.
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Affiliation(s)
- Christine Kuehner
- Research Group Longitudinal and Intervention Research, Central Institute of Mental Health, P.O.Box 122120, 68072 Mannheim, Germany.
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Sitaru AG, Speer CP, Holzhauer S, Obergfell A, Walter U, Grossmann R. Chorioamnionitis is associated with increased CD40L expression on cord blood platelets. Thromb Haemost 2006; 94:1219-23. [PMID: 16411397 DOI: 10.1160/th05-02-0127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/05/2022]
Abstract
Chorioamnionitis (CA) is a severe infection responsible not only for premature birth but also for many severe neonatal diseases. The aim of the present study was to investigate the expression of CD40L and P-selectin on platelets and the plasma levels of their soluble forms in the umbilical cord blood in infants with documented chorioamnionitis. Umbilical cord blood samples were obtained from 10 healthy term newborns, 10 non-infected preterm infants, 10 preterm infants with premature rupture of membranes and 9 preterm infants with clinical and histological CA. The expression of CD40L and P-selectin on platelets was analyzed by flow cytometry. Soluble P-selectin (sCD62P), soluble CD40L (sCD40L) and interleukine-6 (IL-6) were measured in plasma by ELISA assays. Neonates with CA had significantly higher percentages of platelets expressing CD40L in basal conditions (5.3 +/- 2.9% vs. 1.6 +/- 0.7% and in non-infected preterm infants p < 0.05), while the percentages of P-selectin positive platelets were similar among all groups. In contrast, the level of sP-selectin was higher in infants with CA (222 +/- 128 ng/ml vs. 104 +/- 71 ng/ml in non-infected preterm infants, p < 0.05) but no differences were found in the levels of sCD40L. As expected, the levels of IL-6, a pro-inflammatory cytokine were significantly higher in samples obtained from preterm neonates whose mothers had also elevated inflammatory parameters. Our observations suggest that platelets are involved in the complex inflammatory pathogenesis of CA. Neither P-selectin expression on cord blood platelets nor plasma sP-selectin or sCD40L were suitable platelet markers in CA, whereas CD40L was significantly elevated in histologically proven CA.
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Affiliation(s)
- Ana-Gabriela Sitaru
- Institute of Clinical Biochemistry and Pathobiochemistry, Central Laboratory, University of Würzburg, Germany
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Abstract
The haemostatic system in neonates is different from that of adults, possibly contributing to an increased incidence of bleeding disorders, such as intracranial hemorrhage. In this study, we analyzed platelets from cord blood and peripheral blood, collected at three time points after delivery from 20 term and 37 preterm neonates as well as blood from 20 healthy adults. Platelet membrane glycoproteins (GP) were quantified and P-selectin expression and PAC-1 binding ability before and after stimulation with TRAP were analyzed by whole blood flow cytometry. We found no significant differences in neonatal platelets from cord blood and peripheral blood within the first 24h of life. Platelets from infants less than 30 weeks of gestation expressed lower levels of GP (33271+/-9381 vs. 44085+/-17287 for GPIIIa, P<0.05) and were less reactive than platelets from term newborns (4.3+/-3.3 vs. 20.1+/-11.8% PAC-1 positive platelets after stimulation with TRAP, P<0.05). A significantly lower level of GPIIb/IIIa expression on platelets from peripheral blood was seen in term newborns as well as preterm infants, compared to adults. There was only a partial enhancement in the degranulation ability (alpha-granules) (13.4+/-12.3 vs. 50.3+/-16.1% P-selectin positive platelets, P<0.05) and no significant increase for PAC-1 binding (13.6+/-10.9 vs. 15.3+/-5.9% PAC-1 positive platelets, P=0.8) during the first 12 days of life. In conclusion, we could demonstrate that neonatal platelet reactivity increases with gestational age.
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Affiliation(s)
- A G Sitaru
- Institute of Clinical Biochemistry and Pathbiochemistry, Central Laboratory, University of Würzburg, Würzburg, Germany
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