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Pierce C, Branscum A, Irvin VL, Elander J, Bovbjerg M, Witkop M, Smit E. Pain attitudes and pain outcomes among people with bleeding disorders: Results from community voices in research. Haemophilia 2024. [PMID: 38415392 DOI: 10.1111/hae.14942] [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: 07/06/2021] [Revised: 07/07/2023] [Accepted: 12/13/2023] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Among people with bleeding disorders (PwBD), pain is a major problem and pain treatments are often ineffective. Understanding of psychological factors involved in pain processing is limited. Maladaptive pain attitudes are associated with worse pain outcomes and adaptive pain attitudes are associated with better outcomes in high pain conditions, but relationships between pain attitudes and pain outcomes are so far unexplored among PwBD. AIM To investigate relationships between pain attitudes and pain outcomes among PwBD. METHODS Pain attitudes were measured with the Survey of Pain Attitudes, containing two adaptive scales (Control and Emotion) and five maladaptive scales (Disability, Harm, Medication, Solicitude, Medical Cure). Adults with bleeding disorders, who had pain, and were enrolled in Community Voices in Research were eligible. Participants (n = 72) completed an online survey. Cross sectional associations between pain attitudes and pain outcomes (pain and prescribed pain medication use) were investigated using logistic regression. RESULTS After adjustment for covariates, greater Control attitudes were associated with lower odds of more severe pain, and greater Disability, Harm, and Medication attitudes were all associated with higher odds of more severe pain and with higher odds of any prescribed pain medication use and opioid pain medication use. CONCLUSIONS We presented compelling evidence of relationships between pain attitudes and pain outcomes in PwBD, though corroboration is needed from other populations. Our findings suggest that modification of pain attitudes presents a possible avenue for interventions to improve pain outcomes and increase patient satisfaction with pain management.
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Affiliation(s)
- Corey Pierce
- Oregon State University, College of Public Health and Human Sciences, Portland, USA
| | - Adam Branscum
- Oregon State University, College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Corvallis, USA
| | - Veronica L Irvin
- Oregon State University, College of Public Health and Human Sciences, School of Social and Behavioral Health Sciences, Corvallis, USA
| | | | - Marit Bovbjerg
- Oregon State University, College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Corvallis, USA
| | | | - Ellen Smit
- Oregon State University, College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Corvallis, USA
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Page D, Crymble S, Jardine L, Nilson J, Mulder K, Pardy N, Pirnat B, Pirnat M, Quinn W, Sims K, Thompson MH, Wilton P. A national assessment of standards of care for inherited bleeding disorders in Canada. Haemophilia 2023; 29:1450-1455. [PMID: 37766484 DOI: 10.1111/hae.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
AIM The Canadian Integrated and Comprehensive Care Standards for Inherited Bleeding Disorders were adopted in June 2020. In early 2023, a self-assessment of each of the 26 Canadian inherited bleeding disorder treatment centre's (IBDTCs) capacity to meet the Standards was conducted. The goal was to validate the standards by assessing appropriateness and adherence. As a result, centres can compare their own practices and capacity against those of all centres, identify barriers to adherence, identify opportunities for remedial actions and use the results locally as evidence for needed resources. METHODS Healthcare providers (HCPs) in the 26 IBDTCs were provided with a checklist to assess adherence to each of the 66 standards of care. Centre participation was voluntary but strongly encouraged by the healthcare provider and patient associations. RESULTS All 26 centres completed the self-assessments. Collectively, centres reported meeting 88.8% of the standards. Adherence to each standard ranged from 40% to 100%. Forty-one (41) of the standards were adhered to by 90% or more of the centres, 12 by 80%-89% of the centres and 13 by fewer than 80% of the centres. A report consolidating all the assessments was sent to the 26 centres. CONCLUSION None of the comments received in the self-assessment reports indicated that a given standard was irrelevant, unrealistic or unnecessary. These data are strong indicators that the standards, as written, are appropriate. The self-assessments, however, reveal alarming deficiencies in staffing levels, notably in physiotherapy, psychosocial support and data entry and data management. These constitute a barrier to comprehensive care for many centres. The findings echo similar conclusions from a previous assessment conducted in 2015.
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Affiliation(s)
- David Page
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | | | | | - JoAnn Nilson
- Saskatchewan Bleeding Disorders Program, Saskatoon, Saskatchewan, Canada
| | - Kathy Mulder
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Natasha Pardy
- Eastern Health Hemophilia Program, St. John's, Newfoundland and Labrador, Canada
| | - Bojan Pirnat
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Milena Pirnat
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Wendy Quinn
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Karen Sims
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Pam Wilton
- Canadian Hemophilia Society, Montreal, Quebec, Canada
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Booth AJ, Cavell T, Gill T, Hart D, Nanayakkara L. A cohort study and matched pair analysis evaluating the effects of the COVID-19 pandemic on access to dental care for people with inherited bleeding disorders. Haemophilia 2023; 29:1276-1282. [PMID: 37559465 DOI: 10.1111/hae.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/09/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Patients with inherited bleeding disorders (IBDs) can experience challenges in accessing dental care. The COVID-19 pandemic saw the cessation of routine dentistry in England. This study aims to highlight whether access to dental care for patients with IBDs was impacted by the pandemic, and whether the severity of their IBD impacts patients experience of dental care. METHODS Patients over the age of 18 with Haemophilia A and B, Von Willibrands (VWD), Bernard-Soulier syndrome (BSS) and Glanzmann's disease were recruited. One hundred and seventy-eight patients were called and invited to complete a questionnaire. Full cohort and matched pair analysis was performed. RESULTS Seventy participants completed the questionnaire (62 males, mean age 39.9), 26 had a mild IBD and 44 severe. Mild and severe patients were matched on IBD, gender, deprivation index and age. Thirty-one percent of patients tried to seek dental advice during the pandemic. Eighty-one percent of mild patients saw a dentist routinely prior to the pandemic, compared to 58% of severe patients. Doctors were more likely to discuss the importance of dental prevention with patients with severe IBDs (p = .0042). CONCLUSION Fewer patients with severe IBDs accessed regular dental care compared to their matched pair counterparts prior to the pandemic. This could indicate that access to care is more difficult for those with severe IBDs. Patients felt that oral health is relevant to their IBD. While doctors were more likely to discuss the importance of preventing dental disease with patients who have severe IBDs, the profession needs to ensure this translates into routine engagement.
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Affiliation(s)
- Alessandra Joelle Booth
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| | - Tom Cavell
- Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| | - Thomas Gill
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| | - Daniel Hart
- Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| | - Lochana Nanayakkara
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Royal London Dental Hospital, Barts Health NHS Trust, London, UK
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Zolaly MA, Alshawi AH, Binsari IA, Alharbi AA, Almutairi YN, Zolaly FM, Al Belowi MA. Psychological Burden Among Patients With Inherited Bleeding Disorders in Madinah Province, Saudi Arabia. Cureus 2023; 15:e45165. [PMID: 37842369 PMCID: PMC10570756 DOI: 10.7759/cureus.45165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Hereditary bleeding disorders, such as hemophilia and von Willebrand disease (VWD), result from specific deficiencies or malformations in the coagulation cascade proteins. These disorders can significantly impact both physical and psychological health. Complications such as depression, anxiety, and stress (DAS) can further exacerbate these impacts. Despite their significance, detailed prevalence data remain limited, especially for regions such as Madinah province in Saudi Arabia. This study aimed to determine the prevalence of DAS and their associated risk factors among patients with hereditary bleeding disorders in Madinah province, Saudi Arabia. Methods We conducted a cross-sectional study using telephonic interviews involving patients diagnosed with severe hemophilia A or B or VWD attending a hematology clinic in Madinah. Patients over 10 were included, and the study excluded those with central nervous system insults and platelet count concerns. The validated and reliable Depression Anxiety Stress Scale-21-item questionnaire and Statistical Product and Service Solutions (SPSS), version 26.0 (IBM SPSS Statistics for Windows, Armonk, NY), facilitated data collection and analysis, respectively. Results Of the 44 patients studied, 25% exhibited symptoms of depression, 45.5% showed signs of anxiety, and 29.5% had stress symptoms. Regarding symptom severity, 9.1% of patients experienced extremely severe depression, 15.9% had moderate anxiety, and 13.6% reported moderate stress. The prevalence of these psychological issues varied with patients' age and economic status. Notably, a significantly higher rate of depression was observed in patients over 15 years (42.9% vs. 8.7%; p=0.009). Additionally, while not statistically significant, patients with a high economic status reported increased rates of DAS. Conclusions Patients with inherited bleeding disorders, particularly those older than 15, manifest significant psychological distress. There is a pressing need for enhanced awareness, specialized screenings, and tailored counseling services to improve treatment adherence and overall quality of life. Given the findings, a comprehensive national study in Saudi Arabia is highly recommended, alongside the integration of specialized psychological services.
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Affiliation(s)
- Mohammed A Zolaly
- Hematology and Oncology, Taibah University, Al-Madinah al-Munawwarah, SAU
| | - Ali H Alshawi
- Pediatrics, Taibah University, Al-Madinah al-Munawwarah, SAU
| | - Idris A Binsari
- Pediatrics, Taibah University, Al-Madinah al-Munawwarah, SAU
| | | | | | - Fayzah M Zolaly
- Pediatrics, Taibah University, Al-Madinah al-Munawwarah, SAU
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von Mackensen S, Santaella ME, Nichols CD, Khair K, Lambing AY, Witkop ML. Cross-cultural assessment of the influence of the COVID-19 pandemic on the perceived mental health and medical experiences of persons with inherited bleeding disorders and their parents/guardians. Expert Rev Hematol 2023; 16:1107-1123. [PMID: 38099480 DOI: 10.1080/17474086.2023.2277323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Objectives were to 1) assess COVID-19-associated medical and psychological challenges facing persons with inherited bleeding disorders (PIBD) and their parents/guardians (PG) in Germany, the US, and the UK; 2) describe similarities and differences among these countries; 3) identify needs and opportunities for intervention by patient advocacy organizations (PAGs). RESEARCH DESIGN & METHODS A cross-sectional, international survey was conducted in three countries using validated psychometric instruments and investigator-developed items. RESULTS Five hundred and four surveys were included. Significant differences between countries were found including experiences with medical care, specific thoughts, and concerns about COVID-19, anxiety, and other mental health measures, as well as resources used to cope with stress. Age, education, income, race, IBD diagnosis, PIBD vs. BD group, and gender had moderating effects on resources used. Communication with friends/relatives and use of PAG and HTCs as resources for information/coping decreased in all countries during the pandemic. CONCLUSIONS There were similarities and differences between respondents across the country in the perceived impact of the pandemic, mental health scores, and strategies used to cope with stress. Recommendations: strategies to increase PAG access for PIBD and their PG during pandemics and natural disasters, ongoing assessment and adaptation to provide supportive resources to specific patient subgroups.
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Affiliation(s)
- Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cynthia D Nichols
- Munson Medical Center, Quality & Safety Department, Traverse City, MI and National Bleeding Disorders Foundation, consultant to the Research Department, New York, NY, USA
| | | | | | - Michelle L Witkop
- National Bleeding Disorders Foundation at time of research, consultant at time of publication, Traverse City, MI, USA
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Chuansumrit A, Ruchutrakul T, Sirachainan N, Kitpoka P, Panuwannakorn M, Panburana P, Suwannuraks M, Sri-Udomporn N, Kijkunasathian C, Jaovisidha S, Utamakul C, Natesirinilkul R, Pongtanakul B, Traivaree C, Komvilaisak P, Suwantaroj E, Sosothikul D, Angchaisuksiri P, Rojnuckarin P. National strategic advocacy to manage patients with inherited bleeding disorders in low and lower-middle income countries. Expert Rev Hematol 2023; 16:1063-1076. [PMID: 38100503 DOI: 10.1080/17474086.2023.2293092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Inherited bleeding disorders (IBDs) including hemophilia, von Willebrand disease, platelet disorders, mucocutaneous bleeding disorders and coagulation factor deficiencies are rarely found and under-recognized in low and lower-middle-income countries. Some patients succumbed to serious bleeding without diagnosis and treatment during childhood. AREA COVERED Diagnosis, management, and prevention should be integrated into the existing health care system. Although some countries have not implemented appropriate health care infrastructure, an initiative plan should be set up by cooperation of experienced experts and health care providers. Identification of patients with IBDs should be started in the antenatal setting to search for females at risk of carrier state. The investigations include bleeding assessment, mixing venous clotting time, coagulogram, coagulation factor assay and mutation detection. Genotypic analysis is helpful for confirming the definite diagnosis, carrier detection as well as prenatal diagnosis for females at risk of bearing an offspring with severe bleeding manifestations. Management involves replacement therapy ranging from blood component to virus-inactivated factor concentrate. Appropriate research is an essential backbone for improving patients' care. EXPERT OPINION Effective national strategic advocacy to manage patients with IBDs requires intensive collaboration among policy makers, health care providers, patients, and family members.
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Affiliation(s)
- Ampaiwan Chuansumrit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Theera Ruchutrakul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimpun Kitpoka
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Monratta Panuwannakorn
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panyu Panburana
- Department of Obstetrics-Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Monthon Suwannuraks
- Dental Division, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nantana Sri-Udomporn
- Dental Division, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chusak Kijkunasathian
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphaneewan Jaovisidha
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chirawat Utamakul
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Bunchoo Pongtanakul
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanchai Traivaree
- Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Patcharee Komvilaisak
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Darintr Sosothikul
- Department of Pediatrics and Integrative and Innovative Hematology/Oncology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pantep Angchaisuksiri
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Mathews N, Tasneem S, Hayward CPM. Rare inherited coagulation and fibrinolytic defects that challenge diagnostic laboratories. Int J Lab Hematol 2023. [PMID: 37211424 DOI: 10.1111/ijlh.14084] [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: 03/01/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Coagulation factors, anticoagulants, and fibrinolytic proteins are important for hemostasis, and mutations affecting these proteins causes some rare inherited bleeding disorders that are particularly challenging to diagnose. AIMS This review provides current information on rare inherited bleeding disorders that are difficult to diagnose. MATERIAL & METHODS A review of the literature was conducted for up to date information on rare and difficult to diagnose bleeding disorders. RESULTS Some rare bleeding disorders cause an inherited deficiency of multiple coagulation factors (F), such as combined FV and FVIII deficiency and familial vitamin K-dependent clotting factor deficiency. Additionally, congenital disorders of glycosylation can affect a variety of procoagulant and anticoagulant proteins and also platelets. Some bleeding disorders reflect mutations with unique impairments in the procoagulant/anticoagulant balance, including those caused by F5 mutations that secondarily increase the plasma levels of tissue factor pathway inhibitor as well as THBD mutations that increase functional thrombomodulin in plasma or cause a consumptive coagulopathy due to thrombomodulin deficiency. Some bleeding disorders accelerate fibrinolysis due to loss-of-function mutations in SERPINE1 and SERPINF2 or in the case of Quebec platelet disorder, a duplication mutation that rewires PLAU and selectively increases expression in megakaryocytes, resulting in a unique platelet-dependent gain-of-function defect in fibrinolysis. DISCUSSION Current information on rare and difficult to diagnose bleeding disorders indicates they have unique clinical and laboratory features, and pathogenic characteristics to consider for diagnostic evaluation. CONCLUSION Laboratories and clinicians should consider rare inherited disorders, and difficult to diagnose conditions, in their strategy for diagnosing bleeding disorders.
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Affiliation(s)
- Natalie Mathews
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada
| | - Subia Tasneem
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Catherine P M Hayward
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Nagao A, Tokugawa T, Matsuo Y, Shirayama R, Morishita E, Nozima M, Kinai E, Nishida Y, Fukutake K. The length of the sanitary napkins can be used as a handier index than pictorial blood loss assessment chart to predict the heavy menstrual bleeding. J Obstet Gynaecol Res 2023. [PMID: 37141923 DOI: 10.1111/jog.15664] [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: 03/11/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
AIM Many women with inherited bleeding disorders are not diagnosed because of a lack of appropriate indicators. This study aimed to assess the predictability of the pictorial blood loss assessment chart (PBAC) as an indicator of menorrhagia and identify an easy indicator of menorrhagia resulting from bleeding disorders. METHODS A multicenter study enrolled 9 patients with von Willebrand disease (VWD), 23 hemophilia carriers, and 71 controls aged 20-45 years who completed PBACs for two menstrual cycles as well as questionnaires. RESULTS The PBAC scores of the VWD were significantly higher than those of other groups, even in multivariate analysis with age and sanitary item factors (p = 0.014). A PBAC score of 100 was not an appropriate cutoff because of its low specificity (VWD: sensitivity, 100; specificity, 29.5; hemophilia carriers: 74 and 29.5, respectively). In the ROC analysis, the cutoff of optimal PBAC for VWD was 171 (sensitivity, 66.7; specificity, 72.3; AUC, 0.7296). As the pad length increased, the total length of the pads used during one menstrual period could be a new and easy indicator. However, the cutoff for VWD was 735 cm (sensitivity, 42.9; specificity, 94.3; AUC 0.6837). A threshold could not be established for the hemophilia carrier. Therefore, we multiplied the coefficient by the length of thick pads, which caused a lower PBAC. For the VWD, the sensitivity increased to 85.7 (specificity, 77.1). For the hemophilia carrier, sensitivity (66.7) and specificity (88.6) could be separated from the control. CONCLUSIONS The total length of the pads with a thick-pad adjustment can be a simple method to identify bleeding disorders.
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Affiliation(s)
- Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
- Department of Laboratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tazuko Tokugawa
- Department of Hematology, Hyogo Medical University Hospital, Hyogo, Japan
| | - Yoko Matsuo
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Rie Shirayama
- Department of Pediatrics, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Eriko Morishita
- Department of Laboratory Sciences, School of Health Sciences, College of Medicine, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masahiro Nozima
- Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan
| | - Ei Kinai
- Department of Laboratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yasuharu Nishida
- Department of Infectious Diseases, Department of Haemophilia, National Hospital Organization Osaka National Hospital, Osaka, Japan
- Department of Haemophilia, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Katsuyuki Fukutake
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
- Department of Laboratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
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Kinalski MA, Araújo LP, Sarkis-Onofre R, Dos Santos MBF. Endodontic therapy in patients with inherited bleeding disorders: a scoping review. Gen Dent 2023; 71:28-34. [PMID: 37083610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
This systematic scoping review aimed to map available evidence regarding endodontic therapy in patients with inherited bleeding disorders (IBDs). Studies in medicine or dentistry were selected if they reported on endodontic therapy in individuals with IBDs such as hemophilia A, hemophilia B, or von Willebrand disease. Two independent researchers performed searches and screening in PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library. The search initially yielded 676 potentially relevant studies, 14 of which were included in the final analysis. Of these 14 studies, 3 were classified as consensus statements or guidelines, 3 as observational studies, 2 as reviews, 5 as case reports, and 1 as an editorial. Most of the evidence regarding prophylactic treatment (eg, blood transfusion, replacement therapy, or medication administration) prior to endodontic therapy was derived from observational studies. The most frequently reported procedure was endodontic therapy, while 1 case report described a surgical endodontic procedure. Most studies included in the analysis reported that these procedures could be performed under local anesthesia. Two case reports and 1 observational study described complications after endodontic therapy in patients with IBDs. This scoping review revealed a lack of well-designed studies related to the topic of endodontic therapy in patients with IBDs. The available evidence suggests that endodontic therapy in patients with IBDs can be considered a low-risk procedure; local anesthesia should be used in most cases when patients with IBDs are treated, but the use of prophylactic measures is preferred when nerve block anesthesia is required; endodontic therapy can be conducted in a clinical setting without the need for hospital admittance; and, although the number of reported complications is small, the risk should not be ignored.
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Sidonio RF, Bryant PC, Di Paola J, Hale S, Heiman M, Horowitz GS, Humphrey C, Jaffray J, Joyner LC, Kasthuri R, Konkle BA, Kouides PA, Montgomery R, Neeves K, Randi AM, Scappe N, Tarango C, Tickle K, Trapane P, Wang M, Waters B, Flood VH. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities for mucocutaneous bleeding disorders. Expert Rev Hematol 2023; 16:39-54. [PMID: 36920856 DOI: 10.1080/17474086.2023.2171983] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Excessive or abnormal mucocutaneous bleeding (MCB) may impact all aspects of the physical and psychosocial wellbeing of those who live with it (PWMCB). The evidence base for the optimal diagnosis and management of disorders such as inherited platelet disorders, hereditary hemorrhagic telangiectasia (HHT), hypermobility spectrum disorders (HSD), Ehlers-Danlos syndromes (EDS), and von Willebrand disease (VWD) remains thin with enormous potential for targeted research. RESEARCH DESIGN AND METHODS National Hemophilia Foundation and American Thrombosis and Hemostasis Network initiated the development of a National Research Blueprint for Inherited Bleeding Disorders with extensive all-stakeholder consultations to identify the priorities of people with inherited bleeding disorders and those who care for them. They recruited multidisciplinary expert working groups (WG) to distill community-identified priorities into concrete research questions and score their feasibility, impact, and risk. RESULTS WG2 detailed 38 high priority research questions concerning the biology of MCB, VWD, inherited qualitative platelet function defects, HDS/EDS, HHT, bleeding disorder of unknown cause, novel therapeutics, and aging. CONCLUSIONS Improving our understanding of the basic biology of MCB, large cohort longitudinal natural history studies, collaboration, and creative approaches to novel therapeutics will be important in maximizing the benefit of future research for the entire MCB community.
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Affiliation(s)
- Robert F Sidonio
- Department of Pediatrics, Aflac Cancer and Blood Disorders, Atlanta, Georgia, USA.,Hemophilia of Georgia Center for Bleeding and Clotting Disorders, Atlanta, Georgia, USA
| | - Paulette C Bryant
- Pediatric Hematology Oncology, St. Jude Affiliate Clinic at Novant Health Hemby Children's Hospital, Charlotte, North Carolina, USA.,National Hemophilia Foundation, New York, New York, USA
| | - Jorge Di Paola
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA.,Hematology/Oncology Department, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sarah Hale
- Takeda Pharmaceuticals U.S.A, Lexington, Massachusetts, USA
| | - Meadow Heiman
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | | | | | - Julie Jaffray
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lora C Joyner
- East Carolina University Hemophilia Treatment Center, Greenville, North Carolina, USA
| | - Raj Kasthuri
- Division of Hematology, UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barbara A Konkle
- Washington Center for Bleeding Disorders, Seattle, Washington, USA
| | | | - Robert Montgomery
- Blood Center of Wisconsin, Versiti, Milwaukee, Wisconsin, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Keith Neeves
- Hemophilia and Thrombosis Center, University of Colorado Denver, Denver, Colorado, USA.,Department of Bioengineering, University of Colorado Denver, Denver, Colorado, USA.,Department of Pediatrics, University of Colorado Denver, Denver, Colorado, USA.,Department of pediatrics, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anna M Randi
- National Heart and Lung Institute, Imperial College, London, UK
| | - Nikole Scappe
- National Hemophilia Foundation, New York, New York, USA
| | - Cristina Tarango
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kelly Tickle
- Department of Pediatrics, Aflac Cancer and Blood Disorders, Atlanta, Georgia, USA.,Hemophilia of Georgia Center for Bleeding and Clotting Disorders, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Pamela Trapane
- Division of Pediatric Genetics, Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Michael Wang
- Department of pediatrics, Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Veronica H Flood
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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11
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Tran DQ, Benson CC, Boice JA, Chitlur M, Dunn AL, Escobar MA, Gupta K, Johnsen JM, Jorgenson J, Martin SD, Martin S, Meeks SL, Narvaez AA, Quon DV, Reding MT, Reiss UM, Savage B, Schafer K, Steiner B, Thornburg C, Volland LM, von Drygalski A. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities to transform the care of people with hemophilia. Expert Rev Hematol 2023; 16:19-37. [PMID: 36920859 PMCID: PMC10020869 DOI: 10.1080/17474086.2023.2171981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Decades of research have transformed hemophilia from severely limiting children's lives to a manageable disorder compatible with a full, active life, for many in high-income countries. The direction of future research will determine whether exciting developments truly advance health equity for all people with hemophilia (PWH). National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network conducted extensive inclusive all-stakeholder consultations to identify the priorities of people with inherited bleeding disorders and those who care for them. RESEARCH DESIGN AND METHODS Working group (WG) 1 of the NHF State of the Science Research Summit distilled the community-identified priorities for hemophilia A and B into concrete research questions and scored their feasibility, impact, and risk. RESULTS WG1 defined 63 top priority research questions concerning arthropathy/pain/bone health, inhibitors, diagnostics, gene therapy, the pediatric to adult transition of care, disparities faced by the community, and cardiovascular disease. This research has the potential to empower PWH to thrive despite lifelong comorbidities and achieve new standards of wellbeing, including psychosocial. CONCLUSIONS Collaborative research and care delivery will be key to capitalizing on current and horizon treatments and harnessing technical advances to improve diagnostics and testing, to advance health equity for all PWH.
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Affiliation(s)
- Duc Q. Tran
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University, Atlanta, Georgia, USA
| | - Craig C. Benson
- Sanofi ¬ Rare and Rare Blood Disorders Development, Cambridge, Massachusetts, USA
| | | | - Meera Chitlur
- Division of Hematology/Oncology, Central Michigan University College of Medicine, Detroit, Michigan, USA
| | - Amy L. Dunn
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Miguel A. Escobar
- Division of Hematology, UTHealth Houston McGovern Medical School, Gulf States Hemophilia and Thrombophilia Center, Houston, Texas, USA
| | - Kalpna Gupta
- Center for Bleeding and Clotting Disorders, Division Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, California, USA
| | - Jill M. Johnsen
- Bloodworks Northwest, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Washington Center for Bleeding Disorders, Seattle, Washington, USA
| | | | | | - Suzanne Martin
- Bleeding Disorders Association of South Carolina, Greenville, South Carolina, USA
| | - Shannon L. Meeks
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center, Atlanta, Georgia, USA
| | - Alfredo A Narvaez
- Louisiana Center for Bleeding & Clotting Disorders, Tulane University, New Orleans, Louisiana, USA
| | - Doris V. Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Hospital of Los Angeles, California, USA
| | - Mark T. Reding
- Center for Bleeding and Clotting Disorders, Division Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ulrike M. Reiss
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Brittany Savage
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Kim Schafer
- Davis Hemostasis and Thrombosis Center, University of California Davis, Sacramento, California, USA
| | - Bruno Steiner
- Washington Center for Bleeding Disorders, Seattle, Washington, USA
| | - Courtney Thornburg
- Rady Children’s Hospital-San Diego, San Diego, California, USA
- UC San Diego, La Jolla, California, USA
| | | | - Annette von Drygalski
- Hemophilia & Thrombosis Treatment Center, University of California San Diego, California, USA
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12
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Ragni MV, Young G, Batsuli G, Bisson E, Carpenter SL, Croteau SE, Cuker A, Curtis RG, Denne M, Ewenstein B, Federizo A, Frick N, Funkhouser K, George LA, Hoots WK, Jobe SM, Krava E, Langmead CJ, Lewis RJ, López J, Malec L, Mann Z, Miles ME, Neely E, Neufeld EJ, Pierce GF, Pipe SW, Pitler LR, Raffini L, Schnur KM, Shavit JA. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: facilitating research through infrastructure, workforce, resources and funding. Expert Rev Hematol 2023; 16:107-127. [PMID: 36920855 DOI: 10.1080/17474086.2023.2181781] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The National Hemophilia Foundation (NHF) conducted extensive, inclusive community consultations to guide prioritization of research in coming decades in alignment with its mission to find cures and address and prevent complications enabling people and families with blood disorders to thrive. RESEARCH DESIGN AND METHODS With the American Thrombosis and Hemostasis Network, NHF recruited multidisciplinary expert working groups (WG) to distill the community-identified priorities into concrete research questions and score their feasibility, impact, and risk. WG6 was charged with identifying the infrastructure, workforce development, and funding and resources to facilitate the prioritized research. Community input on conclusions was gathered at the NHF State of the Science Research Summit. RESULTS WG6 detailed a minimal research capacity infrastructure threshold, and opportunities to enable its attainment, for bleeding disorders centers to participate in prospective, multicenter national registries. They identified challenges and opportunities to recruit, retain, and train the diverse multidisciplinary care and research workforce required into the future. Innovative collaborative approaches to trial design, resource networking, and funding to surmount obstacles facing research in rare disorders were elucidated. CONCLUSIONS The innovations in infrastructure, workforce development, and resources and funding proposed herein may contribute to facilitating a National Research Blueprint for Inherited Bleeding Disorders.
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Affiliation(s)
- Margaret V Ragni
- Department of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Medical and Scientific Advisory Council, National Hemophilia Foundation, New York, New York, USA
| | - Guy Young
- Cancer and Blood Disorders Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Glaivy Batsuli
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Emily Bisson
- Hemostasis & Thrombosis Center, Connecticut Children's, Hartford, Connecticut, USA
| | - Shannon L Carpenter
- Department of Pediatric Hematology/Oncology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Stacy E Croteau
- Boston Hemophilia Treatment Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam Cuker
- Penn Comprehensive Hemophilia Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Randall G Curtis
- Hematology Utilization Group Study (HUGS), University of Southern California, Los Angeles, California, USA.,Patient Reported Outcomes, Burdens and Experiences (PROBE) Washington, DC, USA
| | - Michael Denne
- Hematology and Rare Disease, Takeda, Cincinnati, Ohio, USA
| | - Bruce Ewenstein
- Takeda Development Center Americas, Inc, Cambridge, Massachusetts, USA
| | - Amber Federizo
- Hemostasis and Thrombosis Center of Nevada, Las Vegas, Nevada, USA
| | - Neil Frick
- National Hemophilia Foundation, New York, New York, USA
| | - Kerry Funkhouser
- Foundation for Women & Girls with Blood Disorders, Montclair, New Jersey, USA
| | - Lindsey A George
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - W Keith Hoots
- Division of Blood Diseases and Resources, National Heart, Lung and Blood Institute, National Institutes of Health; Health and Human Services, Bethesda, Maryland, USA
| | - Shawn M Jobe
- Department of Pediatrics and Human Development, Michigan State University College of Medicine, East Lansing, Michigan, USA
| | - Emily Krava
- Department of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | | | - José López
- Bloodworks Northwest, Seattle, Washington, USA.,Department of Hematology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Lynn Malec
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA
| | - Ziva Mann
- National Hemophilia Foundation, New York, New York, USA.,Ascent Leadership Networks, Newton, Massachusetts, USA
| | - Moses E Miles
- American Thrombosis and Hemostasis Network, Rochester, New York, USA
| | - Emma Neely
- National Hemophilia Foundation, New York, New York, USA
| | - Ellis J Neufeld
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Glenn F Pierce
- World Federation of Hemophilia, Montréal, Québec, Canada
| | - Steven W Pipe
- Medical and Scientific Advisory Council, National Hemophilia Foundation, New York, New York, USA.,Division of Pediatric Hematology and Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa R Pitler
- Alliance for Clinical Trials in Oncology Foundation, Chicago, Illinois, USA
| | - Leslie Raffini
- Hemostasis and Thrombosis Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathaleen M Schnur
- Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA
| | - Jordan A Shavit
- Division of Pediatric Hematology and Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Human Genetics, University of Michigan, Ann Arbor.,Hemophilia and Coagulation Disorders Program, University of Michigan, Ann Arbor, Michigan, USA
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13
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Witkop ML, Robinson F, DiMichele D. Soliciting international perspectives on an American national research agenda for inherited bleeding disorders. Expert Rev Hematol 2023; 16:13-17. [PMID: 36920860 DOI: 10.1080/17474086.2023.2178411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
| | - Fiona Robinson
- Communications, Fiona Robinson PhD, Montréal, Québec, Canada
| | - Donna DiMichele
- Donna DiMichele Consulting, LLC, Washington, DC, USA.,Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
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14
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Baldwin MK, Ahmadzia HK, Bartlett DL, Bensen-Kennedy D, Desai V, Haley KM, Herman-Hilker SL, Kilgore AM, Kulkarni R, Lavin M, Luckey S, Matteson KA, Paulyson-Nuñez K, Philipp CS, Ragosta S, Rosen K, Rotellini D, Weyand AC. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research to advance the health of people with inherited bleeding disorders with the potential to menstruate. Expert Rev Hematol 2023; 16:71-86. [PMID: 36920864 PMCID: PMC10020871 DOI: 10.1080/17474086.2023.2175660] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND People who have or had the potential to menstruate (PPM) with inherited bleeding disorders (BD) face particular challenges receiving appropriate diagnosis and care and participating in research. As part of an initiative to create a National Research Blueprint for future decades of research, the National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network conducted extensive all-stakeholder consultations to identify the priorities of PPM with inherited BDs and those who care for them. RESEARCH DESIGN AND METHODS Working group (WG) 4 of the NHF State of the Science Research Summit distilled community-identified priorities for PPM with inherited BDs into concrete research questions and scored their feasibility, impact, and risk. RESULTS WG4 identified important gaps in the foundational knowledge upon which to base optimal diagnosis and care for PPM with inherited BDs. They defined 44 top-priority research questions concerning lifespan sex biology, pregnancy and the post-partum context, uterine physiology and bleeding, bone and joint health, health care delivery, and patient-reported outcomes and quality-of-life. CONCLUSIONS The needs of PPM will best be advanced with research designed across the spectrum of sex and gender biology, with methodologies and outcome measures tailored to this population, involving them throughout.
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Affiliation(s)
- Maureen K. Baldwin
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Homa K. Ahmadzia
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Vidhi Desai
- CSL Behring, King of Prussia, Pennsylvania, USA
| | - Kristina M. Haley
- The Hemophilia Center, Oregon Health and Science University, Portland, Oregon, USA
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Sherry L. Herman-Hilker
- Hemophilia and Coagulation Disorders Program, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Roshni Kulkarni
- MSU Center of Bleeding and Clotting Disorders, Department Pediatrics and Human Development, Michigan State University, East Lansing, Michigan, USA
| | - Michelle Lavin
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - Shari Luckey
- Hemophilia Foundation of Michigan, Ypsilanti, Michigan, USA
| | - Kristen A. Matteson
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kristin Paulyson-Nuñez
- Duke Health Women & Children’s Services, Duke University Health Systems, Durham, North Carolina, USA
| | - Claire S. Philipp
- Division of Hematology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | - Kimberly Rosen
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA
| | | | - Angela C. Weyand
- Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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15
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Robinson F, Wilkes S, Schaefer N, Goldstein M, Rice M, Gray J, Meyers S, Valentino LA. Patient-centered pharmacovigilance: priority actions from the inherited bleeding disorders community. Ther Adv Drug Saf 2023; 14:20420986221146418. [PMID: 36861041 PMCID: PMC9969430 DOI: 10.1177/20420986221146418] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/01/2022] [Indexed: 02/26/2023] Open
Abstract
Pharmacovigilance, the science and practice of monitoring the effects of medicinals and their safety, is the responsibility of all stakeholders involved in the development, manufacture, regulation, distribution, prescription, and use of drugs and devices. The patient is the stakeholder most impacted by and the greatest source of information on safety issues. It is rare, however, for the patient to take a central role and exert leadership in the design and execution of pharmacovigilance. Patient organizations in the inherited bleeding disorders community are among the most established and empowered, particularly in the rare disorders. In this review, two of the largest bleeding disorders patient organizations, Hemophilia Federation of America (HFA) and National Hemophilia Foundation (NHF), offer insights into the priority actions required of all stakeholders to improve pharmacovigilance. The recent and ongoing increase in incidents raising safety concerns and a therapeutic landscape on the cusp of unprecedented expansion heighten the urgency of a recommitment to the primacy of patient safety and well-being in drug development and distribution. Plain Language Summary Patients at the center of product safety Every medical device and therapeutic product has potential benefits and harms. The pharmaceutical and biomedical companies that develop them must demonstrate that they are effective, and the safety risks are limited or manageable, for regulators to approve them for use and sale. After the product has been approved and people are using it in their daily lives, it is important to continue to collect information about any negative side effects or adverse events; this is called pharmacovigilance. Regulators, like the United States (US) Food and Drug Administration, the companies that sell and distribute the products, and healthcare professionals who prescribe them are all required to participate in collecting, reporting, analyzing, and communicating this information. The people with the most firsthand knowledge of the benefits and harms of the drug or device are the patients who use them. They have an important responsibility to learn how to recognize adverse events, how to report them, and to stay informed of any news about the product from the other partners in the pharmacovigilance network. Those partners have a crucial responsibility to provide clear, easy-to-understand information to patients about any new safety concerns that come to light. The community of people with inherited bleeding disorders has recently encountered problems with poor communication of product safety issues, prompting two large US patient organizations, National Hemophilia Foundation and Hemophilia Federation of America, to hold a Safety Summit with all the pharmacovigilance network partners. Together they developed recommendations to improve the collection and communication of information about product safety so that patients can make well-informed, timely decisions about their use of drugs and devices. This article presents these recommendations in the context of how pharmacovigilance is supposed to work and some of the challenges encountered by the community.
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Affiliation(s)
| | - Sonji Wilkes
- Hemophilia Federation of America, Washington,
DC, USA
| | | | | | | | | | - Sharon Meyers
- Hemophilia Federation of America, Washington,
DC, USA
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16
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Curry N, Bowles L, Clark TJ, Lowe G, Mainwaring J, Mangles S, Myers B, Kadir RA. Gynaecological management of women with inherited bleeding disorders. Haemophilia 2022; 28:917-937. [PMID: 35976756 DOI: 10.1111/hae.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/20/2022] [Accepted: 07/17/2022] [Indexed: 12/17/2022]
Abstract
Women with inherited bleeding disorders (IBDs) may present to healthcare professionals in a variety of ways and commonly will be encountered by either haematology or gynaecology services. Heavy menstrual bleeding is very often the first manifestation of an IBD. There is a wide variation in severity of bleeding for women with IBD and diagnosis and subsequent management of their condition requires multidisciplinary specialised care which is tailored to the individual and includes excellent cross-specialty communication between gynaecology and haematology teams. This guideline is intended for both haematologists and gynaecologists who are involved in the diagnosis and management of women with bleeding disorders. It sets out recommendations about how to investigate heavy menstrual bleeding (HMB), the commonest presentation for women with IBD to hospital services, to guide physicians about how to diagnose an IBD and covers the management of women with known IBD and HMB. The second section sets out recommendations for patients known to have IBD and covers management of patients with IBD in the setting of gynaecological surgery and management for all other non-surgical gynaecological situations.
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Affiliation(s)
- Nicola Curry
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, and NIHR BRC Blood Theme, Oxford University, Oxford, UK
| | - Louise Bowles
- The Royal London Hospital Haemophilia Comprehensive Care Centre, The Royal London Hospital, Whitechapel, London, UK
| | - T Justin Clark
- Birmingham Women's NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Gillian Lowe
- West Midlands Comprehensive Care Haemophilia Unit, University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Jason Mainwaring
- Bournemouth and Poole Haemophilia Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset, UK
| | - Sarah Mangles
- Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Bethan Myers
- Leicester Haemostasis and Thrombosis Centre, University Hospitals of Leicester, Leicester, UK
| | - Rezan Abdul Kadir
- Department of Obstetrics and Gynaecology, Katharine Dormandy Haemophilia and Thrombosis Unit, The Royal Free NHS Foundation Hospital and Institute for Women's Health, University College London, London, UK
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17
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Valentino LA, Witkop ML, Santaella ME, DiMichele D, Recht M. Building the blueprint: Formulating a community-generated national plan for future research in inherited bleeding disorders. Haemophilia 2022; 28:760-768. [PMID: 35700441 PMCID: PMC9546016 DOI: 10.1111/hae.14588] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/13/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
Introduction Decades of inherited bleeding disorders (BD) research transformed severe haemophilia from a childhood killer to a disorder managed across a full lifespan for many in economically developed countries. Health equity, a life unimpaired by disease complications, however, remains unimaginable for most people with an inherited BD (PWIBD). Aim The National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network (ATHN) undertook the development of a community‐driven United States (US) National Blueprint for Inherited Bleeding Disorders Research to transform the experience of all PWIBD and those who care for them. Methods Extensive community consultations were conducted to identify the issues most important to PWIBD and those who love and care for them. Expert multidisciplinary teams distilled these key areas of need into prioritised research questions, and identified the resources and infrastructure required to pursue them. A summit was held to gather feedback and inform the detailed blueprint. Results Community‐prioritised research areas fell into three broad categories: issues common across inherited BDs, those specific to individual disorders, and issues of infrastructure and capacity. NHF State of the Science Research Summit discussions of the research questions derived from the community priorities by six working groups provided important input for the drafting of the research blueprint for the coming decades. Conclusion The inherited BD community came together to develop the US National Blueprint for Inherited Bleeding Disorders Research dedicated to transforming the lives of all PWIBD including innovating solutions for the rarest disorders and under‐represented populations.
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Affiliation(s)
- Leonard A Valentino
- National Hemophilia Foundation, New York, New York, USA.,Internal Medicine and Pediatrics, Rush University, Chicago, Illinois, USA
| | | | | | - Donna DiMichele
- Donna DiMichele Consulting, LLC, Washington, D.C., USA.,Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Michael Recht
- American Thrombosis and Hemostasis Network, Rochester, New York, USA
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18
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Rauch A, Valentino LA, Mills K, Witkop ML, Santaella ME, DiMichele D, Recht M, Susen S. Big picture initiatives in bleeding disorders. Haemophilia 2022; 28 Suppl 4:53-60. [PMID: 35521733 DOI: 10.1111/hae.14532] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The inherited bleeding disorders (IBD) community has witnessed significant therapeutic advances recently, yet important gaps persist, particularly for those with rare disorders and historically underserved populations. AIMS -To create a national research blueprint agenda, led by the National Hemophilia Foundation (NHF), enhancing patient-centric principles, accelerate research progress and address important gaps in care. -To review critical gaps that remain to be addressed in women with IBDs, who face specific bleeding challenges. METHODS The NHF research blueprint research agenda was defined by input from across the community, including caregivers and patients who are considered subject matter experts of their IBD, research leaders, allied health professionals and specialists, and representatives of the biopharmaceutical industry. In addition, two medical experts in the field of IBDs performed a comprehensive review to address the knowledge gaps in women with IBDs. RESULTS Two foundational principles of the NHF blueprint are: (1) it must deliver on key issues that significantly impact the lives of those affected by IBDs, and (2) the priorities defined are relevant and actionable aimed to achieve health equity among all those affected by IBDs. A multidisciplinary approach is necessary for an optimal management of puberty, transition to adulthood and pregnancy. Even if strict guidelines are followed, recent studies show that women with IBDs are still facing a high burden. CONCLUSION NHF blueprint will be issued in 2022. A specific research agenda is needed in women with IBDs to further improve their management and quality of life.
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Affiliation(s)
| | - Leonard A Valentino
- National Hemophilia Foundation, New York, New York, USA.,Rush University, Chicago, Illinois, USA
| | - Kevin Mills
- National Hemophilia Foundation, New York, New York, USA
| | | | | | | | - Michael Recht
- American Thrombosis and Hemostasis Network, Rochester, New York, USA
| | - Sophie Susen
- CHU Lille, Hematology Transfusion, LILLE, France
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19
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Clarke L, Curnow J, Cutts B, Ross B, Kidson-Gerber G. Pregnancy, childbirth and neonatal outcomes in women with inherited bleeding disorders: A retrospective analysis. BJOG 2022; 129:1772-1778. [PMID: 35157368 DOI: 10.1111/1471-0528.17125] [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: 06/18/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
Women with inherited bleeding disorders can deliver without complication when best practices are maintained.
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Affiliation(s)
- Lisa Clarke
- Department of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Transfusion Policy and Education, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Jennifer Curnow
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Briony Cutts
- Department of Obstetrics, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetric Medicine, Joan Kirner Women's and Children's at Sunshine Hospital, Melbourne, Victoria, Australia
| | - Bryony Ross
- Department of Haematology, Calvary Mater Newcastle, Waratah, New South Wales, Australia.,NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Giselle Kidson-Gerber
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Royal Hospital for Woman, Sydney, New South Wales, Australia
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20
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Mousavi SH, Qaderi S, Ahmadi A, Madadi S, Arif S, Essar MY, Lucero-Prisno DE. Inherited bleeding disorders in Afghanistan: The current situation amid COVID-19. Haemophilia 2021; 27:e579-e580. [PMID: 33966320 PMCID: PMC8239604 DOI: 10.1111/hae.14332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Sayed Hamid Mousavi
- Medical Research Center, Kateb University, Kabul, Afghanistan.,Afghanistan National Charity Organization for Special Diseases (ANCOSD), Kabul, Afghanistan
| | - Shohra Qaderi
- Medical Research Center, Kateb University, Kabul, Afghanistan.,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shekiba Madadi
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Shamim Arif
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | | | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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21
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de Azevedo Kinalski M, Brondani LP, de Mattos Carpena ALM, Dos Santos MBF. Delayed bleeding in a hemophilic patient after sinus floor elevation and multiple implant placements. J ORAL IMPLANTOL 2021; 48:133-138. [PMID: 33690855 DOI: 10.1563/aaid-joi-d-20-00043] [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: 11/22/2022]
Abstract
Not required for clinical case letters.
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Affiliation(s)
- Mateus de Azevedo Kinalski
- Graduate student, Graduate Program Prosthodontics, School of Dentistry, Federal University of Pelotas (UFPEL), Pelotas, RS, Brazil
| | - Lucas Pradebon Brondani
- Graduate student, Graduate Program Prosthodontics, School of Dentistry, Federal University of Pelotas (UFPEL), Pelotas, RS, Brazil
| | | | - Mateus Bertolini Fernandes Dos Santos
- Universidade Federal de Pelotas Assistant Professor Graduate Program 457 Gonçalves Chaves BRAZIL Pelotas Rio Grande do Sul 96015560 Universidade Federal de Pelotas
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22
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Abstract
Decades of preclinical and clinical studies developing gene therapy for hemophilia are poised to bear fruit with current promising pivotal studies likely to lead to regulatory approval. However, this recent success should not obscure the multiple challenges that were overcome to reach this destination. Gene therapy for hemophilia A and B benefited from advancements in the general gene therapy field, such as the development of adeno-associated viral vectors, as well as disease-specific breakthroughs, like the identification of B-domain deleted factor VIII and hyperactive factor IX Padua. The gene therapy field has also benefited from hemophilia B clinical studies, which revealed for the first time critical safety concerns related to immune responses to the vector capsid not anticipated in preclinical models. Preclinical studies have also investigated gene transfer approaches for other rare inherited bleeding disorders, including factor VII deficiency, von Willebrand disease, and Glanzmann thrombasthenia. Here we review the successful gene therapy journey for hemophilia and pose some unanswered questions. We then discuss the current state of gene therapy for these other rare inherited bleeding disorders and how the lessons of hemophilia gene therapy may guide clinical development.
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Affiliation(s)
- Valder R. Arruda
- Department of Pediatrics, Division of Hematology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Division of Hematology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Philadelphia, Pennsylvania
| | - Jesse Weber
- Department of Pediatrics, Division of Hematology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin J. Samelson-Jones
- Department of Pediatrics, Division of Hematology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Division of Hematology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Philadelphia, Pennsylvania
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23
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de Azevedo Kinalski M, Sarkis-Onofre R, Dos Santos MBF. Inherited bleeding disorders in oral procedures. Assessment of prophylactic and therapeutic protocols: a scoping review. Aust Dent J 2021; 66:150-158. [PMID: 33336389 DOI: 10.1111/adj.12813] [Citation(s) in RCA: 2] [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] [Accepted: 11/08/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND This scoping review aimed to map available evidence regarding minor/major oral procedures in patients with inherited bleeding disorders (IBDs). METHODS Studies in medicine or dentistry that reported minor and major oral procedures in individuals presenting IBDs (e.g. haemophilia A or B, von Willebrand disease) were selected. Search and screening were performed in PubMed/Medline, Scopus, Web of Science and Cochrane Library by two independent researchers. RESULTS Initial search yielded 4152 citations, of which 257 were included in the final analysis. Most of the evidence for prophylaxis use was derived from observational studies and the most-commonly reported prophylactic protocols were fresh frozen plasma and factor VIII concentrate. A considerable number of studies reported postoperative complications and hospitalizations. CONCLUSION The present study identified that (1) there is room for new studies to assess the use of antifibrinolytic agents with no factor replacement; (2) to date, the use of factor replacement therapy is the most indicated approach when treating patients with IBDs with adjunct systemic or local antifibrinolytic agents to reduce post-operative complications; and (3) there is a critical need for high-quality evidence studies since much of the conclusions of the included studies are not supported by statistical analysis.
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Affiliation(s)
| | - Rafael Sarkis-Onofre
- Graduate Program in Dentistry, Meridional University (IMED), Passo Fundo, RS, Brazil
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24
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Castaman G, James PD. Pregnancy and delivery in women with von Willebrand disease. Eur J Haematol 2019; 103:73-79. [PMID: 31107984 PMCID: PMC7604852 DOI: 10.1111/ejh.13250] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
Given the wide heterogeneity of phenotypes and of the underlying pathophysiological mechanisms associated with the disorder, pregnancy and delivery in von Willebrand disease (VWD) represent a significant clinical challenge. The variable pattern of changes observed during pregnancy of von Willebrand factor (VWF) and factor VIII (FVIII), the protein carried by VWF, prompts a careful evaluation of pregnant women with VWD to plan the most appropriate treatment at the time of parturition. However, there are also instances during pregnancy (amniocentesis, vaginal bleeding associated with placental detachment, sudden abortion) that may require urgent hemostatic treatment to prevent bleeding. Thus, women with VWD should start pregnancy after being well characterised as to their type, subtype and treatments. Women with VWD who have VWF and FVIII basal levels >30 U/dL typically normalise these levels at the end of pregnancy and specific anti-haemorrhagic prophylaxis is seldom required. On the contrary, those with basal levels <20 U/dL usually show a lesser increase and specific treatment is required. Some women with DNA variants associated with increased clearance can be treated with desmopressin, while those unresponsive or with contra-indications to this agent need replacement therapy. For these latter women, the risk of vaginal bleeding during pregnancy may be increased and prophylaxis with VWF concentrates required. Similarly, women with type 2 VWD who maintain reduced VWF activity throughout pregnancy require replacement therapy with FVIII/VWF concentrates. Delayed postpartum bleeding may occur when replacement therapy is not continued for some days. Tranexamic acid is useful at discharge to avoid excessive lochia.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Paula D. James
- Department of Medicine, Queen’s University, Kingston, ON, Canada
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25
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Ragni MV, George LA. The national blueprint for future factor VIII inhibitor clinical trials: NHLBI State of the Science (SOS) Workshop on factor VIII inhibitors. Haemophilia 2019; 25:581-589. [PMID: 31329364 PMCID: PMC9883697 DOI: 10.1111/hae.13717] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/26/2018] [Revised: 12/29/2018] [Accepted: 01/31/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Inhibitor formation is a major complication of haemophilia for which clinical trials are planned. Despite emerging novel haemostatic agents, challenges of rare disease trials are limited subjects and lack of an organized research organization with strategic resources and partnerships. AIM The charge to Working Group 1 was to establish scientific priorities and innovative implementation strategies to conduct inhibitor prevention and eradication trials. To determine feasibility of trial design and strategic resources and partnerships to be leveraged, two clinical trial concepts were considered. RESULTS For the Inhibitor Prevention Trial, we considered adaptive design with early stopping rules, dynamic randomization and Master Protocol models to reduce sample size; and registries to provide concurrent controls and natural history data. For the Inhibitor Eradication Trial using gene therapy, an adaptive design was considered in a small number of subjects, and, if safe and meeting regulatory requirements, enrolment would be expanded. A Haemophilia Clinical Trials Group (HCTG) infrastructure was envisioned, with uniform procedures and standardized outcomes, data collection and assays, within which trial concepts would be developed, vetted and prioritized by a Steering Committee, and submitted to NIH and other research sponsors for review and funding. Mechanistic studies would be embedded within the trials, early stage investigators trained and mentored, and the research infrastructure established within the haemophilia centre (HTC) network and supported by partnerships with foundations, community, federal partners and industry. CONCLUSION The success of inhibitor trials will depend on innovative trial design and an organized HCTG research infrastructure, leveraged through community partnerships.
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26
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Bui J, Martyres D, James PD, Grabell J, Wu J, Steele M, Silva M, Rand ML, Blanchette VS, Barrowman N, Klaassen RJ. Validation of the school age self-administered pediatric bleeding questionnaire (Self-PBQ) in children aged 8-12 years. Pediatr Blood Cancer 2019; 66:e27709. [PMID: 30900820 PMCID: PMC7643750 DOI: 10.1002/pbc.27709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the pediatric population, pathologic bleeding is often challenging to identify. The pediatric bleeding questionnaire (PBQ) was developed as a screening tool for von Willebrand disease (VWD) but was designed to be self-completed by children above 12 years of age. The study objective was to determine whether a modified Self-PBQ could be completed by 8- to 12-year-old children with adult assistance. PROCEDURE The initial phase involved seven children who underwent cognitive debriefing to identify problems in the questionnaire, resulting in modifications to wording and response options. In phase 2, children completed the modified Self-PBQ independently or with assistance from their parent at five Canadian treatment centers. Parents filled out the Self-PBQ separately to serve as a comparison. Bleeding scores derived from the child self-report were compared to those of the parent proxy. RESULTS Twenty-nine out of 31 patient/parent pairs successfully completed the Self-PBQ. Child and parent scores demonstrated a high level of agreement with an intraclass correlation (ICC) of 0.825. In the age subgroup analysis, the ICC was 0.834 and 0.824 for the 8- to 9-year-old and 10- to 12-year-old groups, respectively. The ICC was also determined in children with type 1 VWD (ICC = 0.829) versus those with more severe bleeding disorders (ICC = 0.802). Thus, age and disease severity had no significant effect on degree of agreement. CONCLUSIONS Our study shows that agreement was maintained even in younger children aged 8-9 years and in children with varying bleeding phenotypes. This supports the administration of the modified Self-PBQ to 8- to 12-year-old children.
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Affiliation(s)
- Jessica Bui
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Paula D. James
- Department of Medicine, Queen’s University, Kingston, Canada
| | | | - John Wu
- Division of Hematology/Oncology, British Columbia Children’s Hospital, Vancouver, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Alberta Children’s Hospital, Calgary, Canada
| | | | - Margaret L. Rand
- Division of Hematology/Oncology and Translational Medicine, The Hospital for Sick Children; Departments of Laboratory Medicine & Pathobiology, Biochemistry, and Pediatrics, University of Toronto, Toronto, Canada
| | - Victor S. Blanchette
- Division of Hematology/Oncology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Nick Barrowman
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Robert J. Klaassen
- Department of Pediatrics, Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
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27
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Heremans J, Freson K. High-throughput sequencing for diagnosing platelet disorders: lessons learned from exploring the causes of bleeding disorders. Int J Lab Hematol 2018; 40 Suppl 1:89-96. [PMID: 29741246 DOI: 10.1111/ijlh.12812] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 02/07/2018] [Indexed: 12/21/2022]
Abstract
Inherited platelet disorders (IPDs) are a heterogeneous group of disorders caused by multiple genetic defects. Obtaining a molecular diagnosis for IPD patients using a phenotype- and laboratory-based approach is complex, expensive, time-consuming, and not always successful. High-throughput sequencing (HTS) methods offer a genotype-based approach to facilitate molecular diagnostics. Such approaches are expected to decrease time to diagnosis, increase the diagnostic rate, and they have provided novel insights into the genotype-phenotype correlation of IPDs. Some of these approaches have also focused on the discovery of novel genes and unexpected molecular pathways which modulate megakaryocyte and platelet biology were discovered. A growing number of genetic defects underlying IPDs have been identified and we will here provide an overview of the diverse molecular players. Screening of these genes will deliver a genetic diagnosis for about 40%-50% of the IPDs patients and we will compare different HTS applications that have been developed. A brief focus on gene variant interpretation and classification in a diagnostic setting will be given. Although it is true that successes in diagnostics and gene discovery have been reached, a large fraction of patients still remains without a conclusive diagnosis. In these patients, the sum of non-diagnostic variants in known genes or in potential novel genes might only be proven informative in future studies with larger patient cohorts and by data sharing among the diverse genome medicine initiatives. Finally, we still do not understand the role of the non-coding genome space for IPDs.
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Affiliation(s)
- J Heremans
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - K Freson
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
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28
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Casey LJ, Tuttle A, Grabell J, Hopman W, Moorehead PC, Blanchette VS, Wu JK, Steele M, Klaassen RJ, Silva M, Rand ML, James PD. Generation and optimization of the self-administered pediatric bleeding questionnaire and its validation as a screening tool for von Willebrand disease. Pediatr Blood Cancer 2017; 64. [PMID: 28453185 DOI: 10.1002/pbc.26588] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 09/23/2016] [Revised: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Our objective was to generate, optimize, and validate a self-administered pediatric bleeding questionnaire (Self-PBQ) as a screening tool for von Willebrand disease (VWD) in children referred to the hematology clinic for the first time. STUDY DESIGN The Self-PBQ was generated by combining the validated expert-administered PBQ and the International Society on Thrombosis and Hemostasis (ISTH) bleeding assessment tool (BAT). Medical terminology was translated into lay language requiring a grade 4 reading level. In Phase 1, the Self-PBQ was optimized and the level of agreement between the Self-PBQ and the expert-administered PBQ was determined. Phase 2 established the normal range of bleeding scores (BSs) of the Self-PBQ. Phase 3 examined the Self-PBQ as a screening tool for first-time referrals to the hematology clinic. RESULTS The Self-PBQ is a reliable surrogate for the expert-administered PBQ with an excellent intraclass correlation (ICC) of 0.917. The Self-PBQ was scored with the PBQ and the ISTH-BAT scoring systems, for which its normal BS ranges are -1 to 2 or 0 to 2, respectively. A positive Self-PBQ BS (≥3) had a sensitivity of 78%, a specificity of 37%, a positive predictive value of 0.18, and a negative predictive value of 0.91 for identifying VWD in children being investigated by a hematologist for a bleeding disorder. CONCLUSION The Self-PBQ generates comparable BSs to the expert-administered PBQ and is a reliable, reasonably sensitive screening tool to incorporate into the assessment of children presenting to a hematologist for the investigation of an inherited bleeding disorder.
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Affiliation(s)
| | | | | | | | - Paul C Moorehead
- Janeway Children's Health and Rehabilitation Centre, St. John's, Canada.,Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Canada
| | - Victor S Blanchette
- Division of Hematology/Oncology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - John K Wu
- British Columbia Children's Hospital, Vancouver, Canada
| | | | | | | | - Margaret L Rand
- Division of Hematology/Oncology and Program in Experimental Medicine, The Hospital for Sick Children.,Departments of Laboratory Medicine & Pathobiology, Biochemistry and Pediatrics, University of Toronto, Toronto, Canada
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29
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Deforest M, Grabell J, Albert S, Young J, Tuttle A, Hopman WM, James PD. Generation and optimization of the self-administered bleeding assessment tool and its validation as a screening test for von Willebrand disease. Haemophilia 2015; 21:e384-8. [PMID: 26179127 DOI: 10.1111/hae.12747] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION/AIM Our aim was to generate, optimize and validate a self-administered bleeding assessment tool (self-BAT) for von Willebrand disease (VWD). METHODS In Phase 1, medical terminology in the expert-administered International Society on Thrombosis and Haemostasis (ISTH)-BAT was converted into a Grade 4 reading level to produce the first version of the Self-BAT which was then optimized to ensure agreement with the ISTH-BAT. In Phase 2, the normal range of bleeding scores (BSs) was determined and test-retest reliability analysed. In Phase 3, the optimized Self-BAT was tested as a screening tool for first time referrals to the Haematology clinic. RESULTS Bleeding score from the final optimized version of the Self-BAT showed an excellent intra-class correlation coefficient (ICC) of 0.87 with ISTH-BAT BS in Phase 1. In Phase 2, the normal range of BSs for the optimized Self-BAT was determined to be 0 to +5 for females and 0 to +3 for males and excellent test-retest reliability was shown (ICC = 0.95). In Phase 3, we showed that a positive Self-BAT BS (≥6 for females, ≥4 for males) has a sensitivity of 78%, specificity of 23%, positive predictive value (PPV) of 0.15 and negative predictive value (NPV) of 0.86 for VWD; these figures improved when just the females were analysed; sensitivity of 100%, specificity of 21%, PPV = 0.17 and NPV = 1.0. CONCLUSION We show an optimized Self-BAT can generate comparable BS to the expert-administered ISTH-BAT and is a reliable, effective screening tool to incorporate into the assessment of individuals, particularly women, referred for a possible bleeding disorder.
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Affiliation(s)
- M Deforest
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - J Grabell
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - S Albert
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - J Young
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - A Tuttle
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - W M Hopman
- Clinical Research Centre, Kingston General Hospital, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - P D James
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
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Abstract
Haemophiliacs have high hepatitis C virus (HCV) exposure risk from blood products that did not undergo heat inactivation or disease-specific screening prior to 1987. Repeated exposure to infected factor concentrates predisposes haemophiliacs to higher likelihood of HCV from multiple sources. HIV coinfection could result in impaired clearance of less fit variants resulting in enrichment of quasispecies carrying resistance mutations. We postulated that haemophiliacs demonstrate increased prevalence of baseline signature mutations in the HCV NS3/4 serine protease coding domain. We examined the prevalence of putative HCV protease inhibitor mutations, mutations, subclassified into dominant mutations if changes conferred resistance, and minor variants not associated with drug resistance, in patients with haemophilia A or B, infected with HCV or HCV/HIV, prior to HCV PI exposure. A total of 151 subjects were evaluated, including 22 haemophiliacs and 129 non-haemophilic controls. Of the 58 mutations detected, 55 (95%) were resistance mutations and three (5%) were minor variants. Dominant mutations were detected in 10 (45.5%) haemophiliacs and in 43 (33.3%) controls (OR 1.67, 95% CI 0.67-4.16). There was no statistical difference in proportion of dominant mutations (P = 0.27) or minor variants (P = 0.47) between groups, despite adjustment for HIV status (P = 0.44). No significant differences in dominant or minor resistance mutations between haemophiliacs and non-haemophiliacs were observed. HIV presence or prior HAART exposure did not affect baseline distribution. We conclude that haemophiliacs are not at higher risk for pre-existing HCV PI mutations, and prospective studies of response to PI-based regimens with HCV activity are indicated.
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Affiliation(s)
- M V Lin
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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31
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Haghpanah S, Zahedi Z, Parand S, Karimi M. An experience of using Traumastem P in control of spontaneous nose bleeding in patients with inherited bleeding disorders in southern Iran. Haemophilia 2013; 20:e79-80. [PMID: 24165209 DOI: 10.1111/hae.12270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 01/01/2023]
Affiliation(s)
- S Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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32
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Castaman G, Giacomelli SH, Caccia S, Riccardi F, Rossetti G, Dragani A, Giuffrida AC, Biasoli C, Duga S. The spectrum of factor XI deficiency in Italy. Haemophilia 2013; 20:106-13. [PMID: 24112640 DOI: 10.1111/hae.12257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2013] [Indexed: 11/29/2022]
Abstract
Factor XI (FXI) deficiency is a rare inherited bleeding disorder invariably caused by mutations in the FXI gene. The disorder is rather frequent in Ashkenazi Jews, in whom around 98% of the abnormal alleles is represented by Glu117X and Phe283Leu mutations. A wide heterogeneity of causative mutations has been previously reported in a few FXI deficient patients from Italy. In this article, we enlarge the knowledge on the genetic background of FXI deficiency in Italy. Over 4 years, 22 index cases, eight with severe deficiency and 14 with partial deficiency, have been evaluated. A total of 21 different mutations in 30 disease-associated alleles were identified, 10 of which were novel. Among them, a novel Asp556Gly dysfunctional mutation was also identified. Glu117X was also detected, as previously reported from other patients in Italy, while again Phe283Leu was not identified. A total of 34 heterozygous relatives were also identified. Bleeding tendency was present in very few cases, being inconsistently related to the severity of FXI deficiency in plasma. In conclusion, at variance with other populations, no single major founder effect is present in Italian patients with FXI deficiency.
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Affiliation(s)
- G Castaman
- Department of Cell Therapy and Hematology, Hemophilia and Thrombosis Center, San Bortolo Hospital, Vicenza, Italy
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33
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Rimmer E, Jamieson MA, James P. Malposition and expulsion of the levonorgestrel intrauterine system among women with inherited bleeding disorders. Haemophilia 2013; 19:933-8. [PMID: 23711358 DOI: 10.1111/hae.12184] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 11/30/2022]
Abstract
The levonorgestrel-releasing intrauterine system (LNG-IUS) is indicated for the management of menorrhagia and for contraception. The LNG-IUS is effective at reducing menstrual bleeding and improving haemoglobin among women with bleeding disorders. Expulsion rates for the LNG-IUS among normal women are reported to be approximately 5-10%. The aim of this study was to examine the malposition and expulsion rates of the LNG-IUS among women with inherited bleeding disorders. We conducted a retrospective study of women with an inherited bleeding disorder in Kingston, Canada treated with an LNG-IUS between May 2005 and June 2012. The primary outcome was a combined endpoint of expulsion and/or malposition. Predetermined secondary outcomes were patient satisfaction and changes in haemoglobin and ferritin levels. The median age of the women at the time of LNG-IUS insertion was 31 years (range 18-43, mean 32.1 years). The most common diagnosis was type 1 VWD (12/20, 60%). There were three LNG-IUS expulsions and two episodes of device malposition resulting in removal [5/20 (25.0%), 95% CI 11.2-46.9%]. An additional five women had their device removed prematurely. The overall proportion of devices resulting in discontinuation in this population was 10/20 (50.0%, 95% CI 29.9-70.1%). In this retrospective study, a significant proportion of women with an inherited bleeding disorder had an LGN-IUS removed due to poor patient satisfaction, malposition, or expulsion. Further studies into the causes of higher complication rates and interventions such as premedication or prolonged treatment with antifibrinolytic agents targeted at improving outcomes in this population are required.
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Affiliation(s)
- E Rimmer
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
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34
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Castaman G, Bonetti E, Messina M, Morfini M, Rocino A, Scaraggi FA, Tagariello G. Inhibitors in haemophilia B: the Italian experience. Haemophilia 2013; 19:686-90. [PMID: 23601006 DOI: 10.1111/hae.12158] [Citation(s) in RCA: 25] [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: 04/02/2013] [Indexed: 11/29/2022]
Abstract
The prevalence of inhibitors in haemophilia B is significantly lower than that of patients with haemophilia A. However, the peculiar occurrence of allergic reactions associated with the onset of inhibitor in haemophilia B (HB) may render immune tolerance a risky procedure. We have carried out a detailed survey among all the Italian Hemophilia Centers to analyse all the patients with HB and inhibitors. A total of eight patients were reported among 282 living patients (2.8%) with severe factor IX (FIX) deficiency (FIX < 1 U dL(-1)). In addition, two deceased patients were also identified. Six patients carried nonsense mutations while in four partial or complete gene deletions were detected. Three patients (one deceased) had history of allergic/anaphylactic reaction upon substitutive treatment, which in one case was recurrent and resolved after switching to plasma derived FIX. Immune tolerance was adopted in five patients and in four complete response was achieved while in the remaining it was partial. No nephrotic syndrome was observed. Our data confirm that inhibitors in HB occur in patients with null mutations or complete/partial gene deletion. Immune tolerance can be achieved also in HB patients, without allergic reactions or nephrotic syndrome upon replacement therapy.
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Affiliation(s)
- G Castaman
- Department of Cell Therapy and Hematology, Hemophilia and Thrombosis Center, San Bortolo Hospital, Vicenza, Italy.
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35
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Dasani H, Jackson H, Jones JA, Howlett J. Absence of intrafamilial transmission of hepatitis C in patients with inherited bleeding disorders. Haemophilia 1997; 3:199-200. [PMID: 27214805 DOI: 10.1046/j.1365-2516.1997.00119.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatitis 'C' virus (HCV) infection has caused significant anxiety in patients with inherited bleeding disorders. A significant number of patients with HCV have developed chronic liver disease, cirrhosis and hepatocellular carcinoma. The exact risk of heterosexual and contact transmission is unclear at the moment. A test for antibody to hepatitis 'C' was offered, after counselling, to spouses and family members of 118 known hepatitis 'C' antibody positive patients with inherited bleeding disorders. Two hundred and fifteen family members were tested, 73 partners and 142 household contacts; all were found negative for hepatitis 'C'. Our experience confirms the low risk of heterosexual and contact transmission of hepatitis 'C' virus.
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Affiliation(s)
- H Dasani
- The Arthur Bloom Haemophilia Centre, University Hospital of Wales, Cardiff, UK
| | - H Jackson
- The Arthur Bloom Haemophilia Centre, University Hospital of Wales, Cardiff, UK
| | - J A Jones
- The Arthur Bloom Haemophilia Centre, University Hospital of Wales, Cardiff, UK
| | - J Howlett
- The Arthur Bloom Haemophilia Centre, University Hospital of Wales, Cardiff, UK
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