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Ács N, Korte WC, von Heymann CC, Windyga J, Blatný J. Rationale for the Potential Use of Recombinant Activated Factor VII in Severe Post-Partum Hemorrhage. J Clin Med 2024; 13:2928. [PMID: 38792469 DOI: 10.3390/jcm13102928] [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: 02/28/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Severe post-partum hemorrhage (PPH) is a major cause of maternal mortality worldwide. Recombinant activated factor VII (rFVIIa) has recently been approved by the European Medicines Agency for the treatment of severe PPH if uterotonics fail to achieve hemostasis. Although large randomized controlled trials are lacking, accumulated evidence from smaller studies and international registries supports the efficacy of rFVIIa alongside extended standard treatment to control severe PPH. Because rFVIIa neither substitutes the activity of a missing coagulation factor nor bypasses a coagulation defect in this population, it is not immediately evident how it exerts its beneficial effect. Here, we discuss possible mechanistic explanations for the efficacy of rFVIIa and the published evidence in patients with severe PPH. Recombinant FVIIa may not primarily increase systemic thrombin generation, but may promote local thrombin generation through binding to activated platelets at the site of vascular wall injury. This explanation may also address safety concerns that have been raised over the administration of a procoagulant molecule in a background of increased thromboembolic risk due to both pregnancy-related hemostatic changes and the hemorrhagic state. However, the available safety data for this and other indications are reassuring and the rates of thromboembolic events do not appear to be increased in women with severe PPH treated with rFVIIa. We recommend that the administration of rFVIIa be considered before dilutional coagulopathy develops and used to support the current standard treatment in certain patients with severe PPH.
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Affiliation(s)
- Nándor Ács
- Department of Obstetrics and Gynaecology, Semmelweis University, H-1082 Budapest, Hungary
| | - Wolfgang C Korte
- Centre for Laboratory Medicine, Haemostasis and Haemophilia Centre, CH-9001 St. Gallen, Switzerland
| | - Christian C von Heymann
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum in Friedrichshain, DE-10249 Berlin, Germany
| | - Jerzy Windyga
- Department of Haemostasis Disorders and Internal Medicine, Laboratory of Haemostasis and Metabolic Diseases, Institute of Haematology and Transfusion Medicine, 02-776 Warsaw, Poland
| | - Jan Blatný
- Department of Paediatric Oncology, University Hospital Brno, and Masaryk University, 613 00 Brno, Czech Republic
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2
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Caram-Deelder C, McKinnon Edwards H, Zdanowicz JA, van den Akker T, Birkegård C, Blatný J, van der Bom JG, Colucci G, van Duuren D, van Geloven N, Henriquez DDCA, Knight M, Korsholm L, Landorph A, Lavigne Lissalde G, McQuilten ZK, Surbek D, Wellard C, Wood EM, Mercier FJ. Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage. J Clin Med 2024; 13:2656. [PMID: 38731185 PMCID: PMC11084845 DOI: 10.3390/jcm13092656] [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: 02/28/2024] [Revised: 04/09/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Despite a range of available treatments, it is still sometimes challenging to treat patients with severe post-partum hemorrhage (sPPH). Objective: This study evaluated the efficacy and safety of recombinant activated factor VIIa (rFVIIa) in sPPH management. Methods: An open-label, multi-center, randomized controlled trial (RCT; NCT00370877) and four observational studies (OS; OS-1 (NCT04723979), OS-2, OS-3, and OS-4) were analyzed regarding efficacy (need for subsequent invasive procedures, including uterine compression sutures, uterine or iliac artery ligations, arterial embolization, or hysterectomy) and safety (incidence of thromboembolic events (TE) and maternal mortality) of rFVIIa for sPPH. The RCT, and OS-1 and OS-2, included a control group of women who did not receive rFVIIa (with propensity score-matching used in OS-1 and OS-2), whereas OS-3 and OS-4 provided descriptive data for rFVIIa-exposed women only. Results: A total of 446 women exposed to rFVIIa and 1717 non-exposed controls were included. In the RCT, fewer rFVIIa-exposed women (50% [21/42]) had an invasive procedure versus non-exposed women (91% [38/42]; odds ratio: 0.11; 95% confidence interval: 0.03-0.35). In OS-1, more rFVIIa-exposed women (58% [22/38]) had an invasive procedure versus non-exposed women (35% [13.3/38]; odds ratio: 2.46; 95% confidence interval: 1.06-5.99). In OS-2, 17% (3/18) of rFVIIa-exposed women and 32% (5.6/17.8) of non-exposed women had an invasive procedure (odds ratio: 0.33; 95% confidence interval: 0.03-1.75). Across all included women, TEs occurred in 1.5% (0.2% arterial and 1.2% venous) of rFVIIa-exposed women and 1.6% (0.2% arterial and 1.4% venous) of non-exposed women with available data. Conclusions: The positive treatment effect of rFVIIa on the RCT was not confirmed in the OS. However, the safety analysis did not show any increased incidence of TEs with rFVIIa treatment.
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Affiliation(s)
| | - Hellen McKinnon Edwards
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark
| | - Jarmila A. Zdanowicz
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Thomas van den Akker
- Leiden University Medical Center, 2333 Leiden, The Netherlands
- Athena Institute, Vrije Universiteit, 1081 Amsterdam, The Netherlands
| | | | - Jan Blatný
- Department of Paediatric Oncology, University Hospital Brno, and Masaryk University, 625 00 Brno, Czech Republic
| | | | - Giuseppe Colucci
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Clinica Sant’Anna, 6924 Sorengo, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | | | - Nan van Geloven
- Leiden University Medical Center, 2333 Leiden, The Netherlands
| | - Dacia D. C. A. Henriquez
- Leiden University Medical Center, 2333 Leiden, The Netherlands
- Amsterdam University Medical Center, University of Amsterdam, 1105 Amsterdam, The Netherlands
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | | | | | | | - Zoe K. McQuilten
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Haematology, Monash Health, Melbourne 3004, Australia
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Cameron Wellard
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Erica M. Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Haematology, Monash Health, Melbourne 3004, Australia
| | - Frederic J. Mercier
- Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Université Paris Saclay, 92140 Clamart, France
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Romanová G, Smejkal P, Ovesná P, Drbohlavová E, Dulíček P, Hajšmanová Z, Hluší A, Hrdličková R, Ullrychová J, Vonke I, Blatný J, Čermáková Z, Zápotocká E, Penka M. Bleeding pattern and consumption of factor VIII concentrate in adult patients with haemophilia A without inhibitors in the Czech Republic between 2013 and 2021 (Czech National Haemophilia Programme registry data). Ann Hematol 2023; 102:3261-3270. [PMID: 37740066 PMCID: PMC10567882 DOI: 10.1007/s00277-023-05453-6] [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: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
The manuscript provides an overview of treatment and its changes in adult patients with haemophilia A without inhibitors in the Czech Republic between 2013 and 2021 using data from the registry of the Czech National Haemophilia Programme (CNHP). Over a 9-year period, we focused on the reduction in the annual bleeding rate (ABR), joint bleeding rate (AJBR) and factor VIII consumption when patients with severe haemophilia A switched from on-demand treatment to prophylaxis. The ABR and AJBR include both patient-reported home treatment and treated hospitalisation episodes. All adult patients with severe haemophilia A were categorised into three groups according to the therapeutic regimen. The first group was patients on prophylaxis during the follow-up period, the second group consisted of patients on on-demand treatment, and the third group was patients who received both treatment regimens during follow-up. With an increase in the proportion of patients with severe haemophilia A on prophylaxis from 37 to 74% between 2013 and 2021, the ABR for all patients with severe haemophilia A decreased approximately 6.9-fold, and the AJBR decreased 8.7-fold. Expectedly, the factor consumption increased by approximately 68.5%. In the group of patients with severe haemophilia A who had switched from an on-demand to a prophylactic regimen, the total number of bleeding events decreased 3.5-fold, and the number of joint bleeding episodes decreased 3.9-fold. Factor VIII consumption increased by 78.4%. Our study supports a previously reported positive effect of prophylaxis on bleeding control. We believe that the substantial improvement in ABR justifies the increased treatment costs.
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Affiliation(s)
- Gabriela Romanová
- Department of Internal Medicine, Haematology and, Oncology University Hospital Brno, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Petr Smejkal
- Department of Clinical, Haematology University Hospital Brno, Brno, Czech Republic
- Department of Laboratory Methods Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Ovesná
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Eva Drbohlavová
- Department of Clinical Haematology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Petr Dulíček
- IVth Department of Internal Medicine-Haematology, University Hospital in Hradec Králové, Medical Faculty in Hradec Kralove, Hradec Králové, Czech Republic
- Charles University in Prague, Prague, Czech Republic
| | - Zdeňka Hajšmanová
- Department of Haematology, Institute of Clinical Biochemistry and, Haematology University Hospital Pilsen, Pilsen, Czech Republic
| | - Antonín Hluší
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Radka Hrdličková
- Blood Centre University Hospital Ostrava, Ostrava, Czech Republic
| | - Jana Ullrychová
- Department of Clinical Haematology Krajska Zdravotní a.S., Masaryk Hospital Ústí Nad Labem, Ústí Nad Labem, Czech Republic
| | - Ivan Vonke
- Clinical Haematology Hospital České Budějovice, České Budějovice, Czech Republic
| | - Jan Blatný
- Department of Paediatric Haematology and Biochemistry, University Hospital Brno, Brno, Czech Republic
- Masaryk University, Brno, Czech Republic
| | - Zuzana Čermáková
- Blood Centre University Hospital Ostrava, Ostrava, Czech Republic
| | - Ester Zápotocká
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
- 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Miroslav Penka
- Department of Internal Medicine, Haematology and, Oncology University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Clinical, Haematology University Hospital Brno, Brno, Czech Republic
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Blatný J, Nielsen EM, Reitzel SB, McMillan AC, Danø A, Bystrická L, Kragh N, Klamroth R. Real-world evidence on efmoroctocog alfa in patients with haemophilia A: A systematic literature review of treatment experience in Europe. Haemophilia 2023. [PMID: 37243934 DOI: 10.1111/hae.14797] [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: 02/06/2023] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The real-world effectiveness of the efmoroctocog alfa (recombinant FVIII Fc fusion protein, a rFVIIIFc) has been investigated in numerous studies, however, currently, there exists no comprehensive collection of the existing real-world evidence (RWE) on the performance of prophylactic use of rFVIIIFc. AIM The aims of this systematic literature study were to identify, review, evaluate and collate the RWE of prophylactic rFVIIIFc for patients with haemophilia A reported in Europe. METHODS We searched Medline and Embase from 2014 to February 2022 to identify publications reporting the effectiveness of rFVIIIFc in patients with haemophilia A. The outcomes of interest were annualised bleeding rates (ABR, AjBR, AsBR), injection frequency, factor consumption, adherence, development of inhibitors and quality-of-life measures. RESULTS 46 eligible publications (eight full-text articles) were included. rFVIIIFc showed a low ABR in patients with haemophilia A. Studies assessing treatment switching from a standard half-life (SHL) treatment to rFVIIIFc found that the ABR and consumption were reduced in most patients. Studies assessing rFVIIIFc effectiveness reported a median ABR between 0.0 and 2.0 with median injections per week ranging between 1.8 and 2.4 and median doses between 60 and 105 IU/kg/week. Of the studies assessing inhibitor development, only one study reported an incidence of a low titre inhibitor, and no patients developed clinically significant inhibitors. CONCLUSION rFVIIIFc prophylaxis treatment results in a low ABR across studies in patients with haemophilia A in a European real-world setting, which correlates with findings from clinical trials assessing the efficacy of rFVIIIFc in patients with haemophilia A.
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Affiliation(s)
- Jan Blatný
- Department of Paediatric Haematology and Biochemistry, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | | | | | | | - Anne Danø
- EY Godkendt Revisionspartnerselskab, Frederiksberg, Denmark
| | | | - Nana Kragh
- Swedish Orphan Biovitrum AB, Stockholm, Sweden
| | - Robert Klamroth
- Department for Internal Medicine, Vivantes Hospital Friedrichshain, Haemophilia treatment centre, Berlin, Germany
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
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Astermark J, Blatný J, Königs C, Hermans C, Jiménez-Yuste V, Hart DP. Considerations for shared decision management in previously untreated patients with hemophilia A or B. Ther Adv Hematol 2023; 14:20406207231165857. [PMID: 37113810 PMCID: PMC10126613 DOI: 10.1177/20406207231165857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/04/2023] [Indexed: 04/29/2023] Open
Abstract
Recent advances in therapeutics are now providing a wide range of options for adults and children living with hemophilia. Although therapeutic choices are also increasing for the youngest individuals with severe disease, challenges remain about early management decisions, as supporting data are currently limited. Parents and healthcare professionals are tasked with helping children achieve an inclusive quality of life and maintain good joint health into adulthood. Primary prophylaxis is the gold standard to optimize outcomes and is recommended to start before 2 years of age. A range of topics need to be discussed with parents to aid their understanding of the decisions they can make and how these will affect the management of their child/children. For those with a family history of hemophilia, prenatal considerations include the possibility of genetic counseling, prenatal investigations, and planning for delivery, together with monitoring of the mother and neonate, as well as diagnosis of the newborn and treatment of any birth-associated bleeding. Subsequent considerations, which are also applicable to families where infant bleeding has resulted in a new diagnosis of sporadic hemophilia, involve explaining bleed recognition and treatment options, practical aspects of initiating/continuing prophylaxis, dealing with bleeds, and ongoing aspects of treatment, including possible inhibitor development. Over time, optimizing treatment efficacy, in which individualizing therapy around activities can play a role, and long-term considerations, including retaining joint health and tolerance maintenance, become increasingly important. The evolving treatment landscape is creating a need for continually updated guidance. Multidisciplinary teams and peers from patient organizations can help provide relevant information. Easily accessible, multidisciplinary comprehensive care remains a foundation to care. Equipping parents early with the knowledge to facilitate truly informed decision-making will help achieve the best possible longer-term health equity and quality of life for the child and family living with hemophilia. Plain language summary Points to be taken into account to help families make decisions to best care for children born with hemophilia Medical advances are providing a range of treatment options for adults and children with hemophilia. There is, however, relatively limited information about managing newborns with the condition. Doctors and nurses can help parents to understand the choices for infants born with hemophilia. We describe the various points doctors and nurses should ideally discuss with families to enable informed decision-making. We focus on infants who require early treatment to prevent spontaneous or traumatic bleeding (prophylaxis), which is recommended to start before 2 years of age. Families with a history of hemophilia may benefit from discussions before pregnancy, including how an affected child would be treated to protect against bleeds. When mothers are pregnant, doctors can explain investigations that can provide information about their unborn child, plan for the birth, and monitor mother and baby to minimize bleed risks at delivery. Testing will confirm whether the baby is affected by hemophilia. Not all infants with hemophilia will be born to families with a history of the condition. Identification of hemophilia for the first time in a family (which is 'sporadic hemophilia') occurs in previously undiagnosed infants who have bleeds requiring medical advice and possibly hospital treatment. Before any mothers and babies with hemophilia are discharged from hospital, doctors and nurses will explain to parents how to recognize bleeding and available treatment options can be discussed. Over time, ongoing discussions will help parents to make informed treatment decisions:• When and how to start, then continue, prophylaxis.• How to deal with bleeds (reinforcing previous discussions about bleed recognition and treatment) and other ongoing aspects of treatment. ○ For instance, children may develop neutralizing antibodies (inhibitors) to treatment they are receiving, requiring a change to the planned approach.• Ensuring treatment remains effective as their child grows, considering the varied needs and activities of their child.
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Affiliation(s)
| | - Jan Blatný
- Department of Pediatric Hematology, University
Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Christoph Königs
- Clinical and Molecular Hemostasis, Department
of Pediatrics, University Hospital Frankfurt, Goethe University, Frankfurt,
Germany
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Division of
Hematology, Cliniques Universitaires Saint-Luc, Université catholique de
Louvain (UCLouvain), Brussels, Belgium
| | - Victor Jiménez-Yuste
- Hematology Department, Hospital Universitario
La Paz, Autónoma University, Madrid, Spain
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Komenda M, Černý V, Šnajdárek P, Karolyi M, Hejný M, Panoška P, Jarkovský J, Gregor J, Bulhart V, Šnajdrová L, Májek O, Vymazal T, Blatný J, Dušek L. Control Centre for Intensive Care as a Tool for Effective Coordination, Real-Time Monitoring, and Strategic Planning During the COVID-19 Pandemic. J Med Internet Res 2022; 24:e33149. [PMID: 34995207 PMCID: PMC8852654 DOI: 10.2196/33149] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 01/28/2023] Open
Abstract
In the Czech Republic, the strategic data-based and organizational support for individual regions and for providers of acute care at the nationwide level is coordinated by the Ministry of Health. At the beginning of the COVID-19 pandemic, the country needed to very quickly implement a system for the monitoring, reporting, and overall management of hospital capacities. The aim of this viewpoint is to describe the purpose and basic functions of a web-based application named "Control Centre for Intensive Care," which was developed and made available to meet the needs of systematic online technical support for the management of intensive inpatient care across the Czech Republic during the first wave of the pandemic in spring 2020. Two tools of key importance are described in the context of national methodology: one module for regular online updates and overall monitoring of currently free capacities of intensive care in real time, and a second module for online entering and overall record-keeping of requirements on medications for COVID-19 patients. A total of 134 intensive care providers and 927 users from hospitals across all 14 regions of the Czech Republic were registered in the central Control Centre for Intensive Care database as of March 31, 2021. This web-based application enabled continuous monitoring and decision-making during the mass surge of critical care from autumn 2020 to spring 2021. The Control Center for Intensive Care has become an indispensable part of a set of online tools that are employed on a regular basis for crisis management at the time of the COVID-19 pandemic.
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Affiliation(s)
- Martin Komenda
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.,Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimír Černý
- Ministry of Health of the Czech Republic, Prague, Czech Republic.,Clinic of Anaesthesiology, Perioperative and Intensive Medicine, Masaryk Hospital in Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Petr Šnajdárek
- General Staff, Czech Armed Forces, Prague, Czech Republic
| | - Matěj Karolyi
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Miloš Hejný
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Petr Panoška
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jakub Gregor
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Vojtěch Bulhart
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Lenka Šnajdrová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Ondřej Májek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Tomáš Vymazal
- Clinic of Anaesthesiology, Resuscitation and Intensive Medicine, University Hospital in Motol, Second Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Jan Blatný
- Ministry of Health of the Czech Republic, Prague, Czech Republic.,Department of Paediatric Haematology and Biochemistry, University Hospital Brno, Brno, Czech Republic
| | - Ladislav Dušek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
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7
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Mancuso ME, Male C, Kenet G, Kavakli K, Königs C, Blatný J, Fijnvandraat K. Prophylaxis in children with haemophilia in an evolving treatment landscape. Haemophilia 2021; 27:889-896. [PMID: 34547160 DOI: 10.1111/hae.14412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION For children with haemophilia, early initiation of prophylaxis is crucial to prevent life-threatening bleeds and maintain joint health throughout life. Options for prophylaxis have recently increased from replacement therapy with standard or extended half-life coagulation factor products to include other haemostasis products, such as the non-replacement therapy emicizumab. AIM To review key factors that determine the choice of prophylaxis in young children. METHODS Key clinical questions on the implementation of prophylaxis for haemophilia in children were identified and PubMed was searched for evidence supporting guidance on the implementation of prophylaxis. RESULTS The results of the literature search and the practical experience of the authors were used to build consensus on when to start prophylaxis, the pros and cons of the products available to guide the choice of product, and practical aspects of starting prophylaxis to guide the choice of regimen. CONCLUSIONS In this era of increasing therapeutic choices, available information about the range of treatment options must be considered when initiating prophylaxis in young children. Parents or care givers must be sufficiently informed to allow informed shared decision making. Although plentiful data and clinical experience have been gathered on prophylaxis with clotting factor replacement therapy, its use in young children brings practical challenges, such as the need for intravenous administration. In contrast, our relatively brief experience and limited data with subcutaneously administered non-replacement therapy (i.e., emicizumab) in this patient group imply that starting emicizumab prophylaxis in young children requires careful consideration, despite the more convenient route of administration.
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Affiliation(s)
- Maria Elisa Mancuso
- Centre for Thrombosis and Haemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Christoph Male
- Thrombosis & Haemostasis Unit, Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Gili Kenet
- The National Haemophilia Centre, The Amalia Biron Thrombosis Research Institute, Sheba Medical Centre, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Kaan Kavakli
- Department of Haematology, Ege University Faculty of Medicine, Children's Hospital, Bornova, Izmir, Turkey
| | - Christoph Königs
- Department of Paediatrics and Adolescent Medicine, Clinical and Molecular Haemostasis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jan Blatný
- Department of Paediatric Haematology and Biochemistry, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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8
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Blatný J, Kardos M, Miljic P, Bilić E, Benedik-Dolničar M, Faganel-Kotnik B, Konstantinov D, Kovalova Z, Ovesná P. Incidence of inhibitor development in PUPs with severe Haemophilia A in the CEE region between 2005 and 2015. Thromb Res 2020; 198:196-203. [PMID: 33360154 DOI: 10.1016/j.thromres.2020.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study analyses real-world data on 144 previously untreated patients (PUPs) with severe Haemophilia A, from seven countries in Central and Eastern Europe (CEE: Bulgaria, Croatia, Czech Republic, Hungary, Latvia, Serbia, and Slovenia), over a period of 11 years. It analyses the risk factors associated with development of inhibitors to factor VIII concentrates. METHODS Cox proportional hazard models were used to estimate the hazard risk of factors possibly influencing the development of inhibitors. Patients were followed for up to 100 exposure days (EDs). RESULTS Cumulative inhibitor incidence at the time of 100 EDs was 18.7%, slightly lower than the 25-35% incidence reported in most studies. Of PUPs who developed inhibitors, a majority (56%) developed them within the first 20 EDs and 88% by the 50th ED. FVIII class (recombinant or plasma-derived) did not influence the inhibitors' incidence rate (p = 0.64). We found a significant protective effect of prophylaxis compared to on-demand treatment (p = 0.003). PUPs who had an intensive peak treatment during the first 50 EDs were at significantly higher risk for inhibitor development (HR (95% CI) 5.3 (2.3-12.5), p < 0.001). CONCLUSION Inhibitors are and will continue to be the most significant complication of haemophilia treatment with factor concentrates. This is particularly true for haemophilia A. In our cohort, we were able to show that the treatment regimen used during first 50EDs influenced significantly the inhibitor risk, but the class of the factor concentrate did not play an important role. Real world data will remain one of the important resources for improving our knowledge of haemophilia.
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Affiliation(s)
- Jan Blatný
- Department of Paediatric Haematology, University Hospital and Masaryk University Brno, Czech Republic.
| | - Mária Kardos
- Department of Paediatrics, Mohács Hospital, Mohács, Hungary
| | - Predrag Miljic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ernest Bilić
- Department of Pediatrics, University Hospital Centre Zagreb, School of Medicine, Zagreb, Croatia
| | - Majda Benedik-Dolničar
- Unit for Haematology and Oncology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Barbara Faganel-Kotnik
- Unit for Haematology and Oncology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dobrin Konstantinov
- Pediatric Hematology & Oncology Department, University Hospital "Tsaritsa Johanna-ISUL", Sofia, Bulgaria
| | - Zhanna Kovalova
- Department of Hematology and Oncology, Children's Clinical University Hospital, Riga, Latvia
| | - Petra Ovesná
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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9
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Hermans C, Giangrande PLF, O'Mahony B, de Kleijn P, Bedford M, Batorova A, Blatný J, Jansone K. European principles of inhibitor management in patients with haemophilia: implications of new treatment options. Orphanet J Rare Dis 2020; 15:219. [PMID: 32831110 PMCID: PMC7444030 DOI: 10.1186/s13023-020-01511-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/10/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- C Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium.
| | - P L F Giangrande
- European Haemophilia Consortium, Brussels, Belgium.,University of Oxford, Oxford, UK
| | - B O'Mahony
- European Haemophilia Consortium, Brussels, Belgium.,Trinity College, Dublin, Ireland
| | - P de Kleijn
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M Bedford
- Canterbury Christ Church University, Kent, UK
| | - A Batorova
- National Hemophilia Center, Dept. of Hematology and Transfusion Medicine, School of Medicine of Comenius University and University Hospital, Bratislava, Slovakia
| | - J Blatný
- Children's University Hospital and Masaryk University, Brno, Czech Republic
| | - K Jansone
- European Haemophilia Consortium, Brussels, Belgium
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10
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Ratajová K, Blatný J, Poláčková Šolcová I, Meier Z, Horňáková T, Brnka R, Tavel P. Social support and resilience in persons with severe haemophilia: An interpretative phenomenological analysis. Haemophilia 2020; 26:e74-e80. [PMID: 32291937 PMCID: PMC7383587 DOI: 10.1111/hae.13999] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/25/2020] [Indexed: 12/21/2022]
Abstract
Introduction Haemophilia is a hereditary haemorrhagic disorder characterized by deficiency or dysfunction of coagulation factors. Recurrent joint and muscle bleeds lead to progressive musculoskeletal damage. Haemophilia affects patients physically but also socially and psychologically. Traumatic experiences, chronic stress and illnesses can lead to mental disorders, but many persons with haemophilia maintain a highly positive outlook. Aim To explore qualitatively which coping mechanisms persons with haemophilia use and in what way they help them to live with their diagnosis. Methods We recruited five adults with haemophilia and conducted semi‐structured face‐to‐face interviews. Transcripts were analysed using interpretative phenomenological analysis (IPA). Results Two core themes emerged from the analysis: social support as an external factor and resilience as an internal factor of coping with the disease. Persons with haemophilia usually need help with health‐related complications, and this affects the social support they require. Their wider support network tends to involve family and friends but also healthcare professionals and other specialists. This network provides practical help but also functions as an important psychological protective factor. An unexpected finding was that persons with haemophilia want not only to receive support but are also keen to offer support to others. Conclusion These findings can help identify persons who provide most support to people suffering from haemophilia. Haemophilic centres should include in their teams psychologists and social workers and offer individual and group therapy to their clients, group meetings for friends and families of persons with haemophilia, provide learning resources to teachers aiming to incorporate children with haemophilia in their peer group, and organize Balint groups for physicians, psychologists and other healthcare professionals.
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Affiliation(s)
- Kateřina Ratajová
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jan Blatný
- Department of Paediatric Haematology, Haemophilia Comprehensive Care Centre, Children's University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Iva Poláčková Šolcová
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic.,Institute of Psychology, Czech Academy of Sciences, Praha, Czech Republic
| | - Zdeněk Meier
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Tekla Horňáková
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Robert Brnka
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic.,First Department of Internal Medicine, Faculty of Medicine Comenius University Bratislava, Bratislava, Slovak Republic
| | - Peter Tavel
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
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11
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Vangenechten I, Smejkal P, Zapletal O, Michiels JJ, Berneman Z, Zavrelova J, Blatný J, Penka M, Gadisseur A. Analysis of von Willebrand Disease in the South Moravian Population (Czech Republic): Results from the BRNO-VWD Study. Thromb Haemost 2019; 119:594-605. [PMID: 30722078 DOI: 10.1055/s-0039-1678528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND von Willebrand disease (VWD) is an inherited bleeding disorder caused by a quantitative (type 1 and 3) or qualitative (type 2) defect of von Willebrand factor (VWF). The heterogeneity of laboratory phenotyping makes diagnosing difficult. OBJECTIVE A cross-sectional, family-based VWD study in a collaboration between University Hospital Brno (Czech Republic) and Antwerp University Hospital (Belgium) to improve the understanding of laboratory phenotype/genotype correlation. PATIENTS AND METHODS A total of 205 patients with suspected VWD were identified from historical records. Complete laboratory analysis was established using all available VWD assays including VWF multimers and genetic analysis. RESULTS Based on the current International Society of Thrombosis and Haemostasis (ISTH) - Scientific and Standardization Committee VWD classification and type 2A sub-division into 2A/IIA, IID, IIC and IIE, the majority was characterized as a type 1 VWD, followed by type 2. Proposed laboratory phenotypes were confirmed by their multimeric pattern within 98% of this cohort. All type 2, 3 and 75% of type 1 VWD patients were confirmed by underlying causative mutations. Forty-six different causal mutations (117 not previously described in the literature) could be identified. Fifty per cent of all cases was represented by eight individual mutations, mainly p.Pro812ArgfsX31. Thirteen patients had a large heterozygous gene alteration. CONCLUSION Although an extensive panel of tests was used, VWD classification and (sub)typing remains difficult and fluid. This study provides a cross-sectional overview of the VWD population in the Czech Republic and provides important data to the ISTH/European Association for Haemophilia and Allied Disorders VWD mutation database in linking causal mutations with unique VWD (sub)types. It also identifies new, as not previously described in the literature, causal mutations.
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Affiliation(s)
- Inge Vangenechten
- Haemostasis Unit, Antwerp University Hospital, Edegem, Belgium.,Haemostasis Research Unit, University of Antwerp, Antwerp, Belgium.,CSL Behring Chair in von Willebrand Disease, University of Antwerp, Antwerp, Belgium
| | - Petr Smejkal
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic.,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondrej Zapletal
- Department of Pediatric Haematology, University Hospital Brno, Brno, Czech Republic
| | - Jan Jacques Michiels
- Blood Coagulation and Vascular Medicine Center, Goodheart Institute and Foundation in Nature Medicine, Rotterdam, The Netherlands
| | - Zwi Berneman
- CSL Behring Chair in von Willebrand Disease, University of Antwerp, Antwerp, Belgium.,Department of Haematology, Antwerp University Hospital, Edegem, Belgium
| | - Jiri Zavrelova
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic.,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Blatný
- Department of Pediatric Haematology, University Hospital Brno, Brno, Czech Republic
| | - Miroslav Penka
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic.,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alain Gadisseur
- Haemostasis Unit, Antwerp University Hospital, Edegem, Belgium.,Haemostasis Research Unit, University of Antwerp, Antwerp, Belgium.,CSL Behring Chair in von Willebrand Disease, University of Antwerp, Antwerp, Belgium.,Department of Haematology, Antwerp University Hospital, Edegem, Belgium
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12
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Giangrande PLF, Hermans C, O'Mahony B, de Kleijn P, Bedford M, Batorova A, Blatný J, Jansone K. European principles of inhibitor management in patients with haemophilia. Orphanet J Rare Dis 2018; 13:66. [PMID: 29703220 PMCID: PMC5921290 DOI: 10.1186/s13023-018-0800-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/06/2018] [Indexed: 12/11/2022] Open
Abstract
Background In spite of recent major advances in the understanding and treatment of inhibitor development in patients with haemophilia, multidisciplinary management of many of these patients remains suboptimal and highly heterogenous across Europe. Methods Following a series of multidisciplinary meetings and a review of the literature, the European haemophilia community of health professionals and patients jointly defined practical optimum standards for ensuring and harmonizing treatment and care for patients with an inhibitor. Results Ten complementary principles for the management of inhibitors in haemophilia have been developed, emphasizing the importance and benefits of a centralized, multidisciplinary, expert and holistic approach. Conclusions This document will serve as a benchmark to improve the multidisciplinary and practical management of patients with inhibitor. Implementation and adherence to each of these principles should have a major positive impact on the management and outcomes of patients developing an inhibitor.
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Affiliation(s)
- P L F Giangrande
- European Haemophilia Consortium, Rue de l'Industrie, B-1000, Brussels, Belgium. .,University of Oxford, Oxford, UK.
| | - C Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - B O'Mahony
- European Haemophilia Consortium, Rue de l'Industrie, B-1000, Brussels, Belgium.,Trinity College, Dublin, Ireland
| | - P de Kleijn
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Bedford
- Canterbury Christ Church University, Kent, UK
| | - A Batorova
- National Hemophilia Center, Department of Hematology and Transfusion Medicine, School of Medicine of Comenius University and University Hospital, Bratislava, Slovakia
| | - J Blatný
- Children's University Hospital Brno, Brno, Czech Republic
| | - K Jansone
- European Haemophilia Consortium, Rue de l'Industrie, B-1000, Brussels, Belgium
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13
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Astermark J, Hart D, Lobet S, Blatný J, d'Oiron R, Kenet G, Dolan G, Libotte V, Hermans C. Partnering to change the world for people with haemophilia: 6(th) Haemophilia Global Summit, Prague, Czech Republic, 24-26(th) September 2015. Eur J Haematol 2017; 97 Suppl 84:3-23. [PMID: 27292051 DOI: 10.1111/ejh.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The 6(th) Haemophilia Global Summit was held in Prague, Czech Republic, in September 2015. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and aimed to share optimal management strategies for haemophilia at all life stages, explore recent potential advances in the management of haemophilia A and B and discuss challenges in haemophilia care. In this supplement from the meeting, Dan Hart reviews the lessons that can be learnt from cost-constrained environments with regard to improving care for people with haemophilia globally. Sébastien Lobet discusses the importance of physical activity for optimising care and Roseline d'Oiron and Jan Blatný consider the role of real-world data in understanding the effect of treatment in a clinical setting over the long term and the true impact of treatment on the day-to-day life of the patient. Gili Kenet addresses the current challenges relating to the optimal management of prophylaxis, and Gerry Dolan and Cedric Hermans discuss the value of pharmacokinetic (PK) parameters in informing treatment decisions. Cedric Hermans and Valérie Libotte explore the importance of considering social and occupational development factors as an integral part of haemophilia care, and Jan Astermark reviews key strategies to predict and prevent inhibitor development.
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Affiliation(s)
- Jan Astermark
- Department of Hematology and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Dan Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit, Division of Haematology, Haemophilia Clinic, Saint-Luc University Hospital, Brussels, Belgium
| | - Jan Blatný
- Children's University Hospital Brno, Brno, Czech Republic
| | - Roseline d'Oiron
- Hôpital Bicêtre AP-HP, Paris XI University, Le Kremlin-Bicêtre, France
| | - Gili Kenet
- National Hemophilia Center, Sheba Medical Center, Tel HaShomer, Israel
| | | | - Valérie Libotte
- Service externe de prévention et de protection au travail - CESI - 1200 Brussels, Belgium
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14
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Berntorp E, Dargaud Y, Hart D, Lobet S, Mancuso ME, d'Oiron R, Perry D, Pollard D, van den Berg M, Blatný J, Chambost H, Doria AS, Holme PA, Kaczmarek R, Mantovani L, McLaughlin P, Nanayakkara L, Petrini P, Sannié T, Laane E, Maia R, Dettoraki A, Farrell A, Halimeh S, Raza S, Taylor S. The second Team Haemophilia Education Meeting, 2016, Frankfurt, Germany. Eur J Haematol 2017; 98 Suppl 85:1-15. [DOI: 10.1111/ejh.12828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Erik Berntorp
- Skåne University Hospital; Lund University; Malmö Sweden
| | - Yesim Dargaud
- Clinical Haemostasis Unit; Lyon Hospital; University of Lyon; Lyon France
| | - Daniel Hart
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Sébastien Lobet
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - Maria Elisa Mancuso
- Fondazione IRCCS Ca’ Granda; Ospedale Maggiore Policlinico; Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; Milan Italy
| | - Roseline d'Oiron
- Centre for Haemophilia and Rare Congenital Bleeding Disorders; University Hospitals Paris-Sud; AP-HP Bicêtre Hospital; Le Kremlin-Bicêtre France
| | - David Perry
- Addenbrooke's Hospital; University of Cambridge; Cambridge UK
| | - Debra Pollard
- Katharine Dormandy Haemophilia & Thrombosis Centre; Royal Free Hospital; London UK
| | - Marijke van den Berg
- Department of Health and Epidemiology; University of Utrecht; Utrecht The Netherlands
| | - Jan Blatný
- Department of Paediatric Haematology; Children's University Hospital and Masaryk University; Brno Czech Republic
| | - Hervé Chambost
- Department of Paediatrics; La Timone Children Hospital; APHM and Aix-Marseille University; Marseille France
| | - Andrea S. Doria
- Department of Diagnostic Imaging; The Hospital for Sick Children; Toronto ON Canada
- Department of Medical Imaging; University of Toronto; Toronto ON Canada
| | - Pål André Holme
- Department of Haematology and Institute of Clinical Medicine; Oslo University and Oslo University Hospital; Rikshospitalet Norway
| | - Radoslaw Kaczmarek
- Hirszfeld Institute of Immunology and Experimental Therapy; Wroclaw Poland
| | - Lorenzo Mantovani
- Public Health; CESP-Center of Public Health Research; University of Milano-Bicocca; Milan Italy
| | - Paul McLaughlin
- Department of Physiotherapy; Katharine Dormandy Haemophilia Centre; Royal Free Hospital; London UK
| | | | - Pia Petrini
- Department of Paediatrics; Karolinska University Hospital; Stockholm Sweden
| | - Thomas Sannié
- Association Française des Hémophilies (AFH); Paris France
| | | | - Raquel Maia
- Paediatric Haematology Unit; Dona Estefânia Hospital; Lisbon Portugal
| | - Athina Dettoraki
- Haemophilia Centre and Haemostasis Unit; ‘Aghia Sophia’ Children's Hospital; Athens Greece
| | | | - Susan Halimeh
- Gerinnungszentrum Rhein-Ruhr (GZRR); Duisburg Germany
| | - Sayma Raza
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Stephanie Taylor
- Oxford Haemophilia and Thrombosis Centre; Oxford University Hospitals Foundation Trust; Oxford UK
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15
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Stikarová J, Blatný J, Kotlín R, Suttnar J, Zapletal O, Pimková K, Májek P, Hrachovinová I, Dyr JE. Novel homozygous fibrinogen Aα chain truncation causes severe afibrinogenemia with life threatening complications in a two-year-old boy. Thromb Res 2013; 132:490-2. [PMID: 24050829 DOI: 10.1016/j.thromres.2013.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/14/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jana Stikarová
- Institute of Hematology and Blood Transfusion, Prague 2, Czech Republic
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16
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Seidlová D, Blatný J. [Peripartal life-threating haemorrhage - intensive care and haematological treatment]. Ceska Gynekol 2013; 78:379-384. [PMID: 24040988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Peripartal life-threating bleeding is serious and frequent complication comming during the labor. Diagnosis is based on assesment of blood loss and the reason of bleeding. Obstetrical and surgical treatment including invasive radiological methods combining with resuscitation care based on support organ functions and energic susbstitution coagulation components is essential. The aim is to rescue the life of women and to preserv her reproductive ability.
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17
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Kvasnička J, Balík M, Binder T, Blatný J, Bláha J, Cvachovec K, Cerný V, Dulíček P, Feyereisl J, Hájek Z, Janků P, Malý J, Měchurová A, Pařízek A, Penka M, Procházka M, Roztočil A, Reháček V, Seidlová D, Sevčík P, Valenta J, Ventruba P. [Peripartal life-threatening hemorrhage - interdisciplinary consensus opinion]. Vnitr Lek 2012; 58:661-664. [PMID: 23094811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
22 experts from the fields of gynecology and obstetrics, anesthesiology and resuscitation, intensive care, hematology and transfusion medicine has developed recommendations for diagnosis and procedure for life-threatening peripartum haemorrhage, which is still one of the most common causes of maternal mortality in childbirth. This guidelines, which is valid for the Czech Republic, supported by a total of 10 professional medical societies. There are based on new knowledge applicable at this time and is focused mainly on eliminating the most common causes of bleeding during delivery and prevention of haemorrhagic shock.
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Affiliation(s)
- J Kvasnička
- Tromboticke centrum a Centralni hematologicke laboratore.
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18
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Seidlová D, Blatný J, Penka M, Ovesná P, Brabec P, Sevcík P, Ventruba P, Cerný V. [Recombinant activated factor VII in the treatment of life threatening post-partum haemorrhage; registry UniSeven in the Czech Republic]. Ceska Gynekol 2010; 75:297-305. [PMID: 20925226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To analyze the data related to the treatment of 80 Czech patients with life threatening postpartum haemorrhage recorded in the clinical registry UniSeven during years 2004-2009. DESIGN Retrospective, observational, multicentre study. SETTINGS ICU and Obstetrics departments of University and Regional hospitals in Czech Republic. MATERIAL AND METHODS UniSeven is an international academic project of Masaryk University in Brno, Czech Republic, focused on recording of clinical data related to "off-label" use of rFVIIa (Novo Seven) in life threatening bleeding. Data of 80 case reports of post partum haemorrhage from the registry was analysed from the clinical (efficacy and safety) as well as laboratory aspects. RESULTS In 97.5% of our patients the treatment with rFVIIa was able to control the bleeding. In 53 women (66.3%) only one dose of rFVIIa was sufficient to control the bleeding. The rest of the patient received two or more rFVIIa doses. First dose of rFVIIa given to patients who needed more than one dose was significantly lower (96.6 microg/kg) compared to patient succesfully treated with one dose only (110.6 microg/kg; p = 0.048). The mortality rate in our cohort of patients was 2.5%. We have not recorded any thrombembolic event as and adverse event related to the rFVIIa treatment. In 74.3% of patients where rFVIIa was administered before considering the hysterectomy, it was able to avoid hysterectomy what we consider to be a significant improvement of the patients' quality of life. CONCLUSIONS Our data were also considered during the work up of national guidelines for the treatment of life threatening post-partum haemorrhage in the Czech Republic.
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Affiliation(s)
- Dagmar Seidlová
- Klinika anesteziologie, resuscitace a intenzivní medicíny a Anesteziologicko-resuscitacní oddĕlení FN, LF MU Brno.
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19
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Blatný J, Fiamoli V. Treatment of deep vein thrombosis with continuous intravenous infusion of LMWH in children--an alternative to subcutaneous application when needed. Vnitr Lek 2009; 55:227-232. [PMID: 19378852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Incidence of thrombosis is age dependent with the lowest risk in the childhood. Children mostly suffer from vein thrombosis. Incidence of thrombosis in children is only 0.07/10,000, but it increases among hospitalized children (3.5/10,000). Subcutaneous administration of low molecular weight heparin (LMWH) is preferred treatment of deep vein thrombosis in children. In this study we present group of 33 children with deep vein thrombosis, who were treated with LMWH for their first thrombosis from 2003 till 2006. Twenty-one (63.6%) patients were treated with LMWH by continuous infusion and 12 (36.3%) patients by subcutaneous injection. Duration of the treatment with LMWH was modified in accordance with the course of thrombosis (monitored by Doppler ultrasound with compression) with median of 15 days in patients treated by continuous infusion and 18.5 days when treated subcutaneously. Median dose of LMWH for intravenous and subcutaneous application was 240 IU/kg/24 h and 215 IU/kg/24 h respectively. The administered dose of LMWH was modified to achieve and maintain required therapeutic antiXa level within the range of 0.5-1 IU/ml. The treatment with continuous infusion led to total recanalisation of the occluded vein in 3 cases (14.3%), partial recanalisation was achieved in 15 (71.4%) patients. Three (14.3%) patients were without any recanalisation. The treatment by subcutaneous injection led to total recanalisation of the vein in 4 cases (33.3%), partial recanalisation was seen in 4 (33.3%) patients. Four (33.3%) patients were without any recanalisation. The difference in the outcomes of the therapy between both groups appears to be statistically significant (p = 0.041, nonparametric Mann-Whitney test). We have not noticed any severe adverse event of the treatment in any of our patients. Our results support the hypothesis that the treatment of DVT with continuous infusion of LMWH might be efficient and safe alternative to subcutaneous application in those children in whom we want to avoid subcutaneous administration from certain reasons.
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Affiliation(s)
- J Blatný
- Department of Clinical Haematology, Children's University Hospital Brno.
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Skoloudík D, Fadrná T, Bar M, Zapletalová O, Zapletal O, Blatný J, Penka M, Langová K, Hlustík P, Herzig R, Kanovský P. Changes in haemocoagulation in healthy volunteers after a 1-hour thrombotripsy using a diagnostic 2–4 MHz transcranial probe. J Thromb Thrombolysis 2007; 26:119-24. [PMID: 17665138 DOI: 10.1007/s11239-007-0079-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 07/12/2007] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim was to monitor the changes in haemocoagulation parameters in healthy volunteers after a thrombotripsy with 1-hour transcranial Doppler monitoring using a 2-4 MHz probe. MATERIALS AND METHODS About 10 healthy volunteers underwent a 1-hour thrombotripsy of the middle cerebral artery (MCA), thrombotripsy of the radial artery and a standard 20-min neurosonologic examination (NSE) in 2-week intervals. Platelet count, aPTT, prothrombin time, fibrinogen, D-dimers, tPA, FDP, alpha-2-antiplasmin (AP), plasminogen, PAI-1 antigen, time of euglobulin clot lysis (ECL), homocysteine, and lipoprotein (a) were examined before, at the end and 24 h after a thrombotripsy. All adverse events were monitored. RESULTS After a thrombotripsy of the MCA, PAI-1 antigen, tPA antigen, fibrinogen and AP activity were significantly decreased by a mean of 32, 23, 7, and 4% respectively (P < 0.05 in all cases). After a thrombotripsy of the RA, there was a significant decrease in tPA antigen alone by an average of 14% (P < 0.05). Standard NSE did not affect any of the measured factors. CONCLUSIONS Thrombotripsy with 1-hour TCD monitoring using a 2-4 MHz diagnostic probe may affect the fibrinolytic system in humans.
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Affiliation(s)
- David Skoloudík
- Department of Neurology, University Hospital, Ostrava, Czech Republic.
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21
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Kotlín R, Chytilová M, Suttnar J, Riedel T, Salaj P, Blatný J, Santrůcek J, Klener P, Dyr JE. Fibrinogen Nový Jičín and Praha II: Cases of hereditary Aα 16 Arg→Cys and Aα 16 Arg→His dysfibrinogenemia. Thromb Res 2007; 121:75-84. [PMID: 17408725 DOI: 10.1016/j.thromres.2007.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Revised: 01/18/2007] [Accepted: 02/18/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Various dysfibrinogenemias have been described worldwide. This paper describes two new cases of dysfibrinogenemia identified in the Czech Republic. MATERIALS AND METHODS The proposita of fibrinogen Nový Jicín, a 12-year-old girl, presented with hemorrhagic complications, low Clauss fibrinogen level (0.3 g/l) and prolonged both thrombin (70.8 s) and reptilase (>180 s) time. Her mother and sister both presented with normal coagulation tests, normal fibrinogen level and reported no history of bleeding. The carriers of the fibrinogen Praha II were a 31-year-old man and his 11-year-old daughter. They both presented with low fibrinogen Clauss level (0.88 g/l) and prolonged thrombin and reptilase time. To identify the genetic mutation responsible for these dysfibrinogens, genomic DNA extracted from the blood was analyzed. The presence of the mutant chains in the circulation was determined by MALDI-TOF mass spectroscopy. Scanning electron micrographs of the patients' fibrin clots were obtained. RESULTS The kinetics of fibrinopeptide release and fibrin polymerization were impaired for both fibrinogen Nový Jicín and Praha II. DNA sequencing showed heterogeneous fibrinogen Aalpha R16C mutation in the fibrinogen Nový Jicín case and heterogeneous fibrinogen Aalpha R16H in the fibrinogen Praha II case. The mutant chains were found to be expressed to the circulation by MALDI-TOF mass spectroscopy. Scanning electron micrographs of the patient's fibrin clot were found to be abnormal. CONCLUSIONS The case of dysfibrinogenemia Aalpha R16C-fibrinogen Nový Jicín and the case of dysfibrinogenemia Aalpha R16H were found by routine coagulation testing and were genetically identified.
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Affiliation(s)
- Roman Kotlín
- Institute of Hematology and Blood Transfusion, U nemocnice 1, 128 20 Praha 2, Czech Republic.
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22
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Blatný J. [Prevention of venous thromboembolism in paediatry]. Vnitr Lek 2006; 52 Suppl 1:68-72. [PMID: 16637453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Data in Canadian registry for VTE in children show, that incidence of VTE in children is 0.07/10 000. The situation in adults--with incidence of VTE 37/10 000--is however completely different. Only 5% of VTE in children are idiopathic and less then 10% are related to hereditary prothrombotic risk factors only. In other words, more than 80% of VTE in children are somehow related to acquired prothrombotic risk factors. Despite of this, there have not been found any measures, that would be able to further decrease significantly this very low incidence of VTE in children. This is probably the reason, why to date there are no evidence based recommendations for primary prophylaxis of VTE in children and also there is no valid reason for non-selective screening for hereditary prothrombotic risk factors in population of children, who have not suffered VTE.
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Affiliation(s)
- J Blatný
- Oddĕlení klinické hematologie, Centrum pro trombózu a hemostázu, FN Brno.
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Gumulec J, Kessler P, Penka M, Klodová D, Králová S, Brejcha M, Wróbel M, Sumná E, Blatný J, Klaricová K, Riedlová P, Lasota Z. [Hemorrhagic complications during warfarin treatment]. Vnitr Lek 2006; 52 Suppl 1:79-91. [PMID: 16637455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Bleeding is probably the major complication of anticoagulant treatment with vitamin K antagonists represented nowadays mostly by warfarin in the Czech Republic. The main risk factors in hemorrhagic complications of warfarinisation are the intensity and instability of the anticoagulant treatment, individual patient characteristics, warfarin interactions with other drugs and the length of the anticoagulant therapy. Severe bleeding in warfarin patients is most effectively brought about by a fast and complete undoing of the anticoagulation effect of the drug employing the prothrombin complex concentrate and slow i.v. vitamin K1 infusion regardless of the reason for the anticoagulation. This approach can secure the minimalisation of the bleeding's negative consequences. A less severe bleeding or asymptomatic increase in the international normalized ratio can be treated effectively by skipping or decreasing of the warfarin dosage and/or oral administration of vitamin K1 (i.v. administration only in selected higher risk cases) that does result only in a partial consolidation of coagulopathy but of such type that the risk of thrombotic event requires. The article's goal is to contribute to the treatment standardization in patients with warfarin overdose and/or with hemorrhagic complications due to warfarin treatment and it is available at www.thrombosis.cz. The guidelines include a ready-reference chart whose objective is immediate and quick crash course in the clinical practice.
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Affiliation(s)
- J Gumulec
- Onkologické centrum J.G. Mendla, Nový Jicín.
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Laffan MA, Tait RC, Blatný J, Espersen K, Grabowska I, Loch-Bakoñska L, Pauzkowska A, Stasiak-Pikula E, Michalska G, Wendon J, Piotrowska K. Use of recombinant activated factor VII for bleeding in pancreatitis: a case series. Pancreas 2005; 30:279-84. [PMID: 15782108 DOI: 10.1097/01.mpa.0000158026.30925.b4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To describe the effects of recombinant activated factor VII (rFVIIa) in the treatment of bleeding in a series of patients with acute or chronic pancreatitis. METHODS Twelve patients (age, 2.5-65 years) with pancreatitis and bleeding were treated with 18.5 to 120 microg/kg of rFVIIa. Eight patients also had sepsis/infection and/or disseminated intravascular coagulation (DIC). The effects of rFVIIa on bleeding, coagulation status, and transfusion requirements were noted. RESULTS Bleeding stopped in 4 patients, was markedly reduced in 4 patients, was reduced in 3 patients, and was remained unchanged in 1 patient. For most patients with pre- and post-rFVIIa data, coagulation parameters improved and transfusion requirements reduced. No thrombotic adverse events occurred. Seven patients died for reasons considered to be unrelated to rFVIIa treatment. CONCLUSIONS This case series indicates that rFVIIa may be an effective hemostatic treatment of patients with pancreatitis suffering from massive bleeding. There were no thromboembolic events in any patient, including those with sepsis or DIC.
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Affiliation(s)
- Mike A Laffan
- Imperial College London, Hammersmith Hospital, London, United Kingdom.
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25
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Benes B, Spĕvácková V, Smíd J, Cejchanová M, Kaplanová E, Cerná M, Gajewská V, Blatný J. Determination of normal concentration levels of Cd, Pb, Hg, Cu, Zn and Se in urine of the population in the Czech Republic. Cent Eur J Public Health 2002; 10:3-5. [PMID: 12096681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Knowledge of normal levels of concentrations of trace elements (Cd, Pb, Hg, Cu, Zn, and Se) in the population serves, among others, in design of regulations concerning health protection, determination of exposition limits and prevention of diseases caused by deficiency of trace elements. Concentrations of the named elements in urine of the Czech population were determined by means of atomic absorption spectrometry. The urine has been collected during 1996-2000 from 1192 individuals (816 males and 376 females, average age 34.6 years) and 2008 children (1052 boys and 956 girls, average age 9.9 years). Mineralization in a microwave digestion system was used in sample preparation. The accuracy of results was checked by means of the Control Materials Seronorm 403,125 and BioRad 69,041. Values of concentrations of the trace elements in urine found for adult (medians) were 0.36 microgram Cd.g-1 creatinine, 10.6 micrograms Cu.g-1 creatinine, 0.68 microgram Hg.g-1 creatinine, 3.3 micrograms Pb.g-1 creatinine, 6.2 micrograms Se.g-1 creatinine, and 397 micrograms Zn.g-1 creatinine, respectively. Statistically significant differences between men and women have been found in the concentrations of Cu and Hg. In the juvenile population following concentrations have been found: 0.29 microgram Cd.g-1 creatinine, 16.1 micrograms Cu.g-1 creatinine, 0.32 microgram Hg.g-1 creatinine, 4.8 micrograms Pb.g-1 creatinine, 10.2 micrograms Se.g-1 creatinine and 460 micrograms Zn.g-1 creatinine. Statistically significant differences between boys and girls were found only in Cu and Hg concentrations. Concentrations of the studied elements correspond to the published values concerning population not exposed professionally.
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Affiliation(s)
- B Benes
- National Institute of Public Health, Prague, Srobárova 48, 100 42 Prague 10, Czech Republic.
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Procházka J, Blatný J, Skodová M, Fischerová E. [Congenital deficiency of Hageman factor (factor XII)]. Vnitr Lek 1979; 25:704-13. [PMID: 494507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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27
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Procházka J, Blatný J, Fischerová E, Smrcková H, Manáková D. [Current possibilities in the laboratory detection of hemophilia A carrier state]. Vnitr Lek 1978; 24:32-9. [PMID: 625894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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28
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Blatný J, Rozprínová L, Fiserová E, Frágner J. [Quantitative assay of fibrinogen and fibrin grafts. Simple radial immunodiffusion and electroimmunoassay (author's transl)]. Cas Lek Cesk 1976; 115:861-4. [PMID: 821614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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29
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Libuský D, Gazárek F, Hauftová D, Stehlíková J, Blatný J, Valach V. [Acute lipid degeneration of liver in gravidity (author's transl)]. Cesk Gynekol 1976; 41:247-9. [PMID: 949751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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30
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Blatný J, Procházka J, Bártová A, Fischerová E, Slepicka L, Skodová M. [Factor VIII-like antigen in haemophilia A and in Willebrand's disease (author's transl)]. Cas Lek Cesk 1975; 114:1174-6. [PMID: 1081010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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31
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Blatný J, Procházka J, Bártová A, Fischerová E, Slepicka L, Skodová M. [Quantitative determination of blood factor VIII - like antigen (author's transl)]. Cas Lek Cesk 1975; 114:526-8. [PMID: 1131845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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32
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Blatný J. [Complications in the thrombolytic treatment using streptokinase]. Vnitr Lek 1974; 20:521-7. [PMID: 4844786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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33
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Blatný J, Fischerová E. [Degradation products of fibrinogen during thrombolysis]. Vnitr Lek 1973; 19:1042-8. [PMID: 4201926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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34
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Blatný J, Urbánek K, Fischerová E. [Fibrinolytic activity in the blood of the paralyzed upper extremity]. Blut 1970; 21:87-90. [PMID: 4251404 DOI: 10.1007/bf01632660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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36
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Kojecký Z, Blatný J, Wiedermann M. [Vitamin B 12 58Co in diseases of the small intestine]. Cesk Gastroenterol Vyz 1967; 21:508-13. [PMID: 5593184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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37
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Dolének A, Blatný J. [Streptokinase in retinal vein thrombosis]. Cesk Oftalmol 1967; 23:347-52. [PMID: 6081868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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38
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Kojecký Z, Blatný J. [Changes in fibrinolysis in idiopathic hyperlipemia]. Vnitr Lek 1967; 13:720-5. [PMID: 6080399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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39
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Fischerová E, Blatný J. [Modification of the Pappenheim staining with Tween 80]. Cas Lek Cesk 1966; 105:899-900. [PMID: 4161903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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