scholarly journals Case report of a fatal rectal haemorrhage in a person with severe haemophilia A receiving emicizumab and high‐dose bypassing agents in the HAVEN 1 study

Haemophilia ◽  
2020 ◽  
Vol 26 (6) ◽  
Author(s):  
Liane Khoo ◽  
Stephen Matthews ◽  
Geoffrey Kershaw ◽  
Michael Pidcock ◽  
Alex Phipps ◽  
...  
Keyword(s):  
Case Report ◽  
High Dose ◽  
Haemophilia A ◽  
Severe Haemophilia ◽  
Rectal Haemorrhage ◽  
Bypassing Agents

Inhibitorentwicklung nach früher hoher Exposition und Hirnblutung

2010 ◽  
Vol 30 (S 01) ◽  
pp. S115-S118
Author(s):  
C. Moorthi ◽  
A. Bade ◽  
C. Niekrens ◽  
G. Auerswald ◽  
K. Haubold
Keyword(s):  
High Titer ◽  
Cerebral Haemorrhage ◽  
High Dose ◽  
Haemophilia A ◽  
Severe Haemophilia ◽  
Intron 22 Inversion ◽  
Neurosurgical Intervention

SummarySevere haemophilia A was diagnosed postpartum in a newborn. The mother was known as a conductor (intron 22 inversion) and an uncle had a persistently high titer inhibitor after failed ITI.Due to a cephalhaematoma, a high-dose pdFVIII substitution was given within the first days after birth. At the age of six month a severe cerebral haemorrhage occurred, making a high-dose pdFVIII substitution and neurosurgical intervention necessary. Several days later a porth-a-cath-system was implanted. The development of a high titer inhibitor occured six days later, an ITI was started according to the Bonn Protocol. Initially rFVIIa was given in addition to the pdFVIII substitution. Seven days after the beginning of treatment the inhibitor was no longer detectable. At monthly intervals the FVIII dosage was reduced until the dosage complied with a prophylaxis in severe haemophilia A.The duration of the ITI was nine months. A total of 30 mg rFVIIa and 276 000 IU pdFVIII were used; costs in total: 280 173.60 Euro.

A patient with severe haemophilia A and multiple arterial thromboses caused by large vessel vasculitis: a case report

Haemophilia ◽  
2015 ◽  
Vol 22 (1) ◽  
pp. e39-e42
Author(s):  
L. M. Vos ◽  
R. E. G. Schutgens ◽  
H. W. de Valk ◽  
W. Spiering ◽  
R. H. H. Bemelmans
Keyword(s):  
Case Report ◽  
Large Vessel Vasculitis ◽  
Large Vessel ◽  
Haemophilia A ◽  
Severe Haemophilia

scholarly journals Sports participation and physical activity in adult Dutch and Swedish patients with severe haemophilia: A comparison between intermediate‐ and high‐dose prophylaxis

Haemophilia ◽  
2019 ◽  
Vol 25 (2) ◽  
pp. 244-251 ◽  
Author(s):  
Olav Versloot ◽  
Erik Berntorp ◽  
Pia Petrini ◽  
Rolf Ljung ◽  
Jan Astermark ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sports Participation ◽  
High Dose ◽  
Haemophilia A ◽  
Severe Haemophilia

scholarly journals Experience of Advate rAHF-PFM in previously untreated patients and minimally treated patients with haemophilia A

2012 ◽  
Vol 107 (06) ◽  
pp. 1072-1082 ◽  
Author(s):  
Guenter Auerswald ◽  
Alexis Thompson ◽  
Michael Recht ◽  
Deborah Brown ◽  
Raina Liesner ◽  
...  
Keyword(s):  
Family History ◽  
Adverse Events ◽  
Prospective Trial ◽  
High Dose ◽  
Haemophilia A ◽  
Severe Haemophilia ◽  
Serious Adverse Events ◽  
Inhibitor Development ◽  
Treatment Regimens ◽  
History Of

SummaryWe report a prospective trial of 55 previously untreated patients (PUPs) and minimally treated patients (MTPs) with severe/moderately severe haemophilia A (baseline factor VIII [FVIII] ≤2%) treated with a single FVIII replacement product. It was the objective of this study to evaluate the immunogenicity, efficacy, and safety of rAHF-PFM (Advate®). Ondemand or prophylactic treatment regimens were determined at the discretion of the investigator. rAHF-PFM was also permitted for perioperative management. There were 633 bleeding episodes (BEs), including 517 treated, and 466 rated for efficacy. Haemostatic efficacy was considered excellent/good in 93% of 466 rated treatments. Of 517 treated BEs, 463/517 (90%) were managed with one (356/517 [69%]) or two infusions (107/517 [21%]). There were 27 surgeries. Intraoperative (n=22) and postoperative (n=25) haemostatic efficacies were considered excellent or good in 100% of rated surgeries. Related serious adverse events (SAEs) were inhibitor development in 16/55 (29.1%) subjects who received at least one infusion of rAHF-PFM. Nonserious, related adverse events (AEs) were few in number (14 in eight subjects). The odds ratio (OR [95% Confidence Interval, CI]) of developing inhibitors was significantly higher in subjects with a family history of inhibitor (4.95 [1.29–19.06]), non-Caucasian ethnicity (4.18, [1.18–14.82]), and intensive treatment at high dose (4.5 [1.05–19.25]) within ≤20 exposure days (EDs). In conclusion, rAHF-PFM was safe and effective for the management and perioperative coverage of PUPs/MTPs with severe/moderately severe haemophilia A. This report supports previous findings from studies in which family history of inhibitor, non-Caucasian ethnicity, and high intensity treatment were associated with high risk of inhibitor development.

scholarly journals Management of multiple myeloma in a patient with haemophilia with concurrent emicizumab – case report

2021 ◽  
Vol 8 (1) ◽  
pp. 136-140
Author(s):  
Elizabeth Davies ◽  
Luke Carter-Brzezinski ◽  
Margarita Traintafillou ◽  
Rachel Brown ◽  
Charles R M Hay
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Haematological Malignancy ◽  
Standard Of Care ◽  
Bleeding Disorder ◽  
Plasma Cell Dyscrasia ◽  
Haemophilia A ◽  
Severe Haemophilia ◽  
First Line ◽  
Vte Prophylaxis

Abstract With the increased life expectancies of people with severe haemophilia A, diagnoses of disorders associated with increased age are likely to become more common. Multiple myeloma is a commonly diagnosed plasma cell dyscrasia, with incidence strongly related to age. Both the disease itself and specific myeloma therapies are associated with a significant increase in rates of venous thromboembolism (VTE). Management of VTE prophylaxis can be challenging, especially in patients with a bleeding disorder. In this case report, we describe the management of a patient with concurrent diagnosis of multiple myeloma and severe haemophilia A, undergoing first line myeloma chemotherapy. The patient was successfully managed on standard of care myeloma treatment, with use of emicizumab and venous thromboprophylaxis. This case demonstrates the successful management of a haematological malignancy and a bleeding disorder using integrated and multidisciplinary patient-focused care.

scholarly journals Use of Emicizumab in Patients with Hemophilia a with and without Inhibitors: A Single Center Experience

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4248-4248
Author(s):  
Gaetano Giuffrida ◽  
Daniela Nicolosi ◽  
Annalisa Condorelli ◽  
Uros Markovic ◽  
Francesco Di Raimondo
Keyword(s):  
Quality Of Life ◽  
Replacement Therapy ◽  
Haemophilia A ◽  
Severe Haemophilia ◽  
Factor X ◽  
Bleeding Events ◽  
Single Center Experience ◽  
Fda Approval ◽  
Bypassing Agents

Abstract Emicizumab is a humanized bispecific recombinant monoclonal antibody that binds the enzyme factor IXa and the substrate factor X and mimics the function of FVIII. It solved some unmet needs of haemophilia A (HA) treatment, such as regimen (once weekly up to once monthly infusion) and route of administration (subcutaneous). Most importantly, emicizumab reduce bleeding episodes and improved the quality of life of these patients. Emicizumab received FDA approval for prophylaxis in HA patients with inhibitors in November 2017 and for patients without inhibitors in October 2018.The aim of this study is to provide information on treatment with emicizumab in patients with severe haemophilia A with and without inhibitors in terms of efficacy, safety and quality of life. Here we report our experience with 9 patients with severe haemophilia A (5 with inhibitors and 4 without inhibitors) that were switched from replacement therapy to emicizumab prophylaxis. Median age at initiation of treatment was 26.8 years for patients with inhibitors and 18.7 years for those without inhibitors. Median duration of therapy was 12 months for patients with inhibitors and 8 months for those without inhibitors. All patients were started on emicizumab with a loading dose of 3 mg/kg once weekly for 4 weeks followed by a maintenance dose of 1.5 mg/kg once weekly or every two weeks. The mean annual bleeding rates (ABR) in patients without inhibitor prior to emicizumab was 1.5 compared to 0 while on emicizumab prophylaxis. In subjects with inhibitors ABR was 1.8 compared to 0.4 while on emicizumab prophylaxis. Furthermore, no adverse events including thrombotic events occurred in course of emicizumab prophylaxis. Bleeding events in course of emicizumab prophylaxis did not request any treatment with replacement therapy or bypassing agents. The questionnaire evaluating quality of life (HAL v 2.0 - 2015 ITA; pedHAL v 2.0 - 2015 ITA) was administered to the patients before switch to emicizumab and after a follow up of six months. The scores showed a significant improvement in terms of quality of life in course of emicizumab prophylaxis. In conclusion, our experience suggests that emicizumab prophylaxis is safe and improved protection against bleeding and quality of life compared to replacement therapy in patients with severe A haemophilia. Disclosures Di Raimondo: Amgen: Honoraria; Jazz Pharmaceutical: Honoraria; Pfizer: Honoraria; Janssen Pharmaceuticals: Honoraria; Bristol Myers Squibb: Honoraria; AbbVie: Honoraria.

Homoeopathic Management of a Case of Severe Haemophilia Type A with Inhibitor Positive: Case Report

2020 ◽  
Vol 33 (04) ◽  
pp. 302-308
Author(s):  
Hiral Shah ◽  
Tapas Kumar Kundu ◽  
Afroz Farooque Shaikh
Keyword(s):  
Case Report ◽  
Factor Viii ◽  
Replacement Therapy ◽  
Psychological Status ◽  
Clotting Factor ◽  
Factor Viii Inhibitor ◽  
Haemophilia A ◽  
Severe Haemophilia ◽  
Clotting Factors ◽  
Bleeding Episodes

AbstractHaemophilia is an X-linked inherited immunogenetic bleeding disorder resulting from deficiency of clotting Factor VIII (haemophilia A) or Factor IX (haemophilia B). Haemophilia patients suffer from complication of developing autoantibodies/inhibitor against clotting factors used for the treatment; most commonly patients are treated with Factor VIII replacement therapy. In modern medicine, haemophiliacs with inhibitor positive status are treated with bypassing agents such as Factor VIII inhibitor bypassing agent and immune tolerance induction therapy (ITI) because such patients do not respond to traditional factor replacement therapy during an event of active bleeding. Treatment with ITI is very expensive and it requires medical expertise. Moreover, high cost of such treatment is one part of the problem, while its availability is another problem especially in developing countries. The inhibitor status among haemophilia patients is identified by conducting a blood test which measures the Bethesda units (BU) levels in the blood. In this case report, the homoeopathic management of a patient with haemophilia A severe type (Factor VIII <1%), inhibitor positive (4 BU/mL), is presented. The patient underwent treatment for a span of 4 years. After closely assessing the patient's condition and applying the principles of homeopathy medicine selection, his frequent bleeding episodes were treated with homoeopathic medicines such as Hamamelis Virginica Q, Phosphorus, Arnica montana, Rhus toxicodendron, Calendula officinalis, and Pulsatilla nigricans. Intercurrent medicine—Tuberculinum bovinum—was given when the most indicated medicine failed to relieve the symptoms of the case and was given during non-bleeding phase. The medicines not only helped in reducing haemophilia-related bleeding episodes but also improved complaints of pain, relieved skin complaints, and showed improvement in overall psychological status of patient. It can be concluded that homeopathy medicines were able to successfully reduce the frequency of bleeding and intensity of pain in this patient. Owing to reduced bleeding, he required relatively a smaller number of factor replacement treatment compared with earlier when he was not taking homeopathy. Homoeopathy proved to be effective in managing severe haemophilia patient as a supportive therapy and was able to contribute toward reduced inhibitor levels in severe haemophilia patient.

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