Haemophilia A
Haemophilia A | |
---|---|
Other names | Hemophilia A |
Haematology | |
Symptoms | Prolonged bleeding from common injuries[1] |
Causes | Factor VIII deficiency[2] |
Diagnostic method | Bleeding time,[2] coagulation screen, genetic testing |
Prevention | Hepatitis B vaccine should be considered[2] |
Treatment | Factor VIII, factor VIII inhibitors, emicizumab |
Haemophilia A (or hemophilia A) is a
The medical management of individuals with hemophilia A frequently entails the administration of
Signs and symptoms
Haemophilia A’s phenotype has a quite wide range of symptoms encompassing both internal and external bleeding episodes. Individuals with more severe haemophilia tend to experience more intense and frequent bleeding, whereas those with mild haemophilia typically exhibit milder symptoms unless subjected to surgical procedures or significant trauma. Those with moderate haemophilia may display variable symptoms, falling within the spectrum between severe and mild forms.
One common early indicator of haemophilia is prolonged bleeding from
Complications
One therapeutic conundrum is the development of inhibitor antibodies against factor VIII due to frequent infusions. These develop as the body recognises the infused factor VIII as foreign, as the body does not produce its own copy. In these individuals, activated
Oral Manifestations
The oral manifestations are characterized by frequent bleeding of multiple sites, frequently seen as gingival and postextraction haemorrhages. The symptoms depend on the severity of haemophilia. In the case of severe haemophilia, patients may complain of multiple oral bleeding episodes throughout their life. Haemophilia patients are considered to be a special group of patients as routinely done procedures may be fatal in them. It was seen that almost 14% of all haemophilia patients and 30% of cases with a mild type of haemophilia have been diagnosed early following an episode of severe oral bleeding, of which the most common sites were the labial frenum and the tongue.[8]
Genetics
Haemophilia A is inherited as an
About 5-10% of people with haemophilia A are affected because they make a dysfunctional version of the factor VIII protein, while the remainder are affected because they produce factor VIII in insufficient amounts (quantitative deficiency).[10] Of those who have severe deficiency (defined as <1% activity of factor VIII), 45-50% have the same mutation, an inversion within the factor VIII gene that results in total elimination of protein production.[10]
Since both forms of haemophilia can be caused by a variety of different mutations, initial diagnosis and classification is done by measurement of protein activity rather than by
Diagnosis
The diagnosis of haemophilia A may be suspected as coagulation testing reveals an increased
Severity
There are numerous different mutations which can cause haemophilia A, due to differences in changes to the factor VIII gene (and the resulting protein). Individuals with haemophilia often have some level of active clotting factor. Individuals with less than 1% active factor are classified as having severe haemophilia, those with 1–5% active factor have moderate haemophilia, and those with mild haemophilia have between 5–40% of normal levels of active clotting factor.[13]
Differential diagnosis
Two of the most common
Treatment
In regards to the treatment of this genetic disorder, most individuals with severe haemophilia require regular supplementation with
Dental considerations
The inferior alveolar nerve block should only be given after raising clotting factor levels by appropriate replacement therapy, as there is a risk of bleeding into the muscles along with potential airway compromise due to a haematoma in the retromolar or pterygoid space. The intraligamental technique or interosseous technique should be considered instead of the mandibular block. Articaine has been used as a buccal infiltration to anaesthetize the lower molar teeth. A lingual infiltration also requires appropriate factor replacement since the injection is into an area with a rich plexus of blood vessels and the needle is not adjacent to bone.[20]
Gene therapy
In December 2017, it was reported that doctors had used a new form of gene therapy to treat haemophilia A.[21][22][23]
Monoclonal antibodies
Monoclonal antibody emicizumab has been approved by the FDA in 2017 for therapy of hemophilia A.[24]
Prognosis
Two Dutch studies have followed haemophilia patients for a number of years.
Epidemiology
Haemophilia A occurs in approximately 1 in 5,000 males,[10] while the incidence of haemophilia B is 1 in 30,000 in the male population,[10] of these, 85% have haemophilia A and 15% have haemophilia B.[10]
See also
References
- ^ PMID 20301578.update 2014
- ^ a b c d "Hemophilia A: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 24 June 2016.
- ^ a b "Haemophilia A (Factor VIII Deficiency) information | Patient". Patient. Retrieved 24 June 2016.
- ISBN 9789241547659.
- ISBN 9781118767429.
- ^ a b "How Is Hemophilia Treated? - NHLBI, NIH". www.nhlbi.nih.gov. Retrieved 2016-07-08.
- PMID 17124095.
- ^ Sonu Acharya, Karishma Rathore, Upasana Mahapatra, Sashikant Sethi, Nikita Sahu (2018). "An unusual oral manifestation of hemophilia in a child". Journal of International Oral Health. Retrieved 2019-12-20.
- PMID 22754241.
- ^ ISBN 978-1-4377-0755-7.
- PMID 11836440.
- ^ "OMIM Entry - # 306700 - HEMOPHILIA A; HEMA". omim.org. Retrieved 2016-07-08.
- ^ Hemophilia A at eMedicine
- ^ "Von Willebrand's Disease. About Von Willebrand's Disease | Patient". Patient. Retrieved 2016-07-08.
- ISBN 9781118439302.Google books no page
- PMID 19105504.
- ^ "Guidelines for the Prevention of Intravascular Catheter-Related Infections". www.cdc.gov. Retrieved 8 July 2016.
- S2CID 25748135.
- PMID 21839010.
- ^ Andrew Brewer, Maria Elvira Correa (May 2006). "Guildelines for Dental Treatment of Patients with Inherited Bleeding Disorders" (PDF). Treatment of Hemophilia. 40: 9 – via World Federation of Hemophilia (WFH).
- ^ "Groundbreaking gene therapy trial set to cure haemophilia A". Barts Health NHS Trust. 14 December 2017. Retrieved 14 December 2017.
- ^ "Haemophilia A trial results 'mind-blowing'". BBC. 14 December 2017. Retrieved 14 December 2017.
- PMID 29224506.
- ^ HEMLIBRA- emicizumab injection, solution drug label/data at DailyMed from U.S. National Library of Medicine, National Institutes of Health.
- S2CID 22008880.
- ^ S2CID 13651790.
Further reading
- Casana, P.; Cabrera, N.; Cid, A. R.; Haya, S.; Beneyto, M.; Espinos, C.; Cortina, V.; Dasi, M. A.; Aznar, J. A. (2008-07-01). "Severe and moderate hemophilia A: identification of 38 new genetic alterations". Haematologica. 93 (7): 1091–1094. PMID 18403393.
- Roberts, Harold R. (2008-04-15). Haemophilia and Haemostasis: A Case-based Approach to Management. John Wiley & Sons. ISBN 9780470766439. Retrieved 8 July 2016.
- Collins, Peter; Baudo, Francesco; Huth-Kühne, Angela; Ingerslev, Jørgen; Kessler, Craig M; Castellano, Maria E Mingot; Shima, Midori; St-Louis, Jean; Lévesque, Hervé (7 June 2010). "Consensus recommendations for the diagnosis and treatment of acquired hemophilia A". BMC Research Notes. 3: 161. PMID 20529258.
- Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy; Di Minno, Matteo Nicola Dario (9 February 2015). "Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery". Cochrane Database of Systematic Reviews (2): CD009961. PMID 25922858.
- Kellogg, TF (November 1974). "Steroid balance and tissue cholesterol accumulation in germfree and conventional rats fed diets containing saturated and polyunsaturated fats". Journal of Lipid Research. 15 (6): 574–9. PMID 4430880.
- Armstrong, Elina; Hillarp, Andreas (2014). "Assay discrepancy in mild haemophilia A". European Journal of Haematology. Supplementum. 76: 48–50. S2CID 205100329.