Document Detail


Central nervous system bleeding in patients with rare bleeding disorders.
MedLine Citation:
PMID:  21539694     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Summary.  Central nervous system (CNS) bleeding is one of the most severe and debilitating manifestations occurring in patients with rare bleeding disorders (RBDs). The aim of this study was to retrospectively collect data on patients affected with RBDs who had CNS bleeding, to establish incidence of recurrence, death rate, neurological sequences, most frequent location, type of bleeding and efficacy of treatments. Results pertained to 36 CNS bleeding episodes in 24 patients with severe deficiency except one with moderate factor VII (FVII) deficiency. Six patients (25%) experienced a recurrence and two had more than one recurrence. Seven patients (29%) had an early onset of CNS bleeding before the first 2 years of life, others (71%) later in life. In 76% of cases, CNS bleeding was spontaneous. CNS bleeding was intracerebral in 19 cases (53%), extracerebral in 10 (28%) and both intracerebral and extracerebral in two cases (6%). Neurosurgery was performed in 11 cases, in association with replacement therapy in seven cases. Seizures were noted in four patients. Residual psychomotor abnormalities were seen in two patients. No death was recorded. To prevent recurrence, 17/24 patients (71%) were put on secondary prophylaxis. In conclusion, recurrence of CNS bleeding was confirmed to be relatively frequent in patients with severe FV, FX, FVII and FXIII deficiencies. Most patients were managed with replacement therapy alone, surgery being reserved for those with worsening neurological conditions. Our results indicate that some RBDs require early prophylactic treatment to prevent CNS bleeding. Optimal dosage and frequency of treatment need further evaluation.
Authors:
S M Siboni; E Zanon; G Sottilotta; D Consonni; G Castaman; D Mikovic; F Biondo; A Tagliaferri; A Iorio; P M Mannucci; F Peyvandi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-4
Journal Detail:
Title:  Haemophilia : the official journal of the World Federation of Hemophilia     Volume:  -     ISSN:  1365-2516     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9442916     Medline TA:  Haemophilia     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Affiliation:
Centro Emofilia e Trombosi A. Bianchi Bonomi, Dipartimento di Medicina Interna e Specialità Mediche, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milano, Italy Centro Emofilia Clinica Medica II Azienda Universitaria Ospedaliera di Padova, Padova, Italy Hemophilia Centre, Hemostasis and Thrombosis Service, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy Unità di Epidemiologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milano, Italy Centro per lo Studio delle malattie emorragiche e trombotiche, Ematologia-Ospedale San Bortolo, Vicenza, Italy Blood Transfusion Institute of Serbia Hemostasis Dept and Haemophilia Center, Belgrade, Serbia Dipartimento Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Rome, Italy Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy Sezione di Medicina Interna e Vascolare, Dipartimento di Medicina Interna, Ospedale Santa Maria della Misericordia, Università di Perugia, Perugia, Italy Clinical Epidemiology & Biostatistics and Medicine Departments, McMaster University, Hamilton, ON, Canada Direzione Scientifica, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy.
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