haemophilia Flashcards

1
Q

what are the two types of hemophilia ?

A

hemophilia type A and type B

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2
Q

what are the deficient factors in each type of hemophilia ?

A

A - factor 8
B - factor 9

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3
Q

what is the inheritance pattern of hemophilia ?

A

x-linked recessive

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4
Q

what are the features of hemophilia ?

A

1- hemarthrosis - bleeding of joints
2- soft tissue hematoma
3- prolonged bleeding after surgery or dental extractions
4- large deep ecchymotic patches

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5
Q

what gene mutation is hemophilia A associated with ?

A

defect in the F8 gene

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6
Q

what is the difference between congenital hemophilia and acquired hemophilia ?

A

congenital - deficiency in factor 8
acquired - autoimmune condition where there are antibodies against factor 8

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7
Q

what are the situations that may lead to a diagnosis of hemophilia ?

A

spontaneous joint bleeding
marked bruising after circumcision
excessive bleeding after surgery

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8
Q

what is seen on lab evaluation in cases of haemophilia ?

A

1- prolonged PTT due to affection of the intrinsic pathway
2- decreased factor 8 activity
3- mutations detected in F8 genee sequencing

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9
Q

what does the severity of hemophilia depend on ?

A

the clotting factor level
mild - 5-40
moderate - 1-5
severe - <1

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10
Q

what are the treatment options for hemophilia ?

A

replace the missing factors with concentrates - factor 8 replacement 2-3 times a week
increase endogenous factors
antifibrinolytics
platelets

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11
Q

what is considered curative therapy in hemophilia ?

A

liver transplant
gene therapy

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12
Q

what is the aim level of factor 8 ?

A

keep it above 1

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13
Q

what is the focus of both primary and secondary prophylaxis in hemophilia ?

A

1- primary prophylaxis - avoidance of any joint abnormality

2- secondary prophylaxis - avoidance of the progression of any arthropathy

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14
Q

what is the most serious bleeding symptom in hemophilia ?

A

intracranial haemorrhage

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15
Q

what is the most serious complication associated with hemophilia A ?

A

the development of anti factor 8 inhibitors

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16
Q

what is the cause of development off anti factor 8 inhibitors ?

A

caused by factor 88 replacement therapy

17
Q

what are the two approaches associated with antibody formation against factor 8 ?

A

can either be high or low titre
low titre - below 5 , patient can continue using factor 8 products

high titre- above 5 patients won’t benefit from factor 8 products

18
Q

how can high titre antibodies be resolved ?

A

immune tolerance induction

19
Q

which monoclonal antibody has been used for the replacement of factor 88 ?

A

emicizumab

20
Q

what is the epidemiology in hemophilia A ?

A

almost always in males with sporadic cases in females

21
Q

how can you differentiate between inhibitors and deficiency ?

A

mixing study