Bleeding disorders Virtual clinic
This activity was supported by Novo Nordisk Health Care AG.
Elderly patient with a complex case of acquired haemophilia A
Sarah is an 83-year old woman who was transferred to the haematology in-patient unit at your Haemophilia Treatment Centre from a community hospital with extensive chest and abdominal wall haematomas, gross haematuria, anaemia with a haemoglobin (Hb) value of 9.4 g/dL (normal range in females 12–16 g/dL), severe neutropaenia (0.1 x 109/L; normal range 1.5–8.0 x 109/L), mild thrombocytopaenia (platelet count 102 x 109/L), and a profoundly elevated activated partial thromboplastin time (aPTT) of 104 seconds (normal range 20–40 seconds). Her medical history includes giant cell arteritis, hypertension, chronic obstructive pulmonary disease and chronic renal insufficiency.
You are in charge of Sarah’s care and you examine her thoroughly. Based on the clear clinical signs (bleeding manifested by spontaneously occurring extensive subcutaneous haematomas) and Sarah’s age, you think of acquired haemophilia A (AHA). As Sarah’s bleeding is worrisome but not life threatening and her medication record is ambiguous, you want to order some initial laboratory tests to rule out other diagnoses first.
Early treatment of bleeds and clinical outcomes in congenital haemophilia with inhibitors, managed with NovoSeven
Mario is a 10-month-old alert male infant who crawls. His mother brings him to your clinic because he has slightly swollen knees with large bruises that seem to last a long time. His medical history included no known history of haemophilia in the family, an uncomplicated vaginal delivery, nothing special during first month, stay-at-home care, and no siblings. He is not receiving any over-the-counter or prescription medication currently. Diet is reported to include fresh fruit and vegetables as well as meats, dairy, and grains, so intake of vitamin C and K are probably adequate.
Target Audience
This activity is intended for European based hematologists, pediatricians, and other healthcare professionals who treat patients with hemophilia.
Faculty:
Pier Mannuccio Mannucci, MD
Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milan, Italy.
Jerome Teitel, MD
St. Michael’s Hospital Hemophilia Treatment Centre, Toronto.
Robert Klamroth, MD, PhD
Haemophilia Treatment Centre and the Haemostasis and Thrombosis Unit, Vivantes Klinikum im Friedrichshain, Berlin, Germany.
Disclaimer
The educational activity presented involves simulated, case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient, whether living or deceased, is intended or should be inferred. The material presented here does not necessarily reflect the views of SEI Healthcare, or any individuals or commercial entities that support companies that support educational programming on med-sims.org. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.