Case: 37 year-old Female with Lifelong Epistaxis

(Case provided by Dave McGlasson, please click on Comments to answer) A 37 year-old female complains of recurrent severe epistaxis (nosebleeds) since childhood, occasionally requiring packing or cauterization. She also reports menorrhagia since menarche (menstruation onset) and easy bruising. She experienced no abnormal bleeding during three successful pregnancies. Her father also experiences epistaxis, easy bruising, […]

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Bleeding Disorders

Dec 27 2018

george

ASH Choosing Wisely Champions

The American Society of Hematology named two Choosing Wisely champions at the 2018 ASH Convention in San Diego. The champions are Prakash Vishnu, MD, of the Mayo Clinic, Jacksonville, who described his work on reducing inappropriate blood. transfusions and Ming Lim, MD, from the Medical University of South Carolina, who described the work that led […]

Bleeding Disorders

Hemophilia B and Extended Half-life Concentrates

Here is another note from Paul Riley, PhD examining the effects of extended half-life factor IX concentrates. on hemophilia B testing. Hemophilia B1: Therapy Classes and Monitoring Factor IX Inhibitor? Y/N Y/N Prophylaxis Conventional half-life recombinant or plasma-derived FIX Extended half-life FIX Preferred assay to measure FIX activity OSA2 (or CSA) CSA (or OSA) 1. […]

Bleeding Disorders

More on HemLibra

I follow-up to our October 6, 2018 post describing emicizumab (HemLibra), I have correspondence dated 9/10/18 from Paul Riley, PhD, MBA, Stago Scientific Business Development Manager for North America. Paul writes, “I was wondering if you should put something on FF about emicizumab, like a survey to find out how people are dealing with it […]

Bleeding Disorders

HemLibra

I’ve attached an article from the September, 2018 issue of CAP Today describing the efficacy of emicizumab, Genentech’s synthetic “bispecific” antibody designed to bypass factor VIII inhibitor in hemophilic boys. The article illustrates how emicizumab (HemLibra) is turning hemophilia therapy upside down. Yesterday, October 5, 2018, HemLibra was additionally approved for all hemophilia A sufferers, […]

Bleeding Disorders

East Texas Bleeding Disorder

Here is a fascinating response to our September 2 solution to the August 10 Minimally Prolonged PT discussion, from Dimitrios Liapis MSc, Vascular Research Private Medical Center, Athens, Greece. From Mr. Liapis: A very interesting case! Did the patient or members of the immediate family report any bleeding history? Other coagulation tests besides PT? It […]

Bleeding Disorders

Minimally Prolonged PT: Solution

Referring to our post of August 10, 2018 entitled Minimally Prolonged PT, Dr. Laposata reviewed the patient’s consistently, though slightly prolonged, PT results, and considered a factor VII deficiency. It turns out the patient’s factor VII level was 40%, found also in some first-degree relatives. It may not be that a factor VII level of […]

Bleeding Disorders

Reference Intervals

I recently became reacquainted with colleague Madeline Ducate, PhD, who supports pharmaceutical houses with the laboratory needs for international clinical trials. Madeline is occasionally confronted with a lack of laboratory reference intervals in under-resourced countries, where cultural norms or the lack of funding limit specimen collection and processing from healthy subjects. In vitro diagnostics companies […]

Bleeding Disorders

HGB Variations During the Day

George, periodically we see patients that have a gram or so difference in their hemoglobin levels which causes some duress with the clinicians. Recently we had a nursing home patient (s/p hip fracture repair) who had a venous draw early in the morning that was sent to our in house hospital laboratory and resulted in […]

Bleeding Disorders

July, 2018 Quick Question: Factor IX Assay Method

Here are the results of our July, 2018 Quick Question, “How do you measure factor IX therapy?” Clot-based factor assay (34) 83% Immunoassay (4) 10% Chromogenic substrate (3) 7% We had 41 respondents. Although there are a few chromogenic substrate-based factor IX assays available worldwide, none has been approved by the US FDA, though two […]

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Bleeding Disorders

Bleeding Disorders

Case: 37 year-old Female with Lifelong Epistaxis

ASH Choosing Wisely Champions

Hemophilia B and Extended Half-life Concentrates

More on HemLibra

HemLibra

East Texas Bleeding Disorder

Minimally Prolonged PT: Solution

Reference Intervals

HGB Variations During the Day

July, 2018 Quick Question: Factor IX Assay Method

George Fritsma MS MLS

Cheat Sheets from George

Questions or Comments?

Quick Question