ORIJINAL ARAŞTIRMA
Hemofilik Erişkinlerde Eklem Durumunun Değerlendirilmesi: Tek Merkez Erişkin Hematoloji Kliniği Deneyimi
The Evaluation of the Joint Status of Hemophiliac Adults: Single Center Adult Hematology Clinic Experience
Received Date : 24 Feb 2019
Accepted Date : 29 Jun 2019
Rafiye ÇİFTÇİLERa, Salih AKSUa
a Department of Hematology, Hacettepe Universtiy Faculty of Medicine, Ankara, TURKEY
Doi: 10.31609/jpmrs.2019-65710 - Makale Dili: EN
J PMR Sci. 2019;22(2):48-52
ÖZET
Amaç: Kalıtsal hemofili A, pıhtılaşma faktörü VIII eksikliğine yol açan genetik değişikliklerin
sonucudur, hemostaz sürecini engeller ve hastalarda spontan veya travma sonrası kanamaya
sebep olur. Bu çalışmanın amacı, erişkin hematoloji polikliniğinde izlenen erişkin hemofili A hastalarının
hedef eklem durumlarını değerlendirmektir. Gereç ve Yöntemler: Çalışmada, 2000-2018
yılları arasında Hacettepe Üniversitesi Hastanesi’ndeki erişkin hematoloji polikliniğinde hemofili
A ile takip edilen 33 hastanın hedef eklemi değerlendirildi. Bulgular: Diz eklemi, %57,5 olguda hemartrozdan
en sık etkilenen eklemdi. Ayak bileği eklemi %42,4 olguda, dirsek eklemi %27,2 olguda
etkilenmişti. Kalça eklemi ve omuz eklemi tutulumu sırasıyla %9 ve %6 olguda saptandı. Hemofili
A hastalarının %48,5'inde hedef eklem gelişti. Diz eklemi %56,2 olguda en sık izlenen hedef eklemdi
ve %18,8 olguda ise ayak bileği eklemi hedef eklemdi. Bu çalışmada, inhibitör varlığı ve hedef eklem
gelişimi arasında pozitif bir ilişki olduğu gözlendi. Hedef eklem gelişen 6 hastanın 5’inde inhibitör
saptandı. Sonuç: Sonuç olarak en fazla etkilenen eklemler diz, ayak bileği ve dirsek eklemleri idi.
Ağır hemofili hastalarında profilaksi, hedef eklem gelişiminin daha sık görülmesi nedeniyle daha
erken planlanabilir.
Anahtar Kelimeler: Hemofili; hemofilik artropati; hedef eklem
ABSTRACT
Objective: Hereditary hemophilia A is the result of genetic alterations that cause deficiencies
in clotting factor VIII, obstructing the process of hemostasis and predisposing hemophiliacs
to spontaneous or post-traumatic bleeding. The aim of this study was to identify the target joint
conditions of adult hemophilia A patients followed in adult hematology outpatient clinic. Material
and Methods: We analyzed the target joint of 33 patients followed as hemophilia A in adult hematology
outpatient clinic between 2000 and 2018 years. Results: Knee joint was the predominant
joint affected by hemarthrosis in 57.5% cases. Ankle joint was involved in 42.4% cases and elbow
joint was involved in 27.2% cases. Hip joint and shoulder joint involvement was seen in 9% and 6%
cases, respectively. 48.5% of hemophilia A patients had developed target joint. Knee joint was the
predominant target joint in 56.2% cases and ankle joint was the target joint in 18.8% cases. In this
study, a positive association was observed between inhibitor presence and target joint development.
Inhibitor was detected in 5 of 6 patients who developed target joint. Conclusion: In conclusion, the
most affected joints were knee, ankle and elbow joints. Prophylaxis in patients with severe hemophilia
may be planned earlier because of the more frequent occurrence of target joint development.
Keywords: Hemophilia; hemophilic arthropathy; target joint
REFERENCES
- Falcao R, Pasquini R, Zago M. Hematologia: Fundamentos e Pratica. 1st ed. Sao Paulo: Atheneu; 2001. p.1043.
- Ferreira AA, Bustamante-Teixeira MT, Leite IC, et al. Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center. Rev Bras Hematol Hemoter. 2013;35:23-28. [Crossref] [PubMed] [PMC]
- Valentino LA. Blood-induced joint disease: the pathophysiology of hemophilic arthropathy. J Thromb Haemost. 2010;8:1895-902. [Crossref] [PubMed]
- Aledort LM, Haschmeyer RH, Pettersson H. A longitudinal study of orthopaedic outcomes for severe factor-VIII-deficient haemophiliacs. The Orthopaedic Outcome Study Group. J Intern Med. 1994;236:391-9. [Crossref] [PubMed]
- Cassis FR, Querol F, Forsyth A, et al; HERO International Advisory Board. Psychosocial aspects of haemophilia: a systematic review of methodologies and findings. Haemophilia. 2012;18:e101-e14. [Crossref] [PubMed]
- Abshire T. An approach to target joint bleeding in hemophilia: prophylaxis for all or individualized treatment? J Pediatr. 2004;145:581-3. [Crossref] [PubMed]
- Hirschman RJ, Itscoitz SB, Shulman NR. Prophylactic treatment of factor VIII deficiency. Blood. 1970;35:189-94.
- Oldenburg J, Zimmermann R, Katsarou O, et al. Controlled, cross-sectional MRI evaluation of joint status in severe haemophilia A patients treated with prophylaxis vs. on demand. Haemophilia. 2015;21:171-9. [Crossref] [PubMed] [PMC]
- Kern M, Blanchette V, Stain AM, et al. Clinical and cost implications of target joints in Canadian boys with severe hemophilia A. J Pediatr. 2004;145:628-34. [Crossref]
- Fischer K, van der Bom JG, Mauser-Bunschoten EP, et al. The effects of postponing prophylactic treatment on long-term outcome in patients with severe hemophilia. Blood. 2002;99:2337-41. [Crossref] [PubMed]
- Karim M, Siddique R, Jamal C, et al. Clinical profile of haemophilia in children in a tertiary care hospital. Bangladesh J Child Health. 2013;37:90-6. [Crossref]
- Mohsin SS, Amin H, Hussain S, et al. Haemophilia B: clinical manifestations and complications. Biomedica. 2012;28:52-6.
- Gouw SC, van der Bom JG, Ljung R, et al. Factor VIII products and inhibitor development in severe hemophilia A. N Engl J Med. 2013;368:231-9. [Crossref] [PubMed]
- Lacroix-Desmazes S, Misra N, Bayry J, et al. Pathophysiology of inhibitors to factor VIII in patients with haemophilia A. Haemophilia. 2002;8:273-9. [Crossref] [PubMed]
- van Vulpen LF, Mastbergen SC, Schutgens RE. First preclinical support for the 'danger theory' in inhibitor development. Haemophilia. 2016;22:654-6. [Crossref] [PubMed]
- Chambost H. Assessing risk factors: prevention of inhibitors in haemophilia. Haemophilia. 2010;16:10-5. [Crossref] [PubMed]