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Prophylaxis treatment is considered as the reference approach for children with severe haemophilia A or B. However, no consensus about the best prophylaxis protocol has yet been identified in term of dosage and timing of infusions. Guidelines were drawn up in France in the early 2000s by an expert group. The objective of this 16-year study (2001 to 2016) was to describe the clotting factor concentrates (CFCs) use in haemophiac outpatients. This is a retrospective monocentric study. Pharmaceutical and clinical data were captured using medical records. Main outcome measures are CFCs use and clinical data in paediatrics. Eighty haemophiliacs A or B under 12 years old with a factor level less than 2% were included (74% of HA), from pharmaceutical outpatient data. Global use of CFCs followed the evolution of the patients' number and regimen type introduced: increase of prophylaxis and decrease of on demand regimen. The average age at the prophylaxis introduction is significantly different according to the birth year. Prophylaxis introduction was made earlier with an increase of prophylactic regimen joined to an increase of CFCs use. The significant reduction of haemarthrosis in our cohort can be linked to a first infusion age and a prophylaxis introduction much earlier.

Background Data on the effect of ABO blood group (ABO), von Willebrand factor (VWF) levels, and age on factor VIII (FVIII) in non-severe haemophilia A (HA) is scarce. Objective To investigate if ABO, VWF levels, and age have an influence on the variability of FVIII levels and consequently on the assessment of severity in non-severe HA. Patients/methods Eighty-nine patients with non-severe HA and 82 healthy controls were included. Data on ABO was collected and FVIII clotting activity (FVIII:C) with one-stage clotting assay (FVIII:C OSA) and chromogenic substrate assay (FVIII:C CSA), FVIII antigen (FVIII:Ag) and VWF antigen (VWF:Ag) and activity (VWF:Act) were determined. Results In HA, FVIII:C OSA and CSA and FVIII:Ag were not different between non-O (n = 42, median 15.5, interquartile range 10.4-24.0; 10.0, 6.8-26.0 and 15.2, 10.7-24.9) and O (n = 47, 14.1, 9.0-23.0; 10.0, 5.0-23.0 and 15.2, 9.3-35.5), whereas in healthy controls, non-O individuals had significantly higher FVIII levels. Fviii C showed no relevant correlation with VWF levels in HA, but we observed strong correlations in healthy controls. Age had only a minor influence in HA, but had a considerable impact on FVIII:C in healthy controls. In multivariable regression analysis ABO, VWF:Ag and age were not associated with FVIII:C in HA, whereas this model explained 61.3% of the FVIII:C variance in healthy controls. Conclusions We conclude that in non-severe HA ABO and VWF levels do not substantially influence the variability of FVIII levels and age has only minor effects on it, which is important information for diagnostic procedures.

Trough factor (F) VIII level is a not reliable bleeding risk indicator to predict prophylaxis efficacy in severe haemophilia A (SHA), therefore, accurate biomarkers are much needed. Thrombelastography (TEG) monitors both thrombin and clot formation addressing the global haemostatic status but its usefulness to tailor prophylaxis in haemophilia has been poorly evaluated. In this study, correspondence between individual pharmacodynamic/pharmacokinetic profile of FVIII and joint condition, physical activity and bleeding phenotype of SHA patients under prophylactic treatment was assessed. Nineteen SHA patients 18 years old on long-term prophylaxis treatment with FVIII were studied in an observational cross-sectional study. Whole blood was withdrawn before FVIII administration and at five time-points after infusion for a TEG-based pharmacodynamic- and pharmacokinetic-study. Type of prophylaxis and joint condition at inclusion and physical activity as well as onset of treated spontaneous bleeding events in the previous two years were retrospectively assessed. Six patients had suffered at least one treated spontaneous bleeding event and were named as "bleeders". The rest were named as "non-bleeders". Only the half maximal effective concentration of FVIII (FVIII-EC50) for TEG parameters R-time, K-time and α-angle correlated with the bleeding phenotype being significantly higher in bleeders suggestive of a poorer response to FVIII. Poorer joint condition, trough FVIII levels or type of prophylaxis were not definitive predicting variables of bleeding phenotype. In conclusion, this study reveals FVIII-EC50 for the first time as a valuable biomarker to anticipate individual efficacy of prophylaxis in SHA.

Regular prophylaxis with exogenous Factor VIII (FVIII) is recommended for individuals with severe haemophilia A (HA), but standardised data on bleeding, FVIII use, and quality of life (QoL) for this population in routine clinical practice are scarce. In a prospective, multinational, noninterventional study, male participants age ≥18 years with severe HA (FVIII ≤1 IU/dL) receiving prophylactic FVIII were followed for at least 6 months. Bleeding and FVIII use were reported weekly. Annualised bleeding rate (ABR) and FVIII infusion rate were calculated for participants with ≥6 months follow-up and combined with retrospective data from 6 months prior to baseline. Adverse events (AEs) were collected monthly. Participants completed the haemophilia-specific health-related QoL questionnaire for adults (Haemo-QoL-A) at baseline. This abstract presents a sub analysis of the study's Brazilian population. For all 54 Brazilian participants, median (range) age was 27 (18–47) years. For the 41 (76%) Brazilian participants with ≥6 months follow-up, mean (standard deviation [SD]; median) ABR for treated bleeds was 2.42 (4.05; 0.80) bleeds per year and mean (SD; median) annualised FVIII infusion rate was 167.87 (60.22; 155.17) infusions per year. Mean (SD; median) ABRs of treated traumatic, spontaneous, and joint bleeds were 0.90 (1.6; 0.0), 1.52 (3.3; 0.0), and 1.91 (3.29; 0.0) bleeds per year, respectively. Median (range) percentage of follow-up time adherent with prescribed prophylaxis frequency in Brazilian participants was 94.7%(49%-100%). Mean (SD) Haemo-QoL-A total transformed score (0–100) score was 70.3 (15.1) The lowest mean (SD) domain scores (representing lower QoL) in all Brazilian participants were for treatment concern 45.7 (30.85), physical functioning 66.9 (21.33), and consequences of bleeding 68.1 (22.92). AEs were reported in 22 (40.7%) participants, with the most common AEs being haemophilic arthropathy, nasopharyngitis, and synovitis, each reported in 2 (3.7%) Brazilian participants. Two serious AEs (oesophageal haemorrhage and haematoma) were reported, each by single participant (1.9%). Despite high prophylaxis adherence, participants reported breakthrough spontaneous and joint bleeding and impaired physical functioning. Additional haemostatic options for severe HA are needed.

FVIII inhibitor development in haemophilia A (HA) patients, especially those with severe manifestations is a serious adverse effect in patients with haemophilia A, and the clinical management of these patients is very difficult as most don't respond to conventional treatment. Many genetic and non-genetic risk factors have been proposed however, these are diverse in different population groups, highlighting the importance of determining specific risk factors for each population. F8 mutations and especially inversions, which are the most common causative mutation in severe HA, have been significantly associated with inhibitor development earlier, however there is no conclusive data so far with regard to Indian haemophiliacs. This study provides novel evidence that intron 22 inversions in the F8 gene are indeed significantly associated with FVIII inhibitor development in Indian haemophiliacs. Further studies with other risk factors would enable better insights into the immune response towards FVIII in these patients, and possibly help to characterize patients at a higher risk for inhibitor development.

Haemophilia A is a bleeding disorder that has a spectrum of manifestations ranging from persistent bleeding after minor trauma to spontaneous haemorrhage. As an X-linked disease, it has a rare occurrence in females. We report a case of a pregnant patient with severe haemophilia A, who received epidural analgesia during labour. The prepartum, intrapartum and postpartum care of a patient with such a bleeding diathesis is discussed.