Blood Management for Treatment of Hemophilia and Other Bleeding Disorders

Blood Management for Treatment of Hemophilia and Other Bleeding Disorders

Bleeding disorders are serious conditions that affect a large number of people around the world. Hemophilia alone affects nearly 20,000 people in the United States and more than 400 children are born each year with the disorder. Severe cases of hemophilia occur almost predominantly in men; women can still be carriers of the gene that causes hemophilia, but only develop mild forms of the bleeding disorder.

Other forms of bleeding disorders include:
  • Acquired platelet function defects
  • Congenital platelet function defects
  • Congenital antithrombin III deficiency
  • Congenital protein C or S deficiency
  • Disseminated intravascular coagulation (DIC)
  • Drug-induced immune thrombocytopenia
  • Factor II deficiency
  • Factor V deficiency
  • Factor VII deficiency
  • Factor X deficiency
  • Factor XII
  • Idiopathic thrombocytopenic purpura (ITP)
  • Von Willebrand’s disease

Bleeding disorders can result from a number of different causes and can be either inherited or acquired. The most common element of these disorders is a lack of the blood parts responsible for clotting (platelets). The result is excessive or heavy bleeding that takes longer for the body to control.

Blood Transfusions as Treatment for Hemophilia

In the first half of the 20th century, it was common for hemophilia patients and patients with other clotting disorders to be treated with blood transfusions. The process initially involved the transfusion of whole blood or frozen plasma. This was a laborious process, requiring extended hospital stays for each treatment.

During the 1970s and 80s, the specific clotting factors in the blood became available in more convenient, concentrated forms. Since the clotting factors were the only parts of the blood that hemophiliacs and other patients with bleeding disorders required from the whole blood or plasma, blood transfusions were no longer necessary.

Unfortunately, whether acquired from blood transfusions or through concentrated plasma extracts, the needed platelets still had to come from donor blood banks. By 1987, it became evident that an alarming number of hemophiliac and other bleeding disorder patients had become infected with hepatitis B, hepatitis C, and HIV (the virus that causes AIDS) due to contaminated donor blood.

Although major strides have been made since the late 1980s to improve the safety of donor blood, there are still a number of risks associated with receiving donated blood parts through blood transfusions or other methods. Patients with hemophilia and other bleeding disorders are at risk for any blood borne pathogen, allergic reactions and a number of other complications that can result from receiving donor blood parts or the transfusion process itself.

Blood Management for Treating Hemophilia

The advent of bloodless medicine, including bloodless surgery and a substantial list of blood management techniques, has provided new alternatives for treating hemophilia and other bleeding disorders. The field of bloodless medicine involves a number of different techniques and new technologies that can minimize the loss of blood during major surgeries. Fortunately for hemophiliacs and patients with similar bleeding disorders, many of the fundamentals and techniques used in blood management can be applied to the treatment of these diseases.

One such technique involves a gene modified bone marrow transplant. The patient’s own bone marrow is removed and the stem cells contained in it are treated with Factor VIII – a clotting factor, which is placed in the platelets. The modified bone marrow is transplanted back to the patient, who is now able to produce blood platelets retaining the essential clotting mechanisms that stop internal and external bleeding.

For people suffering from hemophilia and other bleeding disorders, blood management treatments such as these do more than simply eliminate the need for a potentially risk blood transfusion. These new kinds of treatments also have the potential to allow patients to lead a more “normal” life, without frequent hospital visits. Some hemophiliacs require frequent blood transfusions – as many as three per week. Newer treatments utilizing blood management techniques and research have the potential to drastically reduce treatment times.

Contact your local hospital or healthcare system for more information about blood management and any bloodless medicine programs that might be available near you. 

About The Author
Norman A. Smyke Jr, MD, is a board certified specialist in Anesthesiology and is the director of the Center for Blood Conservation at Grant. Dr. Smyke oversees the first bloodless medicine program in Columbus, Ohio and outlying areas to provide formally recognized blood management services, including bloodless surgery. For more information about the CBC at Grant, please visit Ohio Health.
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