June 2019

Give a Pint!

Laurie Kelley June 30, 2019

I love reading about medical history, and naturally blood is a fascinating topic. Rose George’s book Nine Pints: A Journey Through the Money, Medicine, and Mysteries of Blood is snappy and witty, and full of facts. I loved all the statistics, interwoven with real life stories of individuals. I appreciate the focus on the suffering and plight of those with hemophilia, who contracted HIV and hepatitis C. I know some of the people she quoted. George has highlighted some very important and crucial concerns: plasma donation practices, cultural differences regarding blood. A chapter on leeches– so interesting! As I am involved internationally in helping patients in developing countries gain access to clotting factor, I was very interested in the global situations she presented, especially India and Nepal, two countries I have been to many times. Here are some highlights from the book, which I strongly recommend reading:

• Every three seconds, somewhere in the world, a person receives a stranger’s blood. Globally, 13,282 centers in 176 countries collect 110 million donations.

• The mythical Gorgon Medusa, with her head of snakes, showed the two-faced nature of blood best: the veins on her left side contained blood that was lethal, while the right side gave life. Transfusions can be two-faced, too. The right type of blood can save your life; the wrong one can kill you.

• The bone marrow produces two million red blood cells every second. Daily, the blood’s thirty trillion red cells do a full circuit of the body, traveling about twelve thousand miles.

• Forty percent of Caucasians have type A blood, but only 27 percent of Asians. 19 The fact that O-type people are more susceptible to cholera was first noticed in 1977.

• Cold War Americans thought blood type so important that they tattooed it onto adults and children.

• A nation-state needs 1 to 3 percent of its population to give blood to maintain an adequate blood supply, 36 the higher the better.

• In Luxembourg only 14 percent of people give blood; over the border in France, it’s 44 percent.

• A leech bite will usually feel like a vague sensation, not a nip or scratch. Once their teeth are engaged, they emit the best anticoagulants known to exist, so that their blood meal keeps flowing long after they have stopped feeding, often for up to ten hours. The leech is in many ways a simple animal, but its anesthetic and anticoagulant have yet to be bettered by science.

• In 1985, a three-year-old boy from Massachusetts had his ear bitten off by the family dog. He was taken to Boston’s Children’s Hospital, where his surgeons proceeded as they usually did with amputated ears. But the blood couldn’t circulate well in the tight ear area. Leeches were flown in and attached to the area. They drew blood away from the wound and kept the circulation to the newly attached ear.

• The first barber-surgeon on the registry of the Worshipful Company of Barbers was recorded in 1312. The bleeding barber is the reason modern barbers display red and white striped poles: the pole was a stick for the patient to grip; the white stripes were the bandages, the red stripes the blood.

More to come next time!!

Factor your way: empowering you to achieve your goals

admin June 23, 2019

Sponsored Content

This is a paid public announcement from Takeda and does not constitute an endorsement of products or services. When you click on the links in this blog entry, you will be directed to the bleedingdisorders.com website. LA Kelley Communications always advises you to be a savvy consumer when contacting any company; do not reveal identifying information against your will.

Submitted by Takeda

What is hemophilia?

Hemophilia is a rare genetic bleeding disorder that prevents blood from clotting normally.1

At the time of a bleed, proteins in your blood called clotting factors form a clot and stop the bleeding.2,3 However, if you have hemophilia, your blood lacks clotting factors (such as factors VIII and IX), and as a result, you may bleed for a longer time after an injury than you would otherwise.4,5

Replacing what’s missing

The current standard of care for hemophilia is factor replacement therapy.6 Factor therapy is a proven treatment with decades of real-world use and an established safety record.7,8

Factor therapy replaces the missing blood-clotting proteins that are naturally found in your blood.9 It is administered via an intravenous injection (directly into your bloodstream), making these proteins available immediately for use.

Factor therapy can be used in different situations such as on-demand (to treat an ongoing bleed), prophylaxis (to prevent bleeds before they occur), and before or after surgery.6,10

Other treatments for hemophilia

The first non-factor therapy option more recently became available.11 To reduce bleeding, it mimics part of the function of missing clotting proteins by bridging other factors. It is administered subcutaneously and is intended for prophylactic use.

Individualizing your treatment with factor

With factor treatment, your healthcare provider (HCP) can individualize your regimen to align with your unique needs and help you achieve treatment goals.

When determining an appropriate treatment plan, your HCP looks at how factor is processed in your body; this is called pharmacokinetics (PK).13 Many factors such as body weight, age, joint status, activity levels, and bleeding frequency are used to better understand how much and how often you require factor.12

A treatment tailored to your lifestyle and activities may help make it easier for you to stick to your prophylaxis. This may help preserve your joint health by significantly reducing bleeding.12

CASE STUDY

Individualizing factor therapy can make a world of difference

Josh
Age 15 years

Josh is an active teen who enjoys playing sports. He is currently taking factor every other day (25 IU/kg) but has recently been experiencing more bleeds, particularly in his ankles. At his HCP visit, Josh mentions that he has increased his tennis practice from once weekly to 3 nights/week.

Due to an increase in Josh’s activity level, and a considerable growth spurt, he may not always be receiving optimal coverage from his current dosing regimen. His HCP recommended adjusting Josh’s dose of factor VIII and changing his infusion schedule.

After taking a few blood samples, they were able to determine what Josh’s factor levels would be at various time points following an infusion. They agreed to an individualized dosing schedule that was appropriate for Josh’s current activity level. Josh’s new dose is 35 IU/kg three times a week.

Since switching to the new dosing schedule, Josh’s bleeding has been reduced even with his increased activity.

 

 

 

 

 

 

 

 

 

Visit bleedingdisorders.com for more information about hemophilia and individualized factor therapy.

Supporting literature:

  1. Livnat T, Barg AA, Levy-Mendelovich S, Kenet G. Rare bleeding disorders—old diseases in the era of novel options for therapy. Blood Cells Mol Dis. 2017;67:63-68.
  2. Smith SA, Travers RJ, Morrissey JH. How it all starts: initiation of the clotting cascade. Crit Rev Biochem Mol Biol. 2015;50(4):326-336.
  3. Berg JM, Tymoczko JL, Stryer L. Many enzymes are activated by specific proteolytic cleavage. Biochemistry. 5th ed. New York, NY: WH Freeman; 2002. https://www.ncbi.nlm.nih.gov/books/NBK22589/. Accessed April 18, 2019.
  4. Hemophilia. National Heart, Lung, and Blood Institute (NHLBI). https://www.nhlbi.nih.gov/health-topics/hemophilia. Accessed April 17, 2019.
  5. Hemophilia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hemophilia/symptoms-causes/syc-20373327. Accessed April 17, 2019.
  6. Rodriguez-Merchan EC. What’s new in orthopedic surgery for people with hemophilia. Arch Bone Jt Surg. 2018;6(3):157-160.
  7. Pipe SW. New therapies for hemophilia. Hematology Am Soc Hematol Educ Program. 2016;(1):650-656.
  8. Franchini M. Current management of hemophilia B: recommendations, complications and emerging issues. Expert Rev Hematol. 2014;7(5):573-581.
  9. Rolstad EB. Perceptions of men with moderate to severe hemophilia regarding the management of their chronic disorder and utilization of community-based support. Am J Mens Health. 2015;9(6):486-495.
  10. Peyvandi F, Garagiola I, Young G. The past and future of haemophilia: diagnosis, treatments, and its complications. Lancet. 2016;388(10040):187-197.
  11. National Hemophilia Foundation. MASAC document #255. Available at: www.hemophilia.org. Accessed May 2, 2019.
  12. Valentino LA. Considerations in individualizing prophylaxis in patients with haemophilia A. Haemophilia. 2014;20(5):607-615.
  13. Pharmacokinetics. The Free Dictionary by Farlex. http://medicaldictionary.thefreedictionary.com/pharmacokinetics. Accessed April 17, 2019.
Commitment to our community is always a priority for Takeda Hematology (previously part of Shire and Baxalta). As a leader in hemophilia research, Takeda continues to innovate on your behalf, developing programs and services that support your efforts each step of the way. Takeda is focused on providing advanced hematology treatments for today and innovating for the future.

Copyright © 2019 Takeda Pharmaceutical Company Limited. All rights reserved. All trademarks are the property of their respective owners.

S48266 05/19

Patient Newsletter Article 20190226 0.6

When to Suspect an Inhibitor

Laurie Kelley June 16, 2019

Let’s face it: an inhibitor is a major complication of hemophilia. It develops when the body’s immune system does not recognize infused factor as a normal part of blood. Instead, the body thinks that factor is a foreign invader, like a virus or germ, and it develops antibodies to attack the factor and make it harmless—and useless. So despite an infusion of factor, your child continues to bleed. Prolonged bleeding, even after a factor infusion, is the most common sign that your child may have an inhibitor. But other symptoms may also tip you off.

Unresolved bleeds

You may suspect an inhibitor the hard way: when factor no longer works well to stop bleeds. If you’re new to hemophilia, this may be difficult to judge—how long should it take for a bleed to stop after an infusion? It may not immediately dawn on you that the infused factor isn’t working properly, especially if your child is already well into a muscle or joint bleed. It’s common for parents to think that they simply need to give their child more frequent infusions, or give a higher dose per infusion. If you think your child’s bleed is not resolving normally, or wonder whether you should dose higher or more frequently, please call your hemophilia treatment center (HTC).

Increased bruising

Bruising in young children with severe hemophilia is common. But if your child is on prophylaxis and you notice increased bruising, this may be a sign of an inhibitor.

Routine clinic visit

A blood test at your child’s HTC comprehensive clinic visit can identify an inhibitor. Low-level inhibitors are often diagnosed in this way. It’s wise to have a child with hemophilia tested for inhibitors routinely. Learning that he has an inhibitor prior to surgery or a major bleed allows parents to have a plan in place and the correct treatment on hand.

Breakthrough bleeds while on prophylaxis

Prophylaxis is the scheduled infusion of factor to help prevent bleeding. Many children with hemophilia on prophylaxis receive factor two to three times a week, enough to allow circulating factor to prevent most spontaneous bleeds and abnormal bruising. When a child on prophy starts bruising or bleeding more often than usual, an inhibitor may be inactivating some of the factor, lowering his factor level and increasing his risk of bleeding.

Bleeding after surgery

Any kind of surgery on a child with hemophilia requires careful planning and monitoring of factor levels, and any child who continues to bleed following surgery, even with adequate factor, should be immediately tested for an inhibitor. Ideally, all children with hemophilia should be tested for an inhibitor before any surgery. If you see any kind of bleeding following surgery, call your HTC immediately.

Reaction following infusion

An allergic reaction is a response by the immune system to environmental contaminants such as pollen, animal dander, or food. It can also happen after an infusion of factor. Symptoms may include sneezing; itching; hives; rapid swelling of the skin, neck or face; wheezing; faintness; fast heart rate; low blood pressure. Allergic reactions are especially worrisome with hemophilia B. An allergic reaction after a factor IX infusion is sometimes the first sign that an inhibitor to factor IX has developed. A whopping 45% of people with hemophilia B and inhibitors also develop allergic reactions at about the same time that they develop inhibitors.

Don’t downplay allergic reactions. They may start out mild but then increase in severity after repeated exposure to products containing factor IX, often to a serious, life-threatening allergic reaction called anaphylaxis. If your child has severe hemophilia B, his first 20 infusions of factor IX concentrate should be done in a hospital or clinic with expertise in treating severe allergic reactions.

Following a major bleed or emergency

Whenever your child receives large amounts of factor—in response to a major bleed or during and after surgery—he may be at higher risk of developing an inhibitor. Experts aren’t sure if large amounts of factor stimulate inhibitor development, or if the body is more susceptible to inhibitor development during a medical crisis because the immune system is on high alert. But whatever the reasons, be aware that the risk of developing an inhibitor is slightly higher during an illness or surgery.

Later in life

If a person with hemophilia develops an inhibitor, it’s usually while he’s a child, almost always before exposure day 100. And he probably has severe hemophilia. But in rare cases, an inhibitor develops in a teen or an adult—usually in people with mild or moderate hemophilia, and usually after intensive exposure to factor during and after surgery or traumatic injury.

Inhibitors are scary to contemplate. Even when your child passes exposure day 100, don’t be lulled into thinking that he may never develop one. You can always request an inhibitor test from your HTC. Never try to diagnose on your own, or change your child’s dosing regimen on your own.

In your favor? A great array of educational resources, listed in this issue, and a wonderful team of medical experts. Don’t be afraid! Be proactive, just as you were when you learned about hemophilia. Inhibitors are one obstacle to overcome on your family’s hemophilia journey.

PEN 2.11     © 2011 LA Kelley Communications

The Joy of Giving

Laurie Kelley June 9, 2019

“Fundraising is a systematic, coordinated effort inviting people to experience the joy of giving.” Aly Sterling

Last weekend, June 1, I was in New Orleans at the Hope for Hemophilia spring leadership weekend and gala, at the invitation of its president, Jonathan James, who has hemophilia. Hope for Hemophilia is a nonprofit that does in the US what we at Save One Life do overseas: provide direct financial aid for families with bleeding disorders who need assistance. While we have never worked together formally, I sometimes get requests for help here in the US: a plea for rent to be paid for the month, or a heating bill, car payment, co-pay. Even college tuition. I typically will forward the request to Hope first, or maybe HFA’s Helping Hands program, but if the person has already tapped out there, we will try to help them.

There is such joy in giving. Not so much like Christmas gifts or graduation gifts, but a gift that helps a person get ahead in life. A gift with no strings attached, often to a stranger.

Save One Life does this; Hope for Hemophilia does this. And this time, Hope did it to me. Gave me a gift, no strings attached.

Jonathan had not prepared me for the gala, though I had heard it was the most elegant event in hemophilia in the country. Black tie and gowns, everyone was dressed for a ball, and the theme was masquerade. Many people bought charming masquerade masks to cover just their faces, á la Phantom of the Opera.

Doug and I walked arm in arm up a huge flight of stairs to the ballroom, which had such a high ceiling, it felt like a canopy of stars at night. Each of the many tables had huge candelabras; everything was donned in purple, giving it a mysterious, Houdini feel. We sat with Jonathan’s parents, who were charming, and another family, who were founding members of Hope.

The gift Hope for Hemophilia gave to me that night was not just their Legacy Award, lovely in itself, but a beautiful video, narrated and sincere, which chronicled my story from the birth of my son, to my books, to my work overseas. I was stunned. No one had ever paid this type of tribute to me before. I don’t even have time to organize my own photos; how did they do this? How did they have the time, when they had an entire gala, with over one hundred guests, dancers, music, silent auction…

(See the video here)

It made me realize two things: 1) We truly honor whatever we spend time on. Hope for Hemophilia recognized the time and energy I’ve sent the past 30 years in the community, and I was honored with this amazing video. 2) Giving without any expectation of return. I’ve never donated to Hope for Hemophilia, as I have my own nonprofit to fund. And I give away funding to those in need directly. Jonathan James gave me an award and a video as a gift, pure and simple. And it was so profound. I was very humbled by this gesture.

In my acceptance speech, I touched upon this theme. We are put on this earth, I believe, to give without expectation of return on investment. We give because it’s the right thing to do. Because another human being is in need. And what we get in return whether it is immediate or somewhere down the road, or maybe even in the next life, is worth so much more than the gift!

That very week, on Tuesday, a handsome, fit young man of 20 showed up in the Save One Life office. Owen is from Kenya and he wanted to meet Save One Life, since we operate in Kenya. In speaking with him, I found out he also wanted to thank me; 18 years before, he was a two-year-old, in the public hospital, bleeding. There was no factor in Kenya. His doctor, who I know, made a request to us, and we shipped the factor . He was infused, healed and was sent home. Now he is in my home state, studying to be a physical therapist so he can one day work with hemophilia patients.

He came to thank me; I was the one who had sent him that factor, 18 years ago. Amazing!

And his gift to me? He will join our board of directors to represent Africa.

Thanks to Jonathan James, Porter Snow and everyone at Hope for Hemophilia for their generous programs, their sincerity in wanting to make the world a better place, and their goodwill and positivity. Thank you for an amazing weekend. I’m pleased to know we share the same values and outlook, and desire to help, and I would love to work with them in the future.

Please be sure to give, without expectations, and experience the pure joy of it!

See the video here.

When Donating Factor

Laurie Kelley June 2, 2019

“I only want to help…”

It’s disturbing when we see the photo of an impoverished African child with hemophilia who is in pain or has chronic joint damage.

And we feel helpless when we get a Facebook request for factor from a desperate young man with hemophilia in Asia. As patients, we can feel their pain. As parents of children with bleeding disorders, we want to alleviate their suffering. Yet in our desire to do good, we may end up doing something not so good. We may send factor, on our own, to a place we’ve never visited, to people we don’t know. But won’t our generosity help them? What could be wrong with that?

 Plenty.

In our efforts to help, we may make several serious mistakes.

Here’s what to look for if you receive an international request for help.

Laurie Kelley with family in
Pondicherry, India

Is the request for real?

This is your first question. Just because someone says he has hemophilia and needs factor, this doesn’t mean he actually does. At Project SHARE, we do extensive background checks with the local physicians and hemophilia organization (if there is one) to verify the need. And even if the request is valid, don’t forget that English is not the first language in most developing countries; it’s easy to get request mix-ups, dosage errors, even incorrect diagnoses.

SHARE keeps reference files on every one of the hundreds we have helped. We must be sure we have valid and accurate information. If you are approached, always realize that there may be missing information, so ask questions. We always ask for diagnosis, physician’s name and contact info, whether the patient knows how to self-infuse, and how far he lives from an HTC, for starters.

Should a private citizen ship factor?

Factor is a biological drug that requires careful shipping and handling. It’s expensive to ship and must travel via international carrier, such as FedEx. Factor can’t be left on trucks, on planes, or in warehouses. And addresses can be tricky overseas!

In India, for example, one of my favorite addresses is “Next to Camel Lot, behind Cinema.”

Are you familiar with the country’s customs laws? Who will pay the duties, or the tax on the shipment? It may even be illegal for you to ship these products; do you know the penalties for shipping a prescription drug over international borders? If you are employed by a hemophilia organization or HTC, are you putting that entity at risk? Whether you’re a private citizen or employed by a healthcare agency, if you are unsure about duties, penalties, and costs, don’t take the risk—don’t ship.

Getting an infusion of Project SHARE factor in
Vijayawda, India

What if the person is asking to come to the States for treatment?

Just say no. Most medical problems related to bleeding disorders can be handled locally, in the country’s capital. India and Pakistan, for example, have some of the best hematologists on earth. The biggest obstacle to care is often not the lack of doctors or expertise, but the lack of factor. At Project SHARE, we’ve found that many requests to come to the States are not for treatment but for job opportunities, college, or the chance to join relatives, either legally or illegally. Hemophilia is a ticket to get in. Be careful!

“It’s an emergency!”

Emergencies are hard to fix. Often, by the time Project SHARE ships factor, the emergency has passed—for better or worse. Declaring an emergency is sometimes a way for a patient, HTC, or hemophilia organization to acquire donated factor; whether it will be used for the emergency remains to be seen. We must assess the nature of the emergency to see whether a shipment will even help.  If it’s surgery that can wait five days, then we can ship. Once, we saw a devastating photo of a baby in ICU with a head bleed…and we knew no factor shipment was going to help. We declined.

Check locally first.

All requests should first be vetted through the local and/or national hemophilia organization in a country. India has more than 65 chapters, so local is best. By contrast, the Dominican Republic has only one national organization. You can hop online and check the World Federation of Hemophilia’s website (www.wfh.org) to get the name and email of a national organization. But with over 100 member countries, this can be time-consuming and may not produce all the info you need.

Not speaking the patient’s local language may make it hard to communicate! At Project SHARE, we’ve found that we can resolve a lot of questions by informing the local organizations, whose staff often speak English, about requests that are coming from their members directly to the United States. Our goal is never primarily to “rescue” a patient, but to turn the request back to the national organization, to allow it a chance to help, and to strengthen its ability to solve problems.

Social media like Facebook creates connections between the developed and developing world. At SHARE we’ve seen many requests for factor and medical help come through Facebook to nice—but often inexperienced—hemophilia families and organizations who want to help. Americans are generous but aren’t always familiar with the international world. Be careful. Don’t risk losing a shipment of factor. Don’t weaken the local or national groups by training patients to come to you first instead of to the national organizations. Don’t be duped by people who end up getting the lion’s share of donated factor because they know how to use Facebook and email—people who pump out simultaneous requests to many developed countries and organizations.

What can you do that will really help?

Contact Project SHARE. We have been working with more than 65 countries for 17 years, and we’ve shipped over 144 million IU of factor. We’ve seen and heard just about every scenario, and we can make decisions about factor that will give help where it’s most needed, strengthen the national or local hemophilia organizations, and ensure that factor goes to patients with bleeding disorders. Consider us your US experts on hemophilia international aid. Like you, we want to help. Let us help you give help, effectively and efficiently.

© The Parent Empowerment Newsletter (PEN) 02.13  Subscribe for free at www.kelleycom.com .

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