Impact of Prophylaxis on Reducing the Risk of Neurological Problems Associated with Bleeding in Hemophilia A
Bleeding can also cause complications in the nervous system of hemophiliacs. The authors of the work presented below discuss the significance of prophylactic administration of factor VIII coagulation concentrates, specifically concerning neurological complications related to bleeding.
Bleeding Complications of Hemophilia A
Bleeding is the fundamental problem for individuals with hemophilia. Most commonly, it involves joint bleeding, but hemophiliacs can essentially bleed anywhere, including the central nervous system (CNS) or soft tissues with peripheral nerve compression. The incidence of intracranial hemorrhage has significantly decreased since the introduction of prophylactic administration of factors VIII or IX into clinical practice. The benefits of prophylaxis concerning other neurological problems have not yet been assessed.
Study Methodology
The cited work retrospectively evaluated the prevalence of CNS and peripheral nervous system (PNS) diseases related to bleeding in hemophiliacs treated at a regional center in Ceará, Brazil, from 1992 to 2018. Experts also compared the incidence of neurological disorders related to bleeding before (in 2011) and after the introduction of a prophylactic regimen into practice.
Results
Out of 75 evaluated individuals with hemophilia A, 10 (13.3%) had neurological problems—half in the CNS and half in the PNS. Patients receiving FVIII prophylaxis were less likely to have CNS events—between 1992 and 2011, CNS disease was recorded in 5 out of 63 patients, whereas after 2011, no patients experienced CNS bleeding (p = 0.02).
Between 2011 and 2018, authors observed 5 instances of PNS function impairment, all in patients without prophylaxis (n = 20); no disorders were observed in patients on prophylaxis (n = 29) (p = 0.008).
Conclusion
The authors conclude that the prevalence of neurological complications in individuals with hemophilia is similar to the results of other described studies. Prophylaxis reduces not only the risk of CNS bleeding but also those bleedings that impact the function of the peripheral nervous system.
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Source: Fernandes J. M. A., Gondim F. A. A., Dias A. M. N. et al. Factor VIII prophylactic therapy reduces neurological complications in patients with hemophilia A. Arq Neuropsiquiatr 2021 Dec; 79 (12): 1116–1122, doi: 10.1590/0004-282X-ANP-2020-0467.
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