BACKGROUND: Patients with hemophilia (PWH) develop hemophilic arthropathy of the major joints due to recurrent hemarthrosis. This study retrospectively estimated the age at which PWH may expect to develop hemophilic arthropathy and undergo joint replacement surgery. RESEARCH DESIGN AND METHODS: Using retrospective data from PWH at a Czech orthopedic center, Kaplan Meier analyses were used to estimate the cumulative proportions of patients with hemophilic arthropathy and undergoing joint replacement surgery as a function of age. RESULTS: Based on 1028 joint examinations in 167 PWH, hemophilic arthropathy of the knees, elbows, ankles and hips was estimated to develop by a median age of 48, 51, 52 and 61 years, respectively, with ≈80% of patients having such damage by ≈70 years of age. Hemophilic arthropathy of the shoulder occurred much later (median >80 years). In patients undergoing knee or hip replacement surgery, hemophilic arthropathy of the knee and hip occurred at a median age of ≈50 and ≈60 years, respectively, with replacement surgery occurring at a median of ≈70 and >75 years. CONCLUSIONS: In PWH, the risk of developing hemophilic arthropathy accumulates continuously over the patient's lifetime, allowing predictions about the ages at which such damage and joint replacement surgery may occur.
- MeSH
- hemartróza diagnóza etiologie MeSH
- hemofilie A * komplikace MeSH
- kolenní kloub MeSH
- lidé středního věku MeSH
- lidé MeSH
- loketní kloub * MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
A single-center study was conducted on 120 patients with inherited disorders of primary hemostasis followed at our hematological center. These patients presented a variety of bleeding symptoms; however, they had no definitive diagnosis. Establishing a diagnosis has consequences for the investigation of probands in families and for treatment management; therefore, we aimed to improve the diagnosis rate in these patients by implementing advanced diagnostic methods. According to the accepted international guidelines at the time of study, we investigated platelet morphology, platelet function assay, light-transmission aggregometry, and flow cytometry. Using only these methods, we were unable to make a definitive diagnosis for most of our patients. However, next-generation sequencing (NGS), which was applied in 31 patients, allowed us to establish definitive diagnoses in six cases (variants in ANKRD26, ITGA2B, and F8) and helped us to identify suspected variants (NBEAL2, F2, BLOC1S6, AP3D1, GP1BB, ANO6, CD36, and ITGB3) and new suspected variants (GFI1B, FGA, GP1BA, and ITGA2B) in 11 patients. The role of NGS in patients with suspicious bleeding symptoms is growing and it changes the diagnostic algorithm. The greatest disadvantage of NGS, aside from the cost, is the occurrence of gene variants of uncertain significance.
- MeSH
- krevní proteiny genetika MeSH
- krvácení MeSH
- lidé MeSH
- trombocytopatie * diagnóza genetika MeSH
- vyšetření funkce trombocytů MeSH
- vysoce účinné nukleotidové sekvenování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Here, we present the first case of fibrinogen variant FGG c.8G>A. We investigated the behaviour of this mutated fibrinogen in blood coagulation using fibrin polymerization, fibrinolysis, fibrinopeptides release measurement, mass spectrometry (MS), and scanning electron microscopy (SEM). The case was identified by routine coagulation testing of a 34-year-old man diagnosed with thrombosis. Initial genetic analysis revealed a heterozygous mutation in exon 1 of the FGG gene encoding gamma chain signal peptide. Fibrin polymerization by thrombin and reptilase showed the normal formation of the fibrin clot. However, maximal absorbance within polymerization was lower and fibrinolysis had a longer degradation phase than healthy control. SEM revealed a significant difference in clot structure of the patient, and interestingly, MS detected several posttranslational oxidations of fibrinogen. The data suggest that the mutation FGG c.8G>A with the combination of the effect of posttranslational modifications causes a novel case of hypofibrinogenemia associated with thrombosis.
- MeSH
- afibrinogenemie * komplikace genetika MeSH
- dospělí MeSH
- fibrin metabolismus MeSH
- fibrinogen genetika metabolismus MeSH
- fibrinogeny abnormální * genetika metabolismus MeSH
- hemostatika * MeSH
- lidé MeSH
- oxidační stres MeSH
- posttranslační úpravy proteinů MeSH
- trombóza * komplikace genetika MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Congenital fibrinogen disorders are caused by mutations in genes coding for fibrinogen and may lead to various clinical phenotypes. Here, we present a functional and structural analysis of 4 novel variants located in the FGB gene coding for fibrinogen Bβ chain-heterozygous missense BβY416C and BβA68S, homozygous nonsense BβY345*, and heterozygous nonsense BβW403* mutations. The cases were identified by coagulation screening tests and further investigated by various methods. Fibrin polymerization had abnormal development with decreased maximal absorbance in all patients. Plasmin-induced fibrin degradation revealed different lytic phases of BβY416C and BβW403* than those of the control. Fibrinopeptide cleavage measured by reverse phase high pressure liquid chromatography of BβA68S showed impaired release of fibrinopeptide B. Morphological properties, studied through scanning electron microscopy, differed significantly in the fiber thickness of BβY416C, BβA68S, and BβW403*, and in the fiber density of BβY416C and BβW403*. Finally, homology modeling of BβA68S showed that mutation caused negligible alternations in the protein structure. In conclusion, all mutations altered the correct fibrinogen function or structure that led to congenital fibrinogen disorders.
- MeSH
- afibrinogenemie krev diagnóza genetika MeSH
- fenotyp * MeSH
- fibrinogen chemie genetika metabolismus MeSH
- genetická predispozice k nemoci * MeSH
- genetické asociační studie MeSH
- hemokoagulace MeSH
- konformace proteinů MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- molekulární modely MeSH
- mutace * MeSH
- mutační analýza DNA MeSH
- novorozenec MeSH
- senioři MeSH
- vyšetření krevní srážlivosti MeSH
- vztahy mezi strukturou a aktivitou MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: Acquired haemophilia A (AHA) is a rare autoimmune disorder, characterized by bleeds of varying severity caused by autoantibodies against factor VIII (FVIII). AIM: Identify risk factors associated with AHA-related deaths/relapses and assess the effect of increased corticosteroid doses. METHODS: AHA patients treated across two specialist centres in the Czech Republic, generally receiving first-line haemostatic therapy with rFVIIa and immunosuppression with corticosteroids/cyclophosphamide, were included. We analysed the association between early death (within 8 weeks of diagnosis [considered disease-related]) and age, malignancy, FVIII levels and bleeding severity. Risk factors associated with reduced 2-year survival and relapse incidence, and the effect of increased corticosteroid doses on early death and remission were also assessed. RESULTS: The demographics of the described cohort (n = 66) were similar to other AHA registries. Early death occurred in 20% of cases. Unlike age and malignancy, FVIII levels <1% and severe bleeding were associated significantly with early death (P = .010 and P = .046, respectively). Patients with underlying malignancy or requiring continued haemostatic therapy exhibited significantly decreased 2-year survival compared with those without these risk factors (P = .007 and P = .006, respectively). Patients with an underlying autoimmune disease relapsed significantly more than those without (P = .015). Higher corticosteroid doses were associated with a significantly increased incidence of early deaths (P < .001), but also with early remission (P < .001). CONCLUSION: Based on this rather large patient cohort, we were able to evaluate the significance of several risk factors associated with treatment outcomes in AHA and the effect of initial treatment with corticosteroids on survival and time to remission.
- MeSH
- analýza přežití MeSH
- autoimunitní nemoci komplikace MeSH
- autoprotilátky imunologie MeSH
- dospělí MeSH
- faktor VIIa aplikace a dávkování terapeutické užití MeSH
- faktor VIII antagonisté a inhibitory imunologie metabolismus MeSH
- hemofilie A komplikace farmakoterapie mortalita MeSH
- hormony kůry nadledvin škodlivé účinky terapeutické užití MeSH
- imunosupresiva aplikace a dávkování terapeutické užití MeSH
- indukce remise MeSH
- kohortové studie MeSH
- krvácení etiologie imunologie mortalita prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- recidiva MeSH
- rekombinantní proteiny aplikace a dávkování terapeutické užití MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- standardní péče statistika a číselné údaje trendy MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Fibrinogen je klíčový glykoprotein krevní koagulace, během níž je přeměňován na fibrin. Vrozená dysfibrinogenemie je choroba charakterizovaná funkční poruchou molekuly vedoucí k abnormální tvorbě fibrinu. Vrozená hypofibrinogenemie je vzácné onemocnění charakterizované sníženou hladinou funkčního i celkového fibrinogenu v plazmě. Vyšetřili jsme 36 nepříbuzných rodin z celé České republiky s diagnózou suspektní dysfibrinogenemie či afibrinogenemie. Čtyři pacienti měli trombotické komplikace, osm pacientů se manifestovalo krvácivě a ostatní byli asymptomatičtí. Genetické vyšetření odhalilo vrozenou mutaci u třinácti nepříbuzných rodin, u nichž způsobuje vrozenou dysfibrinogenemii. Pomocí genetických, proteomických a funkčních vyšetření bylo odhaleno osm případů dysfibrinogenemie v Aα řetězci, konkrétně se jedná o mutace Aα Arg16Cys; Aα Arg16His; Aα Gly13Glu; Aα Phe98Ile; Aα Asn106Asp; a kombinovanou mutaci Aα Gly13Glu a Aα Ser314Cys. Jeden případ byl nalezen v Bβ řetězci – Bβ Arg237Ser a čtyři případy byly odhaleny v γ řetězci – γ Ser313Gly, γ Tyr262Cys, γ Tyr363Asn a γ Arg275His. V jednom případě byla identifikována molekulární příčina vrozené afibrinogenemie. V jednom případě byla zjištěna příčina získané dysfibrinogenemie v souvislosti s produkcí autoprotilátek proti fibrinogenu u pacienta s mnohočetným myelomem.
Fibrinogen is a key glycoprotein of blood coagulation. During haemocoagulation fibrinogen is converted to fibrin. Congenital dysfibrinogenemia is a disease wherein an inherited abnormality in the fibrinogen molecule results in defective fibrin clot formation. Hereditary hypofibrinogenemia is a disease wherein an inherited abnormality in the fibrinogen molecule results in low fibrinogen level in plasma. 36 unrelated families in the Czech Republic suspected with either dysfibrinogenemia or afibrinogenemia were examined. Four patients presented with thrombosis, eight patients presented with bleeding tendencies and others were asymptomatic. Heterozygous point mutations Aα Arg16Cys (Fibrinogen Nový Jičín, Ostrava I), Aα Arg16His (Fibrinogen Praha II, Ostrava II), Aα Asn106Asp (Fibrinogen Plzeň), γ Tyr363Asn (Fibrinogen Praha III), γ Tyr262Cys (Fibrinogen Liberec) and γ Arg275His (Fibrinogen Brno) were found to be the direct causes of dysfibrinogenemias in the carriers. Molecular genetics experiments revealed inherited mutations in 13 unrelated families causing hereditary dysfibrinogenemia. In one case acquired dysfibrinogenemia secondary to multiple myeloma was found.
- Klíčová slova
- dysfibrinogenemie,
- MeSH
- afibrinogenemie * diagnóza epidemiologie genetika krev MeSH
- fibrinogen analýza chemie MeSH
- fibrinogeny abnormální analýza genetika MeSH
- fibrinolýza MeSH
- genetické testování MeSH
- lidé MeSH
- rodina MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Aeskulap
První vydání 389 stran : : tabulky ; ; 19 cm
- NLK Publikační typ
- kolektivní monografie
