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{{Hemophilia}}
{{Hemophilia}}
{{CMG}}; {{AE}} {{Simrat}}
{{CMG}}; {{AE}} {{Sab}}
==Overview==
==Overview==
Genetic counseling is recommended for hemophilia carrier families.  
Initial [[Screening (medicine)|screening]] [[blood]] investigations for any [[child]] with suspected [[Coagulopathy|bleeding disorder]] include [[platelet]] count, [[Prothrombin time|prothrombin time (PT)]], [[Activated partial thromboplastin time|activated partial thromboplastin time (aPTT)]], and [[fibrinogen]] [[test]]. [[Chorionic villus sampling]] at 11-14 weeks of [[gestation]] can be performed for the [[Genetics|genetic]] [[diagnosis]] of hemophilia.
 
==Screening==
==Screening==
Genetic counseling is recommended in hemophilia carrier families. Genetic counselors provide information and support for carriers and their families, before they conceive a child, and after the unpredicted birth of a son with hemophilia.
*Initial [[Screening (medicine)|screening]] [[blood]] investigations for any [[child]] with suspected [[Coagulopathy|bleeding disorder]] include [[platelet]] count, [[Prothrombin time|prothrombin time (PT)]], and [[Activated partial thromboplastin time|activated partial thromboplastin time (aPTT)]], and [[fibrinogen]] [[test]].<ref name="pmid30129541">{{cite journal |vauthors=Sachdeva A, Gunasekaran V, Ramya HN, Dass J, Kotwal J, Seth T, Das S, Garg K, Kalra M, Sirisha RS, Prakash A |title=Consensus Statement of the Indian Academy of Pediatrics in Diagnosis and Management of Hemophilia |journal=Indian Pediatr |volume=55 |issue=7 |pages=582–590 |date=July 2018 |pmid=30129541 |doi= |url=}}</ref><ref name="pmid17605969">{{cite journal |vauthors=Kamal AH, Tefferi A, Pruthi RK |title=How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults |journal=Mayo Clin. Proc. |volume=82 |issue=7 |pages=864–73 |date=July 2007 |pmid=17605969 |doi=10.4065/82.7.864 |url=}}</ref><ref>https://www.cdc.gov/ncbddd/hemophilia/diagnosis.html</ref>
===Hemophilia can be diagnosed before, during or after birth if there's a family history of the condition. Several options are available to parents.===
*Bethesda assay (to detect and quantify factor VIII [[antibodies]] in acquired hemophilia)<ref name="pmid30653138">{{cite journal |vauthors=Qian L, Ge H, Hu P, Zhu N, Chen J, Shen J, Zhang Y |title=Pregnancy-related acquired hemophilia A initially manifesting as pleural hemorrhage: A case report |journal=Medicine (Baltimore) |volume=98 |issue=3 |pages=e14119 |date=January 2019 |pmid=30653138 |doi=10.1097/MD.0000000000014119 |url=}}</ref><ref name="pmid23546724">{{cite journal |vauthors=Duncan E, Collecutt M, Street A |title=Nijmegen-Bethesda assay to measure factor VIII inhibitors |journal=Methods Mol. Biol. |volume=992 |issue= |pages=321–33 |date=2013 |pmid=23546724 |doi=10.1007/978-1-62703-339-8_24 |url=}}</ref>
If there's no family history of hemophilia, it's usually only diagnosed when a child begins to walk or crawl. They may experience joint bleeds or easy bruising.
*[[Chorionic villus sampling]] at 11-14 weeks of [[gestation]] can be performed for the [[Genetics|genetic]] [[diagnosis]] of hemophilia.<ref name="pmid30129541">{{cite journal |vauthors=Sachdeva A, Gunasekaran V, Ramya HN, Dass J, Kotwal J, Seth T, Das S, Garg K, Kalra M, Sirisha RS, Prakash A |title=Consensus Statement of the Indian Academy of Pediatrics in Diagnosis and Management of Hemophilia |journal=Indian Pediatr |volume=55 |issue=7 |pages=582–590 |date=July 2018 |pmid=30129541 |doi= |url=}}</ref>
Mild hemophilia may only be discovered later, usually after an injury or a dental or surgical procedure.
===Tests before pregnancy===
Genetic testing and counseling are available to help determine the risk of passing the condition onto a child.
This may involve testing a sample of your tissue or blood to look for signs of the genetic [[mutation]] that causes hemophilia.
===Tests during pregnancy===
If you become pregnant and have a history of hemophilia in your family, tests for the hemophilia [[gene]] can be carried out. These include:
*[[Chorionic villus sampling (CVS)]] – a small sample of the placenta is removed from the womb and tested for the hemophilia [[gene]], usually during weeks 11-14 of pregnancy
*[[Amniocentesis]] – a sample of amniotic fluid is taken for testing, usually during weeks 15-20 of pregnancy.
*[[PUBS (percutaneous umbilical blood sampling)]]- PUBS directly tests the blood of the unborn baby. It is done after the 20th week of pregnancy. The doctor takes blood from the umbilical vein which runs from the baby to the placenta. The test results are ready in just a few days. <ref>{{Cite web | title = Hemophilia screening| url =http://www.nhs.uk/Conditions/Haemophilia/Pages/Diagnosis.aspx }}</ref>
There's a small risk of these procedures causing problems such as miscarriage or premature labour, so you may want to discuss this with the doctor in charge of your care.


===Tests after birth===
If hemophilia is suspected after your child has been born, a blood test can usually confirm the diagnosis. Blood from the umbilical cord can be tested at birth if there's a family history of hemophilia. A blood test will also be able to identify whether your child has hemophilia A or B, and how severe it is.
<ref>{{Cite web | title = Hog handbook Hemophilia screening| url =http://www.hog.org/handbook/article/1/3/testing-for-hemophilia }}</ref>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 18:05, 29 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Initial screening blood investigations for any child with suspected bleeding disorder include platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen test. Chorionic villus sampling at 11-14 weeks of gestation can be performed for the genetic diagnosis of hemophilia.

Screening

References

  1. 1.0 1.1 Sachdeva A, Gunasekaran V, Ramya HN, Dass J, Kotwal J, Seth T, Das S, Garg K, Kalra M, Sirisha RS, Prakash A (July 2018). "Consensus Statement of the Indian Academy of Pediatrics in Diagnosis and Management of Hemophilia". Indian Pediatr. 55 (7): 582–590. PMID 30129541.
  2. Kamal AH, Tefferi A, Pruthi RK (July 2007). "How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults". Mayo Clin. Proc. 82 (7): 864–73. doi:10.4065/82.7.864. PMID 17605969.
  3. https://www.cdc.gov/ncbddd/hemophilia/diagnosis.html
  4. Qian L, Ge H, Hu P, Zhu N, Chen J, Shen J, Zhang Y (January 2019). "Pregnancy-related acquired hemophilia A initially manifesting as pleural hemorrhage: A case report". Medicine (Baltimore). 98 (3): e14119. doi:10.1097/MD.0000000000014119. PMID 30653138.
  5. Duncan E, Collecutt M, Street A (2013). "Nijmegen-Bethesda assay to measure factor VIII inhibitors". Methods Mol. Biol. 992: 321–33. doi:10.1007/978-1-62703-339-8_24. PMID 23546724.

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