Common themes and challenges in hemophilia care: a multinational perspective.

OBJECTIVE: To identify ways that provision of hemophilia care can be maximized at the local level, irrespective of available resources or cultural or geographic challenges. METHODS: The SHIELD group used its multinational experience to share examples of local initiatives that have been employed to deliver optimal hemophilia care. RESULTS: The examples were reviewed and categorized into four key themes: guidelines and algorithms for delivery of care; collaboration with patients and allied groups for care and education; registries for the monitoring of treatment and outcomes and health care planning and delivery; and opportunities for personalization of care. These themes were then incorporated into a road map for collaborative care in hemophilia that reflected the contribution of best practice. DISCUSSION: Differing healthcare reimbursement systems, budgetary constraints, and geographical and cultural factors make it difficult for any country to fully deliver ideal care for people with hemophilia. The SHIELD approach for collaborative care provides illustrative examples of how four key themes can be used to optimize hemophilia care in any setting. ABBREVIATIONS: AHCDC: Association of Hemophilia Clinic Directors of Canada; AICE: Italian Association of Hemophilia Centres; ATHN: American Thrombosis and Hemostasis Network; EAHAD: European Association for Haemophilia and Allied Disorders; EHC: European Hemophilia Consortium; FIX: Coagulation Factor IX; FVIII: Coagulation Factor VIII; HAL: Haemophilia Activity List; HJHS: Haemophilia Joint Health Score; HTC: Hemophilia Treatment Centre; HTCCNC: Hemophilia Treatment Centre Collaborative Network of China; MASAC: Medical and Scientific Advisory Council; MDT: Multidisciplinary team; NHD: National Haemophilia Database; NHF: National Hemophilia Foundation; PK: Pharmacokinetics; POCUS: Point of care ultrasound; PWH: People with haemophilia; SHIELD: Supporting Hemophilia through International Education, Learning and Development; WFH: World Federation of Hemophilia.

[Erythrocyte indices and iron stores in cord blood]. / Paramètres érythrocytaires et réserves en fer dans le sang du cordon.

BACKGROUND: Reevaluation of normal red cell values in the cord blood is necessary since these values were established before the use of automated analysers and the introduction of iron supplementation during pregnancy. POPULATION AND METHODS: Cord blood samples from all healthy babies from Monday to Friday for 2 months have been analysed for red cell count and red cell indices, hemoglobin concentration, hemoglobin electrophoresis, serum and erythrocyte ferritin concentration. The results were compared for the mothers to age, parity and duration of iron supplementation and for the neonates to gestational age and birth weight. RESULTS: One hundred and fifty-nine neonates were studied; 87% of their 154 mothers had been given iron during pregnancy. Mean red cell indices were found to be slightly below those of previous reports in the literature. They were associated with mean ferritin concentrations of 135 micrograms/l and 348 ag/cell for plasma and erythrocytic ferritin, respectively. CONCLUSION: There were no correlations between red cell indices and ferritin values in such an iron-repleted population.