Use of telehealth in the delivery of comprehensive care for patients with haemophilia and other inherited bleeding disorders.

Advances in technology such as telemedicine (TM) have made access to cost-effective, quality health care feasible for remote patients. TM is especially well suited for patients with chronic disorders such as haemophilia and related haemostatic disorders that benefit not only from more frequent interaction with care providers at a specialized haemophilia treatment center but also from consultations with other specialists. Telehealth refers to a broader application of TM and includes non-clinical services such as education, provider training, administrative meetings etc. Collaboration with the local primary care provider for management and implementation is key for successful and sustainable TM. This review article provides an overview of types of telemedicine, technical aspects, its benefits and challenges and focuses on the applicability of this technology to persons with bleeding and other blood disorders. Examples of TM strategies, process flow of TM clinic and experiences at the authors haemophilia treatment center (HTC) setting are shared. In addition, mobile health (mHealth) and electronic health (eHealth), both a part of telehealth, and their applications are briefly described. Clearly, widespread adoption of this technology will not only enhance care of patients but will enable more people, especially in underserved areas, to receive specialty care.

Inherited disorders of hemostasis in dogs and cats.

Inherited disorders of hemostasis encompass abnormalities in primary hemostasis, coagulation, and fibrinolysis resulting from genetic mutations. There is significant variation in the phenotype expressed ranging from life limiting to the absence of overt clinical signs. Von Willebrand disease is the most common primary hemostatic disorder in dogs, and hemophilia A is the most common coagulation factor disorder. The diagnosis of inherited bleeding disorders is made by functional and/or quantitative evaluation. Genetic testing has added to the knowledge base, allowing prevention through targeted breeding. Avoidance of trauma and injury is paramount in the prevention of bleeding in animals diagnosed with inherited hemostatic disorders. Current therapeutic options include platelet transfusions, broad replacement of coagulation factors (e.g., plasma), targeted factor replacement (e.g., cryoprecipitate), antifibrinolytic agents and specific factor replacement, and treatment of the symptoms (i.e., bleeding) with blood transfusions.

Health-related hardiness in individuals with chronic illnesses.

The aims of this study were to (a) describe health stressors, health-related hardiness, perception of illness impact, self-perception of health status, and psychosocial adjustment to illness in individuals living with an inherited bleeding disorder; (b) determine relationships between health stressors, health-related hardiness, perception of illness impact, self-perception of health status, and psychosocial adjustment to illness; and (c) determine if perception of illness impact had a direct and/or mediating effect on the relationship between health stressors, health-related hardiness, and self-perception of health status and psychosocial adjustment to illness. A cross-sectional survey design was used. Sixty participants composed the sample. Participants completed five questionnaires. Higher health stressors were associated with higher perception of illness impact, lower perception of health status, and poorer psychosocial adjustment to illness. Individuals with higher perception of illness impact were associated with lower self-perception of health status and poorer psychosocial adjustment to illness.

Focus on factors.

Recombinant factor VIII concentrates used in the treatment of hemophilia A have provided freedom from human viral contamination for hemophiliacs who rely on frequent infusions to control bleeding. This article provides a historical perspective on the treatment of the various hemophilia types and current treatment methods for these and other inherited coagulopathies. Therapy complications associated with replacement factors and patient management issues will be addressed.