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      Management of COVID-19 Coagulopathy in a Patient with Severe Haemophilia A

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          Abstract

          A 54-year-old man with a long history of severe haemophilia A treated prophylactically with efmoroctocog alpha (3,000 IU twice weekly) was diagnosed with COVID-19 infection. He had multiple risk factors for COVID-19 severity including obesity, diabetes mellitus and hypertension. He required prolonged intensive care unit (ICU) stay due to the severity of respiratory failure until his death on day 24. During his ICU stay, he received a continuous infusion of efmoroctocog alpha in order to maintain factor VIII activity between 80 and 100%, together with therapeutic doses of low-molecular-weight heparin targeting anti-Xa activity above 0.5 IU/mol. He tolerated numerous invasive procedures without bleeding. At post-mortem examination, there was no evidence for thrombosis or haemorrhage in the different organs.

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          Hemorrhagic Problem Among the Patients With COVID-19: Clinical Summary of 41 Thai Infected Patients

          In late December 2019, a new emerging infectious disease, coronavirus disease 2019 (COVID-19), started in China. 1 The disease already spread to more than 40 countries at present (February 29, 2020). Thailand is the second country that was affected by this new disease. 2 Focusing on clinical presentation of this new coronavirus infection, the main clinical presentation is acute febrile illness with pulmonary complications. In clinical hematology, the effect of the infection is reported. Leukopenia is a common clinical blood picture. 3,4 Regarding the alteration of coagulation system, decreased platelet count and prothrombin time is observable. 3,4 In fact, this is similar observation to that seen in a previous emerging coronavirus infection, Middle East respiratory syndrome. 5 Nevertheless, there is still no report regarding hemorrhagic problem in the patients with COVID-19. Here, the authors would like to present observation from Thailand on 41 patients (4 males and 37 females, age between 7 and 74 years) with COVID-19 in Thailand (based on most update data at February 29, 2020). The diagnosis of COVID-19 was done by real-time polymerase chain reaction molecular diagnosis and reconfirmed for positive by 2 referencing molecular diagnosis laboratory. All presented with febrile illness and pneumonia within 14 days after history of exposure and the direct human to human contact is mode of transmission. Of these patients, there is no death case (at present, 28 are discharged after complete recovery from illness and 13 are still hospitalized). All of these patients received standard respiratory care in isolate clinical pulmonary unit. Of interest, there is a patient (2.44%) with bleeding presentation, petechiae. For this case, there is no specific additional treatment for hemorrhagic problem. This patient was firstly missed diagnosed to be dengue and cause local transmission to a medical worker. 6 It is recommended that the practitioner should recognize that hemorrhagic problem might be an initial presentation of COVID-19. Also, investigation and follow-up for possible hemorrhagic problem in patient with COVID-19 is recommended.
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            Impact of augmented renal clearance on enoxaparin therapy in critically ill patients

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              In‐hospital management of persons with haemophilia and COVID‐19: practical guidance

              Abstract A new disease (COVID‐19) caused by a coronavirus (SARS‐CoV‐2) that appeared in China at the end of 2019 is currently spreading globally. This emerging virus is mainly responsible for respiratory tract infections and potentially fatal pneumonia, mainly in more frail patients. Persons with haemophilia of variable severity and from all parts of the world will likely be infected and develop COVID‐19. We here propose practical guidance for the in‐hospital specific management of haemophilia persons with COVID‐19 including their possible transfer to intensive care unit. Rapid identification of the haemophilia status, undelayed and regular liaison with the haemophilia team, proper therapy with factor concentrates or alternative treatments appear instrumental to prevent haemophilia‐related complications in this setting. Information of patients and their families about COVID‐19, psychological support and good appreciation of the impact of haemophilia on therapeutic decisions including end of life directives are also addressed.
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                Author and article information

                Journal
                AHA
                Acta Haematol
                10.1159/issn.0001-5792
                Acta Haematologica
                S. Karger AG
                0001-5792
                1421-9662
                25 September 2020
                :
                :
                : 1-3
                Affiliations
                aDepartment of Intensive Care, Cliniques St-Luc, Université Catholique de Louvain, Brussels, Belgium
                bDepartment of Haematology, Cliniques St-Luc, Université Catholique de Louvain, Brussels, Belgium
                Author notes
                *Philippe Hantson, Department of Intensive Care, Cliniques St-Luc, Avenue Hippocrate, 10, BE–1200 Brussels (Belgium), philippe.hantson@uclouvain.be
                Article
                510591 Acta Haematol
                10.1159/000510591
                32980842
                © 2020 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Pages: 3
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/510591
                Self URI (journal page): https://www.karger.com/Tap/Home/278492
                Categories
                Case Report

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