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Semin Thromb Hemost 2009; 35(8): 820-826
DOI: 10.1055/s-0029-1245115
© Thieme Medical Publishers

Management of Hemophilia in Patients with Inhibitors: The Perspective from Developing Countries

Vikram Mathews1 , Sukesh C. Nair1 , Sachin David1 , Auro Viswabandya1 , Alok Srivastava1
  • 1Department of Hematology, Christian Medical College, Vellore, India
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Publication History

Publication Date:
18 February 2010 (online)

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ABSTRACT

Data are limited on inhibitors in people with hemophilia (PWH) in developing countries. There is a perception that the overall prevalence of inhibitors, ranging from 7 to 19% in different reports, may be lower in these countries as compared with that reported from developed countries. This is possible given the fact that most patients are treated after 2 years of age with plasma-derived clotting factor concentrates. Whether genetic or other environmental factors also contribute to this needs further evaluation. There is a need to develop laboratory infrastructure and establish quality control programs for laboratory tests for inhibitors in developing countries. Management options vary widely given the socioeconomic diversity among these countries. Significant individualization of approach to management is therefore required depending on the available resources, particularly with regard to the use of bypassing agents. The limited data on immune tolerance induction with some low-dose regimens deserve further evaluation. Even in resource-constrained environments, education and a policy of systematic screening of patients associated with judicious use of bypassing agents can significantly improve the care of PWH who develop inhibitors.

KEYWORDS

Hemophilia - prevalence - inhibitors - developing countries

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Alok SrivastavaM.D. F.R.A.C.P. F.R.C.P.A. F.R.C.P. 

Department of Hematology, Christian Medical College

Vellore 632004, India

Email: aloks@cmcvellore.ac.in