The Role of Home Infusion Therapy in Haemophilia
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Dis Manage Health Outcomes 2000 Feb; 7 (2): 77-81 1173-8790/00/0002-0077/$20.00/0 © Adis International Limited. All rights reserved.
The Role of Home Infusion Therapy in Haemophilia A Disease Management Perspective Erik Berntorp and Stefan Lethagen Department for Coagulation Disorders, Lund University, Malmö University Hospital, Malmö, Sweden
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Rationale for Home Therapy . . . . . . . . . . . . . . . . . 2. Patient Selection and Implementation of Home Therapy 3. Mode of Treatment . . . . . . . . . . . . . . . . . . . . . . 3.1 Factor Concentrates and Pharmaceutical Services . 4. Problems Encountered . . . . . . . . . . . . . . . . . . . . 5. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Home infusion therapy, i.e. home infusion of deficient or missing clotting factors, is one of the mainstays of haemophilia care in developed countries. The aims of home therapy are: (i) to prevent profuse bleedings by giving treatment immediately in the event of incipient bleeding; (ii) to save time and money in terms of transport to and from hospital; (iii) to reduce absence from school or work; and (iv) to render patients independent so that they can lead ‘normal’ lives. Home therapy should be started immediately when there is an indication for replacement therapy. Initially, parents administer the infusions to the patient with assistance; eventually, the patient can treat themselves. Virtually all patients are eligible for home therapy within the frame of a comprehensive care programme. Studies have shown a dramatic beneficial outcome in both social functioning and joint disease after introduction of this treatment modality.
Haemophilia A and B are two X-linked recessive bleeding disorders caused by the deficiency or lack of coagulation factor VIII or IX in the blood. These diseases affect males and are transmitted to the next generation by female gene carriers who normally do not have a bleeding tendency themselves. Haemophilia is generally classified as severe, moderate or mild, depending on the plasma content of coagulation factors VIII or IX. In pa-
tients with severe haemophilia, the content is less than 1% of normal, compared with 1 to
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