Standard pharmacokinetic (PK) assessments are demanding for persons with hemophilia A, requiring a 72hr washout and 5-11 timed blood samples. A no-washout, single-clinic visit, sparse sampling population PK (PPK) protocol is an attractive alternative. Here, we compared PK parameters obtained with a traditional washout, 6-sampling time point PPK protocol with a no-washout, single-clinic visit, reverse 2-sampling time point PPK protocol in persons with severe hemophilia A (SHA) receiving ADVATE®. 39 inhibitor-negative males with SHA (FVIII:C<2%) were enrolled in a prospective sequential design PK study. Participants completed a washout, 6-sampling time point PPK protocol as well as a no-washout, reverse 2-sampling time point protocol, with samples taken during a single 3hr clinic visit 24hr-post home infusion of FVIII and then 3hr-post infusion in clinic. FVIII:C levels were analyzed by one-stage and chromogenic assays; blood group and VWF:Ag were determined; and PK parameters were analyzed using the ADVATE® myPKFiT® dosing tool. There was moderate to almost perfect agreement for the PK parameters obtained with the 2- and the 6-point PPK protocols using a one-stage FVIII:C assay and a substantial to almost perfect agreement using a chromogenic FVIII:C assay. Significant associations between specific PK parameters and blood group and VWF:Ag were observed. The no-washout, single-clinic visit, reverse 2-sampling time point PPK protocol can be used in the routine clinical setting since it demonstrates sufficient accuracy compared to the more demanding and less practical washout, 6-sampling time point PPK protocol in persons with SHA receiving ADVATE®.

Oddělení klinické hematologie FN Brno, pracoviště Bohunice 2 Katedra laboratorních metod LF MU Brno 3 Krevní centrum FN Ostrava 4 Interní gastroenterologická klinika LF MU a FN Brno, pracoviště Bohunice 5 Centrum kardiovaskulární a transplantační chirurgie Brno 6 Oddělení klinické hematologie FN u sv. Anny Brno Autoři popisují případ ortotopické transplantace jater pro cirhózu v důsledku chronické virové hepatitidy C u pacienta s těžkou hemofilií A. Předoperační farmakokinetická studie s rekombinantním faktorem VIII (F VIII) potvrdila uspokojivé in vivo recovery 2,1 %. Perioperačně byl podán bolus F VIII v dávce 52 j/kg hmotnosti s dosažením požadované aktivity F VIII nad 100,0 %. Celkem bylo perioperačně podáno 30 000 j rekombinantního F VIII, 3 trombocytární koncentráty, 2 erytrocytární koncentráty, 5 transfuzních jednotek (TU) protivirově ošetřené plazmy, jedna TU čerstvě zmražené plazmy a 3 500 j antitrombinu. Perioperačně ani pooperačně nebyly zaznamenány krvácivé komplikace, substituce F VIII byla ukončena 3. pooperační den. Pacient byl propuštěn do domácího ošetřování 20. den po transplantaci.Klíčová slova: hemofilie A, chronická virová hepatitida C, transplantace jater.Liver transplantation as potential curative method in severe hemophilia A: case report and literature reviewThe authors present clinical case of orthotopic liver transplantation for cirhosis due to chronic viral hepatitis C in a subject with severe hemophilia A. Preoperatively performed pharmacokinetic study with recombinant F VIII confirmed satisfactory in vivo recovery of 2.1 %. A bolus application of 52 units F VIII/kg body weight with target F VIII activity over 100.0 % was administred shortly before the transplantation started. Totally, 30 000 units of recombinant F VIII, 3 thrombocyte concentrates, 2 erythrocyte concentrates, 5 units of virally inactivated plasma, 1 unit of fresh frozen plasma and 3 500 antithrombin units were used. There were no perioperative or postoperative bleeding complications, F VIII substitution was stopped on postoperative day 3. The patient was discharged on twentieth postoperative day.