Projeto Score: Survey on Covid-19 Resilience

Objetivos: O objetivo do Projeto SCORE - Survey on COVID-19 REsilience - foi avaliar as emocoes e comportamentos dos adultos brasileiros com hemofilia durante o 1degree ano da pandemia. Material e Metodos: Foi realizada uma pesquisa online, com 17 perguntas, de marco a abril de 2021. Os dados foram coletados por meio de 5 perguntas sobre caracteristicas demograficas e clinicas e 12 perguntas sobre as preocupacoes e medos um ano apos o inicio da pandemia de COVID-19. Resultados: 40 PCH responderam ao questionario. Faixa etaria: 35% de 18-30, 50% 31-50, 15% 51-70. Entre os que responderam, 34 tinham hemofilia A e 6 hemofilia B, com prevalencia de casos graves, 1 tinha inibidor;87,5% PCH faz tratamento de profilaxia enquanto 12,5% realizam tratamento sob demanda. 53,7% declararam nao ter sido afetados pela pandemia, enquanto 24,4% relataram que tanto rotina quanto emergencia foram alterados. Para 19,5% apesar da suspensao das consultas, os atendimentos de urgencia e planos de tratamento foram oferecidos regularmente. Discussao: No que diz respeito as emocoes e sentimentos, para 53,7% dos pacientes, as informacoes fornecidas pelo governo e pela midia nao tiveram o efeito de tranquilizar, pelo contrario, muitas vezes criaram confusao e sensacao de incerteza. Para 31,7% as noticias traziam ainda mais medo e para 19,5%, as informacoes geravam estado de tensao. Apenas 17,1% dos pacientes relatou se sentir tranquilo e confiante. Sobre o apoio psicologico, apesar da maioria reconhecer que esta pandemia teria repercussoes psicologicas, 60% afirmaram nao precisar de apoio na area da saude mental. Para 31% dos pacientes a informacao fornecida pelos Centros de Hemofilia (CTH) foi suficiente, enquanto 9% dos respondentes solicitaram apoio e ajuda psicologica. Quanto ao relacionamento com o CTH, 61% relatou que nada mudou enquanto 12,2% relatou melhora no relacionamento. Para 12,2% houve dificuldades no relacionamento em funcao do medo de possivel contagio. Com relacao ao gerenciamento do controle de sangramentos e das consultas programadas, 53,7% declararam nao terem sido afetados pela pandemia, enquanto 24,4% relataram que tanto rotina quanto emergencia foram alterados. Para 19,5% apesar da suspensao das consultas, os atendimentos de urgencia e planos de tratamento foram oferecidos regularmente. Conclusao: Nossa pesquisa destacou a adaptabilidade dos pacientes durante a pandemia e que mostrou que a disponibilidade da equipe do CTH. Neste momento, mesmo a distancia, garantiu a continuidade das relacoes e do tratamento. Copyright © 2022

No difference in the management of Covid-19 hemophilic and non-hemophilic patients

Background: Several guidelines specifically suggest how to manage hemophilic patients (PWH) with COVID-19, but recent studies have shown that Covid-19 PWH management does not differ from the general population Aims: To evaluate our COVID-19 PWH to confirm if this trend is also present in our Centre Methods: We retrospectively evaluated data about 8 Covid-19 PWH (4 adults and 4 pediatrics) during 2020-22. Median age was 28.7 (range 10-61). 5 were hemophilic A (2 severe and 3 moderate), 3 were severe B (one inhibitor). At the moment of observation 6 they had not yet been vaccinated, two had received the second and third doses respectively Results: Only one 56-year- old patient needed hospitalization: He presented diabetes, hypertension, hepatitis C and prostatic hypertrophy and was admitted to the hospital because of a worsening dyspnea, and was treated with noninvasive ventilation. Heparin was avoided because of the hemorrhagic risk and the other therapies were administered orally or intravenously. He was discharged after 7 days. Of the other adults, a 27-year- old man manifested mild dyspnea and diarrhea without needing hospitalization.The 34-year- old who had received the two doses of vaccine scheduled at that time did not show any symptomatology. The 61-year- old with three doses of vaccine, developed mild symptoms (low grade fever, sore throat, mild muscle pains). All 4 pediatric patients were successfully treated at home:only the inhibitor patient had an episode of nosebleed treated with single by-passant treatment;the pediatric PWH reported mild symptoms: Low-grade fever, asthenia, headache, cold and cough;one had a temporary anosmia and ageusia. Results are resumed in table 1 Conclusion(s): Our experience showed no difference between PWH and the general population: The only adult who needed hospitalization was the one with comorbidities and for whom the application of Guidelines for Covid-19 PWH avoided bleedings.The pediatric patients and the vaccinated adults were pauci-symptomatic and were cured at home.

Incidence of spontaneous iliopsoas hematoma in COVID-19 patients

Background : Low molecular weight heparin (LMWH) is recommended in hospitalized patients with coronavirus disease 2019 (COVID-19) due to high risk of thromboembolism.However, LMWH must be carefully dosed for the bleeding risk related to the hemostatic changes in COVID-9 patients. Aims : To investigate the correlation between COVID-19 related hemorrhagic alterations and the onset of spontaneous Iliopsoas hematoma (IPH). Methods : We analyzed data from our patient's medical records and the reports found in PUBMED. Results : There are currently very few reports about unprovoked IPS in COVID-19 patients: a 69-year-old male, on aspirin, who was started on daily 4000 I.U. LWMH at hospitalization, and who developed severe IPH after 20 days;a 74-year-old man treated with LMWH 4000 IU twice daily (b.i.d.) for atrial fibrillation (AF),with a worsening prolongation of PT and PTT during hospitalization, and a 56-year-old man, on LMWH 4000 b.i.d. for AF, with normal coagulation pattern at the admission, but with a moderately increased PT and a thrombocytopenia during the hospitalization, who developed IPH after 27 days. A bout our experience, we reported two cases (patients ' features summarized in Table 1): a 75-year-old male on clopidogrel due to an ischemic stroke, which was substituted by LMWH 4000 I.U. b.i.d. and who had a transient ischemic attack after 7 days: for this reason, the LMWH dosage was increased to 6000 I.U. b.i.d. After ten days he developed IPS: a moderate and transient thrombocytopenia, disappeared spontaneously after some days, was observed without coagulation alterations. The second case was a 79-year-old obese male, who started increased LMWH prophylaxis with enoxaparin 6000 I.U. b.i.d. Two weeks after admission, the patient manifested a spontaneous IPS. No changes were observed in coagulation parameters, nor a reduction in the platelet count. Conclusions : Differently from other reports, in our experience, IPH in COVID-19 patients cannot be certainly or directly related to depletion of coagulation factors or consuming of platelets. Further studies are needed to assess the hemorrhagic risk of antithrombotic therapy, as well as investigation of virus-related acquired coagulation disorders predisposing to bleeding in COVID-19.