Disease Management and Health Outcomes

, Volume 7, Issue 2, pp 77–81 | Cite as

The Role of Home Infusion Therapy in Haemophilia

A Disease Management Perspective
Review Article

Abstract

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.

Keywords

Factor VIII Severe Haemophilia Home Therapy Coagulation Factor VIII Haemophilia Centre 

References

  1. 1.
    Lusher JM. Considerations for current and future management of haemophilia and its complications. Haemophilia 1995; 1: 2–10CrossRefGoogle Scholar
  2. 2.
    Seremetis SV. Principles of management of hemophiliac bleeding. Hemophilia. In: Forbes CD, Aledort L, Madhok R, editors. London: Chapman & Hall, 1997: 165–9Google Scholar
  3. 3.
    Rabiner SF, Telfer MC. Home transfusions for patients with hemophilia A. N Engl J Med 1970; 283: 1011–5PubMedCrossRefGoogle Scholar
  4. 4.
    Jones P. Haemophilia home therapy. Haemostasis 1992; 22: 247–50PubMedGoogle Scholar
  5. 5.
    Berntorp E, Boulyjenkov V, Brettler D, et al. Modern treatment of haemophilia. Bull World Health Organ 1995; 73: 691–701PubMedGoogle Scholar
  6. 6.
    Nilsson IM. Hemophilia. Stockholm: Pharmacia Plasma Products, 1994Google Scholar
  7. 7.
    Manco-Johnson MJ, Nuss R, Geraghty S, et al. Results of secondary prophylaxis in children with severe hemophilia. Am J Hematol 1994; 47: 113–7PubMedCrossRefGoogle Scholar
  8. 8.
    Aledort LM. Lessons from hemophilia. N Engl J Med 1982; 306: 607–8PubMedCrossRefGoogle Scholar
  9. 9.
    Aledort LM. The treatment of hemophilia: comprehensive hemophilia care. In: Forbes CD, Aledort L, Madhok R, editors. Hemophilia. London: Chapman & Hall Medical, 1997: 159–69Google Scholar
  10. 10.
    Szucs TD, öffner A, Schramm W. Socioeconomic impact of hemophilia care — results of a pilot study. Haemophilia 1996; 2: 211–7CrossRefGoogle Scholar
  11. 11.
    Aledort LM, Haschemeyer RH, Pettersson H, the Orthopaedic outcome study group. A longitudinal study of orthopaedic outcomes for severe factor VIII-deficient haemophiliacs. J Intern Med 1994; 236: 391–9PubMedCrossRefGoogle Scholar
  12. 12.
    Nilsson IM, Berntorp E, Löfqvist T, et al. Twenty-five years experience of prophylactic treatment in severe haemophilia A and B. J Intern Med 1992; 232: 25–32PubMedCrossRefGoogle Scholar
  13. 13.
    Liesner RJ, Khair K, Hann IM. The impact of prophylactic treatment on children with severe haemophilia. Br J Haematol 1996; 92: 973–8PubMedCrossRefGoogle Scholar
  14. 14.
    Bohn R, Avorn J, Glynn RJ, et al. Prophylactic use of factor VIII: an economic evaluation. Thromb Haemost 1998; 79: 932–7PubMedGoogle Scholar
  15. 15.
    Agle DP, Hilgartner MW, Lazerson J, et al. Home care program: a manual for physicians. New York: National Hemophilia Foundation, 1977Google Scholar
  16. 16.
    Hilgartner MW, Cardi D, Goldberg I. Home therapy. In: Forbes CD, Aledort L, Madhok R, et al. Hemophilia. London: Chapman & Hall Medical, 1997: 171–80Google Scholar
  17. 17.
    Berntorp E. Methods of haemophilia care delivery: regular prophylaxis versus episodic treatment. Haemophilia 1995; 1 Suppl. 1: 3–7CrossRefGoogle Scholar
  18. 18.
    Rodeghiero F, Castaman G, Mannucci PM. Prospective multicenter study on subcutaneous concentrated desmopressin for home treatment of patients with von Willebrand disease and mild or moderate hemophilia A. Thromb Haemost 1996; 76: 692–6PubMedGoogle Scholar
  19. 19.
    Lethagen S, Ragnarson-Tenvall G. Self-treatment with desmopressin intranasal spray in patients with bleeding disorders: effect on bleeding symptoms and socio-economic factors. Ann Hematol 1993; 66: 257–60PubMedCrossRefGoogle Scholar
  20. 20.
    Berntorp E, editor. Proceedings of a Nordic von Willebrand Symposium Åland; 1998 Sep. Haemophilia 1999; 5 Suppl. 2: 1–76Google Scholar
  21. 21.
    Hay CR, Lozier JN, Lee CA, et al. Safety profile of porcine factor VIII and its use as hospital and home-therapy for patients with haemophilia-A and inhibitors: the results of an international survey. Thromb Haemost 1996; 75: 25–9PubMedGoogle Scholar
  22. 22.
    Stewart AJ, Hanley JP, Ludlam CA. Safety, efficacy and costeffectiveness of home therapy with recombinant activated factor VII in a patient with severe haemophilia A and antifactor VIII inhibitor. Blood Coagil Fibrinol 1998; Suppl. 1: S93–5Google Scholar
  23. 23.
    Martinowitz U, Schulman S, Gitel S, et al. Adjusted dose continuous infusion of factor VIII in patients with haemophilia A. Br J Haematol 1992; 82: 729–34PubMedCrossRefGoogle Scholar
  24. 24.
    Carlsson MS, Stenberg PB, Björnsson KA, et al. Pharmaceutical services in the treatment of hemophiliac patients. Am J Hosp Pharm 1993; 50: 2073–6PubMedGoogle Scholar
  25. 25.
    Ljung R, Petrini P, Lindgren A-K, et al. Implantable central venous catheter facilitates prophylactic treatment in children with haemophilia. Acta Paediatr 1992; 81: 918–20PubMedCrossRefGoogle Scholar
  26. 26.
    Lobato MN, Hannan J, Simonds RJ, et al. Attitudes, practices, and infection risks of hemophilia treatment center nurses who teach infection control for the home. Infect Control Hosp Epidemiol 1996; 17: 726–31PubMedCrossRefGoogle Scholar
  27. 27.
    Carlsson M, Berntorp E, Björkman S, et al. Improved cost-effectiveness by pharmacokinetic dosing of factor VIII in prophylactic treatment of haemophilia A. Haemophilia 1997; 3: 96–101CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  1. 1.Department for Coagulation DisordersUniversity HospitalMalmöSweden

Personalised recommendations