Clinical Consults™: A Challenging Case of Pregnancy-Associated Acquired Hemophilia A

This activity has expired.
Release Date: May 24, 2018
Expiration Date: May 24, 2019
Estimated Time to Complete Activity: 30 minutes
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Target Audience
This activity has been designed to meet the educational needs of obstetrician/gynecologists, hematologists, anesthesiologists, anesthetists, clinical laboratory professionals, physician assistants, registered nurses, advanced practice registered nurses, pharmacists, midwifes and other specialists in the hemophilia treatment center team, as well as other healthcare providers interested in the management of bleeding complications in patients with acquired hemophilia.

Statement of Need/Program Overview
Acquired hemophilia A (AHA) is a rare but serious etiology of severe bleeding caused by spontaneous formation of neutralizing antibodies (inhibitors) to coagulation factor VIII. The reported mortality rate ranges from 6% to 22% and is in part attributable to delays in diagnosis and appropriate treatment due to a general lack of familiarity with this condition. Because of its rarity, knowledge of AHA and the ability to perform trials to inform management are limited. AHA is rarely suspected, and there is a great need to raise awareness so that those seeing these patients first can act appropriately. If AHA is suspected, immediate consultation with a hematologist or coagulation specialist can improve patient outcomes.

Pregnancy-associated AHA, including postpartum hemorrhage, is rare but accounts for most cases of AHA in people under the age of 40 years. In affected women, delays in diagnosis and treatment can quickly escalate to life-threatening hemorrhage. Transplacental transfer of FVIII inhibitors also poses a bleeding threat to the neonate. Most obstetricians lack experience with this rare condition and thus may not recognize the signs and symptoms or consider a diagnosis of AHA. Consulting hematologists should understand coagulopathies, including AHA, in the context of pregnancy-related bleeding to appropriately advise and guide therapy. Fortunately, when acute bleeding is immediately controlled, the prognosis for women with pregnancy-associated AHA is quite favorable.

Educational Objectives
After participating in this activity, the participant should be better able to:

  • Recognize the clinical signs and symptoms indicative of pregnancy-associated AHA
  • Review laboratory test results to confirm or eliminate AHA etiology
  • Administer appropriate agents to control acute bleeding
  • Individualize strategies for inhibitor eradication and restoration of normal hemostasis

Planning Committee and Presenting Faculty

Miguel A. Escobar, MD
Miguel A. Escobar, MD
Department of Pediatrics and Internal Medicine
Division of Hematology
Professor, University of Texas
Health Science Center at Houston
McGovern Medical School
MD Anderson Cancer Center
Medical Director, Gulf States Hemophilia and
Thrombophilia Center
Houston, Texas

Stefan Tiefenbacher, PhD
Arnold Friedman, MD
Vice Chair for Academic Affairs
Director, Divisions of Gynecology and Urogynecology
Department of Obstetrics and Gynecology
Maimonides Medical Center
Brooklyn, New York
Professor of Obstetrics and Gynecology
Icahn School of Medicine at Mount Sinai
New York, New York

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Educational Concepts in Medicine. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.5 contact hours. Designated for 0.2 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

ASCLS P.A.C.E. ® Credits
Postgraduate Institute for Medicine is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E. ® Program.  This program is approved for up to 0.50 ASCLS P.A.C.E.® contact hours.

Method of Participation
During the period of May 24, 2018, through May 24, 2019, participants must:

  •  Read the learning objectives and faculty disclosures
  • Study the educational activity
  • Complete the posttest by recording the best answer to each question
  • Complete the evaluation form

A statement of credit will be issued automatically upon successful completion of the post-activity survey with a score of 75% or better and submitting the activity evaluation.

Fee Information
There is no fee for this educational activity.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter Reported Financial Relationship
Miguel A. Escobar, MD Consulting Fees: Bayer, CSL Behring, Genentech, HEMA Biologics, National Hemophilia Foundation, Novo Nordisk, Shire.
Arnold Friedman, MD I have no real or apparent conflicts of interest to report.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Planner or Manager Reported Financial Relationship
PIM Clinical Reviewers: Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CHCP; Judi Smelker-Mitchek, RN, BSN; Jan Schultz, RN, MSN, CHCP Have no real or apparent conflicts of interest to report.
ECM: Patrick J. Crowley, MBA, Partner/CEO; Jodi Andrews, BS, Partner/COO; Helen Morfit, BA, Program Director; Christine H. Blood, PhD, Medical Writer Have no real or apparent conflicts of interest to report.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

This educational activity is supported by an independent medical educational grant from Shire.

This activity is jointly provided by: