Case 360⁰™: Module #1: Managing Evidence of Joint Damage in an Adolescent with Hemophilia A

This activity has expired.
Release Date: October 26, 2018
Expiration Date: October 26, 2019
Estimated Time to Complete Activity:
0.75 hours
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Target Audience
This activity has been designed to meet the educational needs of hematologists, physicians, physician assistants, nurse practitioners, advanced practice registered nurses, registered nurses, and other specialists of the hemophilia treatment center (HTC) team, as well as other healthcare providers who are interested in the management of patients with hemophilia A.

Statement of Need/Program Overview
Management of hemophilic arthropathy is one the greatest challenges confronting healthcare professionals who treat people with hemophilia. Hemarthrosis (joint bleeding) is the hallmark of severe hemophilia and the major cause of disability and reduced quality of life in patients with factor VIII or factor IX deficiency. If not properly treated, recurrent bleeding into a joint can lead to soft tissue inflammation and eventually irreversible cartilage and bone destruction (arthropathy). Early detection and prompt multidisciplinary management are essential for preserving healthy joints in patients with hemophilia.

Educational Objectives
After completing this activity, participants should be better able to:

  • Evaluate emerging joint disease in a patient with hemophilia.
  • Identify multiple considerations when evaluating break through bleeding in a patient on prophylaxis.
  • Discuss the use of PK data to determine optimal dosing.
  • Implement individualized hemophilia management strategies that optimize adherence, outcomes, and preference-based utilization of resources, which include shared decision-making by the caregiver/patient.

Planning Committee and Presenting Faculty


Amy D. Shapiro, MD
Amy D. Shapiro, MD

Medical Director and Pediatric Hematologist
Indiana Hemophilia & Thrombosis Center
Indianapolis, Indiana
Adjunct Senior Investigator
Blood Research Institute, Clinical Track
Blood Center of Wisconsin


Stacie Akins, PT, MHS
Stacie Akins, PT, MHS
Physical Therapist
Indiana Hemophilia & Thrombosis Center
Indianapolis, Indiana

Jennifer Maahs, RN-BC, MSN, PNP
Jennifer Maahs, RN-BC, MSN, PNP
Pediatric Nurse Practitioner
Indiana Hemophilia & Thrombosis Center
Indianapolis, Indiana

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine, the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. Postgraduate Institute for Medicine is jointly accredited by the American 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 (PIM) designates this enduring material for a maximum of 0.75 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 0.8 contact hours.

Provider approved by the California Board of Registered Nursing, Provider Number 13485, for 0.8 contact hours.

Interprofessional Continuing Education

This activity was planned by and for the healthcare team, and learners will receive .75 Interprofessional Continuing Education (IPCE) credit for learning and change.

Method of Participation
During the period of October 26, 2018, through October 26, 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
Amy D. Shapiro, MD* Consulting Fees: Bayer, Bioverativ
Contracted Research: Bioverativ
Stacie Akins, PT, MHS* Has no real or apparent conflicts of interest to report.
Jennifer Maahs, RN-BC, MSN, PNP* Consulting Fees: Shire, Genentech, CSL Behring, Biogen
Fees for non-CME services: Novo Nordisk

*All faculty honoraria are paid to the Indiana Hemophilia & Thrombosis Center.

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 Have no real or apparent conflicts of interest to report.
ECM: Patrick J. Crowley, MBA, Managing Partner/CEO; Jodi Andrews, BS, Partner/COO;
Jo-Ann Angelucci, 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. PIM and Educational Concepts in Medicine 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 any organization associated with this activity. 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 in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.


Supported by educational grants from Bayer Healthcare Pharmaceuticals, Inc., Bioverativ Therapeutics Inc., and CSL Behring LLC

This activity is jointly provided by: