Such a joint is no longer considered RO4929097 mw a target joint when there has been no bleeding into this same joint for 12 months . The Canadian Consensus definition of target joint is ‘a joint into which there have been three or more bleeds in a consecutive 3 month period’ . Finally, the Center for Diseases Control Universal Data Collection (UDC) Program uses a definition of ‘4 or more bleeds into a joint within a 6 month period’. Muscle haemorrhage. A muscle bleed is defined as a bleed into a muscle, usually associated with acute onset of pain and some functional limitation, e.g. a calf bleed with an associated limp.
Muscle bleeds are an important cause of serious musculoskeletal disability. The question to be undertaken by the Definitions PG is whether the definition should remain based solely on clinical observation or include the evidence from confirmatory
imaging. Prophylaxis. Prophylaxis is defined as treatment by intravenous selleck products infusion of factor concentrate in anticipation of and to prevent bleeding . Revised definitions of primary and secondary prophylaxis from the PEDNET were published in 2006 , and are detailed in Table 4. Variability in the current definitions relates to age of initiation and number of prior bleeds. The challenge in refining the definition of prophylaxis will be to incorporate dose and dosing intervals representative of current practice worldwide. Inhibitors. White et al. defined a low response inhibitor as an antibody level that is persistently <5 Bethesda Units per ml (BU/ml), whereas the term high response inhibitor was reserved for cases where the inhibitory activity has been >5 BU/ml at any time . The assay recommended for inhibitor measurement is the Nijmegen modification
of the Bethesda assay. The Definitions PG plans to explore consensus definitions for clinically significant and transient inhibitors. Surgical haemostasis. This has traditionally been defined qualitatively find more based on surgical assessment of intraoperative and postoperative bleeding compared with estimated blood loss in the absence of a bleeding diathesis. A more quantitative approach to this definition will be considered by the Definitions PG. Precise definitions are crucial to the design and interpretation of future prospective clinical trials of new therapeutics and treatment strategies, as well as critical informants of long-term observational data collection on outcomes and adverse events in haemophilia. It is anticipated that the report of the Definitions in Hemophilia Project Group will be presented at the 2012 World Federation of Hemophilia Congress. The authors have declared no conflict of interests.