International course in hemophilia – from basic to advanced
Hemophilia, Antibodies, Inhibitors, Immune tolerance induction therapy, Immunology, hemofili, laboratory, factor concentrates, treatment, arthropathy, co-morbidity, genetics
Färdiga specialister (Fortbildning), Läkare under specialistutbildning/ST
Target group: Physicians treating hemophilia from all over the world. Participants should be affiliated to a hemophilia centre and have been working in the area for at least a year and have a proven future commitment to this field. Good English-speaking skills are required.
Hemophilia is a sex-linked, hereditary disorder that mainly affects men. Women can be carriers, and some of these have an increased bleeding tendency. Hemophilia is caused by deficiencies of coagulation factor VIII (hemophilia A) or IX (hemophilia B). In severe forms factor activity is less than 1% of that found in the normal population; in moderate forms, 1%–5%; and in mild forms, >5%–40%. The main symptom is bleeding into the joints with accompanying joint injury, which may result in severe invalidity, but all types of bleeding may occur including intracranial haemorrhages. During the last decades, significant advances have been made in the diagnostics and treatment of hemophilia. Modern molecular biology has improved diagnostics and made it possible to develop new, more secure (free from contamination) factor VIII and IX concentrates for replacement therapy and with an extended half-life. Non-replacement therapy is now also partly available or in the pipeline with options possible to administer subcutaneously. In addition, gene therapy are in clinical trials. The introduction and improvement of prophylactic treatment over the years has remarkably improved clinical outcome and quality of life.
However, despite all these improvements, a major obstacle and concern for all patients and treaters is the development of antibodies against factor VIII and IX. The risk for this complication to occur is highest in those with a severe form of the disease, but will also be significant in those with mild and moderate disease. Specific issues are also associated with inhibitor development in patients with hemophilia B. The understanding of the background immunology, risk factors for inhibitors to develop and clinical management has improved over the years. It is therefore important for all treaters to be familiar with this knowledge in order to be able to offer the best prevention and treatment of this hazardous and costly side effect. In addition, all new published data have to be interpreted with caution.
The aim of this course is to improve the understanding and highlight the key message of importance for the optimal care of patients with hemophilia in an interactive way based on lectures and case discussions. The participants will also be asked to contribute with their own cases for discussion.
4. Kursens mål - förväntat resultat
To be able to use the knowledge (in the field of pathophysiology/diagnostics and treatment) within the area of hemophilia in a manner that is optimal for the patient.
Resultat för deltagaren
Outcomes for participants:
-Knowledge of treatment principles, the use of factor concentrates and pharmacokinetics
-Knowledge of laboratory methods and pitfalls of monitoring
-Knowledge of how to manage a bleeding patient
-Knowledge of outcome measures in hemophilia
-Knowledge of how to manage and monitor patients with or without inhibitor in association with surgical interventions
-Background knowledge of immunology in inhibitor development
-Knowledge of risk factors for inhibitor development
-Knowledge of options and regimens to eradicate an inhibitor
-Knowledge of specific issues to consider in the management of inhibitors in patients with hemophilia B
-Knowledge of the role of genetics in hemophilia
-Knowledge of specific issues and co-morbidities to consider and to manage in childhood, adolescence and adulthood
Resultat för patient och samhället
The course aims to facilitate early diagnosed and optimal treatment of inhibitor patients. Patients’ quality of life and health economy will thus be enhanced and improved.
Tuesday, 15 October
09.45-10.15 Welcome and introduction
10.15-11.00 Hemophilia management of today and tomorrow (JA)
11.15-12.00 Laboratory issues in hemophilia (KS)
13.00-13.45 Genetics (RL)
14.00-14.45 A focus on pediatric issues (NGA)
15.15-16.45 The relevance of PK and personalized medicine in an era of new treatment options (JA)
Wednesday, 16 October
08.30-09.15 A focus on adult issues and co-morbidities (EZ)
09.15-09.45 The value of outcome measures now and in the future (JA)
10.15-12.00 Musculoskeletal issues – management and follow-up (BR/SL)
13.00-14.00 Immunology (SLD)
14.15-15.00 Risk factors for inhibitor development (RL)
15.15-17.00 Inhibitor management – tolerization or not? (JA).
18.30-19.00 Dinner symposium – “The history of hemophilia” (optional) (EB)
Thursday, 17 October
08.30-09.00 Gene therapy (JA)
09.00-10.15 Case discussion – Participants cases (Faculty)
10.30-12.00 Surgery in inhibitor and non-inhibitor patients – management and monitoring.
Interactive case discussion – surgery (PAH)
12.45-14.45 Case discussion – Participants cases (Faculty)
14.45-15.00 Examination and concluding remarks
Prof Jan Astermark, Malmö, Sweden (JA)
Prof Erik Berntorp, Malmö, Sweden (EB)
MD PhD Nadine Gretenkort Andersson, Malmö, Sweden (NGA)
Prof Pål André Holme, Oslo, Norway (PAH)
Prof Sébastien Lacroix-Desmazes, Paris, France (SLD)
Prof Rolf Ljung, Malmö, Sweden (RL)
Prof Sébastien Lobet, Brussels, Belgium (SL)
Prof Björn Rosengren, Malmö, Sweden (BR)
MD PhD Karin Strandberg, Malmö, Sweden (KS)
Associate prof Eva Zetterberg, Malmö, Sweden (EZ)
The management of patients with hemophilia has continuously improved over the last decades and a good knowledge and understanding of the treatment options, laboratory aspects and complications will be fundamental for optional care of patients and the use of resources available.
Nordic Hemophilia Guidelines (http://nordhemophilia.org/frontpage/guidelines/)
Textbook of Hemophilia, 3rd Edition (May 2014, Wiley-Blackwell). Lee, Berntorp, Hoots, editors (ISBN: 978-1-118-39824-1).
The selection of participants and faculty members aims to secure a mix of both men and women.
The course is based on outline lectures; structured case studies of authentic cases in accordance with case methodology. The course will end with an examination.
The course design is interactive but presentations provided will be available in PDF-format on the course web portal (LUVIT). A link to guidelines will be provided: http://vardgivare.skane.se/vardriktlinjer/medicinska-omraden/blod-och-koagulation/#43984.
Recommended literature from the Nordic Hemophilia Guidelines care and an updated book on hemophilia.
At the end of the course there will be an oral interactive examination.
The aim of the course is to create an international network of physicians interested in the field. Continued contact with the physician collective is available, e.g. by email.
The course material and case study discussions will be structured in such a way that course participants will be able to pass the message on to their own department.
Assessment will take place in accordance with Lipus templates and feedback will be given to participants and teachers. If needed, changes will be made based on the results from the course evaluation.
Effekt i verksamheten på längre sikt
The plan is to repeat this course to continuously update and interact within the field of inhibitors, as well as to create networks in the complex field of hemophilia management.
Tidigare Lipus- eller IPULS-certifiering
The current course is continuation (advanced course) of earlier courses:
Course number: 20030077 held 2004-09-20
Course number: 20050086 held 2005-10-10
Course number: 20050452 held 2006-10-09
Course number: 20070127 held 2007-10-08
Course number: 20080046 held 2008-10-06
Course number: 20090107 held 2009-10-05
Course number: 20100028 held 2010-10-18
Course number: 20110169 held 2011-10-12 and 2012-04-12 (advanced, part I and II)
Course number: 20120081 held 2012-10-09
Course number: 20130111 held 2013-10-09 and 2014-01-16 (advanced, part I and II)
Course number: 20140099 held 2014-10-14
Course number: 20150087 held 2015-10-14 (advanced, part I)
Course number: 20160123 held 2016-10-18
Course number: 20170085 held 2017-10-18 (advanced, inhibitor)
Course number: 20180099 held 2018-10-09 (advanced, inhibitor)
The evaluation of previous similar courses have been discussed and used for the design of the current course.
9. Praktisk information
Full time (dinner symposium and dinner on day 2 are optional)
Scandic Triangeln, Malmö
Kursorten – län
English. Good English-speaking skills are required.
The course is sponsored by Shire/Takeda except for travel and lodging. The course includes lunch, coffee on 15-17 October and dinner (optional) on 16 October. Lectures and course literature are included.
Participants must arrange and pay for their own travel and lodging.
Apply to the course through department web page:
Course diploma (including CME credits from EACCME) will be handed out after examination.
Jan Astermark, MD, PhD, Professor
Centre for Thrombosis and Haemostasis
Skåne University Hospital
SE-205 02 MALMÖ
Phone: +46-40-33 71 12
Fax: +46-40-33 62 55
Länk till kursens webbplats
25 applicants in accordance with the criteria for the target group will be accepted.
A written confirmation a month after final date for application at the latest.
Krav för deltagande
It is a prerequisite that employers give consent.
Jan Astermark, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö
Ansvarig för innehåll
Prof Jan Astermark, Centre for Thrombosis and Haemostasis, Malmö
Övergripande kurs- och kvalitetsansvarig
Prof Jan Astermark, Centre for Thrombosis and Haemostasis, Malmö, has worked at the coagulation centre since 1995. Head of the haematology clinic since 2010. Has a broad clinical experience of haemophilia care. Research mainly focused on inhibitor development and treatment of haemophilia patients.
Prof Jan Astermark, Centre for Thrombosis and Haemostasis, Malmö.
Research administrator Camilla Månsson, Lund University, Clinical Coagulation Research Unit, Malmö.
Senior Business Development Manager/Client Manager Camilla Björklund, Lund University Commissioned Education, Lund
Shire/Takeda and Lund University Commissioned Education.
None besides previous evaluations.
The course is sponsored by Shire/Takeda, excluding the costs of travel and accommodation.
Food (including dinner) and course material are covered by the educational grant from Shire/Takeda.
The sponsor can be present with three representatives during the lectures as audience. The presence of the sponsor during the course is in accordance with the agreement between Swedish Association of Local Authorities and Regions and LIF.
Jan Astermark has performed clinical studies in collaboration with Shire/Takeda and received research grants from Shire/Takeda.