Coordination of Care
• Procedural support: Our team will work with offices both in and outside of our network to create safe hemostasis action plans for procedures. This includes but is not limited to dental work, injections, orthopedics, and OB/GYN
care. We meet quarterly with maternal fetal medicine to discuss high risk cases and to discuss in person delivery plans. Hemostasis action plans include pre procedural, during procedure, and post procedural care guidelines for your individual
• Community support: Our hemophilia treatment center nurse is available to assist with education in the community, including individualized school/daycare teaches for children with bleeding disorders.
• Our team works closely with specialty pharmacies to ensure efficient delivery of factor products delivered to the home for self-infusion. We offer education and support on self-infusion and work with the patient/family to ensure the safety
and comfort of administration in the home setting. We also have our own 340B factor specialty pharmacy that supports our program by offsetting the cost of our HTC services.
• Our program works with the American Thrombosis and Hemostasis Network to collect anonymous information on people with bleeding disorders in order to promote research and understanding of these very rare diseases.
The Coagulation and Special Coagulation sections are one of the region's foremost resources for coagulation studies. State of the art tests performed enhance diagnostic capabilities for congenital and acquired bleeding disorders, hypercoagulable evaluations,
platelet disorders, and autoimmune coagulation disorders. The services provided by our laboratory support the Thrombosis and Hemostasis Program and our Hemophilia Treatment Center.
- Routine coagulation including Protime, PTT,
Fibrinogen, D-Dimer, and Mixing Studies
- Therapeutic monitoring for low molecular weight and unfractionated heparin
- Advanced coagulation testing including: coagulation factors, von Willebrand factor antigen and activity and thrombin time
- Bethesda assays (measure the amount of factor specific inhibitor)
- Advanced Hypercoagulability studies including: antithrombin III activity, functional protein C and protein S activity
- Platelet dysfunction testing (PFA, platelet aggregation and secretion, platelet mapping)
- Lupus anticoagulant cascade to detect antiphospholipid antibodies and interference
- Use the thrombelastograph (TEG) analyzer to assist in the assessment of patient clinical hemostasis conditions in the operating room by providing a live quantitative and qualitative indication of the coagulation state of a blood sample
Coagulation Medical Director: Andrew Goodwin, MD
Manager: Cindy Nelson, MT (ASCP)
Supervisor: Lisa Reste, MT (ASCP)
Coagulation Technical Specialist: Kristin Lundy,
- Home and school visits for teaching purposes on individual basis
- Family education provided for newly diagnosed pediatric patients
- Education provided to MD offices as needed
- Coordination of care with regional hemophilia camps
- 24 hour pediatric and adult assistance available via phone
COVID-19 and bleeding disorders
The COVID-19 virus has changed our world quickly. Here is some helpful information specifically regarding people with bleeding disorders.
1. There is no increased risk of contracting COVID-19 just if the patient has a bleeding disorder
COVID-19 is passed primarily through droplets in the air coming from infected persons. These droplets get into the upper respiratory tract where they establish an infection. https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
2. Patients with hemophilia who also have HIV
There is no information about whether patients with hemophilia who also have HIV are at increased risk of acquiring the infection. However, if infected, these patients are at much higher risk for severe disease. For HIV, that includes:
- People with a low CD4 T-cell count (e.g., <200)
- People not on HIV treatment (termed anti-retroviral therapy)
- If there are other underlying diseases associated with severe COVID-19
3. Risks if you have COVID-19 infection and a bleeding disorder
- COVID-19 a potentially deadly infection that causes a wide range of disease, from no symptoms to severe pneumonia and other complications. While older individuals and those with identified risk factors are at greater risk of serious
disease and complications, children and young adults may also develop severe disease, although less frequently.
- Risk factors include other diseases like hypertension, diabetes, cardiovascular disease, and immunosuppression.
- Individuals with hypertension should not discontinue their medication.
- As COVID-19 progresses, there can be activation of the coagulation system called DIC that seems actually to cause clotting and not bleeding.
- If COVID-19 is diagnosed, prophylaxis (to prevent bleeding) with factor replacement therapy should be continued, and if hospitalized for severe infection, higher doses may need to be considered as if treating major trauma.
- The risk of clotting complications for hemophilia patients who are currently treated with non-factor replacement therapies including Hemlibra is unknown in the presence of COVID-19 infection. https://www.hemlibra.com/hcp/safety.html?c=hea165155ea50d&gclid=EAIaIQobChMI7sT20bvG6AIVlddkCh3lFAG0EAAYASACEgI-2vD_BwE&gclsrc=aw.ds
- Patients with bleeding disorders of all severities and COVID-19 should be eligible for all available therapies that would be required depending on their condition (e.g., ventilation support).
4. Have 1-2 weeks of treatment on hand
During a period in which a national emergency has been declared under the National Emergencies Act, or at such other times (e.g., declaration of a natural disaster) that it may reasonably be anticipated that there could be
an interruption in supply, distribution, transportation or home delivery of clotting factor concentrates or non-factor replacement therapy (e.g., Hemlibra) patients with bleeding disorder treated on regular prophylaxis should be able to
obtain a prescription refill for their prophylaxis regimen when their home quantity reaches at a minimum an estimated one-two week’s supply. When refills are provided under these recommendations, the doses remaining at home should
not be deducted from the doses to be dispensed for the next delivery.