Prophylaxis is the new standard of care in patients with haemophilia

Randomised controlled clinical trial evidence on prophylaxis as optimal care for patients with haemophilia was generated more than a decade ago. However, this knowledge has not translated into clinical practice in South Africa (SA) owing to many barriers to prophylaxis. These include the high treatment burden imposed by prophylaxis (frequent injections two to four times a week), the need for intravenous access to administer replacement clotting factor therapies, and the higher volume of clotting factor required compared with episodic treatment. The recently introduced non-factor therapies in haemophilia care have addressed many of these barriers. For example, emicizumab, which is currently the only globally approved non-factor therapy, can be administered subcutaneously less frequently (weekly, fortnightly or every 4 weeks) and has led to global adoption of prophylaxis as the standard of care in haemophilia by the bleeding disorders community. Haemophilia A is the most prevalent clotting factor deficiency in SA, with >2 000 people diagnosed to date. However, only a few of these patients are currently on prophylaxis. In this ‘In Practice’ article, we review the rationale for prophylaxis, outline its goals and benefits, and provide evidence-based guidance on which haemophilia patients should be prioritised for emicizumab prophylaxis. This consensus guidance facilitates the adoption of prophylaxis as a national policy and the new standard of care in haemophilia in SA.http://www.samj.org.zadm2022HaematologyPaediatrics and Child Healt

Student Success at the University of Pretoria, 2009-2019: A Systemic, Intentional and Data-Informed Strategy

Preface: In essence, the publication provides an exposé of the evolution of an increasingly complex and comprehensive student success strategy developed by a South African university (viz the University of Pretoria). The problem facing the University in 2009 was common across the higher education sector in South Africa: the phenomenon of student success. This publication is a case study or series of case studies of how the University of Pretoria intentionally integrated its student support and development programmes between 2009 and 2019, and how it innovated and improved the holistic programme over the decade. The outcome was a gradual increase in the student success rate as measured by both module pass percentage (defined as the number of students who passed v the number who enrolled for the module) and minimum time to completion of individual cohorts (‘cohort’ defined as a group of first-time entering students followed through to graduation). The chapter reflects on contextualised approaches to student success initiatives that are similar to those found at other institutions, nationally and internationally. Using case studies shows how initiatives develop over time within a unique context, as well as challenges and successes. This publication has both a descriptive and exploratory approach in its case studies. Existing but siloed initiatives within the University were uncovered, interrogated, improved and integrated into a broader programme between 2009 and 2019. The cases might provide some insights into the phenomenon of student success that other South African institutions could contextualise

Guidelines for lupus anticoagulant testing in South Africa

CITATION: Bailly, J., et al. 2020. Guidelines for lupus anticoagulant testing in South Africa. Journal of Medical Laboratory Science and Technology of South Africa, 2(1):6-12, doi:The Journal of Medical Laboratory Science & Technology South Africa 2020; 2(1):6-12, doi:10.36303/JMLSTSA.2020.2.1.39.The original publication is available at https://jmlstsa.smltsa.org.zaENGLISH ABSTRACT: The lupus anticoagulant (LA) refers to the prolongation of certain coagulation tests due to the action of heterogenous autoantibodies. However, the LA is a misnomer since it is associated with thrombosis in vivo, and most commonly is detected as an incidental, transient laboratory finding associated with conditions such as autoimmune diseases, infections and even in healthy individuals. Repeatedly positive LA testing in the setting of thrombotic and/or obstetric complications is required to diagnose the antiphospholipid syndrome (APS). This review intends to provide clarity on LA testing in the South African context and to provide a national guideline in order to standardise LA testing, interpretation and reporting of results.https://jmlstsa.smltsa.org.za/index.php/JMLSTSAPublisher's versio

Prophylaxis is the new standard of care in patients with haemophilia

Randomised controlled clinical trial evidence on prophylaxis as optimal care for patients with haemophilia was generated more than a decade ago. However, this knowledge has not translated into clinical practice in South Africa (SA) owing to many barriers to prophylaxis. These include the high treatment burden imposed by prophylaxis (frequent injections two to four times a week), the need for intravenous access to administer replacement clotting factor therapies, and the higher volume of clotting factor required compared with episodic treatment. The recently introduced non-factor therapies in haemophilia care have addressed many of these barriers. For example, emicizumab, which is currently the only globally approved non-factor therapy, can be administered subcutaneously less frequently (weekly, fortnightly or every 4 weeks) and has led to global adoption of prophylaxis as the standard of care in haemophilia by the bleeding disorders community. Haemophilia A is the most prevalent clotting factor deficiency in SA, with >2 000 people diagnosed to date. However, only a few of these patients are currently on prophylaxis. In this ‘In Practice’ article, we review the rationale for prophylaxis, outline its goals and benefits, and provide evidence-based guidance on which haemophilia patients should be prioritised for emicizumab prophylaxis. This consensus guidance facilitates the adoption of prophylaxis as a national policy and the new standard of care in haemophilia in SA