Background : Prophylaxis in hemophilia is the standard of care in developed countries for preventionof further bleeding and to preserve joint functions, thereby improving quality of life. The goals of prophylaxisare minimal or ‘zero bleeds’, no joint deformity and near normal life. The present study was aimed tostudy the outcome of secondary versus tertiary prophylaxis with a lower dose in hemophilia A andHemophilia B children under 12 years of age.Methods : The present prospective study was conducted over a period of 18 months. Total 34patients were included in the study. Hemophilia A (HA) patients were started prophylaxis withrecombinant Fc fusion long acting factor VIII at 15 IU.kg-1.dose-1 twice weekly and hemophilia B (HB) withrecombinant Fc fusion long acting factor IX at 30 IU.kg-1.dose-1 once weekly. Outcome measured interms of median annualized bleeding rate (ABR), hemophilia joint health score (HJHS) and child activity.Results : Among 34 patients included in the study, 28 (82.3%) patients were HA and six (17.7%) wereHB. Mean age of patients was 6.82 years for HA & 6.5 years for HB. Median ABR reduced from 15.6 to 1.9bleeds/year. HJHS in case of secondary and tertiary prophylaxis at first visit were 12.83±3.09 and15.72±1.6 and in fourth visit (at 18 months) were 6.66±3.11 and 8.86±1.45 respectively. None developedinhibitors during study. Child activity measured in terms of combined mean of school activity participation(SAP) score and daily activity (DA) score improved in secondary and tertiary prophylaxis from 1.455±0.12and 2.46±0.11 in first visit to 6.09±0.33 and 5.39±0.23 in fourth visit respectively.Conclusion : When compared, secondary prophylaxis is better than tertiary prophylaxis in children.In resource constraint countries where availability of CFC is an issue, prophylaxis can be individualizedand the goals can be achieved by using even smaller doses.
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