Semin Thromb Hemost 2006; 32: 028-031
DOI: 10.1055/s-2006-946912
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Managing the Pediatric Patient and the Adolescent/Adult Transition

Leonard A. Valentino1 , Elena Santagostino2 , Victor Blanchette3 , Marijke van den Berg4
  • 1Associate Professor of Pediatrics, Director, RUSH Hemophilia and Thrombophilia Center, President, Hemophilia and Thrombosis Research Society, RUSH University Medical Center, Chicago, Illinois
  • 2Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Maggiore Hospital, University of Milan, Italy
  • 3Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 4Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands
Further Information

Publication History

Publication Date:
21 November 2006 (online)


Healthcare management of the developing child with hemophilia presents several difficulties. Determining the optimum medication dose is complicated by the difficulty of performing pharmacokinetic studies in children and the fact that extrapolation from data collected in adults is generally unsatisfactory. Even when pediatric pharmacokinetic data are available, accumulating evidence suggests that there can be wide interindividual differences; age and size are important contributing factors. Achieving the venous access necessary for blood factor administration is frequently difficult in the small child. Preliminary results suggest that an arteriovenous fistula may be an appropriate option in some patients. Finally, there is the question of whether prophylactic therapy should be discontinued as patients enter adulthood. This article provides insights for managing this challenging patient population.


Leonard A ValentinoM.D. 

RUSH University Medical Center

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