Haemorrhagic manifestations in patients with haemophilia A and B are considered quite similar for comparable level of factor deficiency. We investigated the bleeding frequency and factor usage between HA and HB patients with comparable disease severities. We collected data on frequency of bleeds and factor concentrate utilization over 3 years, from January 2001 to December 2003. Information was gathered from home infusion logs recorded by patients or their parents, and treatment records from the Hemophilia Clinic or the Hospital Emergency Department. Data were available on 58 patients with severe HA (FVIII < 0.01 U mL(-1)), 10 with moderate HA (FVIII < 0.05 U mL(-1)), 15 with severe HB, and five with moderate HB who required treatment for episodic bleeds, postoperative haemostasis and for primary or secondary prophylaxis. The HA patients bled more frequently than HB patients (14.4 vs. 8.63 bleeds/patient/year), but used similar amounts of concentrate per year. HA patients underwent surgical procedures 3.2 times more frequently than HB patients to correct musculoskeletal complications. A total of 21,363,409 IU of recombinant FVIII was used by patients with HA (104,722 IU/patient/year) and 6,430, 960 IU of recombinant factor IX, by patients with HB (107,182 IU/patient/year). The difference in factor concentrate usage is not statistically significant (P > 0.05). The decrease in bleed frequency in haemophilia B indicates that the conclusions from randomized trials of prophylaxis in HA may not be accurately applied to HB.

These tools enabled laboratory response to the 10-fold increase in testing demands.

The Commission of Inquiry on the Blood System in Canada ('Krever Commission', 1997) recommended an active programme of surveillance for all blood products. To describe trends in the utilization of coagulation factor concentrates using a comprehensive factor tracking programme. Between 2001 and 2004 in the region of Southern Ontario, we prospectively tracked all coagulation factor concentrates that were distributed from the national blood supplier, issued by hospitals for inpatient use or for home infusions, infused at hospital facilities or at home and wasted. Discrepancies were reconciled by independent audits. Trends in the utilization of FVIII, FIX and FVIIa concentrates are reported. A total of 466 patients with inherited or acquired bleeding disorders were registered. Utilization of FVIII, FIX and FVIIa increased by an average of 13.7%, 33.2% and 34.2% per year respectively. Most FVIII and FIX infusions were administered at home while most FVIIa infusions were in hospital. The increase in FVIII and FIX usage was attributable to an increase in per-patient use, predominantly for prophylaxis. In total, 1.7% of coagulation factor concentrates was wasted during the study period, at a cost of over 1 million Canadian dollars. Utilization of coagulation factor concentrates increased steadily during the study period. A regional programme to track utilization is feasible and may be used to describe trends, assist planning, and reduce costs by minimizing wastage.

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