A Pediatric Hem/Onc s Nightmare Weekend on Call: Two Cases of Unusual Bleeding and Bruising

A Pediatric Hem/Onc's Nightmare Weekend on Call: Two Cases of Unusual Bleeding and Bruising
1 ANCC Contact Hours 1 AMA PRA Category 1 Credit(s)
Launch Date:
August 06, 2013
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Healthcare Providers Interested in Managing Patients With Congenital and Acquired Factor Deficiency Disorders, Hemophilia Teatment Center Clinicians, Pediatric Hematologist/Oncologists, Pediatric Hematologists, Registered Nurses

Relevant Terms:

Factor VII Deficiency, Factor XIII Deficiency, Intracranial Hemorrhage, Menorrhagia, Rare Bleeding Disorders

Amy D. Shapiro, MD

Amy D. Shapiro, MD
Adjunct Professor of Pediatrics
Michigan State University
Medical Director
Indiana Hemophilia & Thrombosis  Center
Indianapolis, Indiana

Amy D. Shapiro, MD, is Adjunct Professor of Pediatrics at Michigan State University in East Lansing and Medical Director of the Indiana Hemophilia and Thrombosis Center in Indianapolis. Dr. Shapiro earned a medical degree at New York University School of Medicine in New York City. She went on to complete a pediatric internship and residency as well as a pediatric hematology/oncology fellowship at the University of Colorado Health Sciences Center in Denver. Dr. Shapiro is board certified in pediatrics, with a subspecialty in pediatric hematology/oncology.

A contributor to the medical literature, Dr. Shapiro has numerous textbook chapters and scholarly articles to her credit. She writes on such subjects as prophylaxis in young children with factor VIII deficiency, immunogenetics of hemophilia inhibitors, and von Willebrand disease. Her scholarship appears in journals including Blood, Haemophilia, Journal of Pediatrics, and the British Journal of Haematology.

In addition to her writing endeavors, Dr. Shapiro holds several professional appointments and memberships. She serves on the Medical and Scientific Advisory Council of the National Hemophilia Foundation and is a former chair of the American Thrombosis and Hemostasis Network Board of Directors, for which she continues to be active. Her professional memberships include the World Federation of Hemophilia, the Hemophilia Research Society, and the International Society on Thrombosis and Hemostasis.

Diane J. Nugent, MD

Diane J. Nugent, MD
Division of Hematology
CHOC Children's Hospital
Medical Director
Center for Inherited Blood Disorders
Clinical Professor
Department of Pediatrics
UCI Medical Center
Orange, California

Diane J. Nugent, MD, is Clinical Professor of Pediatrics at the University of California School of Medicine in Irvine. Clinical appointments include Medical Director of Children's Hospital of Orange County (CHOC) Hematology and Blood & Donor Services and Chief of the CHOC Children's Specialists Division of Hematology. Dr. Nugent earned a medical degree at the University of California, Los Angeles, School of Medicine. An internship and residency were completed at Denver Affiliated Hospitals in Colorado. She completed fellowship training at Children's Hospital Medical Center and at the Fred Hutchinson Cancer Research Center, both in Seattle, Washington. Dr. Nugent is board certified in pediatrics and pediatric hematology/oncology.

Active in numerous research endeavors, Dr. Nugent is Principal Investigator of the Region IX MCHB Hemophilia Treatment Program. Her clinical and research interests include blood disorders, bone marrow failure, and bleeding and clotting disorders. She is currently involved in more than 40 clinical trials for rare blood disorders.

Dr. Nugent has coauthored more than 100 journal articles and book chapters. Her scholarship has appeared in such journals as Haemophilia, Blood, The New England Journal of Medicine, and Thrombosis Research.

Paula Bolton-Maggs, DM, FRCP, FRCPath

Paula Bolton-Maggs, DM, FRCP, FRCPath 
Consultant Haematologist and Medical Director
UK National Haemovigilance Scheme (Serious Hazards of Transfusion [SHOT])
Manchester Blood Centre
Plymouth Grove, Manchester
United Kingdom

Paula Bolton-Maggs, DM, FRCP, FRCPath, is Consultant Haematologist and Medical Director of the Serious Hazards of Transfusion program (SHOT), a UK-wide haemovigilance scheme based at the Manchester Blood Centre in Plymouth Grove, Manchester. She also has an academic appointment as Honorary Senior Lecturer at the University of Manchester. Dr. Bolton-Maggs trained at Cambridge University, following which she attended Oxford University Clinical Medical School.
Regarded as an expert in the field of bleeding disorders, Dr. Bolton-Maggs shares her knowledge through her contributions to the medical literature. She writes on such subjects as rare inherited coagulation disorders, immune thrombocytopenia, laboratory diagnosis of bleeding disorders, and factor XI deficiency. Her work has been published in journals including Blood, Seminars in Hematology, Haemophilia, and the British Journal of Haematology.
Since 2004, Dr. Bolton-Maggs has been a member of the Executive Committee of the World Federation of Hemophilia. She is also a member of the American Society of Hematology and the International Society on Thrombosis and Haemostasis.
1. Review the prevalence, pathophysiology, causes, and clinical assessment of 2 coagulation factor deficiency disorders that cause unusual bleeding and/or bruising in children and adolescents
2. Utilize monitoring strategies that incorporate the interpretation of commonly available coagulation laboratory assays in pediatric or adolescent patients presenting with symptoms of factor-deficient bleeding or bruising
3. Implement treatment strategies for the management of factor VII deficiency and factor XIII deficiency based on analysis of 2 representative case studies
4. Provide appropriate care and counsel for patients and their families

Program Overview
Inherited or acquired deficiencies of coagulation factors such as fibrinogen (FI), FII, FV, FV+FVIII, FVII, FX, FXI, FXIII, and multiple deficiency of vitamin K-dependent factors, with clinical manifestations ranging from mild to severe, are a diagnostic and therapeutic challenge for many pediatric hematologist/oncologists, who may have limited experience in managing patients with these deficiencies. These deficiencies represent 3% to 5% of all the inherited coagulation deficiencies, with prevalence in the general population varying from 1 in 500,000 to 1 in 2,000,000.

Although progress has been made in the detection and treatment of these rare bleeding disorders, the type and severity of bleeding symptoms, underlying molecular defects, actual management of bleeding episodes, and prophylactic treatment in patients with these deficiencies are not well established.

This educational activity will provide participants with an opportunity to examine 2 cases involving a pediatric and an adolescent patient who present with abnormal bleeding and/or bruising. The activity will provide insight and guidance on differential diagnosis, treatment modalities, and strategies for the acute management and stabilization of patients with these disorders.                                     

Program Agenda
60 minutes
Method of Participation

Course Viewing Requirements
Internet Explorer 8.0+ for Windows 2000, 2003, Vista, XP, Windows 7, Windows 8
Google Chrome 18.0+ for Windows, Mac OS, or Linux 
Mozilla Firefox 13.0+ for Windows, Mac OS, or Linux   
Safari 4.0+ for Mac OSX 10.5 and above

Physician Continuing Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine, the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians. 

Credit Designation
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education
Accreditation Statement
Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. 

Credit Designation
This educational activity for
 1.0 ANCC contact hours is provided by Postgraduate Institute for Medicine (www.pimed.com).

Method of Participation
There are no fees for participating and receiving CME credit for this activity. During the period of August 6, 2013 through August 6, 2014, participants must:
  • Read the learning objectives and faculty disclosures
  • Study the educational activity
  • Complete the posttest by recording the best answer to each question
  • Complete the evaluation form
  • A statement of credit will be issued automatically upon successfully completing the posttest with a score of 60% or better
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity: 

Name of Faculty or Presenter
Reported Financial Relationship

Paula Bolton-Maggs, DM, FRCP, FRCPath

Consulting Fees: LFB France

Diane J. Nugent, MD

Consulting Fees: Bayer HealthCare, CSL Behring, Novo Nordisk Inc.
Amy D. Shapiro, MD
Consulting Fees: Baxter Healthcare Corporation, Biogen Idec, Novo Nordisk Inc.; Contracted Research: Adventrx Pharmaceuticals, Inc., Baxter Healthcare Corporation, Bayer HealthCare, Bio Products Laboratory Ltd., Biogen Idec, CSL Behring, Kedrion Biopharma, Novartis Pharmaceuticals Corporation, Octapharma
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Planner or Manager
Reported Financial Relationship
PIM Clinical Reviewers: Laura Excell, ND, NP, MS, MA, LPC, NCC; Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CCMEP; Jan Schultz, RN, MSN, CCMEP; and Patricia Staples, MSN, NP-C, CCRN
Have no real or apparent conflicts of interest to report.
ECM: Patrick J. Crowley, MBA, Vice President/Managing Director; Denise Frontin, Senior Program Manager; Gay Boyle, MA, Chief Medical Writer
Have no real or apparent conflicts of interest to report.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients' conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities. 
Fee Information
There is no fee for this educational activity.

Commercial Support
This activity is supported by an educational grant from Novo Nordisk Inc.