J Haem Pract 2014; 1(2):J Haem Pract 2014; 1(2): 30-34. doi: 10.17225/jhp00022

Authors: Cesar Alberto Montaño,

Dr Cesar Alberto Montaño
Hemolife Pereira, Pereira Technological University, Santa Fé Foundation, Bogotá, Colombia.


The Latin American net of Prophylaxis and Immune Tolerance (RED LAPI) was established in 2010 and comprises a group of physicians dedicated to improving the diagnosis, treatment and quality of life of haemophilia patients in Latin America. The countries represented at RED LAPI are: Argentina, Chile, Uruguay, Venezuela, Colombia, Peru, Honduras, Guatemala, Paraguay, Dominican Republic, Bolivia, Ecuador and Panama. Analysis of the provision of care for haemophilia patients suggests a lack of consistent care both across and within Latin America countries. While some patients receive prophylaxis and immune tolerance induction (ITI), others are not even properly diagnosed, due to variation in patient’s health insurance.
Few countries in Latin America have a national program that registers all patients’ information. Therefore, in many countries it is difficult to identify local, regional and national data regarding the number of diagnosed patients, type of hemophilia, severity, and the kind of treatment. With respect to patients with inhibitors, some countries rely on bypass agents for the treatment of bleeding episodes while a few are able to do ITI. This paper summarises available data obtained by a survey of RED LAPI members regarding the diagnosis and treatment of haemophilia in their countries, as well as the incidence of inhibitors and the treatments available to patients. Based on this analysis, the aim is to propose plans to improve the current situation of haemophilia patients in Latin America.


RED LAPI is a project initiated by Octapharma, which provides support for physicians’ travel and the organisation of meetings. The company has no input into the content of meetings. Participating physicians are: Dr Cesar Montaño, Hemolife Pereira, Pereira Technological University, Dr Mauricio Cortes, Santa Fé Foundation (Bogotá), Colombia; Dr Ana Bastardo and Dr Paula Pérez, Dr Héctor Nouel Joubert Hospital, Bolívar Branch Hemophilia National Center and Maracay Central Hospital, Aragua Branch Hemophilia National Center, Venezuela; Dr Maria Sol Cruz, Salta Hemophilia Foundation, Argentina; Dr Felipe Lemos, Pereira Rossell Hospital Center, Uruguay; Dr Felipe Espinoza, San Borja Arriarán Hospital, Chile; Dr Gloria Chumpitaz, Edgardo Rebagliatti Martins Hospital, Perú; Dr Armando Quiroz, IPS Paraguay Central Hospital; Dr Gerardo Rojas, Dr Mario Ortiz Suárez Children Hospital, Bolivia; Dr Rosa Nieves, Dr Robert Reid Cabra, Children Hospital, República Dominicana, Dr Jose Suárez, Francisco de Ycaza Bustamante Hospital, Ecuador; Dr Armando Peña, Hematology/Oncology Service, Pediatrics University School Hospital, Tegucigalpa DC, Honduras; Dr Oscar Avendaño, Medical Solution, Guatemala; Dr Belgica Moreno, Children Hospital, Panamá.


  1. Shapiro AD. A global view on prophylaxis: possibilities and consequences. Haemophilia 2003; 9 Suppl 1: 10-7.
  2. Stonebraker JS, Brooker M, Amand RE, et al. A study of reported factor VIII use around the world. Haemophilia 2010; 16(1): 33-46.
  3. Manco-Johnson MJ, Abshire TC, Shapiro AD, et al. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia. N Engl J Med 2007; 357(6): 535-44.
  4. National Hemophilia Foundation Medical Bulletin 1994, 193.
  5. World Health Organization. Report of a joint WHO and WFH Meeting on the control of hemophilia: Modern treatment of hemophilia. WHO; Geneva, 1994.
  6. Kruse-Jarres R. Inhibitors: our greatest challenge. Can we minimize the incidence? Haemophilia 2013; 19 Suppl 1: 2-7.
  7. Iorio A, Halimeh S, Holzhauer S, et al. Rate of inhibitor development in previously untreated hemophilia A patients treated with plasma-derived or recombinant factor VIII concentrates: a systematic review. J Thromb Haemost 2010; 8(6): 1256-65.
  8. Santagostino E, Morfini M, Auerswald GK, et al. Paediatric haemophilia with inhibitors: existing management options, treatment gaps and unmet needs. Haemophilia 2009; 15(5): 983-9.
  9. Rothschild C, Gill J, Scharrer I, Bray G. Transient inhibitors in the Recombinate PUP study. Thromb Haemost 2000; 84(1): 145-6.
  10. Lenk H; ITT Study Group. The German Registry of immune tolerance treatment in hemophilia--1999 update. Haematologica 2000; 85(10 Suppl): 45-7.
  11. Ettingshausen CE, Kreuz W. The immune tolerance induction (ITI) dose debate: does the International ITI Study provide a clearer picture? Haemophilia 2013; 19 Suppl 1: 12-7.
  12. Brackmann HH, Schwaab R, Effenberger W, et al. Antibodies to factor VIII in hemophilia A patients. Vox Sang 2000; 78 Suppl 2: 187-90.
  13. Ettingshausen CE, Kreuz W. Role of von Willebrand factor in immune tolerance induction. Blood Coagul Fibrinolysis 2005; 16 Suppl 1: S27-31.
  14. Kallas A, Talpsep T. von Willebrand factor in factor VIII concentrates protects against neutralization by factor VIII antibodies of haemophilia A patients. Haemophilia 2001; 7(4): 375-80.
  15. Berntorp E. Variation in factor VIII inhibitor reactivity with different commercial factor VIII preparations: is it of clinical importance? Haematologica 2003; 88(6):EREP03.
  16. Suzuki T, Arai M, Amano K, et al. Factor VIII inhibitor antibodies with C2 domain specificity are less inhibitory to factor VIII complexed with von Willebrand factor. Thromb Haemost 1996;76(5): 749-54.
  17. Gensana M, Altisent C, Aznar JA, et al. Influence of von Willebrand factor on the reactivity of human factor VIII inhibitors with factor VIII. Haemophilia 2001; 7(4): 369-74.
  18. Astermark J, Voorberg J, Lenk H, et al. Impact of inhibitor epitope profile on the neutralizing effect against plasma-derived and recombinant factor VIII concentrates in vitro. Haemophilia 2003; 9(5): 567-72.
  19. Inoue T, Shima M, Takeyama M, et al. Higher recovery of factor VIII (FVIII) with intermediate FVIII/von Willebrand factor concentrate than with recombinant FVIII in a haemophilia A patient with an inhibitor. Haemophilia 2006; 12(1): 110-3.
  20. Kreuz W, Escuriola-Ettingshausen C, Auerswald G, et al. Immune tolerance induction (ITI) in haemophilia A - patients with inhibitors - the choice of concentrate affecting success. Haematologica 2001; 86(S4): 16-22.
  21. Auerswald G, Spranger T, Brackmann HH. The role of plasma-derived factor VIII/von Willebrand factor concentrates in the treatment of hemophilia A patients. Haematologica 2003; 88(6): EREP05.
  22. Colowick AB, Bohn RL, Avorn J, Ewenstein BM. Immune tolerance induction in hemophilia patients with inhibitors: costly can be cheaper. Blood 2000; 96(5): 1698-702.
  23. Teitel JM, Barnard D, Israels S, et al. Home management of haemophilia. Haemophilia 2004; 10(2): 118-33.
  24. Soucie JM, Symons J 4th, Evatt B, et al. Home-based factor infusion therapy and hospitalization for bleeding complications among males with haemophilia. Haemophilia 2001; 7(2): 198-206.
  25. Kurth MA, Dimichele D, Sexauer C, et al. Immune tolerance therapy utilizing factor VIII/von Willebrand factor concentrate in haemophilia A patients with high titre factor VIII inhibitors. Haemophilia 2008; 14(1): 50-5.

The Journal of Haemophilia Practice is published by Haemnet.

Haemnet is a registered charity that brings together and gives a voice to haemophilia nurses, physiotherapists and allied health care professionals, providing forums for collaborative research, educational activities and support.