PO14 - Normalised Bleeds Under Surgical Intervention and Less Hospital Frequencies, an Emicizumab Patient Case Experience in Western Kenya.

Background: Persons with inherited bleeding disorders are at high risk of bleeding following oral surgery challenging dentists. Prevention of the formation of alloantibodies and inhibitors, Fviii, Fix and immunosuppressives are used in the treatment of hemophilia A and B. Emicizumab is a factor (F)VIIIa-mimicking bispecific antibody that functions through recognition of FIXa and FX fragments thus normalising bleeding patterns in hemophilia A patients.

Aims: To report positive surgical outcomes of prophylactic Emicizumab

Methods: A retrospective chart review of persons with hemophilia A (PwHA) and follow-up of the 29 patients enrolled in an Emicizumab prophylactic program donated by World Federation of Hemophilia (WFH), managed under the patient support program in AMPATH-MTRH were treated with once-weekly subcutaneous loading doses (3mg/kg), followed by 4 weekly maintenance doses (6mg/kg) with more tolerance and good safety profile and efficacy. (PwHA) were switched from less thrombotic risk treatment agents such as BPAs or clotting factor concentrates (CFCs) to Emicizumab and outcomes were assessed through surgical reviews.

Results: Several patients amongst a 10-year-old with severe hemophilia A with inhibitor of 5 Bethesda Units (BU) presented to a dental specialist in a peripheral facility for milk teeth extraction six- months under emicizumab support with no disclosure of his clinical status. He had a safe tooth extraction and was given Amoxicillin for prophylaxis against Staphylococcus aureus along with tranexamic acid and analgesics. ‘My son bled normally after the tooth extraction!’ mother narrates.

Conclusion(s): Emicizumab should be considered when its advantage in prophylaxis surpasses that of CFCs in a typical surgical setting since there is a fulfillment of adequate hemostasis. This fulfills two major unmet needs in PwHA with FVIII inhibitors which provide much more effective therapy for the prevention of bleeding and substantially reduce the treatment burden. A small VD and PK profile of Emicizumab prophylaxis may allow safe minor surgical procedures without CFCs.