Haemophilia In Sweden Research Articles

Persons with Haemophilia in Sweden- Experiences and Strategies in Everyday Life. A Single Centre Study

Introduction/AimHaemophilia is caused by deficiency in coagulation factor VIII or IX. Treatment with the missing coagulation factors has been available in most developed countries for several decades. The aim was to explore the experiences of adults living with severe or moderate haemophilia and their coping strategies at a single centre in Sweden.MethodThe interview study had a qualitative empirical approach and was analyzed on the basis of the method empirical phenomenological psychology. The sample included 14 participants, mean age 42 (19–80 y), who met the inclusion criteria and to saturation of information. Results: General characteristics were; All were satisfied with and grateful for access to medication. An acceptance of the disorder and willingness to live a normal life was identified among all participants. They were all content with the care provided by Haemophilia Treatment Centre (HTC) and felt supported by its multidisciplinary team. Four typologies were identified; Protective adults and assertive children during up-bringing, finding a role in social context, symptoms and treatments, fear of limited resources in the future. Task-, emotional- and avoidance coping strategies were seen in the interviews. The most prominent coping strategy was task oriented.ConclusionThis interview study with Swedish PWH shows that they strive for normality and adaptation in social activities throughout life finding their own niche. The PWH expressed the importance of knowledge and support from the comprehensive medical team at HTC and therefore it seems important to continue comprehensive medical care at HTC in order to follow-up the haemophilia persons regularly.

Recombinant full-length factor VIII (FVIII) and extended half-life FVIII products in prophylaxis--new insight provided by pharmacokinetic modelling.

The pharmacokinetics (PK) of extended half-life factor VIII (FVIII) products might allow longer dosing intervals in prophylaxis, potentially affecting its efficacy. We used published population PK models of a recombinant full-length FVIII (rAHF-PFM) and a recombinant B-domain-deleted FVIII Fc fusion product (rFVIIIFc) to assess the time spent weekly with FVIII levels below 3IUdL(-1) or above 10IUdL(-1) . These FVIII levels were chosen based on the observation that trough levels of 1IUdL(-1) may not be sufficient in all patients. This approach was applied to a simulated population of 1000 severe haemophilia A subjects with dosing regimens included in the prescribing information or evaluated in clinical trials. FVIII levels remained ≥3IUdL(-1) in 57% of patients treated with rAHF-PFM 30IUkg(-1) every 48h compared with 41.1%, 18.3%, 0.9% and 0% of patients treated with rFVIIIFc 30IUkg(-1) every 72h, 50IUkg(-1) every 96h or 120h and 65IUkg(-1) every 168h respectively. Patients on rAHF-PFM 30IUkg(-1) every 48h spent more time weekly with FVIII levels above 10IUdL(-1) than those on rFVIIIFc 50IUkg(-1) every 96h or 120h, and 65IUkg(-1) every 168h. In conclusion, PK modelling indicates that choice and dosing intervals of standard and extended half-life FVIII products require careful evaluation of individual PK to allow more time at protective levels, especially in patients with active lifestyles.

Prenatal diagnosis of haemophilia in Sweden now more commonly used for psychological preparation than termination of pregnancy.

The aims of the study were to define the frequency, outcome and reasons for prenatal diagnosis (PND) in Sweden during a 30-year period in order to study trends and changes. The study population, from the Swedish nationwide registry of PND of haemophilia, consisted of 54 women, compromising >95% of all, who underwent PND (n=90) of haemophilia during 1977-2013. PND was performed by amniocentesis (n=10), chorionic villus sampling (n=64) or by analysis of foetal blood (n=16). A total of 27/90 foetuses were found to have haemophilia. Sixteen went to termination and the remaining 11 were born during the end of the study period (2000-2013). Three of 90 pregnancies were terminated due to findings other than haemophilia and 3/90 PNDs led to miscarriage. In the 30 families with known haemophilia, PNDs (n=55) were used in 27/55 cases for 'psychological preparation' and in 23/55 cases with the aim to terminate the pregnancy. A subgroup of women (n=17) who consecutively underwent PND in the years 1997-2010 were further interviewed. For 11/17, being a carrier had a negative effect on the decision to become pregnant, and in 11 cases PND had influenced their decision to conceive. Our study show that PND of haemophilia is stable over time but increasingly used during the last decade as a psychological preparation for having a child with haemophilia as compared to earlier where more terminations of pregnancies were conducted.

Incidence, mortality rates and causes of deaths in haemophilia patients in Sweden

Sweden has been a pioneer in the treatment of haemophilia, with the first concentrate available in the 1950s. Treatment has improved over the years to its current state-of-the art. The aim of the current study was to evaluate the long-term outcome of haemophilia in terms of incidence, morbidity and mortality. Patients diagnosed with haemophilia A or B registered at the national haemophilia centres and/or the Patient Registry and born before 2009 and alive in 1968 were enrolled and linked to the Cause of Death-, Migration- and Medical Birth registries. Five age- and sex-matched controls were selected for each patient. A total of 1431 patients with haemophilia A or B were compared with 7150 controls. The 3-year moving average incidence rate per 100,000 population varied between 21 and 36. The hazard ratio for all-cause mortality compared with controls was 2.2, 95% CI: [1.8; 2.7], P < 0.001 for the entire group of patients and 1.7, 95% CI: [1.3; 2.2], P < 0.001 when patients with HIV and/or viral hepatitis were excluded. The corresponding figures for the severe haemophilia subgroup were 6.6, 95% CI: [4.5; 10.0], P < 0.001 and 8.2, 95% CI [3.2; 20.8], P < 0.001 respectively. The most common causes of death were related to malignancies and the haemostatic defect. People with haemophilia were 57% less likely to die from ischaemic heart disease than controls. People with haemophilia in Sweden demonstrate higher mortality over time, independent of HIV and viral hepatitis, despite relatively advantageous access to clotting factor concentrates.

Protecting the joints of mice and men

Meija-Carval et al. present a novel murine model for the study of haemophilic synovitis. The model appears suitable for assessing and quantifying joint disease in mice and the appropriate control animals are included. Thus, the results are likely reliable and of a high evidence grade. The study, however, can be questioned from an ethical point of view. The aims of the project were ‘…to test the hypothesis that a minimum number of haemarthroses negatively impacts on joint function and this would be reflected by decreased physical performance of experimental animals’. The results support the following conclusions: ‘(i) haemophilic mice can be trained to ambulate on a rotating rod; (ii) acute haemarthrosis temporarily impairs their ability to ambulate and (iii) following recovery from acute injury, mice developing synovitis demonstrated inferior physical ability compared with mice not developing synovitis’. The experimental animals were anaesthetized at time of the experimental injury but ‘on the third day were forced to exercise on the Rotarod’. The results show, as expected, higher morbidity among the experimental animals, i.e. they lose weight and perform less well in their physical function. Obviously, the animals are adversely affected. The discussion opens with the statement: ‘The data presented here demonstrate for the first time, the ability to monitor the impact on joint bleeding and the development of synovitis on physical performance’. I do not agree with the authors. The disease haemophilia was first described in the Babylonian Talmud, fourth century, Yevamoth 64 BC where it is stated: ‘For it was taught: if she circumcised her first child and he died (as a result of bleeding from the operation), and a second one also died, she must not circumcise her third child’ [1]. Thus, haemophilia is a very serious bleeding disorder with known consequences: acute joint bleeds with severe pain and physical impairment, other serious bleeding into the brain and viscera, and development of chronic joint disease resulting in serious handicap. In the beginning of the 1900s, the median life span among persons with haemophilia in Sweden was 11 years. As late as the period 1943–57, the median age at death was as low as 19 years [2]. Efficacious treatment during the last 50 years has been accompanied by increase in life expectancy [3]. With the introduction of prophylaxis in Europe during the late 1950s and early 1960s, joint outcome has markedly improved [4-7], benefiting quality of life and showing cost effectiveness [7, 8]. In Europe, the decades-long observation by clinicians of the obvious benefit of haemophilia treatment, notably the effectiveness of prophylaxis, has been supported by well-designed cohort studies. Thus, randomized clinical trials comparing prophylaxis with on demand therapy have never been performed, as they have been considered both unnecessary and unethical, and long-term outcome in haemophilia requires decades of follow-up in observational studies [9]. In some parts of North America, the European experience has not been accepted and therefore not only mice but also young children have suffered in the name of science [10]. The murine model described by Meja-Carvajal et al. may have a potential for further study of the pathophysiology of joint disease and the development of better treatment. However, the aims of their study and their results have been observed and confirmed in humans for decades, not to say thousands of years, in other parts of the world. Ethical awareness and readiness to learn from colleagues in other parts of the world must be the leading star for doctors treating patients. The author has stated that he has no interests which might be perceived as posing a conflict or bias.

Willingness to pay for on-demand and prophylactic treatment for severe haemophilia in Sweden.

The objective of the present paper was to provide an estimate of the benefits of on-demand and prophylaxis treatment strategies for severe haemophilia in monetary terms. Using the contingent-valuation method, which simulates a missing market by asking people about their willingness to pay (WTP), we asked a representative sample (n = 609) of the Swedish population if they would be willing to pay a specific amount (bid) so that patients with severe haemophilia could receive on-demand treatment and another bid for prophylactic treatment. Different respondents were offered different bids and the bid vector ranged from 71 Euro cents to EUR 130. The order of the bid questions was randomized so that half of the respondents were asked first about their WTP for on-demand treatment, and then about their WTP for prophylaxis, while the order was reversed for the other half of the respondents. The mean estimated WTP (year 2002) was EUR 39 (95% CI 31-47) for on-demand and EUR 65 (95% CI 55-73) for prophylaxis. Our sensitivity analysis showed that the ranking of the two treatment alternatives was robust in that the WTP was greater for prophylaxis in all possible subsets. The point estimates of WTP varied somewhat in subsets defined by individual characteristics, but confidence intervals always overlapped that of the main results. The WTP for on-demand and prophylaxis exceeded the calculated cost of treatment per taxpayer of providing on-demand and prophylactic treatment, respectively, based on our previous results.

Reproductive choices of haemophilia carriers.

The actual reproductive choices made by slightly over a quarter of all the carriers of severe or moderate haemophilia in Sweden were investigated and compared with those of a randomly selected age-matched group of women who were not carriers of haemophilia. In general, the 105 carriers had the same number of children as other women of similar age. However, carriers who did not choose prenatal diagnosis (PD) often abstained from further pregnancies after the birth of a haemophilic child, and they had significantly fewer children than the remainder of the carriers, as well as fewer children than women in the control group. Logistic regression analysis showed choice of PD to be correlated to a positive attitude towards abortion following PD and a family history of haemophilia. Carriers who have experienced the complications of haemophilia or its treatment appear to be more in favour of PD than women whose haemophilic children have received modern treatment without complications.

Carrier testing and prenatal diagnosis of haemophilia--utilisation and psychological consequences.

Attitudes towards prenatal diagnosis, and abortion vary widely between different countries, religions, cultures and over time. Carrier testing and prenatal diagnosis (PD) of haemophilia have become an integrated part of the comprehensive care for haemophilia in Sweden as well as in many other countries. Almost all carriers are interested in carrier testing if they are aware of the possibility. With the development of PD by chorionic villus sampling in the first trimester, the method became acceptable for many carriers, and it has in Sweden actually had an effect on the incidence of haemophilia in the 1990s. The use of PD is more common among women who perceive haemophilia as a very serious disease and who have a positive attitude towards legal abortion. The main reason for carriers not to use PD was that they do not find haemophilia to be a sufficiently serious disorder to justify an abortion. Women and their spouses are under a great deal of psychological pressure in association with the PD procedure, and the psychological consequences of having to terminate a pregnancy are long-lasting. At follow-up, about 6 years after PD and abortion, these women, however, do not have more signs of psychological distress than women without PD experience. Nevertheless, they must be offered qualified assistance both before and after PD as well as adequate follow-up after an abortion to help them cope with the emotional strain they are under.

Guidelines on treatment of haemophilia in Sweden.

Guidelines on treatment of haemophilia in Sweden.

The impact of prenatal diagnosis on the incidence of haemophilia in Sweden.

A demographic survey was made of all children (n= 137) born with severe or moderate haemophilia in Sweden during the period 1970-92. Bn addition, all prenatal diagnoses (n= 86) performing during the period were evaluated. The annual incidence of severe and moderate haemophilia, having remained constant for decades, increased from 0.78/10,000 males in the 1970s to 1.34 in the 1980s, levelling off at 1.31 in the 1990s. Although prenatal diagnosis did not affect the incidence of haemophilia in the 1970s and 1980s, it did so in the 1990s, because the incidence would have been 40% higher (1.83) had not prental diagnosis been available and 16 affected fetuses been aborted. The average proportion of sporadic cases, 62%, remained almost unchanged during the study period, suggesting mutation rates to be constant. There were fewere children in families with known haemophilia than in sporadic families, but no evidence was found to suggest that the frequency of female offspring (i.e. potential carriers) born in haemophilia families had increased since the option of prenatal diagnosis was introduced.

Management of Haemophilia in Sweden

The incidence of living haemophiliacs in Sweden (total population 8.1 millions) is about 1:15,000 males and about 1:30,000 of the entire population. The number of haemophiliacs born in Sweden in 5-year periods between 1931-1975 (June) has remained almost unchanged. The total number of haemophilia families in Sweden is 284 (77% haemophilia A, 23% haemophila B) with altogether 557 (436 with A and 121 with B) living haemophiliacs. Of the haemophilia A patients 40% have severe, 18% moderate, and 42% mild, haemophilia. The distribution of the haemophilia B patients is about the same. Inhibitors have been demonstrated in 8% of the patients with severe haemophilia A and in 10% of those with severe haemophilia B. There are 2 main Haemophilia Centres (Stockholm, Malmö) to which haemophiliacs from the whole of Sweden are admitted for diagnosis, follow-up and treatment for severe bleedings, joint defects and surgery. Minor bleedings are treated at local hospitals in cooperation with the Haemophilia Centres. The concentrates available for treatment in haemophilia A are human fraction I-0 (AHF-Kabi), cryoprecipitate, Antihaemophilic Factor (Hyland 4) and Kryobulin (Immuno, Wien). AHF-Kabi is the most commonly used preparation. The concentrates available for treatment in haemophilia B are Preconativ (Kabi) and Prothromplex (Immuno). Suffcient amounts of concentrates are available. In Sweden 3.2 million units of factor VIII and 1.0 millino units of factor IX are given per year. Treatment is free of charge. Only 5 patients receive domiciliary treatment, but since 1958 we in Sweden have practised prophylactic treatment of boys (4-18 years old) with severe haemophilia A. At about 5-10 days interval they receive AHF in amounts sufficient to raise the AHF level to 40-50%. This regimen has reduced severe haemophilia to moderate. The joint score is identical with that found in moderate haemophilia in the same age groups. For treatment of patients with haemophilia A and haemophilia B complicated by inhibitors we have used a large dose of antigen (factor VIII or factor IX) combined with cyclophosphamide. In most cases this treatment produced satisfactory haemostasis for 5 to 30 days and prevented the secondary antibody rise.

Haemophilia in Sweden

Acta Medica ScandinavicaVolume 171, Issue 6 p. 759-769 Haemophilia in Sweden IV. Hereditary Investigations OLOF RAMGREN, OLOF RAMGREN the Chemistry Department II (Head: E. Jorpes, M. D.), Karolinska Institutet, Stockholm, the Department of Medicine I (Head: E. Sköld, M. D.), S:t Eriks Sjukhus, Stockholm and the Department of Medicine (Head: J. Waldenström, M. D.), University of Lund, AllmÄnna Sjukhuset, Malmö, SwedenSearch for more papers by this authorINGA MARIE NILSSON, INGA MARIE NILSSON the Chemistry Department II (Head: E. Jorpes, M. D.), Karolinska Institutet, Stockholm, the Department of Medicine I (Head: E. Sköld, M. D.), S:t Eriks Sjukhus, Stockholm and the Department of Medicine (Head: J. Waldenström, M. D.), University of Lund, AllmÄnna Sjukhuset, Malmö, SwedenSearch for more papers by this authorMARGARETA BLOMBÄCK, MARGARETA BLOMBÄCK the Chemistry Department II (Head: E. Jorpes, M. D.), Karolinska Institutet, Stockholm, the Department of Medicine I (Head: E. Sköld, M. D.), S:t Eriks Sjukhus, Stockholm and the Department of Medicine (Head: J. Waldenström, M. D.), University of Lund, AllmÄnna Sjukhuset, Malmö, SwedenSearch for more papers by this author OLOF RAMGREN, OLOF RAMGREN the Chemistry Department II (Head: E. Jorpes, M. D.), Karolinska Institutet, Stockholm, the Department of Medicine I (Head: E. Sköld, M. D.), S:t Eriks Sjukhus, Stockholm and the Department of Medicine (Head: J. Waldenström, M. D.), University of Lund, AllmÄnna Sjukhuset, Malmö, SwedenSearch for more papers by this authorINGA MARIE NILSSON, INGA MARIE NILSSON the Chemistry Department II (Head: E. Jorpes, M. D.), Karolinska Institutet, Stockholm, the Department of Medicine I (Head: E. Sköld, M. D.), S:t Eriks Sjukhus, Stockholm and the Department of Medicine (Head: J. Waldenström, M. D.), University of Lund, AllmÄnna Sjukhuset, Malmö, SwedenSearch for more papers by this authorMARGARETA BLOMBÄCK, MARGARETA BLOMBÄCK the Chemistry Department II (Head: E. Jorpes, M. D.), Karolinska Institutet, Stockholm, the Department of Medicine I (Head: E. Sköld, M. D.), S:t Eriks Sjukhus, Stockholm and the Department of Medicine (Head: J. Waldenström, M. D.), University of Lund, AllmÄnna Sjukhuset, Malmö, SwedenSearch for more papers by this author First published: January/December 1962 https://doi.org/10.1111/j.0954-6820.1962.tb04242.xCitations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume171, Issue6January/December 1962Pages 759-769 RelatedInformation

Haemophilia in Sweden

Acta Medica ScandinavicaVolume 171, Issue 2 p. 223-235 Haemophilia in Sweden II. Carriers of Haemophilia A and B INGA MARIE NILSSON, INGA MARIE NILSSON Department of Medicine (Head: Jan Waldenström, M.D.), University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm, and the Department of Medicine I (Head: Erik Sköld, M.D.), St. Eriks Sjukhus, Stockholm, SwedenSearch for more papers by this authorMARGARETA BLOMBÄCK, MARGARETA BLOMBÄCK Department of Medicine (Head: Jan Waldenström, M.D.), University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm, and the Department of Medicine I (Head: Erik Sköld, M.D.), St. Eriks Sjukhus, Stockholm, SwedenSearch for more papers by this authorOLOF RAMGREN, OLOF RAMGREN Department of Medicine (Head: Jan Waldenström, M.D.), University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm, and the Department of Medicine I (Head: Erik Sköld, M.D.), St. Eriks Sjukhus, Stockholm, SwedenSearch for more papers by this authorIRENE V. FRANCKEN, IRENE V. FRANCKEN Department of Medicine (Head: Jan Waldenström, M.D.), University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm, and the Department of Medicine I (Head: Erik Sköld, M.D.), St. Eriks Sjukhus, Stockholm, SwedenSearch for more papers by this author INGA MARIE NILSSON, INGA MARIE NILSSON Department of Medicine (Head: Jan Waldenström, M.D.), University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm, and the Department of Medicine I (Head: Erik Sköld, M.D.), St. Eriks Sjukhus, Stockholm, SwedenSearch for more papers by this authorMARGARETA BLOMBÄCK, MARGARETA BLOMBÄCK Department of Medicine (Head: Jan Waldenström, M.D.), University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm, and the Department of Medicine I (Head: Erik Sköld, M.D.), St. Eriks Sjukhus, Stockholm, SwedenSearch for more papers by this authorOLOF RAMGREN, OLOF RAMGREN Department of Medicine (Head: Jan Waldenström, M.D.), University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm, and the Department of Medicine I (Head: Erik Sköld, M.D.), St. Eriks Sjukhus, Stockholm, SwedenSearch for more papers by this authorIRENE V. FRANCKEN, IRENE V. FRANCKEN Department of Medicine (Head: Jan Waldenström, M.D.), University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm, and the Department of Medicine I (Head: Erik Sköld, M.D.), St. Eriks Sjukhus, Stockholm, SwedenSearch for more papers by this author First published: January/December 1962 https://doi.org/10.1111/j.0954-6820.1962.tb04184.xCitations: 46AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume171, Issue2January/December 1962Pages 223-235 RelatedInformation

HAEMOPHILIA IN SWEDEN

Acta Medica ScandinavicaVolume 171, Issue S379 p. 61-110 HAEMOPHILIA IN SWEDEN VI. Treatment of Haemophilia A with the Human Antihaemophilic Factor Preparation (Fraction I—0) Inga Marie Nilsson, Inga Marie Nilsson Department of Medicine (Head: Jan Waldenström, M.D.). University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm and the Department of Medicine I (Head: Erik Sköld, M.D.), S:t Erik's Sjukhus, Stockholm, Sweden.Search for more papers by this authorMargareta Blombäck, Margareta Blombäck Department of Medicine (Head: Jan Waldenström, M.D.). University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm and the Department of Medicine I (Head: Erik Sköld, M.D.), S:t Erik's Sjukhus, Stockholm, Sweden.Search for more papers by this authorOlof Ramgren, Olof Ramgren Department of Medicine (Head: Jan Waldenström, M.D.). University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm and the Department of Medicine I (Head: Erik Sköld, M.D.), S:t Erik's Sjukhus, Stockholm, Sweden.Search for more papers by this author Inga Marie Nilsson, Inga Marie Nilsson Department of Medicine (Head: Jan Waldenström, M.D.). University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm and the Department of Medicine I (Head: Erik Sköld, M.D.), S:t Erik's Sjukhus, Stockholm, Sweden.Search for more papers by this authorMargareta Blombäck, Margareta Blombäck Department of Medicine (Head: Jan Waldenström, M.D.). University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm and the Department of Medicine I (Head: Erik Sköld, M.D.), S:t Erik's Sjukhus, Stockholm, Sweden.Search for more papers by this authorOlof Ramgren, Olof Ramgren Department of Medicine (Head: Jan Waldenström, M.D.). University of Lund, Allmänna Sjukhuset, Malmö, Chemistry Department II (Head: Erik Jorpes, M.D.), Karolinska Institutet, Stockholm and the Department of Medicine I (Head: Erik Sköld, M.D.), S:t Erik's Sjukhus, Stockholm, Sweden.Search for more papers by this author First published: January/December 1962 https://doi.org/10.1111/j.0954-6820.1962.tb18848.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume171, IssueS379January/December 1962Pages 61-110 RelatedInformation

Haemophilia in Sweden

Haemophilia in Sweden

Haemophilia in Sweden

Haemophilia in Sweden