Radiosynoviorthesis in haemophilia: how safe?
One of the best procedures to prevent haemarthrosis in haemophilia has been radioactive synovectomy (radiosynoviorthesis). Since 1976 we have performed 119 radiosynoviortheses in 110 patients, aged from 3 to 40 years (mean 10), and of whom 71 were under 12 years of age. The knees were injected in 71, elbow in 29, ankles in 16, and shoulders in 3 cases. Clinical results of the procedure gave excellent results 80% of patients with no further bleeding. In the case of failure a reinjection can be given in the same joint at a 6 month interval. One of the criticisms against this method is possible chromosomal damage. In our centre, 4 studies have been made in order to see whether these changes are permanent, but all have demonstrated that chromosomal changes are reversible. Radioactive material used in 2 studies was Au-189. In 1978, 354 metaphases were studied with 61 ruptures, with 17.23% non-premalignant and 6 structural changes considered premalignant (1.69%). Further study was done in 1982, in the same group of patients with the result of 21 ruptures (3.34%) and no structural changes. The third study was performed in 13 patients that sustained radiosynoviorthesis with Re-186 in 1991. We compared the chromosomal study before and 6 months after the radioactive material injection and the results confirmed that changes appeared equally in non-irradiated and radiated patients and disappeared with time, never reaching the dangerous zone of 2%. In the group treated with Re-186 we studied an additional number of 130 metaphases with identical results and no structural changes. A study performed before and after radiosynoviorthesis with Y-90 revealed no premalignant changes. It seems than radiosynoviorthesis is safe and highly beneficial to haemophilic patients.
National Haemophilia Centre, Municipal Blood Bank, Caracas, Venezuela. feferpal@telcel.net.ve
Federico
F
Fernández-Palazzi
Rafael
R
Viso
Absara
A
Boadas
Arlette
A
Ruiz-Saez
Aida
A
Falcon de Vargas
Norma B
NB
de Bosch
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002869:Chromosome Aberrations / Q000528:radiation effects; D006395:Hemarthrosis / Q000209:etiology / Q000532:radiotherapy*; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007270:Injections, Intra-Articular; D011868:Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects; D013583:Synovial Membrane / Q000528:radiation effects*; D055815:Young Adult
D011868:Radioisotopes