Women’s Blood Disorders Program

Depending on the diagnosis, we offer a full range of personalized and targeted treatments that may continue throughout the reproductive journey. We develop individualized treatment plans to minimize bleeding risk during pregnancy and delivery, heavy menstrual bleeding and after procedures such as contraceptive implant placement. For patients with von Willebrand disease (the most common inherited bleeding disorder among American women), hemophilia and other bleeding disorders, we offer a wide range of treatments to reduce the incidence of bleeding and pain, achieve hemostasis and correct coagulopathy. We also provide prophylactic treatment, such as for dental or surgical procedures and before and after delivery, to prevent bleeding episodes and postpartum hemorrhage and improve quality of life.
 
To treat and prevent bleeding, we offer a variety of hormonal and nonhormonal therapies and factor replacement therapies, including human plasma-derived and recombinant (synthetically manufactured) clotting-factor concentrates, with and without extended half-life, such as recombinant von Willebrand factor. For plasma-derived therapies, including fresh frozen plasma, we use the most advanced screening and viral inactivation techniques to reduce or eliminate bloodborne infections. We also offer bypassing agents to treat bleeding in patients with hemophilia A and B with inhibitors.
 
We have expertise in administering nonreplacement therapies, including bispecific antibody therapy, such as emicizumab, gene and small interfering ribonucleic acid (RNA) therapies, as well as recombinant clotting factor therapies that can be used preventatively. Some of the gene therapies we offer include etranacogene dezaparvovec and fidanacogene elaparvovec—approved for adults with hemophilia B—and turoctocog alfa—approved for adults and children with hemophilia A. While not a cure for hemophilia, these therapies may offer patients hemophilia-free peace of mind, more freedom from hemorrhage without the need for regular treatment with drugs, and longer lifespans. Because these therapies do not rely on human blood plasma, patients are also not at risk of contracting bloodborne infections, such as hepatitis and human immunodeficiency virus (HIV).

For patients with von Willebrand disease or hemophilia, we also offer pharmacologic options, including desmopressin to help reduce bleeding and antifibrinolytics, such as aminocaproic acid and tranexamic acid, to prevent the breakdown of blood clots. We also offer pain management using multimodal treatments such as medications, steroids and physical therapy. Hormone therapies, such as birth control pills, are also used to reduce menstrual bleeding in patients with von Willebrand disease.
 
If surgery is required to manage bleeding complications, such as joint bleeding (hemarthrosis) or other soft-tissue bleeding, our multidisciplinary team of orthopedic surgeons and other surgical specialists offers the latest in open, minimally invasive and robotic surgery.

Depending on the cause of the disorder, we offer the latest pharmacological treatments that target procoagulant factors for venous thromboembolism management and antiplatelet agents (as monotherapy or dual-antiplatelet therapy) for arterial thrombosis management. We use a wide range of anticoagulant agents, from direct oral anticoagulants (such as dabigatran, apixaban, edoxaban and rivaroxaban) and vitamin K antagonists (such as warfarin) to intravenous unfractionated heparin and low-molecular-weight heparin.

Our multidisciplinary team of vascular specialists offers a variety of the latest endovascular treatments, including catheter-directed thrombolysis, percutaneous aspiration thrombectomy, venous balloon dilation and pharmacomechanical catheter-directed thrombolysis, which administers “clot-busting” drugs directly into the clot. In certain cases, inferior vena cava (IVC) filters, including retrievable IVC filters, are also offered.

For women with sickle cell disease (SCD), we work together with our Sickle Cell Center, the first Sickle Cell Center and Research Laboratory in the U.S. and the second largest in the country. We are one of the few gene therapy-authorized treatment centers for SCD in the country, and we offer access to all of the newly approved gene therapies for SCD, including Lyfgenia and Casgevy.

We are at the forefront of diagnosing and treating women with IDA. Most cases of iron deficiency and IDA can be successfully managed with oral iron supplementation. However, certain patients, such as those who have an intolerance to oral iron, have had an unsatisfactory response to oral iron, cannot use oral iron, have anemia from heavy menstrual bleeding and/or have severe IDA in pregnancy, may benefit from intravenous (IV) iron therapy. At Montefiore Einstein, we offer access to the latest iron formulations that allow for administering a total dose infusion in one visit to enhance convenience.
 
We developed a novel telemedicine referral platform (e-Iron Program) for triaging and expediting the management of patients with iron deficiency and IDA who require IV iron infusion. Our e-Iron protocol includes routine screening for a history of heavy menstrual bleeding at the time of the iron infusion, and we have instituted an expedited referral pathway to gynecology providers when deemed necessary.

Certain autoimmune hematologic conditions, such as immune thrombocytopenic purpura, thrombotic thrombocytopenic purpura and autoimmune hemolytic anemia, are more commonly seen in women. Depending on the individual’s platelet count and symptoms, we offer access to the most advanced pharmacological treatments, ranging from traditional medications such as corticosteroids and other immunosuppressive agents, intravenous immunoglobulin, platelet transfusion and hemostatic therapies such as tranexamic acid to newly emerging therapies. We offer access to a wide range of monoclonal antibody therapies that target different parts of the immune system for patients with previous thrombotic events and thrombopoietin receptor agonists for the treatment of chronic immune thrombocytopenia. In refractory cases, removal of the spleen (splenectomy) may be necessary. Our team of internationally recognized surgical specialists uses the latest open, minimally invasive and robotic surgical approaches.
 
The presence of antiphospholipid antibody syndrome can have an adverse impact on pregnancy outcomes and is associated with an increased risk of miscarriage and preterm labor. Our team of immunohematologists works together with maternal fetal medicine, gynecologists, immunologists and rheumatologists to optimize the course of pregnancy and outcomes in patients with autoimmune hematologic disorders.