Corinn Cross, MD (Host): This is Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. I'm your host, Dr. Cori Cross. Today we'll be learning about the Bleeding Disorders Treatment Program at Children's Health and how it provides comprehensive care for pediatric patients with bleeding and clotting disorders.

We are excited to have Dr. Ayesha Zia, who is a pediatric hematologist-oncologist at Children's Health and a professor at UT Southwestern with us today for this discussion. Dr. Zia, thank you for joining us today.

Ayesha Zia, MD: You're most welcome. It's a pleasure to be here.

Host: So Dr. Zia give us a brief understanding of the Bleeding Disorder Treatment Program at Children's Health and the patients it serves.

Ayesha Zia, MD: Yeah, we are a comprehensive, multidisciplinary program that's dedicated to caring for infants, children, adolescents with suspected or confirmed bleeding and clotting disorders.

Host: And is this program unique to Children's Health or are there other pediatric hospitals in North Texas offering similar types of programs?

Ayesha Zia, MD: The comprehensive program is not unique per se, but some of the subspecialty clinics we offer within the program are quite unique. And one of those unique programs is the Young Women's Blood Disorders Program where we offer unique care to women with bleeding disorders who have distinct healthcare needs. And it's a combined clinic with OB GYN and adolescent medicine as well as hematology.

The second unique clinic is a comprehensive stroke clinic that's with stroke neurologists and hematology. And last but not the least, we have an inpatient multidisciplinary program that also falls within the umbrella of this program, which is as is our pulmonary embolism response team, where experts come together in real-time as soon as suspect a severe or suspected PE hits the emergency department or is diagnosed on the floor.

Host: Wow. So what is the age bracket of the patients that you serve?

Ayesha Zia, MD: It's all the way from birth to 21 years.

Host: So when you're saying women, these are women who are still in that pediatric sort of age bracket where pediatricians still treat them. Amazing. And are there some common misconceptions about bleeding disorders that you'd like listeners to know about?

Ayesha Zia, MD: One of the biggest misconceptions is that bleeding disorders are rare or that they only affect males. In fact, bleeding disorders are often underdiagnosed, especially in women and girls, and can present very subtly. Another misconception is that normal baseline coagulation labs rule out a bleeding disorder. But what we do in our program is, really specialized in comprehensive testing and expert interpretation.

Host: So as a pediatrician myself, one of the things that I was taught was if a girl had a heavy menstrual period, that this was something that we should be thinking about. Are there other things, specific signs or symptoms that should prompt primary care providers or community specialists to consider bleeding disorders or to refer to your program?

Ayesha Zia, MD: Yeah. The biggest red flag I would say is if there's bleeding after surgery, in addition to the heavy menstrual bleeding that you mentioned, or if there's unexplained bleeding. An example would be a child that is born after vaginal delivery that's not complicated, that's not prolonged, and has a cephalohematoma, for example. And so things like that should prompt, a referral or at least, a thought process about whether there's a bleeding disorder present.

Host: And is that the same for if they're having dental work done?

Ayesha Zia, MD: Correct. Any bleeding after surgeries or dental procedures or even minor surgeries. In fact, there's at least one bleeding disorder, well more than one, factor 11 deficiency or mild hemophilia in boys that will only present after surgical or hemostatic challenges.

Host: Now, is this something that a primary care provider or community specialist should try to work up on their own and send to you when they're pretty confident of bleeding disorder? Or should they send the patient along because they might not be doing a comprehensive workup on their own?

Ayesha Zia, MD: I think it's perfectly reasonable to initiate some baseline testing. But I would, base that decision on personal family history, which is either recurrent or severe or unexplained or perhaps their family members or multiple family members and all of them bleed unexpectedly or have bled after surgeries, or maybe there's women in the family that have required hysterectomy for heavy periods. And you know, you always get those stories where mom, aunts, grandmoms, all have had hysterectomies in their thirties. Right? So I think those kinds of things should prompt a referral, or at least the thought that could there be a bleeding disorder lurking there.

Host: So when, primary care providers do refer, obviously these are complicated patients, and then it requires a lot of communication between providers to provide the proper amount of care. How does your team collaborate with referring providers, and make this sort of more seamless?

Ayesha Zia, MD: I would say collaboration is at the core of what we do, and we really see ourselves as an extension of the referring providers team, not really a replacement. And we work closely with, I already mentioned OB GYN, adolescent medicine, neurologists and, now more commonly with cardiologists as well.

We work with surgeons, dentists, orthopedic surgeons, and in terms of collaboration, related to surgeries and those with established bleeding disorders. So really this allows us to coordinate care seamlessly, whether it's periprocedural planning, pregnancy management, hopefully not in that adolescent age group, but sometimes that's what we have to do, or long-term follow-up for the complex clotting or bleeding conditions.

Host: So I get a really good sense of how many different departments are involved in caring for these patients, give me a little bit of a sense of the bleeding disorders treatment program. If a patient comes and becomes part of this program, how is their treatment sort of addressed differently than they would be getting at a different facility?Is it that they have like a person who's their point person? What is it that the treatment program offers that allows you to provide such personalized care?

Ayesha Zia, MD: So I used the term comprehensive multidisciplinary program in the beginning. And so in our comp clinic visits, which comp is short for comprehensive, we will have the pediatric hematologist who has specific expertise in bleeding disorders and thrombosis.

And in our program the physicians not only did hematology oncology training, but in additional training in hemostasis and thrombosis. So they have this unique expertise. And then with that, we usually will either have another expert in the clinic, but also social worker, genetics, physical therapist, because some of these bleeds are musculoskeletal bleeds, so they might happen in the joints.

And so, during our comprehensive clinic visits, the patient comes into our clinic. It's a one stop shop, and they get to see all of these. Again, some of these patients will have school needs and so the social worker may help communicate with the school nurse, for example, we may have a plan in place that needs to be administered at school.

They need factor at school according to physical activity level. So, they get to see all of those specialties under one roof.

Host: I'm sure the patients appreciate it, but I'm sure the parents appreciate it as well, because taking a child to so many different visits really can become overwhelming. Let's take a moment to discuss the future and what you see on the horizon. Are there any advancements or emerging treatments in this field that you are particularly excited about?

Ayesha Zia, MD: Yeah, it's an incredibly exciting time in our field and what I'm personally most excited about is gene therapy for hemophilia and we have a cure now. I remember, our medical school days and then our training days where we really you know, you replaced what was missing. We had hemophilia, you gave factor VIII or factor IX products.

They were short half-life and then it advanced to extended half life, to ultra long half life. And now, in addition to that, patient's have the choice of a cure as well. That's why I'm particularly excited about that.

Host: That's amazing. As a wrap up, can you give us a 30 second take-home message for our listeners?

Ayesha Zia, MD: That would be that bleeding and clotting disorders are highly treatable when recognized, and, really no question or concern is too small to raise to your primary care providers. And if there's any doubt or any suspicion, involve hematology early.

Host: I think that's great advice. Thank you, Dr. Zia, for taking the time to speak with us today. If you'd like more information about the Bleeding Disorders Treatment Program at Children's Health, please visit children's.com. Thank you so much for your time with us today and to our audience for listening to Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research.

You can find more information at children's.com, and if you found this podcast helpful, please rate and review and share this episode and please follow Children's Health on your social channels.