i-Build-a-Case: Diagnosing FVII Deficiency in Hospitalized Patients

0.8 ANCC Contact Hours 0.75 AMA PRA Category 1 Credit(s)
Launch Date:
November 14, 2013
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Hematologists, Hematologist/Oncologists, Pediatric Hematologist/Oncologists, Pediatric Hematologists, Surgeons, Anesthesiologists, Intensivists, Critical Care Medicine Specialists, Emergency Medicine Clinicians, Primary Care Physicians, Registered Nurses

Relevant Terms:

Factor VII Deficiency, Factor XIII Deficiency, Postpartum, Acquired Hemophilia, Rare Bleeding Disorders

Amy D. Shapiro, MD

Amy D. Shapiro, MD
Medical Director
Indiana Hemophilia & Thrombosis Center
Adjunct Professor of Pediatrics
Michigan State University
Indianapolis, Indiana

Amy D. Shapiro, MD, is Adjunct Professor of Pediatrics at Michigan State University in East Lansing and Medical Director of the Indiana Hemophilia and Thrombosis Center in Indianapolis. Dr. Shapiro earned a medical degree at New York University School of Medicine in New York City. She went on to complete a pediatric internship and residency as well as a pediatric hematology/oncology fellowship at the University of Colorado Health Sciences Center in Denver. Dr. Shapiro is board certified in pediatrics, with a subspecialty in pediatric hematology/oncology.

A contributor to the medical literature, Dr. Shapiro has numerous textbook chapters and scholarly articles to her credit. She writes on such subjects as prophylaxis in young children with factor VIII deficiency, immunogenetics of hemophilia inhibitors, and von Willebrand disease. Her scholarship appears in journals including Blood, Haemophilia, Journal of Pediatrics, and the British Journal of Haematology.

In addition to her writing endeavors, Dr. Shapiro holds several professional appointments and memberships. She serves on the Medical and Scientific Advisory Council of the National Hemophilia Foundation and is a former chair of the American Thrombosis and Hemostasis Network Board of Directors, for which she continues to be active. Her professional memberships include the World Federation of Hemophilia, the Hemophilia Research Society, and the International Society on Thrombosis and Hemostasis.
1. Identify the clinical presentation and laboratory testing to appropriately diagnose unexplained or unusual bleeding in hospitalized patients
2. Discuss treatment advances for rare bleeding disorders (RBDs), including new and emerging products
3. Explain the evolution and purpose of RBD registries, specifically the RBD registry findings on the clinical phenotype levels and genotypic correlations in factor VII deficiency
4. Provide appropriate education and guidance to patients with RBDs and their families

Program Overview
The treatment of a patient with unexplained spontaneous bleeding typically follows an approach involving requisite knowledge of both normal hemostasis and common laboratory tests. Occasionally, however, a patient will present with an atypical scenario requiring the clinician to investigate more thoroughly to make a correct diagnosis and ultimately arrest bleeding.

Deficiencies of coagulation factors can be especially challenging for clinicians to recognize and treat due to their rarity in the general population. Although FVII deficiency is one of the more "common" rare bleeding disorders, its diagnosis and management can pose a challenge to healthcare practitioners, as it is a clinically heterogeneous disorder with a highly variable bleeding tendency.

Ongoing research continues to expand clinicians' understanding of the pathophysiology of unexplained bleeding due to factor deficiencies in hospitalized patients. Available and emerging clinical trials and registry data complement medical practice, resulting in early diagnosis and the application of new treatment options, as well as improved patient outcomes.

This interactive learning activity provides clinicians with the opportunity to build a case and, based on their choices, learn from expert commentary about the diagnosis and management of a rare coagulation factor deficiency.

Target Audience
This CME activity has been designed specifically to meet the educational needs of hospitalists, hematologists, HEM/ONCs, surgeons and anesthesiologists, intensivists and critical care medicine specialists, emergency medicine clinicians, primary care physicians, registered nurses and other healthcare providers interested in managing hospitalized patients with bleeding disorders such as acquired hemophilia and unexplained bleeding due to a coagulation factor deficiency.

Estimated Time to Complete Activity
45 minutes

Course Viewing Requirements

Supported Browsers:
Internet Explorer 8.0+ for Windows 2000, 2003, Vista, XP, Windows 7, Windows 8
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 5.0+ for Mac OSX 10.5 and above
Supported Phones & Tablets:
Android 4.0.3 and above
iPhone/iPad with iOS 6.1 or above

Physician Continuing Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine, the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians. 

Credit Designation
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education
Accreditation Statement
Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. 

Credit Designation
This educational activity for 0.8 ANCC contact hours is provided by Postgraduate Institute for Medicine (www.pimed.com).
Method of Participation
There are no fees for participating and receiving CME credit for this activity. During the period of November 14, 2013, through November 14, 2014, participants must:
  • Read the learning objectives and faculty disclosures
  • Study the educational activity
  • Complete the posttest by recording the best answer to each question
  • Complete the evaluation form
A statement of credit will be issued automatically upon successfully completing the posttest with a score of 70% or better.
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity: 
Name of Faculty or Presenter Reported Financial Relationship
Amy D. Shapiro, MD Has no real or apparent conflicts of interest to report.
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Name of Planner or Manager Reported Financial Relationship
PIM Clinical Reviewers: Laura Excell, ND, NP, MS, MA, LPC, NCC; Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CCMEP; and Jan Schultz, RN, MSN, CCMEP Have no real or apparent conflicts of interest to report.
ECM: Patrick J. Crowley, MBA, Vice President/Managing Director; Cassie Rametta, BA, Program Director; Gay Boyle, MA, Chief Medical Writer Have no real or apparent conflicts of interest to report.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients' conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities. 
Fee Information
There is no fee for this educational activity.

Commercial Support
This activity is supported by an educational grant from Novo Nordisk Inc.