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CBD for Hemophilia

Can CBD help with hemophilia, and if so, how?

The Centers for Disease Control and Prevention describes hemophilia as a usually-inherited bleeding disorder where the blood would not clot as it should, leading to spontaneous bleeding (1). 

Blood contains many proteins called clotting factors that can help stop bleeding. 

Hemophilia A, also called factor VIII deficiency or classic hemophilia, is a genetic disorder caused by a missing or defective factor VIII, a clotting protein.

Meanwhile, Hemophilia B, also called factor IX (FIX) deficiency or Christmas disease, is caused by a missing or defective factor IX.

Although both types of hemophilia are passed down to children from their parents, about 1 in 3 cases are caused by a spontaneous mutation or a change in a gene, says the National Hemophilia Foundation (2). 

Signs and symptoms of spontaneous bleeding include: (3) 

Excessive bleeding can be life-threatening if it occurs in any vital organs such as the brain. Therefore, it becomes crucial to treat hemophilia before it becomes severe. 

Why Some People Are Taking CBD for Hemophilia Symptoms

CBD may not be a recommended treatment for hemophilia. However, CBD’s purported therapeutic characteristics may be useful in treating some of the symptoms commonly linked to hemophilia, such as pain, inflammation, nausea, vomiting, and seizures.

According to the Hemophilia Federation of America (HFA), joint disease is the most common complication of hemophilia. A joint is where two bones are held together. 

People with hemophilia can bleed into the joint space after an injury or, at times, without an apparent cause. The pressure of blood filling the joint cavity causes significant pain and can lead to chronic swelling and deformity (4). 

CBD may help in the treatment of different types of chronic pain (5). Thus, CBD may help provide much-needed pain relief when dealing with joint problems.

Meanwhile, CBD’s anti-inflammatory characteristics have been shown in several human and animal studies, like that of a 2014 study published in the Journal of Clinical Investigation and a 2012 research conducted by authors from the Department of Pathology, School of Veterinary Medicine in the University of São Paulo, Brazil (6).

In addition, research published in the Free Radical Biology & Medicine Journal by George Booz of the University of Mississippi Medical Center showed that CBD, which may interact with the endocannabinoid system, is a promising prototype for anti-inflammatory drug development (7).

Those with hemophilia can have bleeding in and around the brain, after an injury or without a known cause. Head bleeds may result in permanent brain damage or even death (8). 

Signs of having a head bleed include:

CBD may be able to help alleviate some of those symptoms.

A 2011 study published in the British Journal of Pharmacology revealed the antiemetic effects of cannabinoids in response to a toxic challenge. Cannabidiol (CBD), the primary non-psychoactive compound in cannabis, was shown to suppress nausea and vomiting within a limited dose range (9).

CBD may also help reduce muscle spasms, a feature of neuropathic damage which often manifests in painful, uncontrolled muscle twitches (10). 

However, the most substantial scientific evidence is for CBD’s effectiveness in treating some epilepsy syndromes, like Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically do not respond to antiseizure medications (11)

Epidiolex, which contains CBD, was the first drug ever approved by the U.S. Food and Drug Administration (FDA) for those conditions (12).

Conclusion

Cannabidiol (CBD) is not a replacement for traditional hemophilia treatment. Still, CBD’s therapeutic health benefits may help relieve some of the symptoms linked to hemophilia, such as nausea, vomiting, pain, inflammation, and seizures.

However, a consultation with a doctor experienced in cannabis use is essential before using CBD as a treatment for any symptom or disorder or using CBD as an adjunct therapy.

References

  1. CDC. (2019, June 3). What is Hemophilia? Retrieved from https://www.cdc.gov/ncbddd/hemophilia/facts.html.
  2. NHF. Hemophilia A. Retrieved from https://www.hemophilia.org/Bleeding-Disorders/Types-of-Bleeding-Disorders/Hemophilia-A; NHF. Hemophilia B. Retrieved from https://www.hemophilia.org/Bleeding-Disorders/Types-of-Bleeding-Disorders/Hemophilia-B.
  3. Mayo Clinic. (2019, Aug 22). Hemophilia. Retrieved from https://www.mayoclinic.org/diseases-conditions/hemophilia/symptoms-causes/syc-20373327.
  4. HFA. Joint Damage. Retrieved from https://www.hemophiliafed.org/understanding-bleeding-disorders/complications/joint-damage/.
  5. Grinspoon, P. (2019, Aug 27). Cannabidiol (CBD) — what we know and what we don’t. Retrieved from https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476.
  6. Oláh A, Tóth BI, Borbíró I, et al. Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes. J Clin Invest. 2014;124(9):3713–3724. doi:10.1172/JCI64628; Ribeiro A et al. Cannabidiol, a non-psychotropic plant-derived cannabinoid, decreases inflammation in a murine model of acute lung injury: role for the adenosine A(2A) receptor. Eur J Pharmacol. 2012 Mar 5;678(1-3):78-85. doi: 10.1016/j.ejphar.2011.12.043. Epub 2012 Jan 12.
  7. Booz GW. Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress. Free Radic Biol Med. 2011;51(5):1054–1061. DOI:10.1016/j.freeradbiomed.2011.01.007.
  8. Hemophilia of Georgia. Head Bleeds. Retrieved from https://www.hog.org/handbook/article/3/33/head-bleeds.
  9. Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol. 2011;163(7):1411–1422. DOI:10.1111/j.1476-5381.2010.01176.x.
  10. NINDS. (2018, Aug). Peripheral Neuropathy Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet.
  11. Grinspoon, P. (2019, Aug 27). Cannabidiol (CBD) — what we know and what we don’t. Retrieved from https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476.

FDA News. (2018, June 25). Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms.


    HYPERMAGNESAEMIA



    DEFINITION



    A serum magnesium concentration above the normal range (typically 0.8

    to 1.2 mmol/L, 1.6 to 2.4 mEq/L, 2.0 to 2.6 mg/dL).



    TOXIC CAUSES



    States of magnesium excess usually result from overzealous therapeutic

    administration of magnesium or from conventional doses in the presence

    of impaired renal function.



    NON-TOXIC CAUSES



    Adrenal insufficiency

    End-stage renal disease

    Familial benign hypocalciuric hypercalcaemia.

    Rhabdomyolysis



    CLINICAL FEATURES



    Magnesium reduces neuromuscular transmission and acts as a central

    nervous system depressant.  Nausea usually appears at 3 to 5 mEq/L. 

    Sedation, hypoventilation with respiratory acidosis, decreased deep

    tendon reflexes and muscle weakness appear at 4 to 7 mEq/L. 

    Hypotension, bradycardia and diffuse vasodilatation appear at 5 to 10

    mEq/L. Respiratory paralysis occurs at 10 to 15 mEq/L.



    DIFFERENTIAL DIAGNOSIS



    Bradycardia due to other causes (e.g. beta-adrenoceptor antagonists,

    digoxin, myocardial infarction).

    Disturbance of consciousness due to other causes (e.g. drug overdose).

    Muscle weakness due to other causes (e.g. muscular dystrophies). 



    RELEVANT INVESTIGATIONS



    Serum electrolytes, blood urea, creatinine, glucose and arterial blood

    gases are helpful in determining the diagnosis and in evaluating the

    severity of this disorder.  An ECG may be indicated to assess any

    cardiac dysrrhythmias.



    TREATMENT



    Treatment of hypermagnesaemia is directed firstly at removal of the

    source of magnesium and secondly at enhancing removal if the serum

    concentration of magnesium poses a threat to survival.  Infusion of

    calcium will produce a rapid but short-lived reduction in the serum

    magnesium and often dramatic improvement in the patient's clinical

    condition.  High serum concentrations of magnesium in the presence of

    impaired renal function may require haemodialysis.



    CLINICAL COURSE AND MONITORING



    Magnesium concentrations should be monitored during therapeutic

    intervention.  If the concentration does not return to the normal

    range, further correction may be necessary.  Fluid balance,

    electrolytes, cardiac status and acid-base balance should also be

    monitored.



    LONG-TERM COMPLICATIONS



    None.



    AUTHOR(S)/REVIEWERS:



    Authors:       Tim Meredith and Yeong-Liang Lin

                   Center for Clinical Toxicology

                   Vanderbilt University Medical Center

                   Nashville, USA.



    Reviewers:     Rio de Janeiro  9/97:  J.N. Bernstein, E. Birtanov,

                   R. Fernando, H. Hentschel, T.J. Meredith, Y. Ostapenko,

                   P. Pelclova, C.P. Snook, J. Szajewski.

    

    

HYPOMAGNESAEMIA DEFINITION A serum magnesium concentration below the normal range (typically 0.8 to 1.2 mmol/L, 1.6 to 2.4 mEq/L, 2.0 to 2.6 mg/dL). TOXIC CAUSES Alcoholism Amphotericin Aminoglycosides Beta agonists Cisplatin Cyclosporin Diuretics Hydrofluoric acid Laxatives Pentamidine Theophylline NON-TOXIC CAUSES Congenital renal magnesium wasting Diabetes mellitus Hyperparathyroidism Hyperthyroidism Inadequate magnesium intake Pancreatitis Primary hyperaldosteronism Prolonged diarrhoea Prolonged nasogastric suction Renal transplantation Total parenteral nutrition CLINICAL FEATURES The clinical features are non-specific, variable and not well correlated with serum magnesium concentration. Initially, anorexia, nausea, vomiting, lethargy and weakness may develop. The principal symptoms of magnesium deficiency consist of paresthesiae, muscular cramps, irritability, decreased attention span and mental confusion. Physical findings reflect associated hypocalcaemia and may include positive Trousseau's and Chvostek's signs, tremor, hyperreflexia, peculiar movements of the fingers described as "athetoid tetany" and, sometimes, convulsions. Cardiac arrhythmias, disturbances of conduction, ventricular fibrillation and cardiac arrest can occur in patients with coexisting hypokalaemia. DIFFERENTIAL DIAGNOSIS Hypocalcaemia Hypokalaemia Neurologic disorders with increased deep tendon reflexes (e.g. progressive primary muscular atrophy) Seizures due to other causes RELEVANT INVESTIGATIONS Serum magnesium Serum calcium, phosphorus Serum sodium, potassium, chloride, bicarbonate Renal function tests (urea, creatinine) ECG Arterial blood gas analysis TREATMENT In treating magnesium deficiency, it is important to detect and correct any associated potassium and calcium deficiencies. In mild magnesium deficiency, restoration of body stores occurs quickly after providing a diet high in magnesium. In more severe magnesium deficiency, parenteral administration of magnesium salts is safe and effective but must be used cautiously in patients with renal insufficiency. Initial treatment requires 8 to 12 g of intravenous magnesium sulfate in divided doses over the first 24 hours, followed by 4 to 5 g daily for 3 to 4 days. It is important to replete magnesium stores in patients with hypomagnesaemia but not to provide an excess. Magnesium oxide is typically supplied as 600 mg tablets containing 30 mEq/L of magnesium per tablet. Several days of 4 to 6 tablets per day should be sufficient to restore the deficit in most patients. Administration of oral magnesium can cause diarrhoea. CLINICAL COURSE AND MONITORING The management of moderate-to-severe hypomagnesaemia should include admission to hospital with monitoring of haemodynamic status, neurologic status and serum electrolytes. During replacement therapy, serum magnesium and deep tendon reflexes should be monitored closely, especially in patients with renal insufficiency. If the patient becomes weak or loses deep tendon reflexes, stop the infusion immediately. LONG-TERM COMPLICATIONS None AUTHOR(S)/REVIEWERS Authors: Dr Tim Meredith and Dr Yeong-Liang Lin Center for Clinical Toxicology Vanderbilt University Medical Center Nashville, USA. Reviewers: Rio de Janeiro 9/97: J.N. Bernstein, E. Birtanov, H. Hentschel, T.M. Meredith, Y. Ostapenko, P. Pelclova, C.P. Snook, J. Szajewski Birmingham 3/99: B. Groszek, H. Kupferschmidt, N. Langford, K. Olson, J. Pronczuk. MAGNESIUM (POWDER) ICSC: 0289 Date of Peer Review: April 2000 CAS # 7439-95-4 Mg RTECS # OM2100000 Atomic mass: 24.30 UN # 1418 EC Index # 012-001-00-3 (pyrophoric) TYPES OF HAZARD / EXPOSURE ACUTE HAZARDS / SYMPTOMS PREVENTION FIRST AID / FIRE FIGHTING FIRE Highly flammable. Gives off irritating or toxic fumes (or gases) in a fire. NO open flames, NO sparks, and NO smoking. NO contact with moisture, acids, halogens and many other substances. Special powder, dry sand, NO other agents. NO water. EXPLOSION Finely dispersed particles form explosive mixtures in air. Do NOT expose to friction or shock. Prevent build-up of electrostatic charges (e.g., by grounding). EXPOSURE PREVENT DISPERSION OF DUST! Inhalation Cough. Laboured breathing. Headache. Dullness. Weakness. Fever or elevated body temperature. Skin Eyes Redness. Pain. Safety goggles. Ingestion Abdominal pain. Diarrhoea. Do not eat, drink, or smoke during work. Rinse mouth. Refer for medical attention. SPILLAGE DISPOSAL PACKAGING & LABELLING Do NOT wash away into sewer. Sweep spilled substance into containers. Carefully collect remainder, then remove to safe place. Personal protection: P2 filter respirator for harmful particles. Airtight. EU Classification Symbol: F R: 15-17 S: (2-)-7/8-43 UN Classification UN Hazard Class: 4.3 UN Subsidiary Risks: 4.2 UN Pack Group: ll EMERGENCY RESPONSE STORAGE Transport Emergency Card: TEC (R)-43GWS-II+III NFPA Code: H0; F1; R2; Fireproof. Separated from strong oxidants, acids. Dry. IPCS International Programme on Chemical Safety Prepared in the context of cooperation between the International Programme on Chemical Safety and the Commission of the European Communities © IPCS, CEC 2005 SEE IMPORTANT INFORMATION ON BACK MAGNESIUM (POWDER) ICSC: 0289 IMPORTANT DATA PHYSICAL STATE; APPEARANCE: GREY POWDER PHYSICAL DANGERS: Dust explosion possible if in powder or granular form, mixed with air. If dry, it can be charged electrostatically by swirling, pneumatic transport, pouring, etc. CHEMICAL DANGERS: The substance may spontaneously ignite on contact with air or moisture producing irritating or toxic fumes. Reacts violently with strong oxidants. Reacts violently with many substances causing fire and explosion hazard. Reacts with acids and water forming flammable/explosive gas (hydrogen - see ICSC0001), causing fire and explosion hazard. OCCUPATIONAL EXPOSURE LIMITS: TLV not established. MAK not established. ROUTES OF EXPOSURE: The substance can be absorbed into the body by inhalation. INHALATION RISK: Evaporation at 20°C is negligible; a harmful concentration of airborne particles can, however, be reached quickly. EFFECTS OF SHORT-TERM EXPOSURE: Inhalation of fumes may cause metal fume fever. PHYSICAL PROPERTIES Boiling point: 1100°C Melting point: 651°C Density: 1.7 g/cm³ Solubility in water: none Auto-ignition temperature: 473°C Explosive limits, vol% in air: see Notes ENVIRONMENTAL DATA NOTES Burns with an intense flame. In order to prevent eye injury do not look directly at magnesium fires. Reacts violently with fire extinguishing agents such as water, carbon dioxide and powder. Explosive limits, vol% in air: (LEL) 0.03 kg/m³. Card has been partly updated in October 2005. See section Emergency Response. ADDITIONAL INFORMATION LEGAL NOTICE Neither the CEC nor the IPCS nor any person acting on behalf of the CEC or the IPCS is responsible for the use which might be made of this information © IPCS, CEC 2005 CALCIUM CARBIDE ICSC: 0406 Date of Peer Review: October 1995 Calcium acetylide Acetylenogen CAS # 75-20-7 CaC2 RTECS # EV9400000 Molecular mass: 64.1 UN # 1402 EC Index # 006-004-00-9 TYPES OF HAZARD / EXPOSURE ACUTE HAZARDS / SYMPTOMS PREVENTION FIRST AID / FIRE FIGHTING FIRE Not combustible but forms flammable gas on contact with water or damp air. Many reactions may cause fire or explosion. NO contact with water. Special powder, dry sand, NO other agents. EXPLOSION Risk of fire and explosion on contact with water. Use non-sparking handtools. Prevent deposition of dust; closed system, dust explosion-proof electrical equipment and lighting. In case of fire: cool drums, etc., by spraying with water but avoid contact of the substance with water. EXPOSURE PREVENT DISPERSION OF DUST! STRICT HYGIENE! Inhalation Cough. Laboured breathing. Shortness of breath. Sore throat. Local exhaust or breathing protection. Fresh air, rest. Half-upright position. Refer for medical attention. Skin Redness. Skin burns. Pain. Protective gloves. Protective clothing. Remove contaminated clothes. Rinse skin with plenty of water or shower. Eyes Redness. Pain. Blurred vision. Severe deep burns. Safety goggles or eye protection in combination with breathing protection if powder. First rinse with plenty of water for several minutes (remove contact lenses if easily possible), then take to a doctor. Ingestion Laboured breathing. Shock or collapse. (Further see Inhalation). Do not eat, drink, or smoke during work. Wash hands before eating. Rinse mouth. Do NOT induce vomiting. Refer for medical attention. See Notes. SPILLAGE DISPOSAL PACKAGING & LABELLING Remove all ignition sources. Sweep spilled substance into clean dry containers. Carefully collect remainder, then remove to safe place. Do not use water. Airtight. EU Classification Symbol: F R: 15 S: (2-)-8-43 UN Classification UN Hazard Class: 4.3 UN Pack Group: II EMERGENCY RESPONSE STORAGE Transport Emergency Card: TEC (R)-43S1402 or 43GW2-II+III NFPA Code: H1; F3; R2; W Separated from incompatible materials. See Chemical Dangers. Dry. Well closed. IPCS International Programme on Chemical Safety Prepared in the context of cooperation between the International Programme on Chemical Safety and the Commission of the European Communities © IPCS, CEC 2005 SEE IMPORTANT INFORMATION ON BACK CALCIUM CARBIDE ICSC: 0406 IMPORTANT DATA PHYSICAL STATE; APPEARANCE: GREY CRYSTALS OR BLACK LUMPS, WITH CHARACTERISTIC ODOUR. CHEMICAL DANGERS: Shock-sensitive compounds are formed with silver nitrate and copper salts. The substance decomposes violently on contact with moisture and water producing highly flammable and explosive acetylene gas (ICSC # 0089), causing fire and explosion hazard. Reacts with chlorine, bromine, iodine, hydrogen chloride, lead, fluoride magnesium, sodium peroxide and sulphur, causing fire and explosion hazard. Mixtures with iron (III) chloride, iron (III) oxide and tin (II) chloride ignite easily and burn fiercely. OCCUPATIONAL EXPOSURE LIMITS: TLV not established. ROUTES OF EXPOSURE: The substance can be absorbed into the body by inhalation. INHALATION RISK: Evaporation at 20°C is negligible; a harmful concentration of airborne particles can, however, be reached quickly especially if powdered. EFFECTS OF SHORT-TERM EXPOSURE: Corrosive. The substance is corrosive to the eyes, the skin and the respiratory tract. Inhalation of the substance may cause lung oedema (see Notes). PHYSICAL PROPERTIES Melting point: about 2300°C Relative density (water = 1): 2.22 Solubility in water: reaction ENVIRONMENTAL DATA NOTES Reacts violently with fire extinguishing agents such as water, producing explosive gas. The substance may contain contaminant resulting in the release of the toxic gas phosphine on contact with water. The symptoms of lung oedema often do not become manifest until a few hours have passed and they are aggravated by physical effort. Rest and medical observation are therefore essential. Immediate administration of an appropriate inhalation therapy by a doctor or a person authorized by him/her, should be considered. Specific treatment is necessary in case of poisoning with this substance; the appropriate means with instructions must be available. Also consult ICSC 0089 Acetylene. Card has been partly updated in October 2005. See section Emergency Response. ADDITIONAL INFORMATION LEGAL NOTICE Neither the CEC nor the IPCS nor any person acting on behalf of the CEC or the IPCS is responsible for the use which might be made of this information © IPCS, CEC 2005 MAGNESIUM (PELLETS) ICSC: 0701 Date of Peer Review: March 1995 Magnesium turnings CAS # 7439-95-4 Mg RTECS # OM2100000 Atomic mass: 24.3 UN # 1869 EC Index # 012-002-00-9 TYPES OF HAZARD / EXPOSURE ACUTE HAZARDS / SYMPTOMS PREVENTION FIRST AID / FIRE FIGHTING FIRE Highly flammable in powder form. Gives off irritating or toxic fumes (or gases) in a fire. NO open flames, NO sparks, and NO smoking. NO contact with moisture or acid. Dry sand. Special powder. NO hydrous agents. NO water. EXPLOSION Finely dispersed particles form explosive mixtures in air. Prevent deposition of dust; closed system, dust explosion-proof electrical equipment and lighting. EXPOSURE PREVENT DISPERSION OF DUST! Inhalation Cough. Local exhaust or breathing protection. Fresh air, rest. Skin Protective gloves. Rinse skin with plenty of water or shower. Eyes Redness. Pain. Safety goggles. First rinse with plenty of water for several minutes (remove contact lenses if easily possible), then take to a doctor. Ingestion Do not eat, drink, or smoke during work. Rinse mouth. SPILLAGE DISPOSAL PACKAGING & LABELLING Sweep spilled substance into containers. Do NOT wash away into sewer. Carefully collect remainder, then remove to safe place. Personal protection: P2 filter respirator for harmful particles. Airtight. EU Classification Symbol: F R: 11-15 S: (2-)-7/8-43 UN Classification UN Hazard Class: 4.1 UN Pack Group: III EMERGENCY RESPONSE STORAGE Transport Emergency Card: TEC (R)-41GF3-II+III NFPA Code: H0; F1; R1; Fireproof. Separated from strong oxidants, acids, carbonates, halogens. Dry. IPCS International Programme on Chemical Safety Prepared in the context of cooperation between the International Programme on Chemical Safety and the Commission of the European Communities © IPCS, CEC 2005 SEE IMPORTANT INFORMATION ON BACK MAGNESIUM (PELLETS) ICSC: 0701 IMPORTANT DATA PHYSICAL STATE; APPEARANCE: SILVERY-WHITE METALLIC SOLID IN VARIOUS FORMS. CHEMICAL DANGERS: The substance may spontaneously ignite on contact with air if finely divided or on heating. Upon heating, toxic fumes are formed. The substance is a strong reducing agent and reacts violently with oxidants and many other substances, causing fire and explosion hazard. Reacts with moisture or acids, evolving combustible gas (Hydrogen - see ICSC 0001), causing fire and explosion hazard. OCCUPATIONAL EXPOSURE LIMITS: TLV not established. ROUTES OF EXPOSURE: The substance can be absorbed into the body by ingestion. PHYSICAL PROPERTIES Boiling point: 1100°C Melting point: 649°C Relative density (water = 1): 1.74 Solubility in water: reaction ENVIRONMENTAL DATA NOTES Magnesium burns with an intense flame. Avoid direct viewing of magnesium fires. Reacts violently with fire extinguishing agents such as water, powder, carbon dioxide and halons. Card has been partly updated in October 2004. See sections Occupational Exposure Limits, EU classification, Emergency Response. ADDITIONAL INFORMATION LEGAL NOTICE Neither the CEC nor the IPCS nor any person acting on behalf of the CEC or the IPCS is responsible for the use which might be made of this information © IPCS, CEC 2005