Sheba saves life of Palestinian hemophiliac

A 14-year-old Palestinian hemophiliac, who nearly bled to death after injections and orthopedic surgery at Makassed Hospital in east Jerusalem on Saturday, was transferred to Sheba Hospital at Tel Hashomer, where NIS 120,000 worth of special medications were given that stopped repeated hemorrhages.

Prof. Uri Martinovich, head of the National Hemophilia Center at Sheba, told The Jerusalem Post that Makassed doctors should not have given him the treatments. He said the boy had antibodies to the conventional and less-expensive hemophilia drug Clotting Factor 8, and thus it could not have stopped the bleeding. Makassed had no immediate comment.

The urgent transfer of the boy, Deeb Harfoush of Harbata east of Ramallah, was approved on an emergency basis by Health Ministry deputy director-general Dr. Yitzhak Berlovich, who heads its medical branch.

"We did not discuss payment," he said. "We knew his life was in danger, and we gave the green light to save him. Now that he is stable and the bleeding has stopped, we can discuss payment."

Berlovich added that as Makassed is in east Jerusalem, the ministry supervises its functioning. "First we will ask Makassed for a copy of the boy's medical file and explanations in writing. Then, if necessary, we will consult with an orthopedics expert and then decide if we will send an investigator to look into the case," he said.

Martinovich and the boy's father, unemployed electrician Ayid Harfoush, said that four years ago, the boy underwent circumcision at Ramallah Hospital, after which he began to bleed. When the bleeding did not stop with Factor 8, he needed treatment in Israel with Factor 7, a highly expensive, genetically engineered treatment for the 15 percent of hemophiliacs who develop antibodies to Factor 8.

Novo Nordisk-Israel, which makes Factor 7, donated the units for his treatment.

Deeb was born with a severely deformed leg that is turned at a 90-degree angle from the normal one. Over the weekend, Makassed attempted Ilizarov treatment, in which metal screws are inserted to bones to gradually extend and straighten them, but injections into his healthy leg caused severe bleeding, as did the surgery on his abnormal leg.

The father told the Post that a few months after Deeb was born, they realized he was a hemophiliac. The couple, who are first cousins, have six children, and their youngest - 16 months old - also has hemophilia, an inherited condition.

The father complained that Deeb cried terribly at Makassed when his leg swelled and his bleeding was uncontrollable after treatment there.

Dr. Rostum Namari, head of orthopedics at Makassed, could not be reached for comment. Dr. Hitam Hassan, director-general of the hospital, said he was not familiar with the case and could not comment within a matter of hours.

"We will look at the medical records and see what was done. We will investigate as usual. I do not know who did the operation or treated him, he said.

Speaking excellent Hebrew, the father said he worked for years in Israel as an electrician but since the recent violence has not had a permit to work in Israel. "I do odd jobs in our village and nearby and earn NIS 20 a day."

He blamed Makassed for performing the surgery even though it was dangerous. "I told the doctors he was bleeding, but they said they knew what they were doing," he said.

Dalia Bassa, medical coordinator for the Civil Administration, learned of the case over the weekend and contacted Martinovich and Berlovich, who agreed to the transfer to Sheba.

"I don't know if Makassed doctors knew of Deeb's medical history that meant he could not be treated with Factor 8. They must have received his medical file in advance," she said. "Perhaps they just decided to go ahead with the operation despite knowing about his case."

Bassa added that Makassed should have declined to do the surgery and instead ask for permission to send him to Sheba.

"It may be that the Ilizarov operation is impossible to perform on somebody with the inability to take Factor 8," Bassa said.
Bassa said she received a Palestinian Authority commitment to cover any costs for treatment of the boy. "It is an open commitment, so the PA will have to cover the expenses," she said.

Martinovich said that research he and his colleagues have done made it possible to successful use Factor 7 not only on hemophiliacs, but also on trauma victims or women who bleed severely in childbirth.