Wolfgang Miesbach։ What a Near-Perfect FISH Score Fails to See
Wolfgang Miesbach, Head of Hemostasis/Hemophilia Center at Medical Clinic 2 at University Hospital Frankfurt, shared a post on LinkedIn about a recent article by Sanjeev Manasseh Padankatti et al, published in Haemophilia, adding:
”What a near-perfect FISH score fails to see
The Functional Independence Score in Haemophilia (FISH) is the standard performance-based test of physical function in haemophilia. Most children on early prophylaxis now score 31 or 32, so the test can no longer tell near-normal from normal function.
The CMC Vellore team (Padankatti, Poonnoose, Srivastava and colleagues) added two harder tasks: a seated basketball chest throw and a ten by five metre shuttle sprint
Age norms came from 710 healthy boys.
They tested 20 boys with severe haemophilia A on prophylaxis, all with a FISH score of 31 or 32:
- Only 1 reached the top band in both tests
- About half scored at least 1 SD below age norms (55 percent throw, 50 percent sprint)
- Sprint times fell behind from age 7, throwing from age 12
- No bleeds occurred during testing
A normal FISH does not mean normal function. Treatment now aims beyond preventing bleeds, and outcome measures need to keep pace.
The cohort is small, the reference values are Indian, and the analysis is descriptive only. Multicentre validation comes next.”
Title: Enhanced Functional Independence Score for Haemophilia (E-FISH) for Early Detection of Musculoskeletal Changes
Authors: Sanjeev Manasseh Padankatti, S Priyadarshini, Ronald Thomvic, Paul Jebaraj, Grace Elizabeth Muppidi, Divya Jebaraj, Kavitha M Lakshmi, Tunny Sebastian, Judy Ann David, Pradeep Mathew Poonnoose, Aby Abraham, Alok Srivastava
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