Typical Crisis Bleeding in Hemophilia ! 1. Hemarthrosis The most common bleeding problem of the hemophiliac population is spontaneous bleeding into a joint. The most frequently affected joints are the elbow and the knee, but involvement of any joint can occur. Many patients develop “target joints” that bleed more frequently. The bleeding episode is associated with the development of significant pain. Swelling and erythema can occur subsequently, but diagnosis and treatment of an acute hemarthrosis does not require well-developed signs. Indeed, an x-ray of the joint is most likely to show chronic changes from prior bleeding episodes, but is unlikely to provide a clue to the current diagnosis. Therefore, radiograms are not routinely obtained with every incident. Because of the significant benefits of early treatment, classic symptoms in a reliable patient are a sufficient basis for immediate treatment. Irritability, guarding, and lack of movement of the affected joint are signs of probable hemarthrosis in young children who are unable to articulate pain. Diagnosis and early treatment in this group is difficult. Chronic deformity of the joint, with swelling and chronic pain, is the sequelae of recurrent or inadequately managed joint bleeds. Within 8 to 12 hours of treatment, patients can note the effects of restoration of haemostasis by decreased pain and pressure. The joint should be initially rested (i.e., immobilized), but mobilization within the first several days is a requirement for the rapid restoration of baseline range of motion of the joint. Initial therapy with factor VIII or factor IX requires that the factor level be raised to about 30% to 50%. A sustained minimal level of 15% to 25% for a longer period of time may be required for severe bleeding episodes, particularly if the bleeding involves a weight-bearing joint. If the bleeding episode requires physical therapy, prophylactic therapy may be indicated to avoid bleeding during efforts to mobilize the joint. #Hemophilia_Awareness
Posted on: Fri, 19 Sep 2014 02:38:01 +0000
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