The identification of high risk knee bleeds in adolescents with severe haemophilia A

Abstract

Summary One hundred and thirty‐seven knee bleeds treated with an initial dose of 11–16 units of factor VIII/kg have been reviewed in an attempt to find the predictive factors for bleeds requiring retransfusion. Thirty‐two bleeds (23.4%) were retransfused within 48 hours because of extension of bleeding or poor progress. Fifty‐nine per cent of bleeds which were retransfused presented with pain and 72% were tender at presentation. These figures contrasted with those for bleeds which were not retransfused of 30% and 45%. The difference in each case is significant. Forty‐seven per cent of retransfused bleeds presented with less than 50% of normal movement against 12% who were not retransfused. This difference was also highly significant. It is suggested that knee bleeds presenting with pain, tenderness and/or more than 50% restriction of movement should be considered for higher initial doses of factor VIII.

The use of an activated factor IX complex (Autoplex) in the management of haemarthroses in haemophiliacs with antibodies to factor VIII

“…We suggest, therefore, that a dose level of 45-57 units/kg of Autoplex corresponds roughly in effect with a calculated 10% dose factor VIII in haemophiliacs without antibodies to factor VIII. The response to such a dose is likely to be variable and influenced by the site of bleeding, severity of the lesion, presence or absence of risk factors and the underlying state of the joint (Aronstam et al , 1981a(Aronstam et al , 1981b(Aronstam et al , 1982. We believe that this is the reason for variable reported responses to Autoplex.…”

“…As not all bleeds presented with all parameters, the final score for each bleeding episode is recorded as a percentage of the possible score. The severity of each bleed was scored according to the presence or absence of the high risk factors for major haemarthroses (Aronstam et al 1981a(Aronstam et al , 1982. One point was assigned for each of the three risk factors, pain, tenderness and delay of more than 3 hours from the institution of treatment.…”