Elsevier

The Journal of Emergency Medicine

Volume 11, Issue 5, September–October 1993, Pages 519-524
The Journal of Emergency Medicine

Original contribution
Experience with the hemophiliac child in a pediatric emergency department

https://doi.org/10.1016/0736-4679(93)90304-PGet rights and content

Abstract

We conducted a retrospective chart review of all hemophiliacs followed by our pediatric hematology service from January 1, 1980 to December 31, 1989 inclusive, to determine the frequency and nature of their visits to our Emergency Department (ED). Of 36 patients studied, 26 were Factor VIII deficient (13 mild, 3 moderate, and 10 severe) and 10 had Factor IX deficiency (7 mild and 3 severe). No patient had red blood cell (RBC) antibodies or factor inhibitors. One patient was HBsAg positive and 4 patients were HIV positive.

One hundred and twenty-six ED visits [98 (78%) in the 1–5 age group] occurred. Soft tissue hematomas accounted for 48% of total injuries, hemarthroses for 24%, and head injuries for 12%. Twelve patients were admitted to hospital for observation or ongoing factor replacement. Of 15 episodes of head injuries, 1 patient had intracranial hemorrhages on 2 occasions, while 13 received prophylactic factor replacement and recovered uneventfully. Despite the availability of home factor replacement, the ED remains an important locus for the management of the pediatric patient with hemophilia.

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Cited by (11)

  • Treatment of hemophilia with inhibitors: An advance in options for pediatric patients

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    The most common reason for ED visits in the Colorado study was hemorrhage (64.8%), with traumatic hemorrhage being slightly more common (37.6%) than hemorrhage of unknown cause (27.2%).11 In another study 48% of ED visits by pediatric hemophilia patients were the result of soft-tissue hematomas, 24% were the result of hemarthrosis, and 12% were due to head injuries.12 Severe and/or repeated bleeding episodes into joints increase the risk of joint deterioration and permanent disability; therefore consultation with a hematologist is warranted upon presentation.

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