Comprehensive Management of Haemophilia

Radiation therapy in pseudotumour haemarthrosis

Total or partial deficiency of factor VIII and IX in the coagulation cascade leads to haemophilia. Haemophilia affecting weight-bearing joints gives a 'pseudotumour' or haemarthrosis-like condition. Surgery and cryoprecipitate infusions have been the treatment for this condition. Radiocolloids and radiation therapy have been used with some benefit. One case of ankle pseudotumour which was treated by low-dose external beam radiation is presented here.

Hemoptysis as a presentation of mild hemophilia A in an adult

It is not unusual for mild hemophilia A to escape detection into adolescent years and it is often detected following dental extractions or other mild trauma. The present report describes a patient shown to have only 8 to 9 percent factor VIII activity at age 30 years. The presentation of recurrent mild hemoptysis with upper respiratory tract infections is unusual and of interest in the differential diagnosis of hemoptysis.

Hemostatic effects of salsalate in normal subjects and patients with hemophilia A

Salsalate in a non-acetylated salicylate with activity as an antirheumatic agent. The hemostatic effects of this agent were studied in twelve healthy subjects and nine patients with hemophilia A. Healthy subjects showed no change in bleeding time, platelet aggregation response to adenosine diphosphate (ADP) or collagen, or adenosine triphosphate (ATP) release in response to arachidonic acid as measured in an impedance whole blood lumi-aggregometer. The patients with hemophilia A showed no bleeding time prolongation nor an effect on ADP or collagen induced platelet aggregation in platelet rich plasma. It is concluded that this agent may be useful in the treatment of arthritis in patients with hereditary coagulation disorders.

Modern haemophilia treatment: medical improvements and quality of life

Adequate replacement therapy in haemophilia has been available for two decades. This has led to considerable improvements in the life expectancy and physical status of haemophilia patients. A study was conducted to investigate whether this has also led to improvements in quality of life. With this aim, information was obtained from 935 Dutch haemophiliacs by mailed questionnaires on relationships, marriage, family life and employment. Haemophilia patients were less often married than men in the general population (13% fewer) and had a lower total number of children (30% lower, 17% for those who were married). Twenty-two per cent of the patients were not employed and received an income from the disability funds. While severity of haemophilia, joint damage and age increased the risk of disability, it was noted that home treatment was associated with a 50% reduction in this risk. Remarkably, haemophilia patients did not differ from the general population in their view of the quality of their own health. The results of this study show a positive influence of modern haemophilia treatment on quality of life. At present, AIDS overshadows all optimistic feelings one may have about this field. However, the results described here demonstrate the benefits that can be achieved with adequate replacement therapy, and justify the expectation of further improvements in the near future.

School absences, school achievements and personality traits of the haemophilic child

Cross-sectional comparisons between haemophiliacs and their healthy classmates were made in the years 1971-72 and 1987-88. The more recent set of data indicated no difference in respect to school absenteeism and school achievements between haemophiliacs and classmates in contrast to the older data, which showed such differences. In 1987-1988 the personality of the haemophilic boy was assessed both by teacher-ratings as well as by self-rating scales, and they indicated that the haemophiliacs were self-assured and independent but also less caring, less joyful, less open and more bullied than their healthy classmates. The mildly to moderately affected haemophiliacs tended to have more emotional disturbances than classmates and severely affected haemophiliacs. The latter were the least likely to avoid potentially hazardous activities. The haemophiliac's conflicts about adapting to a restricting chronic disease were elucidated.

Prophylactic treatment of postperfusion bleeding using EACA

To determine the effects of prophylactic treatment with EACA for blood loss after cardipulmonary bypass surgery, 350 consecutive patients undergoing open-heart surgery were studied. One hundred seventy patients received an initial dose of 5 g of EACA prior to skin incision, followed by intravenous administration of 1 g/h for the next 6 to 8 h. The control group received saline solution in the same fashion. The EACA-treated group had decreased chest tube blood loss 24 h postoperatively. In addition, EACA-treated patients had fewer myocardial infarctions, cerebrovascular accidents or reoperations for bleeding. Treated patients needed fewer units of blood transfusions than the nontreated group. There was no incidence of hyperthrombotic state or other side effects in the EACA-treated group. We concluded that prophylactic treatment with EACA for open-heart surgery requiring extracorporeal circulation may reduce the total blood loss and the number of blood transfusions in a safe and tolerable manner.

Hematologic problems in the preoperative patient

A number of topics have been reviewed pertaining to hematologic problems in preoperative patients. Most if not all of the problems discussed can be evaluated reasonably well by history, physical examination, and a few simple laboratory tests. Because the morbidity arising from some of these abnormalities can be quite significant, evaluation and treatment should be completed prior to surgery whenever possible. It is also critical to recall that therapy for a number of hematologic problems involves the transfusion of blood or blood products. This therapy should not be taken lightly as both immediate reactions (fever, anaphalaxis, hemolysis) as well as delayed effects (allosensitization and viral infections) occur frequently. The prudent clinician should try to minimize his patients' exposure to these potentially toxic materials by using alternative therapies.