Joint haemorrhage in haemophilia: is full advantage taken of plasma therapy?

An examination of joint laxity in haemophilia

An adolescent haemophiliac group (all less than 1 per cent Factor VIII) and a normal, similarly aged, 'control group' of boys were examined to measure joint laxity in an effort to identify a causative factor for bleeding. Definitive laxity was found in the thumb joints and in finger extension of haemophiliacs compared with normal boys. The haemophiliacs who were more lax-jointed showed no tendency towards an increased number of bleeds when they were followed for 100 days. Possible explanations for these phenomena are discussed.

The social impact of haemophilia

Haemophilia, one of the oldest known genetic disorders, imposes varying degrees of disability on those affected. A survey of 137 haemophiliacs, seventy-eight adults and fifty-nine children, in the north of England was conducted to discover the extent of social, educational and employment problems created by the disease, while investigation of sixty-nine mothers of patients provided information on its impact on family life.

Some problems are adequately met, others not; those of education and employment are the most serious. Educational deficiencies are due to incomplete and interrupted schooling. Choice of employment is severely restricted for them, and stability of employment is adversely affected by episodes of ill-health. But with improved methods of medical treatment the children are losing less school time than the adults did, fewer of them attend schools for the physically handicapped, and this should result in the attainment of better educational standards, and therefore more hope for permanent and satisfactory employment in the future.

The birth of a haemophilic child markedly affects the family, particularly the mother, but again there is a difference in response between the present and the older generation of mothers.

Cryoprecipitate therapy in haemophilia

This paper describes experience over an 18-month period of a new preparation of factor VIII, cryoprecipitate, prepared by the Regional Blood Transfusion Service from human plasma. This relatively simple and inexpensive method selectively extracts the factor VIII leaving behind the other blood products for use in other ways.

Replacement therapy in the treatment of haemophilia has been generally regarded as inadequate due to the difficulty in obtaining potent antihaemophilic globulin in sufficient amounts, and cryoprecipitate represents a useful advance.

Bleeding episodes in 25 patients with factor VIII deficiency have been treated with cryoprecipitate on 41 occasions and an assessment of the haemostatic effect of this material has been made in treating haemarthrosis, muscle haematomata and the management of major and minor surgical operations. Routine follow-up over a 6 month period was undertaken to determine the incidence of side effects. Two cases of hepatitis were found, possibly resulting from cryoprecipitate therapy. However, both patients had also received blood or fresh frozen plasma and the source of the hepatitis virus must remain in doubt. No factor VIII inhibitors were found despite repeated courses of therapy in several patients.

The advantages and disadvantages of cryoprecipitate are set out and its encouraging place in the management of haemophilic bleeding assessed.