Home Treatment of Haemophilia and Christmas Disease: Five Years' Experience

Summary. The Oxford home treatment programme began in 1971. The material used was human factor VIII concentrate made by the Lister Institute's Plasma Fractionation Laboratory at Oxford Haemophilia Centre. The first group of patients admitted to the programme were those making heaviest demands on the Centre for ‘on demand’ treatment. No problems were encountered by these patients, and other patients have been admitted to the programme each year since. By the end of 1975, 56 haemophilic patients and seven Christmas disease patients were receiving regular home treatment. The haemophilic patients on home treatment have on average increased their factor VIII requirements while on home treatment by 31 % to 1945 u of factor VIII per month, although some of the patients who were making very heavy demands for treatment are now using less than before starting home treatment. Since the introduction of home treatment programme, 68% of the treatment received by the 56 haemophilic patients in the scheme was given at home thus saving the patients the cost and discomfort of travelling to the Centre to receive treatment, and saving the staff of the Centre the work of giving the treatment. Including factor VIII used to cover surgical procedures and doses received at other hospitals, the patients received on average 1893 u of factor VIH per month after commencing home treatment. The standard home treatment dose received by the haemophilic patients during 1975 was 250 International Units of factor VIII which proved satisfactory in resolving the majority of bleeds. The lesions treated at home required on average 1.16 doses per bleed (290 u of factor VIII). The Christmas disease patients receive human factor IX concentrate made by the Plasma Fractionation Laboratory in Oxford and follow a regime of weekly or fortnightly prophylactic infusions of 800–1600 u of factor IX, depending on the weight of the patient. Prophylactic infusions account for 40% of the home treatment doses received by the Christmas disease patients.