Intraarticular Bleeding in Children with Hemophilia

The treatment of about 400 hemorrhages in the joints of 46 children with hemophilia A are described. The procedures varied according to the location and seriousness of the bleeding and the level of the clotting factor. We always transfused just enough cryoprecipitate to obtain a hemostatic level of factor VIII. When necessary, we would remove blood from the joint. Physical therapy was instituted. The average follow-up period after the initial intra-articular bleeding was 15 years. In patients with a severe form of hemophilia, only 24% of the affected knee joints were in stages III, IV, or V of arthropathy, which should be regarded as a positive result of treatment. We confirmed advanced arthropathy in 21% of the affected elbow joints. Arthropathy occurred only rarely in ankle joints. These results compare favorably to the results obtained among patients undergoing preventative infusions of factor VIII at home.