How to treat an acute hemarthrosis in a patient with hemophilia?
The mainstay of therapy for acute hemarthrosis in hemophilia is rapid replacement of deficient factor to achieve a level of ≥30%. A useful rule of thumb is that each international unit of virally inactivated plasma-derived or recombinant factor VIII (or IX) concentrate infused per kilogram of body weight causes a rise in factor levels by 2% or 2 IU/dL. In appropriate patients, factor replacement therapy can be promptly instituted by the family at the first symptoms of hemarthrosis to decrease the risks of sequelae. Transmission of human immunodeficiency virus (HIV) is no longer a risk and transmission of hepatitis is significantly reduced with factor replacement currently given. Patient education and involvement are critical for the success of any treatment program. Other initial treatment consists of placing the joint at rest in as much extension as can be tolerated (to prevent contractures), with applications of ice packs and other local measures. Analgesics are given for pain. Mild compression bandaging may be useful. Some authors have advocated intraarticular glucocorticoids (GCs). Arthrocentesis, after appropriate factor replacement, may help relieve symptoms. Once acute bleeding and pain are controlled, graded physical therapy to prevent muscle atrophy and contractures should be instituted.
