Joint Aspiration for Acute Hemarthrosis in Children Receiving Factor VIII Prophylaxis for Severe Hemophilia: 11-year Safety Data.
OBJECTIVE
The aims of this study were (1) to document the prevalence of acute hemarthrosis in a cohort of 46 boys with severe hemophilia A receiving full primary prophylaxis in Western Australia (WA), and (2) to investigate the safety of the WA protocol over 11 years for management of hemarthrosis.


METHODS
Case review. The WA protocol involves a pediatric rheumatologist washing out all acute hemarthrosis of large joints promptly and then instilling intraarticular (IA) corticosteroids.


RESULTS
This study showed that joint bleeds occurred in 22 boys of 46 (47.8%). In over 11 years, 84 washouts were performed on 32 joints in 22 boys. No adverse events occurred. Fifteen of 22 boys had normal joints with a Hemophilic Joint Health Score = 0. Fifteen boys who had had all hemarthrosis washed out had clinically normal joints (100%). Seven boys had sustained joint damage prior to full instigation of the protocol, each having had documented hemarthrosis without aspiration. Parents needed to understand that joint bleeds constituted an emergency.


CONCLUSIONS
Of our cohort, 47.8% of patients with severe hemophilia receiving prophylaxis developed joint bleeding. The WA protocol is safe. There is evidence suggesting joint outcomes of hemophilic patients having hemarthrosis despite factor VIII prophylaxis may be much improved if there is access to a center using a procedure similar to the WA protocol.
From the School of Paediatrics and Child Health, and Faculty of Medicine, University of Western Australia; Department of Haematology, Princess Margaret Hospital for Children, Subiaco, Australia.P.J. Manners, MBBS, FRACP, School of Paediatrics and Child Health, University of Western Australia; P. Price, MBBS, FRACP, Department of Haematology, Princess Margaret Hospital for Children; D. Buurman, BSc; B. Lewin, BSc; B. Smith, BSc, Faculty of Medicine, University of Western Australia; C.H. Cole, MBBS, FRACP, FRCPA, School of Paediatrics and Child Health, University of Western Australia, and Department of Haematology, Princess Margaret Hospital for Children.
Prudence J
PJ
Manners
From the School of Paediatrics and Child Health, and Faculty of Medicine, University of Western Australia; Department of Haematology, Princess Margaret Hospital for Children, Subiaco, Australia.P.J. Manners, MBBS, FRACP, School of Paediatrics and Child Health, University of Western Australia; P. Price, MBBS, FRACP, Department of Haematology, Princess Margaret Hospital for Children; D. Buurman, BSc; B. Lewin, BSc; B. Smith, BSc, Faculty of Medicine, University of Western Australia; C.H. Cole, MBBS, FRACP, FRCPA, School of Paediatrics and Child Health, University of Western Australia, and Department of Haematology, Princess Margaret Hospital for Children.
Peter
P
Price
From the School of Paediatrics and Child Health, and Faculty of Medicine, University of Western Australia; Department of Haematology, Princess Margaret Hospital for Children, Subiaco, Australia.P.J. Manners, MBBS, FRACP, School of Paediatrics and Child Health, University of Western Australia; P. Price, MBBS, FRACP, Department of Haematology, Princess Margaret Hospital for Children; D. Buurman, BSc; B. Lewin, BSc; B. Smith, BSc, Faculty of Medicine, University of Western Australia; C.H. Cole, MBBS, FRACP, FRCPA, School of Paediatrics and Child Health, University of Western Australia, and Department of Haematology, Princess Margaret Hospital for Children.
Danika
D
Buurman
From the School of Paediatrics and Child Health, and Faculty of Medicine, University of Western Australia; Department of Haematology, Princess Margaret Hospital for Children, Subiaco, Australia.P.J. Manners, MBBS, FRACP, School of Paediatrics and Child Health, University of Western Australia; P. Price, MBBS, FRACP, Department of Haematology, Princess Margaret Hospital for Children; D. Buurman, BSc; B. Lewin, BSc; B. Smith, BSc, Faculty of Medicine, University of Western Australia; C.H. Cole, MBBS, FRACP, FRCPA, School of Paediatrics and Child Health, University of Western Australia, and Department of Haematology, Princess Margaret Hospital for Children.
Brittany
B
Lewin
From the School of Paediatrics and Child Health, and Faculty of Medicine, University of Western Australia; Department of Haematology, Princess Margaret Hospital for Children, Subiaco, Australia.P.J. Manners, MBBS, FRACP, School of Paediatrics and Child Health, University of Western Australia; P. Price, MBBS, FRACP, Department of Haematology, Princess Margaret Hospital for Children; D. Buurman, BSc; B. Lewin, BSc; B. Smith, BSc, Faculty of Medicine, University of Western Australia; C.H. Cole, MBBS, FRACP, FRCPA, School of Paediatrics and Child Health, University of Western Australia, and Department of Haematology, Princess Margaret Hospital for Children.
Brooke
B
Smith
From the School of Paediatrics and Child Health, and Faculty of Medicine, University of Western Australia; Department of Haematology, Princess Margaret Hospital for Children, Subiaco, Australia.P.J. Manners, MBBS, FRACP, School of Paediatrics and Child Health, University of Western Australia; P. Price, MBBS, FRACP, Department of Haematology, Princess Margaret Hospital for Children; D. Buurman, BSc; B. Lewin, BSc; B. Smith, BSc, Faculty of Medicine, University of Western Australia; C.H. Cole, MBBS, FRACP, FRCPA, School of Paediatrics and Child Health, University of Western Australia, and Department of Haematology, Princess Margaret Hospital for Children. catherine.cole@health.wa.gov.au.
Catherine H
CH
Cole
D000293:Adolescent; D000069237:Arthrocentesis / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005169:Factor VIII / Q000627:therapeutic use*; D006395:Hemarthrosis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D016896:Treatment Outcome
D005169:Factor VIII
ARTHROCENTESIS; FACTOR VIII; HEMARTHROSIS; HEMOPHILIA A; INTRAARTICULAR STEROIDS