title: Avoidable Compartment Syndrome! High Index of Suspicion for a Newly Presenting Haemophiliac: A Case Series.
abstract: Bleeding disorders can present at any age and vary in their severity. Haemophilia, which is characterised by its x-linked recessive inheritance, can present with a spontaneous mutation and therefore no family history will be evident. Three cases of trauma induced thigh haematomas as an initial presenting feature for people with haemophilia are discussed. The cases highlight the importance of a coagulation screen if the patients bleeding phenotype does not match the injury sustained. An isolated prolonged APTT with no offending anticoagulant cause should always be investigated to look for underlying haemophilia. Interestingly the cases demonstrate the limitations of a coagulation screen. Factor VIII being an acute phase reactant can result in the fact that the initial coagulation screen may be temporarily normal. Therefore, if there is a high index of suspicion for a bleeding disorder, consider repeating the coagulation screen and seeking haematology opinion. Early diagnosis and appropriate specific factor replacement for an injured haemophiliac prevent haematomas expanding thus avoiding potential complications like compartment syndrome or unnecessary surgical input.
authors.affiliation: Northern Ireland Haemophilia Comprehensive Care Centre, Belfast City Hospital, Lisburn Road, Belfast BT10 7AB, UK.
authors.forename: A
authors.identifier: 0000-0001-9454-2692
authors.initials: A
authors.lastname: Niblock
authors.affiliation: Department of Orthopaedics, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: K
authors.initials: K
authors.lastname: Donnelly
authors.affiliation: Department of Physiotherapy, Belfast City Hospital, Lisburn Road, Belfast BT10 7AB, UK.
authors.forename: F
authors.initials: F
authors.lastname: Sayers
authors.affiliation: Genetics Department, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK.
authors.forename: P
authors.identifier: 0000-0003-4676-990X
authors.initials: P
authors.lastname: Winter
authors.affiliation: Northern Ireland Haemophilia Comprehensive Care Centre, Belfast City Hospital, Lisburn Road, Belfast BT10 7AB, UK.
authors.forename: G
authors.initials: G
authors.lastname: Benson