Pattern Of Bleeding In Nigerian Haemophilliacs Seen In A Tertiary Hospital

Abstract

Haemophilia A and B are X-chromosome linked bleeding disorders, due to defective synthesis of factor VIII or IX respectively, and are characterised by delayed and sustained bleeding. Bleeding into the joints (Haemarthrosis) is the most common presentation.Recurrent haemarthrosis leads to crippling haemarthropathy and flexion deformities, typically in the hinge and socket joints. This study determined the pattern of bleeds in the Nigerian haemophiliacs in order to locate the usual sites and influence their care in emergencies. We reviewed the records of 28 haemophiliacs who were seen at the Haematology Day Care Unit over a 2-year period for emergency care of acute bleeds. The patients were aged between 16 months and 42 years with a median age of 12.5 years. Twenty-six of these patients had Haemophilia A (93%) and Haemophilia B constituted 7%. The coagulation factor levels ranged between 0.4% and 8%. The commonest bleeding site was the joint which constituted 41% of cases followed by soft tissue involvement, observed in 25% of patients and gastrointestinal tract, in 16% of cases. All 28 (100%) patients received fresh frozen plasma either given alone or in combination with other therapeutic options. Ten (36%) patients received cryoprecipitate; 6(21%) got recombinant factor VIII, 5(18%) received fresh whole blood and 3(11%) patients were given antifibrinolytic agents for the management of acute bleeding episodes. We concluded that the joints are the commonest site of bleeding in our hospital with knee joint involvement being the most frequent. This may result in physical disability. Patients experiencing bleeding episodes might require a more personalized approach to treatment in which case, there might be the need to consider prophylaxis for some of our patients.

Key words: Bleeding Pattern, Haemophilia, Emergency Care.