...less medical jargon in a 'Quick Glance' format!
Recurrent or chronic Hemarthrosis is the most common complication of a group of heritable disorders of blood coagulation. This disease can be a complication of anticoagulant therapy or severe trauma to a normal joint. In hemophilia, joint bleeding usually begins before the age of five and tends to recur repeatedly during childhood in response to even minor injury. The most common sites are the knees, elbows, and ankles, but any joint can be involved.
Acute hemarthrosis usually results in marked local inflammation and joint symptoms that can last for days to weeks. Approximately one half of patients with hemophilia develop chronic deformities in one or more joints. Some of them develop a chronic progressive synovitis, restricted to one or a few joints, which clinically and roentgenographically resembles rheumatoid arthritis. In chronic cases there is marked synovial membrane hyperplasia, destruction of articular cartilage, and erosions of subchondral bone. This chronic pro- gressive pattern probably results from a low level of continuous or intermittent bleeding into involved joints. joint fluid, in chronic cases, usually contains blood and very high levels of leukocyte-derived proteases. Other musculoskeletal manifestations of hemophilia include bleeding into muscle and bone. The resolution of large hematomas can produce chronic cysts within these tissues.
Symptoms:
Symptoms of hemarthrosis are usually first noticed during infancy or childhood. But some people who have milder forms of hemophilia may not have symptoms until later in life. Although there are different types of hemophilia, the symptoms are the same.
The following are signs of hemophilia that may be noticed shortly after birth:
Bleeding into the muscle, resulting in a deep bruise after receiving a routine vitamin K shot
Prolonged bleeding after a male child is circumcised
In rare cases, prolonged bleeding after the umbilical cord is cut at birth
Other symptoms of hemophilia include:
Bleeding into a joint or muscle that causes pain and swelling
Abnormal bleeding after an injury or surgery
Easy bruising.
Frequent nosebleeds
Blood in the urine
Bleeding after dental work
Symptoms of bleeding into a joint include:
Warmth and/or tingling in the joint during the early stages of hemarthrosis. This is called an aura. If bleeding is not treated, it can progress to severe pain.
Swelling and inflammation in the joint, caused by repeated episodes of bleeding. If episodes continue, it may lead to chronic pain and destruction of the joint.
An infant's or child's reluctance to move an arm or leg because of bleeding into an affected joint, often first noticed when a child begins to walk.
There are many possible symptoms of bleeding into muscle, including:
Bruising
Swelling
Muscle hardening
Tenderness
Pain, especially when large muscle groups are affected
Occasionally, bleeding into certain muscles (forearm, groin, or leg) puts enough pressure on arteries and nerves to cause a complication called compartment syndrome. A compartment syndrome is a medical emergency that requires immediate treatment to prevent permanent damage to muscle, bones, and other tissue. Symptoms of compartment syndrome include:
Weakness and paleness in the affected extremity
Swelling and numbness
Severe pain during movement
Inability to move an extremity
Causes:
It usually follows injury but occurs mainly in patients with a predisposition to hemorrhage such as those being treated with warfarin and patients suffering from hemophilia. It can be associated with knee joint arthroplasty.
Treatment:
In hemophilia it may occur spontaneously, and recurrent hemarthroses are a major cause of disability in that patient group due to hemophilic arthropathy, requiring synovectomy, joint replacement and increased medical therapy to prevent further bleeding episodes, although it is controversial whether clotting factor administration adequately prevents hemarthroses.
CONCLUSION:
Hemophilia is a bleeding disorder that affects males. Many advances have been made over the years in the treatment and management of this disorder. Replacement therapy has become much safer and there are new options for patients with inhibitors. Physical therapy also has become an integral part of the treatment for hemophiliacs. Therefore, it is pertinent that practicing physical therapists understand the mechanisms of the disease, the complications that may arise, and the effective methods of treatment.
