Describe the Management

A 15 y/o M with known Hemophilia A presents to the ED with headache s/p trip and fall while hitting his head.  No LOC was reported.  At this time the patient is neurologically intact with normal vital signs. 

What should the immediate management of this patient entail prior to obtaining radiologic studies?  



Immediate treatment should include factor replacement PRIOR to obtaining Head CT.

Depending on the site of bleeding, differing levels of factor replacement are needed.  For CNS and GI bleeds, 100% factor replacement is required.  The amount of factor replacement needed can be calculated via the following formula:

Weight (kg) x 0.5 x Percentage change in factor (1-100%)

High Yield Points:

Hemophilia A: X-linked, recessive disorder; deficiency of factor VIII; Hemophilia B - Factor IX deficiency

Morbidity and Mortality - Primarily the result of hemorrhage; condition can result in spontaneous bleeding or excessive hemorrhage in response to trauma

Hemorrhage sites include joints, muscles, CNS, GI tract, GU system, pulmonary, and cardiovascular systems;  ICH most common in patients < 18 y/o

Lab Results - usually aPTT is prolonged

Clinicians should have low suspicion for obtaining imaging, this should be done AFTER factor replacement initiated.