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Patients with hemophilia

Patients with haemophilia
WHAT TO DO IN CASE OF.
Caution: if bleeding persists despite the first aid-methods mentioned below or if you
have any doubt, call the nearest haemophilia centre and / or inject factor VIII / IX
Note: Octostim® by subcutaneous injection or intranasal spray is only effective in case
of mild haemophilia A

Haemarthrosis (bleeding in a joint)
− Immediately inject Factor VIII (25-40 U/kg) or IX (30-50 U/kg).
− Apply ice (e.g. cold-pack) wrapped in a cloth or a cold compress.
− Immobilise the joint with a bandage or a splint (never with plaster) for 24 to 48 hours if the
haemarthrosis is severe and / or was not treated immediately. − In case of doubt (severe haemarthrosis, persistent pain), call the physician (in some cases, although rarely, it is necessary to make a puncture to evacuate the haematoma).
Haematoma (haematoma in a muscle, bruise, ecchymosis, contusion)
Dangerous areas: bruising in the face (around eyes, mouth), neck, armpit, front of forearm,
buttocks, groin, behind the knee, calf, and the iliopsoas muscle. − In case of deep haematoma (in the muscle) immediately inject factor VIII / IX (or Octostim®).
− In all situations, apply ice (e.g. cold-pack) wrapped in a cloth or a cold compress and compress
(possibly with a slight compression bandage) for ten minutes (if no ice available, compress with the palm of the hand). − Optionally, define the size of the hematoma with a pen (encircle the hematoma) to monitor its progress and note the time of its appearance: if the size of the haematoma increases, inject factor VIII / IX (or Octostim®) and call the physician.
Head injury
− In case of severe blow on the head, immediately inject factor VIII / IX and call the physician.
Warning: all cases of known or suspected head injury require immediate hospital care (possible
signs are: headache, change of behaviour including drowsiness, vomiting, blurred vision, fainting, etc.). In case of unconsciousness or short loss of conscience, hospital-based care is necessary.
Skin wound and superficial cuts
− Disinfect or wash the wound.
− Compress for 10 minutes and then make a compression bandage.
− If profound wound, inject factor VIII / IX (or take Octostim®) and see a physician for stitches if

Nosebleed (epistaxis)
− Always remain seated, head bent forward (do not lie down or tilt your head backwards).
− Blow your nose once strongly, clean the nasal cavity with saline solution and then compress the − Possibly put ice (e.g. cold-pack) on the neck and forehead. − If persistent or recurrent bleeding, take Cyklokapron® for 7 to 10 days and possibly inject factor − If no improvement, see an ENT specialist for a gaze plugging or cauterization.
Dangerous areas: bleeding further back in the nose (with blood flow in the throat).

Bleeding in the mouth (tongue, inner cheek, lip, gum)
− Rinse mouth with Hextril®.
− If possible, manually compress 10 minutes with one or more compresses soaked with
− Suck on ice cubes and eat cold semi-liquid foods for several days. − If persistence or recurrence, take Cyklokapron® for 7 to 10 days and possibly inject factor VIII / − Dangerous area: bleeding from the tongue.

Loosing milk teeth (baby teeth)
− Bite on compresses soaked with Cyklokapron®.
− Eat cold semi-liquid foods for several days.
− If persistence or recurrence, take Cyklokapron® for 7 to 10 days and possibly inject factor VIII /

Tooth extraction or other dental procedures
− Call your physician and dentist to discuss treatment: factor VIII / IX or Octostim® before and after any dental treatment, Cyklokapron® for 7 to 10 days, antibiotics if necessary (especially if prosthetic hip, knee, etc.).
Blood in urine
− Bed rest.
− Drink large amount if no pain (if pain, call the physician).
− Inject factor VIII / IX only if persistent or severe bleeding (in this case, call the physician).
Caution: do not take Cyklokapron®.

Vomiting of blood or blood in the stool (black stools or red blood in / on stool)
− Inject factor VIII / IX and call the physician.
Geneva, May 2010.
Octostim® = DDAVP, Cyklokapron® = tranexamic acid, Hextril® = hexetidine.

Source: http://hemophilie.hug-ge.ch/_library/pdf/WhatToDoInCaseOf.pdf

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