Treatment

Treatment is with:

• administration of the appropriate factor
• application of a removable splint
• starting gentle passive exercise within 48 hours of the bleed

The joint is not aspirated because of the risk of infection.*

Special treatment considerations are required for hemophiliacs presenting with acute hemarthrosis. Coagulation factor replacement should be administered promptly at the first sign of joint bleeding—including the prodromal phase of stiffness or tingling before pain and swelling—ideally within 2 hours of bleed identification. For bleeding into the hip, target joints, or trauma-associated hemarthrosis, higher factor activity levels of 80% to 100% are recommended. (1)

*Arthrocentesis is generally unnecessary when diagnosing joint bleeding in patients with known haemophilia. If required to rule out septic arthritis or relieve pressure from accumulated blood, it should only be performed after factor replacement has raised specific factor levels. (2)

Reference

1. Srivastava A, Santagostino E, Dougall A, et al. WFH guidelines for the management of hemophilia, 3rd edition. Haemophilia. 2020 Aug;26 Suppl 6:1-158.
2. De la Corte-Rodriguez H et al. Accelerating recovery from acute hemarthrosis in patients with hemophilia: the role of joint aspiration. Blood Coagul Fibrinolysis. 2019 Apr;30(3):111-119