Hemophilia B With Intracranial Hemorrhage Rehabilitation in High-Dependency Unit: A Case Report

Hemophilia B, an X-linked recessive coagulation disorder, poses significant risks of life-threatening intracranial hemorrhage (ICH). This case report details the multidisciplinary rehabilitation of a 41-year-old male with moderate hemophilia B (FIX activity: 3.9%) and ICH in a resource-limited setting. Admitted to a high-dependency unit postneurosurgical intervention, the patient received low-dose prophylactic coagulation factor IX (maintained at 34.6%-66.2%) alongside real-time coagulation monitoring. A stepwise rehabilitation protocol was implemented, including early passive joint mobilization, neuromuscular electrical stimulation, and progressive task-oriented training, tailored to minimize bleeding risk. Over 7 weeks, the patient achieved marked functional improvement: Activity of Daily Living score increased from 0 to 80, modified Rankin Scale improved from 5 to 3, and Fugl-Meyer Assessment (FMA) rose from 0 to 60, with no secondary bleeding. This case highlights the feasibility of integrating low-dose prophylaxis with early rehabilitation in developing countries, offering a cost-effective model to enhance functional recovery and reduce disability in hemophilia-related ICH.