Experience with the hemophiliac child in a pediatric emergency department

We conducted a retrospective chart review of all hemophiliacs followed by our pediatric hematology service from January 1, 1980 to December 31, 1989 inclusive, to determine the frequency and nature of their visits to our Emergency Department (ED). Of 36 patients studied, 26 were Factor VIII deficient (13 mild, 3 moderate, and 10 severe) and 10 had Factor IX deficiency (7 mild and 3 severe). No patient had red blood cell (RBC) antibodies or factor inhibitors. One patient was HBsAg positive and 4 patients were HIV positive. One hundred and twenty-six ED visits [98 (78%) in the 1-5 age group] occurred. Soft tissue hematomas accounted for 48% of total injuries, hemarthroses for 24%, and head injuries for 12%. Twelve patients were admitted to hospital for observation or ongoing factor replacement. Of 15 episodes of head injuries, 1 patient had intracranial hemorrhages on 2 occasions, while 13 received prophylactic factor replacement and recovered uneventfully. Despite the availability of home factor replacement, the ED remains an important locus for the management of the pediatric patient with hemophilia.