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Joint aspiration safe in children with acute hemarthrosis, severe hemophilia A
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During an 11-year study period, boys in Western Australia with severe hemophilia A and acute hemarthrosis safely had joint aspiration to avoid joint damage, according to recently published research.
Researchers retrospectively studied hospital records of 46 boys younger than 16 years of age with severe hemophilia A who received full primary prophylaxis with recombinant factor VIII between 2002 and 2013. Patients were examined every 3 months by a hematologist, a pediatric rheumatologist, a pediatric physiotherapist, a hemophilia nurse and a hemophilia social worker in a multidisciplinary outpatient setting.
Of the 46 boys, 22 required joint washouts during the 11-year study period, with a similar protocol followed for each patient. In total, 84 procedures were performed during the study period.
In the presence of bleeding in the joints, aspiration was performed as soon as possible, with a target range of less than 3 days after inception to avoid migration of monocytes, which trigger a chronic inflammatory cycle. Examination was performed to confirm hemarthrosis and rule out other conditions. Ultrasound evaluation of joints was not routine.
Aspiration of large joints was performed using a 19-gauge or 21-gauge needed with a micro-extension tube attached after administration of 25 units per kg of recombinant factor VIII. Small increments of normal saline were injected via a three-way tap and continued until the fluid removed was clear. Corticosteroids were injected into the joint after the procedure except in the presence of sepsis, and recombinant factor was administered the next morning to avoid additional bleeding. Patients were advised to avoid bearing weight for 48 hours. No antibiotics were prescribed post-treatment, and analgesics were deemed unnecessary.
Of the 84 joint bleeds in 32 joints, no infections or extra-intra-articular bleeding occurred as a result of the washout procedures, and joint rupture did not occur, according to the researchers. No other side effects from the procedures were observed during the 11-year study period.
Of the 22 boys who underwent the washout procedure, 15 had clinically normal joints during follow-up. Seven children with joint damage either had damage documented prior to the procedure or did not have complete removal of hemarthrosis during the procedure, the researchers reported. - by Shirley Pulawski
Disclosur e: No disclosure information was available at the time of publication.
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