Figure 1. Bleeding Emergency
Mild Hemophilia A (factor
Life or Limb Threatening
• Desmopressin if previously
• Otherwise, treatment
other individuals with
Patient presents with
Urgent
Administer clotting
1) Suspected bleeding into a joint or muscle.
2) Any significant injury to the head, neck, mouth or eyes
3) Any new or unusual headache, particularly one following
4) Severe pain or swelling at any site.
5) All open wounds requiring surgical closure, wound adhesive,
6) History of an accident or trauma that might result in internal
7) Any invasive procedure or surgery.
8) Heavy or persistent bleeding from any site.
9) Gastrointestinal bleeding.
10) Acute fractures, dislocations and sprains.
11) Heavy menstrual bleeding leading to moderate to severe
Hemophilia A without Inhibitor
• Recombinant factor VIII or else the patient's product of
choice.
• Plasma-derived concentrate when recombinant Factor
VIII is not available.
• When bleeding is severe, the appropriate dose of factor
VIII is 50 units/kg. (This should result in a factor VIII level
of 80-100%.)
Consultation with the patient's hematologist
For individuals with inhibitors (antibodies to factor VIII or IX), treatment decisions
urgently discussed with the patient's hematologist. If an individual with an inhibitor
action is to prescribe recombinant factor VIIa (rFVIIa) at a dose of 90 mcg/kg or
patient or family can also provide information on response
* Note: rFVIIa is recommended over FEIBA for acute bleeding events or procedures in
thrombosis or thrombotic microangiopathy in those
* Note: In factor IX patients with a history of inhibitors and anaphylaxis,
Treatment
