PB1246 - A clinical case of severe hemophilia A with posttraumatic complicated hemarthrosis

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

AM

Alisa A. Movsisyan

Hematologist
Armeinan Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia

Co-Author(s)

Nelli S. Sargsyan

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
Liana G. Hambardzumyan, Master's degree

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
LP

Lilit S. Petrosyan

hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
CS

Clodet Stepanians

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
MM

Meri A. Movsisyan

Radiologist
Scientific Center of Traumatology and Orthopedics, Yerevan, Armenia
Yerevan, Yerevan, Armenia
NM

Nata Melqikyan

Hematologist
Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia

Presenting Author(s)

Heghine S. Khachatryan, MD, PhD

Head of Hemophilia and Thrombosis Center
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan Armenia YSMU, department of Hematology and Pediatric oncology
Yerevan, Yerevan, Armenia

Background: Hemophilia A is a congenital deficiency of clotting factor VIII characterized by spontaneous and trauma-related bleeding.

Aims: We present a case of a 12-year-old male with severe hemophilia A who exhibited a complex clinical course following left foot trauma.

Methods: In 2013, the patient was diagnosed with severe hemophilia A after presenting with unexplained bruises and injection site bleeding. The initial FVIII level at diagnosis was 0.4%. Over the years, the child experienced recurrent episodes of intramuscular hematoma, hemarthrosis of the elbows, and knee joints, leading to contractures of the knees. Inhibitor levels were 0.8-6.5 BE in the 2015-2021 period, requiring periodic plasmapheresis and topical steroid treatments. Immunotherapy therapy was initiated in 2022 due to persistent challenges in managing bleeding episodes.

Results: The patient presented to our center with left foot swelling, pain, and an inability to walk, two months after trauma (Image 1). Conservative treatment failed, and the development of fever prompted further investigation. MRI and joint aspiration confirmed a phlegmon formation. The patient was treated with surgical incision in addition to FVIII injections, steroids, and antibiotic therapy based on the antimicrobial sensitivity. Despite initial interventions, delayed surgical cut healing led to the discovery of Staphylococcus aureus and Streptococcus pyogenes in a repeated bacteriological test two months later. Antibacterial therapy and a second surgical intervention were performed, followed by a 4-week casting period. In parallel, the patient received osteoporosis treatment with zoledronic acid.
Currently, three months after treatment, the patient experiences swelling and warmth in the left foot. (Image 2). Immunotherapy therapy with concomitant FVIII concentrate administration is ongoing. An upcoming MRI examination of the left foot is planned.

Conclusion(s): This case highlights the challenges in managing a complex presentation of hemophilia A, involving recurrent bleeding episodes and joint complications. The current condition of the patient necessitates a multidisciplinary approach and ongoing management.