Haemophilia

Haemophilia is a bleeding problem due to a lack of normal levels of a clotting factor. Clotting factors are proteins in blood which help to control bleeding. People with haemophilia do not bleed faster than normal, but they can bleed for a longer period of time.

Haemophilia is quite rare and it affects about one in 7,000 males. The most common type of haemophilia is called Haemophilia A. This means the person does not have enough clotting Factor 8 (VIII). A less common type is called Haemopholia B. This person does not have enough clotting Factor 9 (IX).

Bleeding into a joint or muscle causes

• An ache or "funny feeling"
• Swelling
• Pain and stiffness
• Difficulty using a joint or muscle

• Treatment for haemophilia today is very effective. The missing clotting factor is injected into the bloodstream using a needle. Bleeding stops when sufficient clotting factor reaches the spot that is bleeding.
• Treat bleeding quickly! Quick treatment will help reduce pain and damage to the joints, muscles and organs. The time frame should be within one to two hours of initial onset of bleeds. The faster the bleed is treated, the more effective the treatment will be.
• If in doubt, treat! If you think your child has a bleed, get treatment even if you are unsure. NEVER wait until a joint is hot, swollen or painful. Do not worry that you may "waste" a few treatments with clotting factors.
• Currently, there is no cure yet, but with treatment, people with haemophilia can live normal healthy lives. Without treatment, people with severe haemophilia may find it difficult to go to school or work regularly. They might become physically disabled and have trouble walking, doing simple activities or die young.

When should treatment with clotting factors be given?

Treatment is given for

• Surgery, including dental work
• Activities that could cause bleeding

Treatment with clotting factors may not be required

• Small bruises are common in children with haemophilia, but they are usually not dangerous. However, bruises on the head might become serious and should be checked by a haemophilia nurse or doctor.
• Small superficial cuts and scratches will bleed for the same amount of time as in a normal person. They are usually not dangerous.
• Deepr cuts will often, but not always, bleed longer than normal. The bleeding may be stopped by putting direct pressure on the cut.
• Nosebleeds may be stopped by putting direct pressure on the nose for at least five minutes. If bleeding is heavy or does not stop, treatment with clotting factor is needed.

Important points for people living with haemophilia

Treat the bleeds quickly!
When you stop the bleeding quickly, your child will have less pain and damage to joints, muscles and organs. Your child will need less amounts of clotting factor to control the bleeding.

Stay physically fit
Strong muscles help protect your child from joint problems and spontaneous bleeding (bleeding for no clear reason). Consult your haemophilia doctor or physiotherapist for advice on the appropriate sports and exercises for your child's condition.

Do not take NSAIDs (Non-Steroidal Anti-Inflammatory Agents)
NSAIDs affect the function of platelets and can worsen bleeding. Examples of NSAIDs are Brufen and Aspirin. Other drugs can affect clotting too. Always seek your doctor's advice on whether the medicines are safe.

See a haemophilia doctor or nurse regularly
The Haematologist or Haematology Resource Nurse will give help and advice about managing your child's health.

Avoid injections into muscles
A muscle injection can cause painful bleeding. However, vaccinations are important and safe for a person with haemophilia, and can be given with appropriate precautions. Most other medications should be taken orally or injected into a vein rather than into a muscle. Speak to the Haematologist or Haematology Resource Nurse for advice.

Take care of your child's teeth
To prevent problems, follow your dentist's instructions and advice. Dental injections and surgery can cause major bleeding. Clotting factor should be given prior to dental procedures which can cause bleeding.

Carry medical identification with information about your health
Carry the World Federation of Haemophilia medical card or Medic Awas card with you at all times so that information about your child's condition and treatment plan is always available.

Learn basic first aid. Quick first aid helps manage bleeding
Remember that very small cuts, scratches, and bruises are usually not dangerous. They may not require treatment with clotting factor. First aid is often sufficient.

• Apply R.I.C.E* in cases of bruises that are not dangerous and rest the affected site for a period of time till bruises subside.
• Apply R.I.C.E* in serious bleeds and quickly seek medical attention within one to two hours of initial onset of bleeds.

*R.I.C.E refers to
Rest --> Ice -->Compression --> Elevation

In case of bleeds

During office hours (8.00am to 5.00pm)

• Contact the Children's Day Therapy Centre at +65 6394 2145 or the Haematology Resource Nurse at +65 8189 5298 to make an appointment. Consult a doctor and seek treatment within one to two hours from initial onset of bleeds.
• Children's Day Therapy Centre is located at Children's Tower, Level 7, KK Women's and Children's Hospital, next to Ward 76.

After office hours (before 8.00am and after 5.00pm)

• Bring your child to the Children's Emergency Department in KK Women's and Children's Hospital, Basement 1, to see a doctor and seek treatment within one to two hours from initial onset of bleeds.
• Inform the Haematology Resource Nurse at +65 8189 5298 on the next working day for advice on further management and follow up.