Hemophilia
The best treatment of hemophilia is to replace the defective clotting factor, which enables the blood to clot in a natural way.
In mild hemophilia, we don’t require those factors.
In moderate hemophilia, we need clotting factors when bleeding occurs. In severe hemophilia, Doctors recommend preventive use of those factors two or three times per week and may continue for life. Rapid treatment of bleeding episodes decreases harm to the body.
- Hemophilia A requires Factor VIII.
- Hemophilia B requires factor IX.
Factor replacement can be either separated from human plasma, recombinant, or a mixture of the two.
Inhibitors
Part of individuals with hemophilia develops an antibody (called an inhibitor) that inhibits the effect of the clotting factors used to treat bleeding, so treatment becomes remarkably complex. The value of medical care grows because more clotting factor or a different type is needed.
Patients with inhibitors suffer from joint disease and other complications of bleeding that diminish the quality of life.
Inhibitors develop because of the reaction between the immune system with the infused clotting factor.
The immune system marks the factor as a foreign element and provides inhibitors, or antibodies, to destroy the factor. Most inhibitors originate in the initial 75 clotting factor dosage with the highest risk in the first 10-20 dosages.
Inhibitors are most prevalent in patients with severe Hemophilia A.
Other medication
We can use the following treatment:
- Desmopressin (DDAVP) with mild hemophilia A
- Tranexamic acid or epsilon aminocaproic acid prevents the breakdown of clots.
- Pain reliever drugs, steroids, and physical therapy reduce pain and swelling in an affected joint.
- Omalizumab with severe hemophilia A
In acquired hemophilia,
- The most effective treatment is corticosteroids, which eliminate the auto-antibodies in half of the individuals.
- We may use cyclophosphamide and cyclosporine in patients who did not respond to the steroid treatments.
- We may apply high doses of intravenous immunoglobulin or immunosorbent that control bleeding.
Contraindications
- Anticoagulants, such as heparin and warfarin, can worsen clotting difficulties.
- We shouldn’t use drugs that have “blood thinning” side effects, such as drugs that contain aspirin, ibuprofen, or naproxen sodium, because they produce the side effect of prolonged bleeding.
- Patients should avoid activities and sports with a high incidence of trauma, such as motorcycling, boxing, and wrestling.
