Decreased factor VIII activity and hemarthrosis in a 50-year-old male

Abstract

Patient: 50-year-old male. Chief Complaint: Persistent left knee swelling and pain. History of Present Illness: The patient presented with left knee hemarthrosis and increasing pain of 4 months duration secondary to minor trauma. He received 2 cryoprecipitate infusions with moderate improvement in pain and swelling. He was seen by an orthopedist, and arthroscopy was recommended due to diffuse hemosiderin deposition from prior hemarthroses. Worsening pain led to the patient's presentation in the emergency department. Past Medical History: The patient was diagnosed with hemophilia A at 18 months of age secondary to a prolonged bleeding time. He has had recurrent spontaneous and trauma-induced hemarthroses in both the ankles and knees, episodes of gastrointestinal and soft tissue bleeding, and bleeding with dental procedures. His bleeding episodes were treated with cryoprecipitate infusions, except for a 2-year period during which he received Factor VIII concentrate. Family History: Unremarkable for bleeding disorders, including a fraternal twin. Physical Examination: Swollen left knee, warm but not erythematous. Limited range of motion at the knee.