Case study: The treatment of soft tissue hemorrhages in a severe classical hemophiliac with an unusual antibody to factor VIII

Abstract

A known severe classical hemophiliac patient presented with a large hemorrhage into his left shin and complained of paresthesia in his toes. Large doses of factor VIII had failed to halt the expanding shin hematoma. Laboratory investigations revealed an antibody titer of 5 Bethesda units. In vitro and in vivo testing showed swift neutralization of factor VIII to a level of 20% and thereafter degradation of factor VIII in accordance to the half-life expectancy. The patient was successfully treated with a continuous infusion of small doses of cryoprecipitate. The Bethesda method of antibody measurement does not distinguish between low and high affinity antibodies and thus in vitro testing should be carried out before a decision is made on the use of expensive activated prothrombin complex. The initial approach of the physical therapist is to aid in attempting to limit the swelling and enhance hematoma reabsorption. Once the bleeding has been controlled, a long-term physical therapy program is necessary to regain dorsiflexion of the ankle joint.