The following text comes from www.HemophiliaEmergencyCare.com. To determine specific factor dosages for a given patient, go to the web site and click on 'Get Factor Dosage Orders'.

Labs/X-rays

Never delay factor

In general, patients with hemophilia who are experiencing an acute bleeding episode need factor only. Other procedures should not be done unless there is another clinical indication for the study. In any situation, the infusion of factor should never be delayed if any bleeding is suspected. Delaying the infusion simply increases bleeding that will result in greater morbidity.

Laboratory studies

If the only complaint is an acute joint or muscle bleed, no laboratory studies are necessary. If GI, abdominal, large muscle, or oral cavity bleeding is suspected and has potentially been extensive, a CBC may be indicated to determine if the individual is anemic. Factor levels and inhibitor levels are not necessary for treatment in an acute emergency setting. Factor should not be delayed for laboratory studies to be drawn or completed.

X-rays and other radiological studies

Give factor first, then decide if a radiological study is indicated. Remember that a swollen joint or extremity is usually the result of internal bleeding, not a fracture. X-rays of the joint can be used to document a joint bleed, but are generally not useful in detecting early onset bleeds (and that is when treatment is optimal). The patient will be aware of joint bleeding before radiological changes are evident.

A CT of the head is necessary when dealing with a potential head bleed. It can document location and extent of bleeding and help direct further treatment. First give a major factor dose.

Lacerations and sutures

Sutures and staples should be used as on any other patient. If the laceration is significant enough to require sutures, the patient should first receive a routine dose of factor then the procedure. Contact the patient's hematologist for follow-up factor infusion instructions. For removal of sutures, a routine dose of factor is usually needed.

Invasive procedures

Invasive procedures should be performed as clinically indicated, i.e., lumbar puncture with symptoms of meningitis. However, a major dose of factor should be given before the procedure begins.

Arterial sticks and venipunctures

Do not do arterial sticks unless no other option is available. If an arterial stick must be done, then a major factor dose must be given first.

Venipuncture may be done at any location; hands are generally excellent and no factor treatment is necessary. Avoid "digging" for deep veins. Apply pressure for several minutes after the puncture.

Discharge Instructions

Patient should follow-up with the hemophilia treatment center or his hematologist the next day

Head Injury: Discharge with routine post head injury instructions (patient to follow-up for two weeks instead of 48 hours).

Sutures: Remind the patient he will need factor for suture removal.