Muscle Bleeds
Signs, symptoms, and sites
Muscle bleeding is common in persons with hemophilia. Any muscle group may be subject to bleeding. Muscles that exhibit warmth, pain, and swelling should be treated with a routine dose of factor. Common bleeding sites include the upper arm, forearm, thigh, and calf muscles. Toddlers frequently have buttock and groin bleeds. Abdominal wall muscles and iliopsoas muscles are also common bleeding sites. These abdominal muscles generally do not have observable swelling, yet they may hold a large amount of blood. Patients who complain of low abdomen or groin pain, especially with signs of nerve compression, are probably experiencing an iliopsoas bleed. These patients should receive an emergency hematology consult and possible admission for observation and several major doses of factor coverage. The hallmark sign of iliopsoas bleeding is spontaneous flexion of the leg on the affected side with an inability to extend the leg without pain.
Consequences of muscle bleeds
Muscle bleeds can result in serious consequences if not treated promptly. Extensive blood loss may occur in large muscle groups. Muscle bleeding places pressure on nerves and blood vessels and, if left untreated, these bleeds may result in permanent disabilities such as foot drop and wrist contracture. It is important that the patient's hematologist be consulted before any surgical consults. Most muscle bleeds respond well to medical management and do not require fasciotomy. Such an extreme measure will usually generate problems for the patient and require a tremendous amount of post-surgical factor infusions, more so than if the patient was treated medically.
Treatment and follow-up care
Most muscle bleeds are treated with a routine dose of factor. Large abdominal muscle groups and iliopsoas bleeds should be treated with a major dose of factor. Rest and ice packs are also helpful. The patient should be referred back to his hemophilia treatment center or to his hematologist for follow-up as soon as possible. If any suspicion of compartment syndrome and nerve compression exists, then the patient should have an emergency hematology consult and should be admitted to the hospital.
Soft tissue and superficial bleeds
Soft tissue bleeds usually do not require aggressive treatment. Superficial hematomas and bruises may appear anywhere on the body and if they do not threaten function and mobility, they do not need to be treated.
Discharge Instructions
For the next 24 hours:
- rest
- ice
- non-weight bearing
- follow-up with the hemophilia treatment center or the patient's hematologist.