Grand Rounds

The target joint in Severe Hemophilia A

Govind Kendre, Sunil Hilalpure, Shruti Mantri, Suraj Goyanka, Leo Prince, Murlidharan C
Department of Clinical Hematology, Seth G.S. Medical College, KEM Hospital, Mumbai, India

Address for Correspondence: Dr. Govind Kendre, Department of Clinical Haematology, Seth G.S. Medical College, KEM Hospital, Parel, Mumbai, India. Email:

Clinical Problem:
Keywords: Hemophilia A, factor VIII, prophylaxis, target joint

A 12-years-old-boy presented with recurrent left knee joint swelling for 6 months. He was diagnosed to have severe hemophilia A at the age of one year when he was evaluated for multiple ecchymoses over the body. Since then, he has been receiving factor VIII concentrates on an episodic basis for various problems such as hemarthrosis, muscle hematoma, and gastrointestinal bleeding. He developed a left knee joint swelling 6-months ago following a trivial trauma which was associated with pain and restriction of joint movement. He developed four more spontaneous episodes of left knee joint swelling over a 6-month period. Each time his symptoms resolved with a single dose of factor VIII concentrate (20U/Kg). The current episode was treated with RICE (rest, ice, compression, and elevation) measures and a single dose of factor VIII concentrate (20U/Kg). His pain resolved and joint movement improved but there was residual joint swelling. On further evaluation, ultrasonography showed synovitis of the left knee joint. After this episode, he was put on secondary prophylaxis with FVIII concentrate (20U/Kg twice a week). He is on prophylaxis for 6 months and has not developed any further episodes of joint bleed.

Figure 1: The Target Joint

What is the target joint and how it should be managed?

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