Iliopsoas haemorrhage in patients with haemophilia: results from one centre

Abstract

Iliopsoas haematoma is a well-recognized complication of haemophilia, and is considered as potentially life threatening and significantly associated with morbidity. There are only rare reports on the incidence or outcomes of iliopsoas bleeding since the widespread usage of modern therapies for haemophilia. In this study, we present the experience of Ege University Haemophilia Centre with iliopsoas bleeding and its early and late complications. We reviewed 146 haemophiliacs (106 haemophilia A, 40 haemophilia B). Fourteen iliopsoas bleeding episodes were identified in eight haemophiliacs. Three patients (37%) had one episode, four (50%) had two episodes and one (13%) had three episodes. Two patients had a high titre inhibitor against factor VIII and accounted for three bleeding episodes (21%). We did not observe any episodes in six patients receiving prophylaxis. Iliopsoas haematomas were confirmed by ultrasonography in all patients. In physical examination, the most common symptoms were thigh, hip and groin pain, hip flexion contracture, abdominal tenderness and paraesthesia in the distribution of the femoral nerve. The mean duration of therapy with clotting factor concentrate was 7.8 +/- 1.6 days. The mean duration of hospitalization was 4.8 +/- 2.0 days. All patients started to receive a physical therapy program 6.0 +/- 2.4 days after the initiation of haemostatic therapy which lasted 20.0 +/- 6.0 days. Ultrasonographic findings related to iliopsoas haematoma disappeared in all patients within 3 months from the initial episodes. Only in one patient with mild haemophilia A, heterotopic bone formation (myositis ossificans) developed as a long-term complication. In conclusion, pain around the hip joint, femoral neuropathy and hip flexion contracture in a patient with haemophilia should alert the physician to the possibility of an iliopsoas haematoma. Early and effective factor replacement therapy is essential in the prevention of the complications.

Epidemiology of iliopsoas haematoma in patients with haemophilia

“…[10] Argentina begun prophylaxis program to patients under eighteen years old (law approved in National Congress) in 2000. [4,5,10] This is consistent with beneficial effects of the introduction of prophylactic factor therapy, which may decrease the rate of bleeding episodes and increase the age of appearance. [10] The proportion of patients with haemophilia A and B remains unchanged in our two series.…”

“…Many publications describe this entity. [3][4][5] In relation to occurrence of IPH in PWH treated in the Argentinean Haemophilia Foundation we found that in the 2008-2013 series was 1.54%, thirty-six out of 2,327 patients and in the pre 1995 series was 10%, 109 out of 1,079 patients. This is statistically significant (p: .001).…”

“…[5] In Minnesota's series between 1972 and 2000 two 221 PWH were recorded and twenty-eight presented IPH, the occurrence was 12.67%. [4] France's series had five patients with IPH out of 410 patients recorded between 2001 and 2005 and the occurrence was 1.2%. [10] Argentina begun prophylaxis program to patients under eighteen years old (law approved in National Congress) in 2000.…”

“…[3][4][5]9] The aim of this paper is to show the current epidemiology of IPHs in PWH treated at the Argentinean Haemophilia Foundation, and to review the evolution of the treatment of the disease and how this affected the incidence of new cases of IPHs.…”

“…[1] Iliopsoas haemorrhages (IPH) are a wellrecognized complication of haemophilia with significant associated morbidity [1][2][3][4][5] .…”