Treatment of muscle haematomas in haemophiliacs with special emphasis on percutaneous drainage

Abstract

Between 10 and 23% of bleeding episodes in the musculoskeletal system of haemophilia patients occur in the muscles. Until now, the most widely accepted treatment for muscle haematomas in patients with haemophilia has been a combination of rehabilitation and intravenous infusion of replacement clotting factor, until the haematoma completely disappears. The only way to prevent muscle bleeds in haemophilia is primary haematological prophylaxis (from cradle to college). Home treatment is currently the standard of care for patients with severe haemophilia. When a muscle bleed is suspected, confirmation must be achieved by means of imaging tests (ultrasound, MRI, CT). Then, immediate (early) enhanced on-demand haematological treatment must be started until the full disappearance of the haematoma. If untreated, muscle bleeds can cause complications such as nerve injury, compartment syndrome, myositis ossificans, pseudotumour, and even infection (abscess). Currently, the literature for muscle hematomas in the nonhaemophiliac population suggests that ultrasound-guided percutaneous drainage, or surgical drainage performed as open surgery if percutaneous drainage fails, could be beneficial in terms of achieving better and faster symptom relief. Ultrasound-guided haematoma evacuation is a well tolerated procedure. However, the proportion of unsuccessful evacuations and hematoma recurrence is substantial (13%). Such a rate of unsuccessful evacuation is because of excessive density and/or viscosity of the content. Ideally, haematoma evacuation must be performed before 3-5 days since the beginning of the muscular bleed. Although we have not found publications about ultrasound-guided decompression of muscle haematomas in haemophilia, the current status of progress in both the haematological and ultrasound fields leads us to think that this technique should be increasingly considered for the treatment of haemophilia patients, especially in the case of large haematomas in the liquid phase.

Modular reorganization of gait in chronic but not in artificial knee joint constraint

“…Second, the long exposure to the joint constraint may also result in secondary changes in the central nervous system (e.g., muscle hyperreflexia, altered somatosensory feedback, and intersegmental facilitative pathways at spinal level) (27,28,94), contributing to abnormal timing of leg extensors during the stance phase (94). Third, the repetitive intra-and intermuscular bleeding and, hence, scar tissue formation is a common manifestation of hemophilia (95). This may change the extent of mechanical connectivity between neighboring, synergistic muscles and, thereby, their intermuscular coordination during locomotion (96).…”

Kinesiotaping for the Treatment of Haematomas in Haemophiliacs: a Case Control Study

“…After joint bleeding, muscle haematoma (MH) is the second most common type of bleeding in patients with haemophilia (2)(3)(4)(5). In haemophilic patients, MH is more frequently localized in the iliopsoas muscle, in the quadriceps femoris, in the calf and forearm muscles (6). Unlike hemarthrosis, MH is mostly associated with trauma, it is more common in young and athletic subjects (7).…”

“…movement patterns which increase the risk of injury, even after minor strains (6). The development of a MH, often impairs the quality of life of patients, limiting recreational activities due to the fear and/or risk of bleeding (8).…”

“…To date, advances in rehabilitation, combined with hemophilia therapy, are focused on the prevention of bleeding and bleeding-related musculoskeletal complications through targeted and specific rehabilitation programs. This allows patients with haemophilia to be more active and to participate in sports (6). The guidelines of the World Federation of Hemophilia (WFH) on the management of MH indicate that the levels of the deficiency factor should be increased immediately, after the first symptoms or trauma, maintaining adequate factor levels for approximately 5-7 days.…”

Point‐of‐care ultrasonography in haemophilia care: Training and competency for muscular haematomas

“…Large muscular haematomas may cause flexion contractures, distal paraesthesia and, in severe cases, compartment syndrome . Lack of adequate and/or timely therapy may also result in limb‐altering complications including infections, pseudotumor development, tendon damage, muscle paralysis, severe blood loss and myositis ossificans . On the other hand, misinterpreting symptoms erroneously as a muscle bleed may lead to the incorrect treatment being administered while missing the underlying pathology.…”