Protocols - Hemorio

TREATMENT OF HEMORRHAGIC EPISODES
The replacement therapy to each clinical situation is described on TABLE 3; however, there are different
ways to conduct it. As follows, we will describe the most used procedures for:
HEMATOMAS: Hematomas in the acute phase require replacement of deficient factor, immobilization, bed
rest and ice bag for 20 minutes at most, every 2 hours, during the initial 48 hours (the exception is
hemorrhage of iliopsoas muscle: bed rest during 4 days). After the acute phase the physiotherapy must be
started with short waves and ultrasound. Do not use antifibrinolytics and do not deplete the hematomas.
Hematomas located on the tongue, neck, forearm, calf, and iliopsoas muscles are considered risky. These
hematomas deserve to be stressed by severity and due to the fact they leave disabling sequelae, if not
treated properly. Hard to resolve hematomas may become pseudo-tumors, with required follow-up using
ultrasound or MRI. It is important to stress that the clotting factor replaced does not help to reabsorb the
hematoma. Therefore, the replacement suspension does not coincide with normalization of physical test.
Note: every patient with a hematoma must remain hospitalized, until the end of factor replacement. The
patient needs to be forwarded to PHYSIATRY evaluation at all times.
HEMARTHROSIS: is the most common clinical manifestation found in the locomotive system. The most
wounded articulations, by order of frequency are: knees, elbows, ankles, shoulders and hips.
Replacement therapy, associated with bed rest sand ice on site, is enough to stop those bleedings.
Measure the maximum diameter of articulation and movement amplitude. Start physiotherapy as soon as
possible. Hemarthrosis may relapse, progressing to arthropathy. Patients presenting repeated
hemarthrosis in a frequency of 3 episodes a month must be forwarded, mandatorily, to the Hemostasis
Change Group.
Note: Every patient with hemarthrosis must be forwarded to PHYSIATRY, for follow-up.
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