Brain Hemorrhage in Boy with Hemophilia Treated with Transfusions

Researchers in India recently reported the case of child with hemophilia and traumatic intracerebellar hemorrhage, who was successfully treated with transfusions of plasma. They recommend a conservative approach as a first line of treatment, before more invasive alternatives such as surgery.

The case report, “Intracerebellar haemorrage in a haemophilia child,” was published in the Asian Journal of Neurosurgery.

Hemophilia A is caused by deficiency of clotting factor VIII, and its treatment is usually managed with factor replacement products and medications. Access to these products, however, can be difficult for patients in developing nations.

A 12-year-old boy, with a history of transient loss of consciousness and vomiting, sustained a head injury in a fall, and was taken to SCB Medical College and Hospital, in Cuttack, Odisha. Through a computed tomography (CT) scan, physicians identified a well-defined lesion in the intracranial cavity of the boy’s brain. As acute intracerebellar bleeding was suspected, the child was advised to see a neurosurgeon. But his condition was stable, and his parents decided to differ.  Some six weeks after the incident, however, the boy returned to the hospital with symptoms of headache, intermittent vomiting, and an unsteady gait. Magnetic resonance imaging of brain revealed mid-posterior cerebellar, sub-acute, intracerebellar bleeding.

The boy’s coagulation profile was suggestive of moderately severe hemophilia. He was treated with six units of fresh frozen plasma and intravenous tranexamic acid, a medication used to control unwanted bleeding. This treatment led to clinical improvement  and, eventually, the hematoma spontaneously resolved. Such results indicate that early detection and correction of factor levels when intracranial bleeding occurs could prevent possible life-threatening complications.

“Choosing safe sports is vital for children with hemophilia. In case of traumatic intracranial bleed, prompt diagnosis and conservative approach through procoagulant transfusion and intravenous fibrinolysis inhibitors should be tried as first line of management. Before daring for surgery, sufficient amount of factor replacement should be kept available,” the researchers concluded.