Shannon Walker, MD, explains why patients should report suspected bleeds promptly and why treatment may need to begin before imaging confirms a bleed.
What are the most common mistakes you see in the acute management of bleeds?
Transcript
So, when I think about my patients having acute bleeds, I see kind of two different areas where I think that acute bleed management could be improved.
And the first one is on the patient side. And I think that sometimes my patients wait too long to let us know after an injury if they’re having a bleed.
And I think that sometimes it’s a little bit of wishful thinking. And they would like the — the bleed to get better, and it’s not going to get worse. And they don’t need to call us. And the other is they just don’t often know, you know, they don’t have a lot of bleeds.
So, they don’t always know that the feeling of a bleed — they don’t know, you know, when to — when to call us and report a bleed, or it’s an inconvenience. They just don’t want to. And so, that’s kind of a little bit more on my patients and just waiting to report a bleed.
The other is from medical providers that don’t see a lot of patients with hemophilia. So, the ER colleagues, urgent care, kind of other sites, they will often want to wait for imaging of a bleed, or they’ll want to wait for some sort of study that’s going to tell them that there’s a bleed there.
And generally, when we are worried about a bleed, we don’t feel like we need to wait for imaging to treat. We’d rather treat up front and then, you know, have any sort of imaging that might help guide further treatment, but not necessarily waiting on that first imaging study before treating.
I see this a lot in my pediatric patients that have a head injury. They’ve fallen, they’ve hit their head, they have a goose egg, they have a bruise, and they’ve come into the ER, and we would recommend going ahead and treating with factor regardless, just to kind of get that on board to help with healing, no matter what’s going on.
And a lot of the ER colleagues prefer to wait until a CT of the head comes back to see if there’s imaging to see if factor is needed. And so, we’ve done a lot of education in our ER. You know, go ahead and give the factor. Don’t necessarily wait for the imaging, trying to get it in as quickly as possible here.
But a lot of our patients come from further away. And so, they may not end up in our ER first.
And so, you know, just advocating for our patients and empowering our families to be able to be their advocates when we’re not able to be there are something that we try to do in our clinic to really ensure that the patients are getting the factor as quickly as they need it, regardless of where they end up for management of their injury.
