Case 133: Some more details…

2. You attend A&E to review the young boy.

– He was previously known at a different centre but the family have only recently moved to the area. The family have a planned appointment in a few weeks at the local haemophilia centre.

– He has a diagnosis of haemophilia A and has never needed any treatment before. Mum has a letter from his previous centre showing that he has a factor VIII level of <1%.

– Mum says he started walking at 17 months of age.  He has had a few ‘bumps and bruises’ on his legs but nothing that caused a problem. He had a normal delivery with no complications.

– He has no siblings and he has a maternal uncle with haemophilia A.

– A few hours ago he was climbing on the sofa and fell off the sofa arm onto his knee.  Mum put a cold pack on his leg but is concerned that he won’t walk on the leg and the swelling seems to be increasing.

– On examination he is reluctant to weight bear, the knee is flexed and it is painful on passive movement.  The knee is swollen and red.

What should happen now?

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