Paediatric-History taking & Physical examination of a patient with Disorder of clotting factor – Haemophilia

Paediatric-History taking & Physical examination of a patient with Disorder of clotting factor – HaemophiliaCreated OnApril 28, 2020Last Updated OnApril 28, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of a patient with Disorder of clotting factor - Haemophilia < All Topics Table of Contents History Taking: Ask about identifications of patient – Age, Male sex Ask about the chief complaint and history of presenting illness: Spontaneous or delayed onset bleeding(joints, muscular and soft tissue, mucosa) in response to different degrees of trauma Repeated hemarthrosis → joint destruction causing hemophilic arthropathy In infants, early signs of hemarthrosis include irritability, lack of use of affected joint In older children, it presents as prodromal stiffness, warmness, swelling and acutely pain. Usually weight bearing joints particularly knees and ankles are involved. Musculoskeletal bleeding – pain and swelling of the involved area Mucocutaneous bleeding – epistaxis, bleeding from gums following dental procedures Easy bruising is common when crawling and walking Symptoms of anemia can be present if there is significant bleeding Patient with <1% factor activity (severe type) may have spontaneous bleeding or bleeding with minor trauma. Those with 1-5% factor activity (moderate) usually require moderate trauma to induce bleeding episodes. Those with >5% factor activity (mild), significant trauma is needed to induce bleeding. Spontaneous bleeding does not occur. Severe haemophilia usually present during infancy whereas mild haemophilia can be undiagnosed for many years. Further sites/symptoms of hemorrhage: CNS (headache, neck stiffness) Gastrointestinal tract (distended abdomen, melena, hematemesis) Genitourinary system (hematuria) Female carriers may show mild symptoms. Ask about birth history: 3 to 5% of severe hemophilia patients develop significant subgaleal or intracranial hemorrhage in the perinatal period Seizures are common during the acute intracranial hemorrhagic episode and may leads to cerebral palsy Ask about family history: In most of the cases, the mother of a male patient is a carrier. However, approximately 30% of patients with hemophilia have a negative family history. (spontaneous mutation accounts for 25-30 % of haemophilia cases) Ask about past medical history: Previous bleeding episodes – presentation, severity, management Infection status due to possibility of transmission of blood-borne infection of Hepatitis A, B, C, D and HIV in...

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