Current practice in the management of muscle haematomas in patients with severe haemophilia.

Muscle haematomas (MH) represent 10-25% of all bleeds in patients with severe Haemophilia. We performed a cross sectional survey on current practice in management of MH with participation from 22 consultants. The respondents reported 492 MH/year, corresponding an average of 25/centre, most associated with trauma. Iliopsoas (55%), calf (18%), and thigh (18%) bleeds were scored as most serious. Half of respondents distinguished between contusion and strains, whereas the majority (68.2%) did not categorise bleedings as intra- or intermuscular, although 77.3% routinely used ultrasound. Half of respondents used a standard protocol for management of MH. A total of 20 of 22 (90.9%) offered physiotherapy in the hospital following MH, with no clear consensus on timing and type of treatment. In a theoretical case, 70 kg patient with a soleus triceps haematoma, the average initial dose was 2730 U (range: 1750-4000) twice daily for 3-5 days. In a similar case of a patient with inhibitors, 31.8% reported first line and only use of either rFVIIa or aPCC, while 36.4% switched between bypassing agents. Using rFVIIa the median dose was 100 µg/kg (range: 85 - 270) and with aPCC the median dose was 70 U/kg (range: 50 - 100). The majority (68.2%) did not use antifibrinolytics. Resolution of pain (81.8% & 77.3%) was regarded the key clinical marker of arrest of bleeding as compared to diminished swelling and improved range of motion. The survey outlines limited consensus in management of MH in patients with Haemophilia and highlights potential topics for future studies.