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Hematology Center
Hemophilia

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1. Treatment of Specific Hemorrhages in Hemophilia
2. Calculation of Doses

Hemarthrosis
*** Hemophilia A- 20 U/Kg factor VIII concentrate; 15 U/Kg if treated early; repeat dose the following day if severe bleed.
*** Hemophilia B- 30 U/Kg factor IX concentrate; 20 U/Kg if treated early
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Muscle or subcutaneous hematoma:
*** Hemophilia A- 20 U/Kg factor VIII concentrate; Q48 hr until well controlled.
*** Hemophilia B- 30 U/Kg factor IX concentrate. May need Q2-3 d treatment until well controlled
____________________________________________
Epistaxis
*** Hemophilia A
20 U/Kg factor VIII concentrate if other measures fail
*** Hemophilia B
30 U/Kg factor IX concentrate if other measures fail
NOTE: need to try antifibrinolytic therapy first.
____________________________________________
Major surgery or life threatening hemorrhage
*** Hemophilia A- 50 U/Kg factor VIII concentrate, followed by 25 U/Kg Q12 (or C.I.) to maintain factor VIII level above 50 U/Dl for 5-7 days & then to maintain factor VIII level above 30 U/Dl for 5-7 days
*** Hemophilia B-
80 U/Kg factor IX concentrate followed by 20-40 U/Kg Q12-24 hr to maintain factor level above 40 U/Dl for 5-7 days then to maintain factor level above 30 U/dl for 5-7 days
____________________________________________
Ileopsoas Hemorrhage
Hemophilia A- 50 U/Kg factor VIII concentrate followed by 25 U/Kg until symptoms relieved then 20 U Q 48 hr for 10-14 days
Hemophilia B- 80 U/Kg factor IX concecntrate then20-40 U/Kg Q12-24 hrs to maintain levels above 40 U/dl until asymptomatic then 30 U Q 48 hours for 10-14 days
____________________________________________
Hematuria
Hemophilia A- If other measures fail in 48 hours then try 20 U/Kg factor VIII concentrate
(may try prednisone)
Hemophilia B- If other measures fail then try 30 U/Kg factor IX concentrate
(may try prednisone)
____________________________________________

Calculation of doses
----------------------------
Hemophilia A:
Dose needed(U)=% desired rise plasma factor VIII X Body Weight (Kg) X 0.5

Hemophilia B:
Dose needed (IU) = % desired rise X Body Weight (Kg)