MM is a five years old boy who was diagnosed with Haemophilia A since six months of age. He presented to the daycare of the Paediatric department with left elbow swelling for one day after hitting it against the wall while playing. The swelling increased in size and became more painful. The left elbow had decreased in range of motion as the day progressed. He was unable to fully extend his arm. His father then brought him to the daycare the next morning. There was no other swelling or bruises noticed by the father. On systemic review, there was no fever, no haematuria, no bleeding noticed, bowel movement was normal. He was still active. There was no lethargy and no loss of appetite.
On physical examination, he looks well and his vitals were stable. There was no pallor or jaundice. On examination of his upper and lower limbs, there were no bruises noted on the skin. There was a joint deformity with valgus deformity noted on his right elbow however range of motion of the right elbow was normal. On the examination of the left elbow, there was a swelling. There was loss of bony prominences. On palpation, the joint was warm and tender to touch. There is presence of moderate effusion in the left elbow joint. There was restricted joint movement. Flexion was 0°-140° however on extension movement there was a 90° fixed flexion. Examination of other systems was normal.
He was diagnosed with haemarthrosis of the left elbow joint. MM was transfused with 250 IU of Factor VIII. MM returned to the daycare the next day for another dose of Factor VIII. He was given Factor VIII transfusion 250 IU once daily for the next four days. The dose was then increased to 300 IU twice daily for two days. The pain and swelling subsided and improved after the first dose of Factor VIII transfusion and his range of motion improved. He was discharge after 7 days of Factor VIII transfusion when the left elbow haemarthrosis resolved.
Chief complaint
MM is a five years old boy who was diagnosed with Haemophilia A since six months of age. He presented to the daycare of the Paediatric department with left elbow swelling for one day.
History of present illness
MM presented with left elbow swelling for one day after hitting it against the wall while playing with his brother in the afternoon prior to admission. There was no bruising or bleeding at the site of injury. The swelling had increased in size and became more painful and had decreased in range of motion as the day progressed. He was unable to fully extend his arm. He did not use any medications to relieve the pain and movement of the joint will aggravate the pain. MM’s father noticed that MM had not been moving his left hand. His father then brought him to the daycare the next morning. There was no other swelling or bruises noticed by the father. On systemic review, there was no fever, no haematuria, no mucosal bleeding such as gum bleeding or epistaxis noticed, bowel movement was normal. He was still active despite the pain in his left elbow. His sleep was not affected. There was no lethargy and no loss of appetite.