Test Your Skills

By now you should have a good understanding of potential bleeding areas and how to manage bleeding episodes. Take a look at these two patients and think about how you would answer questions that correspond to them. You can also use these examples to start discussions within your HTC.

Choose a patient to test your skills!

Think About It: Barry

Barry is a 6-year-old boy with severe hemophilia A who comes in for a routine comprehensive evaluation. His parents have brought bleeding records that show an increase in joint bleeding episodes over the past 6 months. Many of these have occurred in the evening, requiring trips at night to the emergency room. Some treatments have been delayed because of difficulty finding transportation for emergency room visits. Barry is treated with recombinant factor VIII.

1. What information about choice of factor VIII products would you give the parents?
2. Should home treatment be recommended for Barry?
3. What would be the advantages of home treatment?
4. What steps should be taken to prepare the family for home treatment?

Think About It: Mike

Mike is a 28-year-old with severe factor VIII deficiency. He calls the center to order more factor VIII for home infusion. He reports that he needs more factor because he is having a right knee bleed that has not resolved after three infusions of factor VIII. He mentions that he has had other bleeds recently that were slow to respond. There are no bleeding records on the chart for the last 10 months.

1. What questions would you ask about his current bleeding episode?
2. What would you ask about Mike’s recent history?
3. What considerations for choice of product , dose, and dosage would you discuss?
4. Are there adherence concerns for this patient?
5. When you see the patient, what would you look for as you assess his joint?
6. What signs would alert you to potential progression of joint disease?