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DESCRIPTION
Hemophilia is a rare genetic bleeding disorder caused by a shortage of certain clotting factors. Blood clotting factors are needed to help stop bleeding after a cut or injury to prevent spontaneous bleeding. Approximately 20,000 people in the United States suffer from hemophilia.
In a healthy individual, a minor bump can damage a blood vessel, causing blood to leak into the surrounding tissue, producing a bruise. A process called hemostasis (coagulation) plugs the hole in the damaged vessel and forms a clot that stops the blood loss and limits the size of the bruise.
In people with hemophilia and related problems, bleeding can take a very different course. The blood does not clot normally because of one or another of the blood proteins (clotting factors) that collaborate to repair damaged vessels and form clots is defective, deficient, or totally absent. The photo to the right shows a person with mild hemophilia after an injection in the buttocks and the bruising that occurred afterward from uncontrolled bleeding. When the blood doesn't clot normally, even minor injuries can cause serious bleeding. This can lead to blood loss, injury to internal organs, or permanent damage to muscles or joints.
The idea that people with hemophilia can bleed to death from a minor cut or injury is a misconception. In fact, external bleeding is seldom a serious problem for hemophiliacs. They may bleed somewhat longer than other people, but minor bleeding episodes can generally be controlled by ordinary first aid measures.
But injuries can commonly cause bleeding inside the body - bleeding we may neither see nor feel. Unchecked internal bleeding can be serious - even life threatening - for a person with hemophilia. Blood that leaks into the knee joint, a common site of internal bleeding, can cause painful swelling. Repeated bleeding eventually destroys the cartilage that enables the knee to work smoothly and easily. The joint becomes permanently stiff and painful, the result of hemophiliac arthritis. Other joints, such as the ankle, wrist, or elbow, can be similarly affected by internal bleeding. People with hemophilia can also bleed into muscle and other soft tissue. Internal bleeding can ultimately obstruct air passages or damage the brain or other vital organs.
The hemophilia gene can contain many different errors, leading to different degrees of abnormality. The degree of abnormality in the gene determines how much clotting factor is produced. Hemophilia is classified by its severity. There are three levels of hemophilia, although they can overlap. Hemophilia can be mild, moderate, or severe, depending on how impaired an individual's production of clotting factors is and what situations bleeding most often occurs. The percentage of clotting factors stays about the same throughout a person's life. All family members who have hemophilia usually will have similar forms.
- Severe Hemophilia: In severe hemophilia, clotting factor VIII or clotting factor IX activity is less than 1 percent of normal. Injury, surgery, or dental care can present significant problems for such people. Spontaneous bleeding (bleeding with no apparent reason) often happens one or more times a week and can require infusion of clotting factor concentrate as often as several times a week.
- Moderate Hemophilia: People with moderate hemophilia (clotting factor VIII or clotting factor IX levels between 1 and 5 percent of normal) do not usually experience spontaneous bleeding, but even a minor injury, such as a fall, sprain, or strain, if untreated, can cause prolonged bleeding.
- Mild Hemophilia: In mild hemophilia, clotting factor VIII or clotting factor IX activity ranges between 5 and 50 percent of normal. Bleeding can be expected from surgery, major dental care, or trauma. These individuals rarely bleed into joints, and their disease usually does not interfere with normal living.
The National Hemophilia Foundation estimates that nearly 450 babies with hemophilia are born each year in the United States. This is 1 in every 4,400 live male births. The number of female hemophiliacs is not known. Hemophilia is hereditary. It primarily affects males and is passed down through females. This is because it is linked to a defect in one of two genes that are involved in the production of clotting factors. These genes are located on the X chromosome, and while females have two X chromosomes, males have only one. For a female to develop the disease, both of her X chromosomes would have to carry the defective gene (which is unlikely), whereas a male has only a single X chromosome, so one of its clotting factor genes is defective, he will be affected.
A woman who has one defective gene will not develop hemophilia herself, but is considered a carrier of the condition. All children of (female) carriers have a 50 percent chance of inheriting the defective gene. For sons, this means a 50 percent chance of developing the disease for daughters, it means a 50 percent chance of being carriers, like their mothers. For the children of (male) hemophiliacs, the story is somewhat different. Sons are not affected (unless the mother is a carrier), but daughters always become carriers. For hemophilia to occur in a female, she would have to have both a father with the condition and a mother who is either a hemophiliac or a carrier.
There are two major types of hemophilia. They are classified according to the particular protein, or clotting factor that is deficient:
- Hemophilia A is caused by a deficiency of active clotting factor VIII. Approximately 80% of all the people with hemophilia have type A, and most of these cases are severe. It is inherited by male children of mothers who are carriers. Approximately 1 out of every 10,000 male babies is born with hemophilia A.
- Hemophilia B (Christmas Disease) is caused by a lack of active clotting factor IX. It occurs less commonly; 1 out of every 25,000 to 30,0000 male babies is born with hemophilia B. It too is passed on by carrier mothers to male children.
It is also possible to have a bleeding disorder due to factor XI deficiency. Unlike hemophilia A and B, this problem can be carried by either the male or female parent, and can be passed on to both male and female offspring.
Blood tests can help determine whether you have hemophilia. Genetic tests are also available for women who want to know if they are a carrier of the condition.
Most people with hemophilia can successfully manage their bleeding problems with clotting factor replacement therapy. Clotting factors may be injected:
- On a regular basis, to prevent bleeding episodes.
- When needed. On-demand therapy is used before participating in activities with a high risk for injury or once it is suspected that bleeding has begun.
Untreated or severe forms of hemophilia can cause frequent bleeding that may damage organs and joints.
SIGNS & SYMPTOMS
Symptoms of hemophilia are usually first noticed during infancy or childhood. However, some people with milder forms of hemophilia may not develop symptoms until later on.
The following are signs of hemophilia that may be noticed shortly after birth:
- Bleeding into the muscle, resulting in a deep bruise after receiving a routine vitamin K shot.
- Prolonged bleeding after a male child is circumcised.
Other symptoms of hemophilia include:
- Bleeding into a joint or muscle that causes pain and swelling.
- Abnormal bleeding after an injury.
- Easy bruising.
- Frequent nosebleeds.
- Blood in the urine (hematuria).
The most common bleeding problem a person with severe hemophilia has is bleeding into a joint (hemarthrosis), often without an injury. Bleeding usually occurs in one joint at a time. Bleeding may develop in any joint, but knees, elbows, and ankles are most commonly affected. Sometimes one particular joint, called a target joint, will tend to bleed most often. Signs and symptoms of bleeding into a joint include:
- Warmth and/or tingling in the joint during the early stages of hemarthrosis. This is called an aura. If bleeding is not treated, mild discomfort can progress to severe pain.
- Swelling and inflammation in the joint, caused by repeated episodes of bleeding. If episodes continue, it may lead to chronic pain and destruction of the joint.
- An infant or child's reluctance to move an arm or leg because of bleeding into an affected joint. This is often first noticed when a child begins to walk.
Another common symptom of hemophilia is bleeding into a muscle (hematoma), which can be mild or severe. Serious bleeding deep in the muscle can cause significant pain and scarring. There are many possible symptoms of bleeding into muscle, including:
- Bruising.
- Swelling.
- Muscle hardening.
- Tenderness.
- Pain, especially when large muscle groups are affected.
Occasionally, bleeding into certain muscles (forearm, groin, or leg) puts enough pressure on arteries and nerves to cause a complication called compartment syndrome. If compartment syndrome is not treated promptly, muscles and nerves can die, seriously damaging muscle, bones, and other tissue. Symptoms of compartment syndrome include:
- Weakness and paleness in the affected extremity.
- Swelling and numbness.
- Severe pain during movement.
- Inability to move an extremity (paralysis).
ABOUT COMPARTMENT SYNDROME
Muscles, nerves, blood vessels, and bones are often grouped together and enclosed by a fibrous tissue (fascia), creating a compartment. This fibrous compartment is rigid and does not expand as its contents swell.
A compartment syndrome occurs when swelling takes place within a compartment and increases pressure on arteries, veins, and nerves. In addition to causing extreme pain, this slows circulation to the muscles and nerves and may cause permanent damage to these tissues. Swelling may be caused by decreased blood flow, bleeding, fluid buildup, and many other factors.
A compartment syndrome is a medical emergency. It requires immediate treatment to prevent tissue death and permanent dysfunction.
(Occasionally, people involved in a greatly increased level of physical activity - such as long-distance runners or new military recruits - may develop chronic compartment syndrome. With chronic compartment syndrome, symptoms are less sudden and less severe and often improve with rest.)
Other conditions with symptoms similar to hemophilia:
Abnormal or excessive bleeding is the most obvious symptom of hemophilia. Like hemophilia, some other disorders with similar symptoms are deficient in one or more clotting factors (such as clotting factor XI or XII). There are many types of bleeding disorders, although most are very rare.
Von Willebrand's disease is the most common of the inherited blood disorders. Like hemophilia, von Willebrand's disease can cause repeated bleeding episodes in the muscles and joints, which may result in permanent damage over time. Von Willebrand's disease is a bleeding disorder in which the body's blood system has a missing or malfunctioning von willebrand factor. The von Willebrand factor ordinarily attracts platelets and helps them to stick together to form a blood clot, which is necessary to stop bleeding when you are cut or injured. The von Willebrand factor also protects a related blood-clotting component called factor VIII. For more information about this disorder, see WebMD: Von Willebrand's Disease
Unlike the gene abnormality that causes hemophilia, the gene abnormality that causes Von Willebrand's disease is not located on the X chromosome, so the disease affects the same number of females as males.
A health professional can help determine specifically what type of bleeding disorder you have.
CAUSES
Hemophilia A and hemophilia B are caused by a defect in a pair of chromosomes. The genetic defect affects how much clotting factor a person will produce and how the factor will function. The less normal clotting factor a person has, the more severe the hemophilia.
- Hemophilia A is caused by a defect in the production of clotting factor VIII.
- Hemophilia B is caused by a defect in the production of clotting factor IX.
Although hemophilia is a genetic disorder, about one-third of all people with hemophilia have no family history of the condition. In these cases, hemophilia occurs spontaneously when a normal chromosome develops an abnormality (mutates) that affects the gene that codes for clotting factor VIII or IX. A child who inherits this mutation may be born with hemophilia or may be a carrier.
WHAT TO EXPECT
The idea that people with hemophilia can bleed to death from a minor cut or injury is a misconception. In fact, external bleeding is seldom a serious problem. People with hemophilia may bleed somewhat longer than other people but minor bleeding episodes can generally be controlled by ordinary first aid measures. If you have hemophilia, your blood does not clot properly. Once bleeding starts, it takes longer for bleeding to stop than in a person who has blood that clots normally. A bleeding episode often begins with an injury. Minor injuries may not always cause excessive bleeding. More severe injuries, or injuries in the mouth, more often cause excessive bleeding and frequently require emergency care.
Injuries also commonly cause bleeding inside the body. This is bleeding we may neither see nor feel. Unchecked internal bleeding can be serious - even life threatening - for a person with hemophilia.
Bleeding into a muscle or joint is a concern for a person with hemophilia because internal bleeding can damage organs or joints. Blood that leaks into the knee joint, a common site of internal bleeding, can cause painful swelling. Repeated bleeding eventually destroys the cartilage that enables the knee to work smoothly and easily. The joint becomes permanently stiff and painful, the result of hemophilic arthritis. Other joints such as the ankle, wrist or elbow can be similarly affected by internal bleeding.
People with hemophilia can also bleed into the muscle and other soft tissue. Internal bleeding can obstruct air passages or damage to other vital organs. Less commonly, bleeding in the brain can cause serious brain damage and possibly death. For these reasons, a person with hemophilia usually needs urgent treatment with clotting factors.
Even with treatment, bleeding is sometimes difficult to control. Frequent bleeding episodes or a serious injury can lead to complications and excessive blood loss. Most complications are successfully managed by the injection of clotting factors. People with severe hemophilia require treatment with clotting factors on a regular basis to prevent major bleeding episodes. Other people with less severe forms of hemophilia may only require clotting factor treatment on demand after bleeding starts or before an activity or procedure with a high risk of causing bleeding, such as certain sports or surgery. Complications can result from clotting factor treatment. However, life expectancy in people with hemophilia has doubled from 25 years to approximately 50 years with the use of new clotting factor concentrates.
COMPLICATIONS
Hemophilia can cause complications related to excessive and/or frequent blood loss such as:
- Compartment syndrome, a rare complication that develops when bleeding in the muscle puts pressure on arteries and nerves inside the muscle. This syndrome can cause serious damage to the limb.
- Bleeding in the digestive system, most often noticed in vomit or stool. Blood in the digestive system may sometimes give a black, tarry, or coffee-grounds appearance to the stool. If enough blood is lost, the person might have symptoms of anemia such as lightheadedness, weakness, and fatigue.
- Bleeding inside the head (intracranial hemorrhage). This is very dangerous because it may cause brain damage and death. This type of bleeding is often a result of a head injury.
- Blood in the urine (hematuria). While this is a common condition for people with hemophilia, it usually is not dangerous when treated appropriately. Blood clots that form in the urethra (the tube through which urine flows out of the body) can cause sharp stomach pain because urine flow out of the bladder is blocked.
INCREASED RISK
Hemophilia is an inherited genetic disease. The risk of a child inheriting hemophilia depends on the parents' genetic makeup. sometimes, a child can be born with hemophilia when part of a normal chromosome changes (mutates) in the sperm or the eggs of on or both parents. Medical researchers do not yet know why this mutation occurs in some people.
PREVENTION
You cannot prevent hemophilia. However, you can prevent bleeding episodes from occurring or becoming worse. See "Treatment" below for more information.
TREATMENT
DIAGNOSIS & TESTS
Severe hemophilia is usually diagnosed in early childhood or infancy. However, mild forms may not be noticed until adulthood. If a bleeding problem is suspected, the following tests from a single blood sample will help your health care provider diagnose hemophilia, its type, and severity:Prothrombin time (PT) , which measures certain clotting factors other than those related to hemophilia. High PT levels indicate that hemophilia is not the cause of bleeding problems and that another clotting disorder, antibodies to certain clotting factors (inhibitors), or a vitamin K deficiency may be responsible.
Partial thromboplastin time (PTT) measures clotting factors VIII or IX that are absent or not working properly in people with hemophilia. If PTT is elevated, you or your child may have hemophilia. However, this test cannot determine which type of hemophilia (A or B) is present.
Thromboplastin generation test (TGT), which helps determine which clotting factor (VIII or IX) is absent or not working properly. If factor VIII is missing or abnormal, hemophilia A is diagnosed. If factor IX is missing or abnormal, hemophilia B is diagnosed. Factor assay test, which determines the severity of hemophilia by measuring the levels of factor VIII and factor IX.
Hemophilia can be mild, moderate, or severe, depending on how impaired an individual's production of clotting factors is.
- Mild hemophilia: Clotting factor VIII or IX level is 5% of normal or greater. Mild hemophilia might not be recognized until excessive bleeding develops after a major trauma or surgery. In mild hemophilia, factor activity ranges between 5 and 50 percent of normal. Bleeding can be expected from surgery, major dental care, or trauma. These individuals rarely bleed into joints, and their disease usually does not interfere with normal living.
- Moderate hemophilia:. Clotting factor VIII or IX level is 1% to 5% of normal. Bleeding usually follows a fall, sprain, or strain. People with moderate hemophilia (factor levels between 1 and 5 percent of normal) do not usually experience spontaneous bleeding, but even a minor injury, if untreated, can cause prolonged bleeding.
- Severe hemophilia: Clotting factor VIII or IX level is less than 1% of normal. Bleeding often happens one or more times a week for no apparent reason. Injury, surgery, or dental care can present significant problems for such people. Spontaneous bleeding can require infusion of clotting factor concentrate as often as several times a week.
GENETIC SCREENING TESTS
The National Hemophilia Foundation estimates that nearly 450 American boys with hemophilia are born each year. The number of females with hemophilia is not known. A woman who has one defective gene will not develop hemophilia herself, but is a carrier of the condition. All children of (female) carriers have a 50 percent chance of inheriting the defective gene and becoming a carrier like their mothers. For sons, this means there is a 50 percent chance of developing the disease. For the children of hemophiliacs, the story is somewhat different. Sons are not affected (unless the mother is a carrier), but daughters always become carriers. For hemophilia to occur in a female, she would have to have both a carrier mother and a father with the condition.
If you know that hemophilia runs in your family and you are planning to have children, you can be tested for the genetic defect that causes hemophilia to determine if you are a carrier. This will allow you to make informed decisions about pregnancy and prenatal care.
During pregnancy, health care providers can use amniocentesis and chorionic villus sampling (CVS) to test the fetus for the genetic defect that causes hemophilia. If the fetus is found to have hemophilia, you may choose whether you want to complete or terminate the pregnancy. If you decide to continue with the pregnancy, you will need to learn about health issues that affect the fetus before delivery and your child after he or she is born. A genetic counselor can help provide information about these issues.
A child can also be tested for hemophilia after birth. A sample of blood can be taken from a newborn's umbilical cord to test for hemophilia A if one or both parents have the condition. Testing for hemophilia B in newborns is not effective; newborns naturally have lower levels of clotting factor IX. Blood tests for clotting factor IX deficiency should take place after a child is 6 months old.
CONVENTIONAL MEDICAL TREATMENT
Hemophilia is primarily treated by replacing the absent or abnormal clotting factors to prevent severe blood loss and complications from bleeding. Clotting factors are replaced by injecting (infusing) them into the veins (see the Other Treatment section). The severity of the disease determines how clotting factors are replaced.
- Severe forms of hemophilia: Clotting factors may be replaced on a regularly scheduled basis (prophylaxis), to prevent bleeding.
- Less severe forms of hemophilia: Clotting factors are replaced on demand, when:
- Bleeding starts, such as after an injury.
- Bleeding is expected, such as before surgery.
- When participating in activities that increase the risk for bleeding, such as contact sports.
Hemophilia patients treated after 1985 usually have a normal life expectancy. Since 1985, blood products (such as clotting factor concentrates used to treat hemophilia) are screened for viral diseases, such as the human immunodeficiency virus (HIV).
Medications can also be used to help increase clotting factors when undergoing certain medical or dental procedures. These are effective if you have mild hemophilia, or in combination with clotting factors if you have a more severe form of the disease.
If you have hemophilia, pay careful attention to lifestyle choices that may put you at risk for bleeding. Taking precautions when exercising or participating in physical activities, maintaining a healthy body weight, and learning to recognize bleeding episodes are some of the important self-care issues that can impact the course of the disease.
Hemophilia treatment centers are available at most large medical centers and are an excellent resource to help you and your family get the best care for this condition. These centers have hematologists, nurses, social workers, physical therapists, and dentists who specialize in treating people with hemophilia.
TREATMENT CONCERNS
People with hemophilia are commonly treated with plasma concentrates prepared from pooled blood plasma. As a result, as many as 2/3 of all Americans with hemophilia became infected with HIV before the virus was identified and a screening test developed. Blood donors are now screened for HIV and clotting factor products are routinely subjected to heat to minimize, if not eliminate, the risk of transmission of the virus, but the chance of contracting HIV understandably remains a source of concern for people with hemophilia. Hepatitis viruses have also been a problem for people using blood products.
Viruses can be transmitted through donated blood products, although it is very rare. All donated blood is now tested to screen for most viruses, including HIV, hepatitis B, and hepatitis C. Blood suspected of being contaminated with these viruses is not used. Current blood-purifying procedures also destroy most viruses that are not detected during screening. Some virus risk still exists because of hepatitis A and parvovirus, which are difficult to detect and destroy because of their molecular structure. As a result, in very rare cases some viruses are transmitted through the clotting factor plasma products from donated blood, which can result in complications. Plasma concentrates produced in a lab (using recombinant DNA technology) do not transmit viruses.
Clotting factor replacement products are expensive. Regularly scheduled clotting factors to prevent bleeding problems are estimated to cost at least three times as much as on-demand treatment.4 Researchers are seeking different ways to administer clotting factors that may reduce the costs of using replacement factors in this way.
The less expensive use of clotting factors only when needed (on demand) is not as effective as regularly scheduled infusions of clotting factors in preventing long-term problems.
Chronic pain from joint damage commonly occurs in people who have hemophilia and have one or more severe bleeding episodes inside a joint every year. Narcotics are the most effective drugs to relieve the acute joint pain associated with hemophilia.
MEDICATIONS
Medications can be used in specific situations or in combination with clotting factor replacement to treat hemophilia.
Desmopressin Acetate is used to treat mild hemophilia A. This medication releases unused clotting factor VIII from the cells that line blood vessels, which greatly increases the percentage of clotting factor VIII that is in the blood. Usually, desmopressin acetate is used in addition to clotting factor replacement. In mild forms of hemophilia, however, it can be used instead of clotting factor replacement.
DESMOPRESSIN ACETATE (DDAVP) FOR HEMOPHILIA
Medical researchers believe that this drug acts by releasing unused clotting factor VIII from cells that line blood vessels. It is indicated for people with mild to moderate hemophilia A before dental and minor surgical procedures. It is also indicated for mild bleeding episodes. Desmopressin acetate is not indicated in certain situations, such as:
- Severe cases of hemophilia.
- Children under 1 year of age.
- Serious injuries.
In mild to moderate cases of hemophilia, desmopressin acetate can sometimes be effective in controlling bleeding because it increases the percentage of clotting factor VIII in the blood. However, its effectiveness varies with each individual, and the drug's effectiveness is not known until it is tested.
Possible side effects include:
- Fluid retention.
- Mild increase in pulse or blood pressure.
- Redness of the face and neck (flushing).
- Headache.
The medication:
- Is usually injected, but a nasal spray is available.
- Treats hemophilia A only.
- Does not carry infectious diseases.
- May become ineffective if used too often.
- Is safe for adults.
- Is inexpensive compared to clotting factor replacement.
Antifibrinolytic agents prevent chemicals in the blood from breaking down blood clots. This type of medication is used before dental procedures and to treat nosebleeds because it slows bleeding in the mucous membranes. These drugs are usually used in combination with clotting factors.
ANTIFIBRINOLYTIC AGENTS FOR HEMOPHILIA Epsilon-aminocaproic acid (Amicar).
Tranexamic acid (Cyklokapron).
Antifibrinolytic agents prevent the breakdown of blood clots by neutralizing chemicals in the mucous membranes of the mouth, nose, and urinary tract that break down clots. Antifibrinolytic agents are used to treat nosebleeds (epistaxis) and to help prevent bleeding in the mouth before dental surgery. These medications effectively prevent bleeding of the mouth when combined with a preventive dose of clotting factor.
Possible side effects include:
- Upset stomach.
- Headache.
- Flushing.
- Abnormally low blood pressure (hypotension).
Antifibrinolytic medications:
- Do not carry infectious diseases.
- Help prevent bleeding in the mouth, nose, or urinary tract only.
- Can be used instead of clotting factor replacement after dental surgery.
- Can be taken in pill or liquid form and do not have to be injected (unlike clotting factors).
Fibrin glue helps stop oozing of minor skin wounds in people with hemophilia A. Fibrin glue is often used during dental procedures. People who have a blood-clotting disorder such as von Willebrand's disease or hemophilia may be treated with fibrin glue to help control bleeding. Fibrin glue contains clotting factors to help a wound stop bleeding. It is used for people who lack or have a shortage of clotting factor VIII. It is applied directly on a wound (topically) and is most often used after dental procedures to treat people with bleeding problems. Sometimes, fibrin glue is also used to help stop minor bleeding around a wound or to supplement other treatments.
These drugs do not replace clotting factors as the major treatment for hemophilia.
OTHER CONVENTIONAL MEDICAL TREATMENT OPTIONS
Bleeding problems caused by hemophilia can be prevented and treated with clotting factor replacement. Clotting factors come from blood donors (plasma-derived clotting factors) or are produced in a laboratory (recombinant or DNA-engineered). The amount of factor needed is determined by the severity of hemophilia and/or the location of the bleeding. More clotting factor is needed for surgery or bleeding in the brain than for less serious situations, such as routine dental procedures.
Clotting factor replacement: If you have hemophilia, you must receive clotting factors in order to prevent damage from internal bleeding. There are different types of clotting factor replacement. Depending upon the severity of the disease, you can choose to:
- Receive regularly scheduled infusions of clotting factor to prevent bleeding.
- Receive clotting factor only after bleeding starts or before you participate in an activity that will likely cause bleeding (on demand).
Treatment for people with inhibitors: Approximately 20 percent of the people with hemophilia A develop antibodies to the injected clotting factor. The antibodies are called inhibitors. Inhibitors may make it more difficult to treat bleeding episodes, because the body's natural defense system (immune system) interferes with the function of replacement clotting factors. In these cases, treatment may require specially engineered replacement clotting factors. The following are more likely to develop inhibitors to replacement clotting therapy:
- People with a severe form of hemophilia.
- Children.
- People who have never been treated with clotting factor replacement therapy.
Clotting factor replacement for hemophilia: Clotting factors are replaced by injecting (infusing) a clotting factor replacement into the veins. Types of clotting factors include:
- Fresh frozen plasma (FFP).
- Cryoprecipitate (concentrated frozen plasma).
- Factor concentrates, which are donated or produced in a lab (using recombinant DNA technology).
The person with hemophilia should learn how to self-infuse with replacement clotting factors. By the age of 10, most children with hemophilia should be able to infuse themselves.
Clotting factors are infused before surgeries and activities that may cause bleeding. People with severe hemophilia may need to infuse clotting factors regularly (three times a week) to prevent spontaneous bleeding in joints and muscles. Infusing clotting factors helps blood to clot normally and prevents damage to muscle, joints, and organs. The following describe the different kinds of blood clotting factors.
- Fresh Frozen Plasma
Advantages:
- It contains all blood factors, so it can be used to treat many varieties of blood disorders. It is used to treat people who have unidentified clotting problems.
- It is less expensive than donated and recombinant factor concentrates.
Disadvantages:
- It requires a large amount of plasma to provide enough clotting factor to prevent bleeding.
- It must be frozen, so it is not easily kept at home.
- Although it is rare, viruses can be transmitted through donated blood products, which can result in complications. All donated blood is now tested to carefully screen for most viruses, including HIV, hepatitis B, and hepatitis C. Blood suspected of being contaminated with these viruses is not used. Current blood-purifying technology also allows most viruses that are not detected during screening to be destroyed. However, hepatitis A and parvovirus can still sometimes be transmitted when using fresh frozen plasma, cryoprecipitate, or a donated factor concentrate. These viruses are difficult to detect and destroy because of their molecular structure.
- Cryoprecipitate (Concentrated Frozen Plasma)
Advantages:
- It is not likely to transmit a disease, because it is from only one donor.
- It contains all clotting factors, so it can be used to treat many varieties of blood disorders. It is used to treat people who have unidentified clotting problems.
- It requires less cryoprecipitate than fresh frozen plasma to treat a bleeding episode because cryoprecipitate has been concentrated.
- It is less expensive than donated and recombinant factor concentrates.
Disadvantages:
- Although concentrated, it still requires a relatively large amount of cryoprecipitate compared to factor concentrates and recombinant products to increase clotting factors to a safe level.
- It must be frozen, so it is not easily kept at home.
- Although it is rare, viruses can be transmitted through donated blood products, which can result in complications. All donated blood is now tested to carefully screen for most viruses, including HIV, hepatitis B, and hepatitis C. Blood suspected of being contaminated with these viruses is not used. Current blood-purifying technology also allows most viruses that are not detected during screening to be destroyed. However, hepatitis A and parvovirus can still sometimes be transmitted when using fresh frozen plasma, cryoprecipitate, or a donated factor concentrate. These viruses are difficult to detect and destroy because of their molecular structure.
- Donated Factor Concentrates
Advantages:
- Factor concentrates are made specifically for one type of hemophilia. Factor VIII concentrates treat hemophilia A. Factor IX concentrates treat hemophilia B.
- It requires relatively small amounts of factor concentrates to bring clotting factors in the blood to a normal level.
- These products come in powder form, so they can be kept and used at home. They are mixed with sterile water that comes with the concentrate and then injected.
- Factor concentrates come in a variety of purities. The purer the concentrate, the more of the specific factor it contains compared to other clotting factors. The purer the product, the better it will work, but the more expensive it will be.
Disadvantages:
- Although it is rare, viruses can be transmitted through donated blood products, which can result in complications. All donated blood is now tested to carefully screen for most viruses, including HIV, hepatitis B, and hepatitis C. Blood suspected of being contaminated with these viruses is not used. Current blood-purifying technology also allows most viruses that are not detected during screening to be destroyed. However, hepatitis A and parvovirus can still sometimes be transmitted when using fresh frozen plasma, cryoprecipitate, or a donated factor concentrate. These viruses are difficult to detect and destroy because of their molecular structure.
- Factor concentrates are expensive compared to fresh frozen plasma and cryoprecipitate.
- Lab-Produced (Recombinant) Factor Concentrates
Advantages:
- The type of recombinant clotting factor produced for hemophilia B does not contain any human or animal products, so there is no risk of contracting a virus.
- Relatively small amounts of factor concentrates are required to bring clotting factors in the blood up to normal levels.
- These products come in powder form, so they can be kept and used at home. They are mixed with sterile water that comes with the concentrate and then injected.
Disadvantages:
- They are very expensive.
- Shortages of recombinant concentrates occur more frequently than with other forms of clotting factor.
After Treatment: The infusion of clotting factor stops bleeding within hours, although the exact amount of time varies. Heavy bleeding takes longer to control than light bleeding. If the proper amount of replacement factors is given, bleeding will stop normally.
People with hemophilia can use clotting factors to treat bleeding episodes or to prevent bleeding before activities that may cause bleeding. Clotting factors will be used in situations such as:
- After an injury.
- Before surgery.
- Before activities, such as sports, in which the person with hemophilia may get injured.
- Clotting factors can be injected as a preventive treatment for severe hemophilia. Infusing clotting factor concentrates three times a week can prevent spontaneous bleeding.
If treated quickly, the blood will clot normally, and bleeding will not damage the muscles and joints.
Risks: About 20 percent of people with hemophilia A develop inhibitors to clotting factors. When this occurs, the usual forms of clotting factors may not be effective in preventing or stopping bleeding.
Treatment Concerns:
- To stop internal bleeding from causing long-term damage to joints, a person with hemophilia must replace clotting factors promptly.
- There is little risk of getting viruses such as the human immunodeficiency virus (HIV), hepatitis B, or hepatitis C from clotting factors that use donated blood products (fresh frozen plasma, cryoprecipitate, or donated factor concentrates). Donors are carefully screened and donated blood goes through purifying processes that kill viruses. Hepatitis A and parvovirus can still sometimes be transmitted when using clotting factors made from donated blood (fresh frozen plasma, cryoprecipitate, or a donated factor concentrate). These viruses are difficult to detect and destroy because of their molecular structure.
- Children are more likely to develop antibodies (inhibitors) to clotting factors than adults.
- Injecting clotting factors regularly is expensive, but it is effective in preventing joint damage. Because clotting factor must be injected into a vein every few days, it may be difficult to stay on schedule with the injections.
Treatment For People With Inhibitors: Sometimes a person's body develops antibodies to the injected clotting factor called inhibitors. When this occurs, specially engineered replacement clotting factors may be required. It can be difficult to treat a person with hemophilia who has inhibitors to the clotting factor. Some people produce few inhibitors; others produce many. Managing hemophilia in people who develop inhibitors depends on the amount of inhibitors produced. A person who produces antibodies (inhibitors) that react with clotting factors can be treated with:
- Factor bypassing agents. These clotting factors are used to skip the part of the clotting process that requires either clotting factor VIII or IX. This treatment is unpredictable, and it is hard to determine the correct dose. There is also a slight risk of heart attack or developing blood clots.
- A regimen that allows the body to get used to the clotting factor so that it won't produce as many or any inhibitors. This is done by giving large amounts of clotting factors daily over an extended period of time (1 to 3 years). During the first part of the treatment, a person will get a factor bypassing agent along with the regular clotting factors to ensure that any injury will heal. Once the body starts getting used to the clotting factor, the bypassing agent is no longer needed. This method is very expensive and prolonged.
- Suppression of the body's natural defense system. Inhibitors are produced by the body's natural defense system (immune system). The body thinks that the replacement clotting factors don't belong in the body, so it creates antibodies (inhibitors) to get rid of them. Drugs are used to suppress the immune system so it won't create any inhibitors. Combinations with other drugs can make the inhibitors nonfunctional. It is a complicated treatment and requires special equipment.
In addition to the treatments above, those who produce few inhibitors in reaction to clotting factors can be treated with:
- Large doses of the clotting factor, which can overwhelm the inhibitors.
- Factors taken from pig plasma (porcine factors). People with a lot of inhibitors who do not respond to human clotting factors often respond well to porcine factors.
- A new clotting factor product (NovoSeven) that is produced in a lab. Since it is man-made and doesn't come from human blood products, there are no risks of getting viral infections when it is injected.
- People who produce many inhibitors may also be treated by reducing or neutralizing the inhibitors in the body. This is done by pumping blood through a machine that removes or neutralizes the inhibitors (plasmapheresis). This process only works temporarily and is used before a surgery or after a major injury. It is expensive and complicated and takes a long time.
Gene Replacement Therapy For Hemophilia: Researchers are working on a possible cure for hemophilia. Gene therapy may hold the key to curing hemophilia, but it has yet to be tried in humans. Studies in laboratory and experimental animals seem to show that the technique can work. Ongoing studies using a retrovirus as a "genetic bullet" to replace the hemophiliacs' defective clotting gene show promise for eventually curing this disease. It is hoped that gene replacement therapy will someday allow defective genes to produce clotting factors.
***Gene replacement therapy for hemophilia UPDATE: Researchers have succeeded in developing genes that, when given to lab animals, cause the animals' bodies to produce clotting factors for a short time (2 to 3 weeks). These researchers are currently working on a method that enables the human body to produce clotting factors for a longer period of time. Trials of gene therapy in humans are now under way.
Surgery: There is no surgical treatment for hemophilia. However, the complications of hemophilia, such as compartment syndrome or bleeding around the brain, may require surgery. Blood-clotting factor replacement is needed before, during, and after any surgical procedure, including some dental procedures. A person with mild hemophilia may be given an antifibrinolytic agent or desmopressin acetate before dental procedures. Clotting factors, antifibrinolytic agents, fibrin glue, and possibly desmopressin acetate are usually used in combination to control bleeding in the mouth.
HELPFUL RESOURCES
National Hemophilia Foundation (NHF)
116 W. 32nd Street, 11th Floor
New York, NY 10001
Phone: (212) 328-3700
Phone: 1-800-42-HANDI (1-800-424-2634)
Fax: (212) 328-3777
E-mail: HANDI@hemophilia.org
Web Address: http://www.hemophilia.org
The National Hemophilia Foundation (NHF) is dedicated to the cures of inherited bleeding disorders and the prevention and treatment of their complications through education, advocacy, and research. The NHF has chapters throughout the country and a communications network that brings health professionals and the public the latest news about bleeding disorders. NHF's Web site provides information on the nature, symptoms, and treatments of many disorders.
World Federation of Hemophilia (WFH)
1425 René Lévesque Boulevard West
Montréal, Québec H3G 1T7 Canada
Phone: (514) 875-7944
Fax: (514) 875-8916
E-mail: wfh@wfh.org
Web Address: http://www.wfh.org
The World Federation of Hemophilia works to introduce, improve, and maintain care for people with hemophilia and related bleeding disorders around the world. The WFH provides various health care development programs and publications. The Web site provides general information on the disease, as well as research updates. Links to other organizations and further research resources are also listed.
HOME TREATMENT
Home treatment for hemophilia includes learning how to recognize when bleeding has started, administering clotting factors, eating well, and exercising regularly. Learning how to care for yourself or a child with hemophilia at home can lead to a better quality of life. There are many steps you can take to improve your health and prevent bleeding episodes.
- Maintain proper body weight. If you are overweight, the additional stress on joints can trigger bleeding episodes.
- Exercise with care.
- Monitor your non-prescription medications.
- Preventing injuries and accidents around your home is also an important part of managing your hemophilia.
Exercise For Hemophilia: People with hemophilia can help prevent bleeding episodes by choosing appropriate exercises that keep muscles and joints in good shape. Exercise helps keep muscles flexible and strong and helps control weight, lessening the likelihood of a bleeding episode. Before you or a child is allowed to participate in any sport, the family needs to have learned how to administer clotting factors at home. Injuries can then be treated quickly. The sooner a bleeding episode is treated, the less damage bleeding will do to muscles and joints.
People with hemophilia need to be careful when participating in certain activities in order to prevent injury and serious bleeding. Stretching and warming up with a few minutes of gentle exercise are important; muscles will be less likely to be pulled or torn and therefore less likely to bleed.
Sports and activities that are recommended for adults and children with hemophilia include:
- Swimming.
- Bicycling.
- Walking.
Sports that are possible but carry an increased risk of bleeding include:
- Baseball.
- Tennis.
- Basketball.
Sports that are not recommended for people with hemophilia include:
- Football.
- Hockey.
- Weight lifting (with heavy weights).
- Wrestling.
Monitor Your Non-Prescription Medications: People with hemophilia often take non-prescription medications to relieve pain caused by bleeding into the muscles and joints. Pain is a common problem, and it is necessary to try to control it carefully. Health care providers recommend acetaminophen for pain relief in people with hemophilia. Although acetaminophen does not reduce swelling, it is safer than other medications. Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (such as Aleve, Orudis KT, and Actron) can cause bleeding in the stomach or intestines, interfere with blood clotting, and affect the function of the cells that initially plug a wound (platelets). Acetaminophen does not have these side effects.
Drugs that people with hemophilia should NOT take include the following:
- Aspirin.
- Ibuprofen (such as Advil, Motrin IB).
- Drugs that contain the ingredient salicylate. This ingredient is closely related to aspirin. (Alka-Seltzer, Pepto-Bismol, and many cough medicines have salicylates.)
- Other nonsteroidal anti-inflammatory drugs (such as Aleve, Orudis KT, Actron). These drugs are designed to reduce swelling and reduce pain.
Preventing Common Injuries In The Home: Preventing injuries and accidents around your home is also an important part of managing your hemophilia.
You can help prevent falls in the home by:
- Remove and repair household hazards that can cause falls.
- Avoid slippery floors. Use non-skid floor wax, and wipe up spills immediately.
- Avoid poor lighting. Add extra lighting to poorly lighted areas.
- Avoid cluttered walkways. Rearrange furniture to keep furniture out of walking paths.
- Avoid throw rugs. Fasten area carpets to the floor with tape or tacks, and do not use throw rugs.
- Avoid raised doorway thresholds. Level off any raised doorway thresholds to prevent tripping and falls.
- Use caution when using electrical cords. Rearrange electrical cords to keep electrical cords out of walking paths.
- Keep furniture or other items that have sharp edges away from normal pathways through your house.
- Remove coffee tables.
- Pad the rocks around fireplaces.
- Take precautions when going outdoors.
- Walk on the grass when the sidewalks are slippery.
- If you live in an area that gets snow and ice in the winter, sprinkle salt or cat litter on slippery steps and sidewalks.
- Check the condition of your shoes on a regular basis.
- Check the heels and soles of your shoes for wear.
- Repair or replace worn heels or soles.
- Wear low-heeled shoes that fit well and give your feet good support.
- Loose-fitting shoes can cause you to lose you balance and fall. Wear slippers or shoes with non-skid soles.
Recognizing Bleeding Episodes: In addition, you should know how to recognize bleeding episodes so that if an injury or spontaneous bleeding occurs, you can start treatment immediately.
Maintain Alertness: Be alert for early warning signs of internal bleeding, including a bubbling or tingling sensation or a feeling of warmth, tightness, or stiffness in the affected area. A blow to the head, headache, confusion, drowsiness, or other evidence of neurological impairment may signal intracranial bleeding.
If you care for an infant or toddler with hemophilia, be alert for signs of joint or muscle pain caused by internal bleeding. The child may cry for no apparent reason, refuse to use an arm or leg, refuse to walk, or have swelling or excessive bleeding. If you suspect internal bleeding, seek treatment immediately.
Adults and older children with hemophilia will learn with experience what internal bleeding feels like. During the early stages, a warmth, tightness, or stiffness in the affected area and/or bubbling or tingling sensation, called an aura, is often felt. Bleeding is usually recognized before there is any physical evidence. A blow to the head, headache, confusion, drowsiness, or other evidence of neurological impairment may signal intracranial bleeding. It is important to begin infusion with clotting factors as soon as possible once a bleeding episode has started, before any physical signs develop.
Home Infusion of Clotting Factors For Hemophilia: Treatment for hemophilia consists of intravenous infusions of the missing clotting factor. This is now usually done at home. You may also be able to infuse blood-clotting factors at home to treat hemophilia. This option should be discussed with your health care provider. How much anti-hemophilic factor an individual needs and when depends on the severity of his disease.
Adults with hemophilia and parents of children with hemophilia can learn to inject (infuse) replacement clotting factors. Children may also be taught to infuse themselves with clotting factors by age 10. Younger children and those who have developed antibodies (inhibitors) may not be able to infuse themselves.
Being able to infuse at home will speed treatment and prevent much of the damage bleeding can cause to muscles and joints. Clotting factor comes from donated blood or is produced in a lab (using recombinant DNA technology).
People with moderate or mild hemophilia may only need to infuse clotting factors on demand after an injury or before participating in an activity that may cause an injury. People with severe hemophilia may also choose to regularly schedule clotting replacement therapy, which is the infusion of clotting factors on a regular basis in order to prevent bleeding episodes from occurring.
Gene therapy may hold the key to curing hemophilia, although the factor VIII gene is extremely complex, and it may be some time before scientists are able to replace these defective genes in people with hemophilia.
OTC HELPFUL PRODUCTS
BLOOD STOP PRODUCT INFORMATION
Indications: BloodSTOP and BloodSTOP IX hemostatic gauze can be used on anyone who is bleeding whether they are bleeding because of a minor cut or a major surgery. It is commonly used in a wide variety of settings including home first aid kits, school athletic fields, emergency responders' kits, veterinary offices, surgery rooms, dental offices, ob/gyn offices, and battlefields.
Ingredients: 100% Natural Fiber Cellulose
Directions: Clean the wound, then apply BloodSTOP with gentle pressure for a few seconds. Keep BloodSTOP moist with water or petroleum jelly. Additional BloodSTOP may be applied if necessary. Once bleeding stops, remove BloodSTOP by saturating with water and gently wiping BloodSTOP away from the clotted surface.
NUTRITION & SUPPLEMENTS
Eat a diet high in vitamin K. Foods that contain a measurable amount of this vitamin are alfalfa, broccoli, cauliflower, egg yolks, kale, liver, spinach, and all green leafy vegetables.
"Green Drinks" made from the vegetables listed above are very beneficial and healthful. Drink one of these a day for vitamin K and other essential clotting factors. See Juicing for more information.
HERBS
Alfalfa is a good source of vitamin K. It can be taken in tablet form, eaten in a natural form, such as alfalfa sprouts, or in liquid form as a concentrated liquid nutritional supplement.
Chlorophyll With Alfalfa Powder, NOW Foods, 100 mg, 90 Caps
Chlorophyll is a unique substance found in all green plants and is sometimes called the blood of plant life. Identified as sodium-copper chlorophyllin, this water soluble extract is derived exclusively from alfalfa through a natural process.
AlfaMax Alfalfa Extract, Nature's Way, 525 mg, 100 Caps
Nature's Way Alfa-Max Alfalfa Extract capsules is a 10X extract of fresh green Alfalfa leaves.
Alfalfa, NOW Foods, 650 mg, 500 Tabs
NOW Food's Alfalfa tablets deliver excellent health benefits. Alfalfa is a rich natural source of chlorophyll, vitamins, minerals and protein which supports a healthy colon.
Alfalfa Tincture, 100% Organic, 2 fl. oz.
Alfalfa (Medicago sativa) is Useful to generate energy and endurance; a tonic for the whole body, due to its highly nutritive value.
Alfalfa Leaves, Nature's Way, 405 mg, 100 Caps
Nature's Way Alfalfa Leaves are organically grown by Trout Lake Farm, Washington, and Certified Organically Processed in accordance with Oregon Tilth standards and the California Organic Foods Act of 1990.
Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb.
Alfalfa Powder is a supplement which can be blended into vegetable juices or used in baking or in vegetarian dishes. It is 20% protein and 15% fiber; plus it contains 16 amino acids, 13 trace minerals and 13 vitamins. Alfalfa Powder is a whole food supplement highly valued for its nutrition.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the following recommended doses are for those over the age of 18 years. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
HEMOPHILIA SUPPLEMENTS & PRODUCTS
Information, products and supplements for hemophilia, a rare disease that prevents the blood from clotting normally. These products are meant to supplement the diet and relieve bruising problems, not take the place of standard medical care for hemophilia.
Alfalfa, NOW Foods, 650 mg, 500 Tabs
NOW Food's Alfalfa tablets deliver excellent health benefits. Alfalfa is a rich natural source of chlorophyll, vitamins, minerals and protein which supports a healthy colon.Alive! Whole Food Energizer Multi-Vitamin & Mineral with 18 mg of Iron Added, Nature's Way, 90 Tabs
Nature's Way Alive multi-vitamin with mineral is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands. No other supplement contains more life-giving nutrients than ALIVE, which is just the way it will make you feel.Alive! Whole Food Energizer Multi-Vitamin & Mineral with Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Tabs
No other supplement contains more life-giving nutrients than Nature's Way ALIVE! It is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.Arnica Gel, Arniflora Homeopathics, Boericke & Tafel, 2.75 oz. Topical Gel
Arniflora is a modern pharmaceutical preparation containing 8% tincture of Arnica montana. Relieves: Pain, Swelling, Stiffness, Bruising, Pain relieving gel for bumps, bruises, sprains, sports injuries, over-exercising, and more.Arnica Montana Tincture, 100% Organic, 2 fl. oz.
Arnica Montana is used primarily to relieve the after-effects of falls, blows, sports injuries and overexertion.Bumps & Bruises Wellness Oil, 100% Organic, 2 fl. oz.
Bumps & Bruises Wellness Oil, when massaged into the skin or held onto the injury with a cloth, will help reduce swelling and bruising. The swelling and unsightly bruising that comes after a bump or fall can almost be worse than the pain of the original impact. When moments like this happen - and we all have them - it's important to act relatively quickly. The sooner you address bruising and swelling, the shorter the duration will be. You can also speed up the healing process by applying ice to the bruise. This oil is a great one to have stored in the medicine cabinet, as bumps happen all the time - it's great to have a natural treatment at the ready! Ingredients include unrefined grapeseed oil, and an essential oil blend of lavender, geranium, & black pepper.CAL/MAG/ZINC, Calcium Magnesium Zinc Supplement, 90 Tablets
This unique Calcium Magnesium Zinc Supplement formula perfectly balances calcium, magnesium, and zinc with over 70 minerals and trace elements found in ConcenTrace for maximum absorption and utilization by the body.Cell Rejuvenator, Peter Gillham's Natural Vitality, 8 oz.
Cell Rejuvenator is a precisely engineered formula designed to give cells the exact nutrients they need to rejuvenate quickly and in the best condition possible.Chlorofresh Chlorophyll Supplement, Nature's Way, 50 mg, 90 Softgels
Chlorofresh, Chlorophyll Supplement, is used chiefly as an aid to reduce odor from a colostomy or ileostomy and to reduce fecal odor due to incontinence. Chlorophyll is rich with vitamin K, needed for blood clotting.Daily Two Iron-Free Multi-Vitamin Supplement, 100% Natural, Nature's Way, 100 Tabs
This iron free multi-vitamin supplement was developed for the protection growth and maintenance of body systems as they age.Ester C with Bioflavonoids, Nature's way, 1000 mg, 90 Tabs
Nature's Way Ester C with Bioflavonoids offers enhanced Retention. Ester-C is 100% natural Vitamin C (calcium ascorbate) with enhanced cellular uptake and retention.Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system. Calcium and magnesium are essential for blood clotting.MSM (Methylsulfonylmethane), Pure Lignisul, With Vitamin C, 875 mg/100 mg, 120 Caps
MSM with Vitamin C offers support for allergies, connective tissue, joint flexibility, immune function, arthritis, osteoporosis, digestive disorders, circulation, bruising, carpal tunnel syndrome, and antioxidant protection.Multi-Vitamin Without Iron, Nature's Way, 100 Caps
The vitamins and minerals in this Multi Vitamin without Iron play many important roles in the body: antioxidants to protect fats, cells and DNA, coenzyme precursors for energy production and metabolism, and cofactors for hormones and enzymes which regulate body processes.Nettle Herb, 435 mg, 100 Caps
Nettle herb from Nature's Way is wild harvested, gently dried and ground to a usable form and encapsulated. Nettle herb contains no chemicals, additives or artificial coloring. Nettle is a good source of iron and vitamin K.Ultimate B (Vitamin B Complex Formula), 60 Tabs
Superbly formulated, Ultimate B, vitamin B Complex Formula, is a synergistic blend of herbs, superfoods, and enzymes made of 33% food ingredients for easy absorption.Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.
Vitamin B-12 Helps to maintain a healthy nervous system, and helps in the prevention of pernicious anemia. Folic Acid should be taken by all females of child bearing age to help prevent neuro-tube birth defects. Folic acid is also linked to heart health.Vitamin C 1000 with Bioflavonoids, 100% Natural, 1000 mg, 250 Vcaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Vitamin C 500 with Rosehips, 100% Natural, 500 mg, 250 Vcaps
Nature's Way Vitamin C with Rosehips offers a rich whole plant source of vitamin C and provides antioxidant protection for many of the body's important enzyme systems.Witch Hazel Tincture, 100% Organic, 2 fl. oz.
Witch Hazel can be taken internally for diarrhea and hemorrhage.
Herbal Remedies: Hemophilia Information
Herbal Remedies: Hemophilia Supplements, Information & Products
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or your child has one or more of the following symptoms:
- Easy bruising.
- A wound that does not stop bleeding easily or continues to ooze blood.
- Limited motion or obvious swelling in a limb.
If you know your child has hemophilia:
- Immediate treatment is needed for head injuries because they are very dangerous. Take your child to the nearest hospital emergency room when a head injury occurs. If you are trained in treating hemophilia and have the supplies, begin infusions first.
- Call a hematologist for other types of injuries if you are unsure whether treatment is necessary.
Watchful Waiting: Most people with hemophilia become skilled at recognizing early signs of bleeding. Work with your health professional to develop a plan describing what to do if you or your child has a bleeding episode. This will allow you to start treatment immediately once a bleeding episode is suspected.
A child with hemophilia who is injured should be treated to prevent long-term damage to muscles and joints.
If you have hemophilia, inform your health professionals and people you see often, such as co-workers and close friends. Likewise, people who care for your child, such as school officials or day care staff, should be aware if he or she has hemophilia.
The following health professionals can help diagnose hemophilia:
- Family practice physician.
- Pediatrician.
After you or your child is diagnosed with hemophilia, one of the following health care providers can help you develop a treatment plan or provide urgent care:
- Hematologist (blood specialist).
- Emergency room practitioner when bleeding is severe or a child has had a head injury.
HELPFUL RELATED LINKS
WebMD: Hemophilia Medications
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
This is only a small sample of educational materials and products available through Amazon.com. Use the search box provided below to search for a particular item.
HERBS, OILS, & SUPPLIES
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
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