Treatment Approaches
There are two common approaches to treating bleeding disorders:
On-Demand Treatment: This approach involves administering factor after bleeding has already begun. When a person with a bleeding disorder experiences a bleed, they would infuse the necessary clotting factor to help stop the bleeding. Depending on the severity of the bleed, multiple infusions over several days may be required until the bleeding is under control. On-demand treatment is often used for individuals with mild or moderate forms of the bleeding disorder, as well as for specific situations where prophylactic treatment is not feasible.
Prophylactic Treatment: Prophylaxis is considered the optimal treatment approach, especially for people with severe Hemophilia A and Hemophilia B. In this approach, individuals infuse factor regularly to maintain a sufficiently high level of clotting factor in their blood. By doing so, they aim to prevent bleeds from occurring in the first place. Typically, factor infusions are administered one to three times a week, depending on the individual's needs and the recommendation of their healthcare provider. Although prophylactic treatment may incur higher costs due to the increased frequency of factor infusions, it can help reduce the risk of complications associated with bleeds, ultimately leading to better long-term outcomes.
Moreover, individuals with bleeding disorders may also utilize the prophylactic approach in specific situations where there is a high likelihood of bleeding. For example, before engaging in activities that pose an increased risk of injury, such as sports or physical exertion, they may choose to administer clotting factor in advance to prevent potential bleeds. Similarly, prior to dental procedures or surgery, it is common for individuals with bleeding disorders to receive factor infusions to minimize the risk of bleeding complications.
It is important to note that the choice of treatment approach may vary depending on the specific bleeding disorder, its severity, individual patient factors, and the guidance of the treating healthcare professionals.
In the case of a target joint, where an individual with Hemophilia experiences repeated bleeding episodes in the same joint, a specific treatment approach may be employed to address the issue.
To treat a target joint, the individual's healthcare provider may prescribe a regimen where factor infusions are administered at regular intervals, typically every two to four days, for a few weeks or even longer. By doing so, the clotting factor levels in the person's blood are elevated to a level that helps prevent further bleeding episodes in the affected joint.
In addition to factor infusions, it is often recommended that individuals with Hemophilia engage in regular exercise to strengthen the muscles surrounding the affected joint. Strengthening these muscles can help provide additional support and stability to the joint, potentially reducing the likelihood of bleeding when treatments are discontinued or less frequent.
The goal of treating a target joint is to alleviate symptoms, promote joint health, and minimize the impact of repeated bleeding episodes on the affected joint. The specific treatment plan may vary depending on the severity of the target joint, the individual's overall health, and the recommendations of the medical team managing their care.
It's worth noting that the treatment of target joints and the management of Hemophilia should always be guided by healthcare professionals with expertise in bleeding disorders to ensure the best possible outcomes for the individual.
How long factor works in your body
Clotting factor that has been infused does not stay in the body but is used up. The rate at which it is used up is called its “half-life”. This means that the amount of factor VIII or IX working in the body drops by half. Factor IX typically lasts longer in the body than factor VIII.
The time of day to take factor
You should never delay taking factor if you think you are having a bleed. By treating right away, you can reduce the number of treatments needed to stop the bleeding. It also lowers the chances of having permanent damage.
Sometimes Hemophilia doctors want you to take factor regularly for a period of time to prevent bleeds. The best time for this prophylactic or preventive treatment is in the morning. By taking factor in the morning, you can have your highest factor level during your most active time of the day. You will have the most protection at the time you are most likely to bleed.
If you take factor at night, your factor level will be highest when you are asleep. It will have dropped by half the next morning when you really need the protection.
How many doses to take
Usually, one to two doses of factor are all that is needed to stop a mild to moderate bleed. If the symptoms get worse or last longer than you expect, you may still be bleeding. Call your HTC for advice.
Different types of bleeds need a different number of doses. Your HTC can provide you with treatment plans for the various types of bleeds.
You may need to take more doses of factor if:
- You did not treat early enough.
- You did not use a high enough dose of factor.
- You have been too active on a joint after a bleed.
- You have a very bad or difficult bleed and need to be sure it doesn’t start again. (Since there may be a medical reason for the problem, you may need to talk to your doctor.)