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Case Reports in Emergency Medicine
Volume 2016, Article ID 3263261, 6 pages
http://dx.doi.org/10.1155/2016/3263261
Case Report

Avoidable Compartment Syndrome! High Index of Suspicion for a Newly Presenting Haemophiliac: A Case Series

1Northern Ireland Haemophilia Comprehensive Care Centre, Belfast City Hospital, Lisburn Road, Belfast BT10 7AB, UK
2Department of Orthopaedics, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK
3Department of Physiotherapy, Belfast City Hospital, Lisburn Road, Belfast BT10 7AB, UK
4Genetics Department, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK

Received 26 February 2016; Revised 5 May 2016; Accepted 5 May 2016

Academic Editor: Aristomenis K. Exadaktylos

Copyright © 2016 A. Niblock et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bleeding disorders can present at any age and vary in their severity. Haemophilia, which is characterised by its x-linked recessive inheritance, can present with a spontaneous mutation and therefore no family history will be evident. Three cases of trauma induced thigh haematomas as an initial presenting feature for people with haemophilia are discussed. The cases highlight the importance of a coagulation screen if the patients bleeding phenotype does not match the injury sustained. An isolated prolonged APTT with no offending anticoagulant cause should always be investigated to look for underlying haemophilia. Interestingly the cases demonstrate the limitations of a coagulation screen. Factor VIII being an acute phase reactant can result in the fact that the initial coagulation screen may be temporarily normal. Therefore, if there is a high index of suspicion for a bleeding disorder, consider repeating the coagulation screen and seeking haematology opinion. Early diagnosis and appropriate specific factor replacement for an injured haemophiliac prevent haematomas expanding thus avoiding potential complications like compartment syndrome or unnecessary surgical input.