PHYSICAL GROWTH AND THE VICIOUS CYCLE OF HEMOPHILIC BLEEDING

Abstract

In hemophilia, the most common problem is that of spontaneous hemorrhages into various joints, most often the elbows, the knees and the ankles. Hemophilic intraarticular bleeding recurs in a particular joint. Bleeding in a joint seriously damages the adjacent tissue, and causes joint contracture, muscule weakness and joint instability. Joint instability may cause further bleeding, resulting in a vicious cycle and chronic arthropathy. The hemophilic patient becomes limited in his daily activities with deterioration of the joints. For many hemophilic patients, the vicious cycle of hemophilic intraarticular bleeding begins at adolescence. The purpose of this paper was to investigate the relationship between physical growth and hemophilic intraarticular bleeding. The subjects were five adolescent hemophilic patients (four cases, hemophilia A; one case, hemophilia B) ranging from 8 to 15 years old. The major findings were as follows: (1) The frequency of hemophilic intraarticular bleeding increases with age. In addition, bleeding tends to concentrate on a particular joint. (2) The increase in the frequency of and the concentration on a particular joint of hemophilic intraarticular bleeding appeared to be divided into two types: sudden and gradual. (3) The most remarkable increase and concentration of hemophilic intraarticular bleeding appeared in the year after height (cm/yr) increased the most. (4) Bleeding patterns differed in the two types of onset, particularly in the 10 days preceding severe hemorrhage. In the year when the increase and concentration of bleeding was the most remarkable, the frequency of mild bleeding in other regions increased 3 or 4 days before severe hemorrhage in gradual type onset. In addition, we discussed the mechanisms of the development of the vicious cycle of hemophilic intraarticular bleeding during adolescence. The movements and actions of the human body are performed with the coordination of the functional units consisting of the skeletal, muscular, and nervous systems. During adolescence, all skeletal and muscular systems take part in the growth spurt, though not to an equal degree. Coordination of the functional units is distorted by an unbalance in physical growth. It may be that a distortion in coordination is closely relate to the development of the vicious cycle of hemophilic intraarticular bleeding. Moreover, during adolescence, the distortion of the coordination of the functional units is accelerated with mild bleeding. As a result, severe hemorrhage may occur.