Intracranial bleeding in haemophilia beyond the neonatal period - the role of CT imaging in suspected intracranial bleeding

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia 2007-09, Vol.13 (5), p.552-559
• Main Authors: TRAIVAREE, C., BLANCHETTE, V., ARMSTRONG, D., FLOROS, G., STAIN, A. M., CARCAO, M. D.
• Format: Article
• Language: English
• Subjects: Adolescent; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - etiology; Child, Preschool; computed tomography; Data Collection - statistics & numerical data; Factor VIII - therapeutic use; Female; haemophilia; head trauma; Hemophilia A - complications; Humans; Infant; intracranial haemorrhage; neurological impairment; paediatrics; radiology; Tomography, X-Ray Computed
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/j.1365-2516.2007.01545.x

We conducted a review of a single institutional experience of patients with haemophilia presenting with suspected intracranial haemorrhage (ICH) who underwent computed tomographic (CT) neuro‐imaging. We found that over a 9‐year period (1996–2004) 43 patients with haemophilia presented 73 times with suspected ICH: 10 presented multiple times (range: 2–9 times). The median age at presentation was 3.5 years (range: 0.5–17). Preceding trauma occurred in most (62/73; 85%) episodes. ICH was confirmed in 11 of the 73 (16%) episodes in eight patients. Patients with severe haemophilia accounted for a disproportionate number of episodes of suspected (60/73; 82%) and of confirmed ICH (10/11; 91%). All ICH occurred in patients not on prophylaxis; five occurred in three inhibitor‐positive patients. Altered consciousness at presentation was present in 10/11 (91%) cases of confirmed ICH but only in 5/62 (8%) (ICH‐negative) episodes. The positive and negative predictive values of altered consciousness to predict/rule out an ICH was 67% and 98%, respectively. The following were associated with an increased risk of presenting with suspected ICH and of having a confirmed ICH: (i) having severe haemophilia; (ii) not being on prophylaxis; (iii) having an inhibitor; and (iv) presenting with an altered level of consciousness. Patients without any of these features may not need to undergo CT imaging when presenting with suspected ICH. Ideally a prospective study to evaluate this hypothesis should be conducted.