Clinical Review Lesson of the week

Unsuspected haemophilia in children with a single swollen joint

BMJ 2003; 326 doi: (Published 18 January 2003) Cite this as: BMJ 2003;326:151
  1. Beatrice Nolan, specialist registrar,
  2. Vicky Vidler, nurse consultant (paediatric haematology),
  3. Ajay Vora, consultant physician,
  4. Michael Makris (, reader in haematology
  1. Sheffield Children's Hospital, Sheffield S10 2TH
  1. Correspondence to: M Makris
  • Accepted 22 April 2002

A clotting screen to exclude haemophilia is an essential investigation in a child with a single swollen joint

A clotting screen should always be performed in a child with a swollen joint, even if there is a history of minor trauma, to exclude underlying bleeding disorders. A prompt diagnosis of haemophilia will allow early arrest of bleeding by appropriate treatment, which will in turn minimise complications and reduce total exposure to blood products.

Case reports

Case 1

A 1 year old boy, an only child, presented to an accident and emergency department with a painful, swollen right elbow following minor trauma. Examination and a radiograph showed no evidence of bone injury and he was sent home.

Three days later, he was brought back because of increasing pain and swelling. Joint aspiration yielded haemorrhagic fluid. Osteomyelitis was suspected and he was started empirically on antibiotic treatment. Approximately four weeks later, as the effusion had not resolved, the joint was explored, yielding dark blood, and a biopsy specimen was taken from a localised area of synovitis. Postoperatively the wound bled persistently. A coagulation screen showed normal prothrombin time but prolonged activated partial thromboplastin time (96 s; normal range …

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