Moderate risk of bleeding shouldn’t rule out sports in children with haemophiliaBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6778 (Published 10 October 2012) Cite this as: BMJ 2012;345:e6778
Some sports are associated with a moderately increased risk of bleeding in boys with haemophilia. An observational study from Australia reports odds ratios of 2.7 (95% CI 1.7 to 4.8) for team sports, such as basketball and football, and 3.7 (2.3 to 7.3) for collision sports, such as wrestling, when compared with inactivity or low risk sports such as swimming.
Absolute risks looked low, however. Most bleeds reported by 104 boys aged 4-18 years were not preceded by sports activities. The authors implicate sports in one bleed per year for a boy doing vigorous sports three times a week who usually has five bleeds a year.
Children with haemophilia can and probably should participate in vigorous sports, says a linked editorial (p 1480), providing they and their parents are fully informed about the risks, which look manageable. Most of the boys in this study were treated with prophylactic infusions of clotting factors, and tailoring treatment protocols to sports timetables might protect them further. The incidence of bleeding fell by 2% (1% to 3%) for every 1% increase in clotting factor concentration.
The boys all had moderate or severe haemophilia A or B. They reported all bleeds requiring extra infusions of clotting factor during one year, then answered questions about what they had been doing during the eight hours before the bleed. The authors compared exposure to sports in that time window with exposure to sports in two eight hour control windows in the 24 hours and 48 hours before each bleed.
The boys reported 336 new bleeds during the year, most often in or around a knee (15%), ankle (14%), or elbow (10%).
Cite this as: BMJ 2012;345:e6778