Treating ER Patients with Bleeding Disorders
December 2007, Submitted to Atlanta Hospital News
By Cathy Hulbert, LCSW, and Rueleen Lavergne, RN, Hemophilia of Georgia Outreach Staff
Just a few years ago, people with bleeding disorders such as hemophilia and von Willebrand Disease were frequent visitors to hospital emergency rooms. Now, with the advent of home infusion of clotting factor concentrate, these patients rarely need emergency care for routine joint bleeds. However, if people who have bleeding disorders arrive in an emergency room with serious injuries they must be treated quickly and appropriately to stop internal bleeding.
In treating patients with bleeding disorders, it is important for physicians to know that they have an important ally in linking with hematologists at the state's hemophilia treatment centers in Atlanta at Emory Healthcare and Children's Healthcare of Atlanta, in Augusta at the Medical College of Georgia, and in Savannah at Backus Children's Hospital. Hemophilia of Georgia, a nonprofit organization, is a trusted resource for medical providers and a crucial link between patients, hematologists and emergency room physicians.
HoG was founded 34 years ago so that people in Georgia affected by bleeding disorders live as normally and productively as possible. To this end, outreach nurses from Hemophilia of Georgia make home visits to people with bleeding disorders to assist with home infusion and to provide education about healthy living. The HoG outreach nurses encourage these clients to wear MedicAlert bracelets and to carry an Emergency Action Plan with them at all times. These small laminated cards contain patient-specific treatment plans that detail the medications required to stop hemorrhages.
For physicians and other medical providers, Hemophilia of Georgia publishes Protocols for the Treatment of Hemophilia and von Willebrand Disease and provides a 24-hour physician-to-physician hotline for Georgia physicians who need emergency treatment information.
In addition to educating patients and providing resources for physicians, Hemophilia of Georgia provides comprehensive community services that can give doctors and nurses added peace of mind: outreach nurses and social workers are frequently in the field throughout the entire state doing in-services at emergency rooms and the offices of dentists, pediatricians and general practitioners. In-services also are done at schools and day care centers. The HoG staff also attends numerous health fairs around the state to enhance community awareness of bleeding disorders.
Hemophilia of Georgia's non-profit pharmacy provides convenient home delivery of clotting factor and other medications. And, in emergency situations, hospitals can obtain factor for HoG clients from the HoG pharmacy.
The HoG staff is available to answer questions and provide additional information. Please call 770-518-8272 or email mail@hog.org. We look forward to hearing from you!
Additional Facts About Bleeding Disorders
- Hemophilia is a hereditary blood clothing disorder which affects males almost exclusively. It results in a deficiency of clotting factor in the blood. It affects people of all races, nationalities and economic levels.
- Contrary to popular belief, people with hemophilia do not bleed to death from minor external wounds.
- The major problem for people with hemophilia and other inherited bleeding disorders is bleeding inside the body, especially bleeding into joints such as the knees, elbows and ankles.
- Current treatment for hemophilia is clotting factor, which is genetically engineered. It is infused into the veins to stop bleeding episodes. More serious bleeding episodes require repeated infusions.
- Von Willebrand Disease (VWD) is an autosomal dominant disorder affecting males and females equally. According to the CDC, approximately 1-2% of the U.S. population is affected by von Willebrand Disease. Von Willebrand Factor is a clotting protein produced in cells that line blood vessels and are slowly released into the blood stream. VWD is caused by a defect or a deficiency of von Willebrand Factor.
- Most types of VWD can be treated with a synthetic hormone called Desmopressin Acetate (DDAVP), either by IV or Stimate nasal spray. In some cases DDAVP does not work. In these cases, a hematologist may recommend a clotting factor concentrate.
- Patients affected by storage pool or Platelet Function Disorders have a normal amount of platelets, but they are abnormal in size or shape, or do not function properly.