At the National Hemophilia Foundation’s 58th Annual Meeting in Philadelphia in October 2006, a parent stood up in a session and asked a question about how to take care of a child with a bleeding disorder when he/she gets common illnesses like a cold or stomach flu. Although there are many guidelines and protocols to help treat serious medical problems associated with bleeding disorders, parents sometimes have no idea how to deal with more common ailments.
Getting sick is a natural part of childhood, but when a child with hemophilia catches a nasty bug, parents need to take special precautions.
For starters, Toni Ferrell, a mother of two in Allons, Tennessee, keeps an eye on the active ingredients in common medications. Her seven-year-old son, Palin, has severe hemophilia A. “One of the things we really worry about is making sure none of the over-the-counter medications has anything in them that would cause a problem with the hemophilia, such as aspirin or a blood thinner.”
When it comes to common childhood illnesses and hemophilia, there really isn’t much medical information out there, says hematologist Edward Gomperts, MD, at Childrens Hospital Los Angeles. “Only the occasional medical review will talk about this issue.”
Children with hemophilia aren’t more likely to come down with a common illness, says Gomperts, but their bleeding disorder could complicate things. He offers the following important advice for managing colds, flu, high fever or any another condition: no aspirin. It interferes with platelet function and could cause bleeding problems. When checking the ingredients of medications, avoid those with acetyl salicylic acid, the chemical name for aspirin.
Fevers are usually associated with upper respiratory tract infections or viral enteritis (intestinal flu). Any temperature above 102 degrees Fahrenheit is considered too high and could lead to febrile seizures.
Febrile seizures (severe uncontrolled shaking) are serious for any child, but in hemophilia they could also result in injury and bleeding, Gomperts says. An appropriate dose of acetaminophen depending on the child’s weight and age should be given, or in many cases, ibuprofen may be acceptable because it treats fever symptoms more effectively. “Some doctors don’t like to give ibuprofen. There are minor side effects with ibuprofen as it has a minimal effect on platelet function; however, it is used in adults with hemophilia and usually does not result in more bleeding,” Gomperts says.
It’s best not to take a child’s temperature rectally; instead take an axillary (under the arm) temperature or use a tympanic (ear) thermometer. These thermometers tend to read lower, so if the temperature reading is 102 degrees F, the child’s temperature is probably higher.
Bleeding Caused by Other Childhood Illnesses
“It would be very unusual to see bleeding complications in hemophilia with common childhood illnesses,” says Gomperts, but he advises caution in the following situations:
Throwing up—Vomiting can indicate viral gastroenteritis, but it also is an early sign of intracranial bleeding (bleeding around the brain). If a child is vomiting, parents should call their hemophilia treatment center (HTC) because of the possibility of an intracranial bleed. An intracranial bleed may have occurred if the child had fallen and hit his or her head.
Severe gastroenteritis (diarrhea, nausea, vomiting)—If a child has a fever, is vomiting and has diarrhea, these symptoms suggest a viral illness or food poisoning. The vomiting could tear the lining of the stomach or the esophagus, causing the child to throw up blood. In such cases, bleeding could be severe and the child would need an infusion of clotting factor. A child throwing up blood should be taken to the emergency room.
Diarrhea could cause abrasions to the anus and result in some bleeding from the anal site. However, most cases of mild diarrhea are usually not serious.
Tonsillitis—In severe cases, the child could bleed from the tonsil area and vomit blood. When this happens, the child could lose a lot of blood very quickly and should be taken to the emergency room.
Chicken pox—There may be some bleeding from the pox, or vesicles, especially if the child scratches them. This would not cause a life-threatening bleed, but it could cause some scarring.
Teething—This is generally not a problem for children with hemophilia, unless a child falls and the tooth cuts the tongue or lips. Once children start losing their primary teeth when they are five or six years old, there is very little bleeding if a tooth is allowed to fall out on its own. There could be more serious bleeding if a child or adult pulls out a tooth.
Immunizations—Children with bleeding disorders should get all the recommended vaccines. “In general, everyone should get the hepatitis B series vaccine,” says Jennifer Domm, MD, a hematologist at Vanderbilt Children’s Hospital in Nashville, Tennessee. “And in our clinic we give the hepatitis A vaccine, too.” NHF's Medical and Scientific Advisory Council (MASAC) recommends all patients with bleeding disorders be vaccinated against hepatitis A and B viruses. The person giving the injection should be careful to make sure that any immunizations are given subcutaneously (under the skin), not intramuscularly (into a muscle), which can cause bleeding into the muscle.
Parents should trust their instincts when treating their kids for common medical conditions, but ask for help from their HTC if they feel unsure.