Abstract Ref Number = APCP898
A CASE REPORT OF DELAYED DIAGNOSIS OF HAEMOPHILIA B POST VACCINATION IN 6 YEARS 9 MONTHS OLD BOY
Wira Mondana,Bidasari Lubis,Olga Rasiyanti Siregar
Department of Child Health Faculty of Medicine Universitas Sumatera Utara Hematology Oncology Division Department of Child Health Faculty of Medicine Universitas Sumatera Utara
Background : Hemophilia is a relatively rare bleeding disorder. It is an X-linked hereditary bleeding disorder caused by a deficient or defective coagulation factor VIII (Hemophilia A) or factor IX (Hemophilia B). Children with bleeding disorders, especially with severe disease, are at risk for muscle hematoma with intramuscular injections. Thus, there has been interest in subcutaneous (SQ) vaccination, but few data exist concerning its safety.
Case Presentation Summary : A 6 years 9 months old boy presented with bruise on the left arm and pale. The patient had received a measles vaccine at elementary school 2 days prior to admission. He was afebrile with a heart rate of 120 beats/min and a blood pressure of 100/60 mmHg. Cardiovascular, respiratory and neurological examinations were unremarkable. A complete blood count revealed a hemoglobin level of 5.7 g/dl, hematocrit of 17 %, leucocyte 12.670, platelet count of 332.000. A peripheral blood smear showed normochromic normocytic red cells, some polychromasia, no schistocytes, with predominant lymphocytes. A coagulogram revealed a increased prothrombin time 19.8 (15), increased of activated partial thromboplastin time 79.5 (34), increased thrombin time 14.9 (17.5) and low factor IX 4.5%. Renal and liver function tests were normal. Viral serologies (dengue NS-1 antigen, IgM, IgG, and anti-HIV) were all negative. Because the patient had bruise and pale, packed red cell, factor IX concentrates was administered. On the second day of hospitalization, the complete blood count was stable. Three days after factor IX administration, the patient was no longer pale, and the bruise disappeared. He was discharged home after 5 days hospitalization
Learning Points/Discussion : The immunization of patients with bleeding disorders differs from that of the normal population with respect to the risk of haematoma formation at the vaccination site and the unusual infective risks associated with the potential, and past, exposure to blood products. Most vaccinations can be given subcutaneously and this should be the preferred route. All routine childhood vaccinations should be given at the appropriate time.
Keywords: hemophilia vaccination haematoma