dr. Clara Devina, dr. Khainir Akbar, Sp.A
OBJECTIVE Hemophilia is a blood coagulation disease that is hereditary found. If it is not treated well, it can lead to any disabilities. However, it is also can be managed with better treatment among the coagulation disorders. Our aim on reporting this case is to describe the disorder, to determine the role VIII and IX factor in diagnosing hemophilia, and to discuss the treatment. CASE REPORT A 6 – year old boy came with his parents to the Emergency Department complaining of gingival bleeding since 1 day ago. There is a previous bleeding episode once but recovered itself. From the oral examination, ongoing bleeding from gingiva is already stopped. Mother told that there is a small bruise in his son’s arm. From the history of the family, we collected that maternal grandfather had hemophilia. A signed informed consent was done. The patient is suspected hemophilia. The child is given infusion from Ringer Lactate solution and a pledge upon the gingiva to control bleeding. Diagnostic approach is done from the laboratorium diagnosis, with Hemoglobin level 6,3 mg/dL, leukocyte level 20.670/µl, and thrombocyte count is 456.000/µl. Patient is then admitted to the room to be managed furtherly. The child is given 175 cc of packed red cell transfusion and antibiotics. We also check bleeding time and clotting time,4’30” and 10’, which is normal. APTT score is 65,8”, which is higher than normal, PT 15”, INR 0,81. Considering of the high APTT level, we check the VIII and IX factor to make sure which type of hemophilia the child is. VIII factor is shown low (20,20 %) which is categorized as mild hemophilia and IX factor is normal(70.00%). With the given treatment for 2 days,the child shown a normal values of hemoglobin level now (Hb 9,8 mg/dl) and leucocyte count (11.120/µL), control of bleeding, and freed from infection. Patient is dismissed from hospital and prepared for the next check up with pediatrics. CONCLUSION Doctor will always face a serious challenge from the case of bleeding disorders, such as hemophilia. Always remember to take a screening if we suspect any clotting deficiencies, particularly in those who are clinically unseen. This study will enhance every professionals to improve health of hemophilic children.