How Would You Initially Manage This Patient With Hemophilia A?

How Would You Initially Manage This Patient With Hemophilia A?

An older male adult presents to the emergency department (ED) with a chief complaint of paresthesia in his right lower leg and foot. The patient is assessed in the ED triage and a round tumor-like mass is noted on his right anterior thigh. 

The patient reveals that he has had this mass for “a week or so” and that he has been unable to receive regular medical care because he is homeless and uninsured. The patient continues to state that the pain has become so severe that he can no longer move his leg. He denies any history of injury or trauma to the area and denies the use of medically prescribed or recreational use drugs. He shares, “I take a little aspirin here and there for the pain.” 

Diagnostic imaging and serum laboratory tests are immediately ordered, and the healthcare team subsequently discovers the patient has a history of frequent visits to this ED for similar complaints. Review of his electronic health record reveals he has a history of hemophilia A. 

The team confirms the diagnosis with the patient who responds that he had forgotten to mention it and does not receive regular factor VIII replacement therapy. Further assessment, examination, and interventions – including an open excisional biopsy and subsequent amputation – confirm the diagnosis of osseous hemophilic pseudotumor.