Home Treatment for Patients with Congenital Bleeding
Disorders in a Developing Country
AMPAIWAN CHUANSUMRIT, M.D.*,
PARTTRAPORN ISARANGKURA, M.D., D.Sc.*
AROONRAT CHANTANAKAJORNFUNG, B.Sc.**, WANPEN PANTHANGKOOL, B.Sc.*,
PHONGJAN HATHIRAT,M.D.*
Affiliation : * Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok I 0400,
** National Blood Center, Thai Red Cross Society, Bangkok 10330, Thailand.
AbstractNinety-six patients with congenital bleeding disorders were enrolled in a home treatment
program from 1979 to 1997. The diagnosis included severe and moderate hemophilia A and B
(n = 63), mild hemophilia A (n = 18), von Willebrand disease (vWD) (n = 12) and congenital
factor VII deficiency (n = 3). The median age was 9 years and the median duration of follow-up
was 4 3/12 years. The home treatment was modified 4 ways: (1) Using locally-prepared single
units of fresh dry plasma in the majority of the patients while mild hemophilia A and vWD
patients received 1-dearnino 8D-arginine vasopressin. (2) Recruiting local health personnel as the
primary care providers. (3) Teaching and training patients and parents intensively. (4) Maintaining
an effective control system. The heartful effort of the health personnel was not in vain; the patients
learned to take good care of themselves. Twenty patients and 20 parents or relatives were able to
perform venipuncture properly and no adverse effect was observed. Since the hemorrhage was
treated very early, the severity and sequelae of bleeding were decreased. The utilized blood
components and days of hospitalization were reduced. Impressively, the absenteeism from work
or school was minimized so that the patients could enjoy a near normal life in their family, school
and society.
Keywords : Home Treatment, Bleeding Disorders
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