Hemarthrosis

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Hemarthrosis

Other names Haemarthrosis

Lipohemarthrosis (blood and fat in the joint space) seen in a person

with a subtle tibial plateau fracture. The arrow indicates a fluid level

between the upper fat component and the lower blood component.

Specialty Orthopedics

Hemarthrosis is a bleeding into joint spaces. It is a common feature of hemophilia.

Contents

 1Causes
 2Diagnosis
 3Treatment
 4Complications
 5References
 6External links

Causes[edit]
It usually follows injury but occurs mainly in patients with a predisposition
to hemorrhage such as those being treated with warfarin (or other anticoagulants) and
patients with hemophilia.
It can be associated with knee joint arthroplasty.[1]
It has also been reported as a part of hemorrhagic syndrome in the Crimean-Congo
Hemorrhagic Fever, suggesting a viral cause to the bleeding in a joint space. [2][3]

Diagnosis[edit]
Synovial fluid examination[4][5]

%
Type WBC per mm3 Viscosity Appearance
neutrophils

Normal <200 0 High Transparent

Osteoarthritis <5000 <25 High Clear yellow

Trauma <10,000 <50 Variable Bloody

Inflammatory 2,000-50,000 50-80 Low Cloudy yellow

Septic
>50,000 >75 Low Cloudy yellow
arthritis

Gonorrhea ~10,000 60 Low Cloudy yellow

Tuberculosis ~20,000 70 Low Cloudy yellow

Inflammatory = gout, rheumatoid arthritis, rheumatic fever

Hemarthrosis is diagnosed through the methods listed below:

A physical examination is the first step, the joints of the patient are moved and bent to
study the functioning.[6]
Synovial Fluid analysis is another method to diagnose Hemarthrosis. It involves a small
needle being inserted into the joint to draw the fluid. [7] Reddish-colored hue of the
sample is an indication of the blood being present. Imaging tests are normally done.
The tests also include MRI, Ultrasound and X-ray test, which give better information
about the joint inflammation.[8]

Treatment[edit]
In hemophilia it may occur spontaneously, and recurrent hemarthroses are a major
cause of disability in that patient group due to hemophilic arthropathy,
requiring synovectomy, joint replacement[9] and increased medical therapy to prevent
further bleeding episodes.
Reducing hemarthroses events using intravenous administration of blood clotting factor
concentrate on a regular basis starting in early childhood, reduces joint deterioration
and increases the person's quality of life compared to "on demand" treatment (treating
after a bleed).[10] The minimal effective dose and best dosage frequency have not been
established.[10] It is not clear, due to lack of sufficient data, if preventative therapy with
clotting factor concentrate is also effective at reducing joint deterioration if treatment is
started after joint damage has occurred. [10]

Complications[edit]
Up to a quarter of all severe ligament or capsular knee injuries leading to a
hemarthrosis are associated with cartilage damage that can lead to
progressive degenerative arthritis.[11]

X-ray of Hemarthrosis
 

X-ray of Hemarthrosis

References[edit]
 1. ^ Ohdera T, Tokunaga M, Hiroshima S, Yoshimoto E,
Matsuda S (2004). "Recurrent hemarthrosis after knee joint
arthroplasty: etiology and treatment". J Arthroplasty. 19 (2):
157–61. doi:10.1016/j.arth.2003.09.009.  PMID  14973857.
2. ^ Ahmeti, Salih; Ajazaj-Berisha, Lindita; Halili, Bahrije; Shala,
Anita (Apr 2014). "Acute arthritis in Crimean-Congo
hemorrhagic fever".  Journal of Global Infectious
Diseases.  6(2): 79–81.  doi:10.4103/0974-
777X.132052.  PMC 4049045. PMID 24926169.
3. ^ Heyman, Paul; Cochez, Christel; Hofhuis, Agnetha; van der
Giessen, Joke; Sprong, Hein; Porter, Sarah Rebecca;
Losson, Bertrand; Saegerman, Claude; Donoso-Mantke,
Oliver; Niedrig, Matthias; Papa, Anna (2010). "A Clear and
Present Danger: Tick-borne Diseases in Europe". Expert Rev
Anti Infect Ther. 8  (1): 33–
50.  doi:10.1586/eri.09.118.  PMID  20014900.
4. ^ Flynn, John A.; Choi, Michael J.; Wooster, L. Dwight
(2013).  Oxford American Handbook of Clinical Medicine.
OUP USA. p. 400.  ISBN  978-0-19-991494-4.
5. ^ Seidman, Aaron J.; Limaiem, Faten (2019), "Synovial Fluid
Analysis",  StatPearls, StatPearls
Publishing, PMID 30725799, retrieved  2019-12-19
6. ^ "Hemarthrosis".  Healthline. Retrieved 2017-11-21.
7. ^ "Hemarthrosis - What You Need to Know".  Drugs.com.
Retrieved 2017-11-21.
8. ^ Baker, C. L. (June 1992). "Acute hemarthrosis of the
knee".  Journal of the Medical Association of Georgia. 81 (6):
301–305. ISSN 0025-7028.  PMID  1607844.
9. ^ Dunn AL (Sep 2005). "Management and prevention of
recurrent hemarthrosis in patients with hemophilia". Current
Opinion in Hematology. 12 (5): 390–
4. doi:10.1097/01.moh.0000169285.66841.c8.  PMID  160937
85.
10. ^ Jump up to:a b c Iorio, Alfonso; Marchesini, Emanuela; Marcucci,
Maura; Stobart, Kent; Chan, Anthony Kc (2011-09-
07).  "Clotting factor concentrates given to prevent bleeding
and bleeding-related complications in people with hemophilia
A or B"  (PDF).  The Cochrane Database of Systematic
Reviews  (9):
CD003429. doi:10.1002/14651858.CD003429.pub4.  hdl:243
4/231551.  ISSN  1469-493X.  PMID  21901684.
11. ^ Goldberg A, Stansby G "Surgical Talk" 2nd edition

External links[edit]
Classification D

 ICD-10: M25.0

 ICD-9-CM: 719.1

 MeSH: D006395

 DiseasesDB: 29653
 show

Diseases of joints

show

Disorders of bleeding and clotting
Categories: 
 Arthropathies
 Bleeding
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Hemangioma
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Hemangioma
 Hemangioma

Specialty Oncology 

A hemangioma or haemangioma is a usually benign vascular tumor derived from

blood vessel cell types. The most common form is infantile hemangioma, known
colloquially as a "strawberry mark", most commonly seen on the skin at birth or in the
first weeks of life. A hemangioma can occur anywhere on the body, but most commonly
appears on the face, scalp, chest or back. They tend to grow for up to a year before
gradually shrinking as the child gets older. A hemangioma may need to be treated if it
interferes with vision or breathing or is likely to cause long-term disfigurement. In rare
cases internal hemangiomas can cause or contribute to other medical problems. The
first line treatment option is beta blockers, which are highly effective in the majority of
cases.

Contents

 1Types
o 1.1Infantile hemangiomas
o 1.2Congenital hemangiomas
 2Other types
o 2.1Cavernous liver hemangioma
o 2.2Drug-induced hemangioma
 3Diagnosis
 4Treatment
 5References

Types[edit]
Hemangioma on a child's arm.

Hemangiomas are benign (noncancerous) vascular tumors, and many different types

occur. The correct terminology for these hemangioma types is constantly being updated
by the International Society for the Study of Vascular Anomalies (ISSVA). [1] The most
common are infantile hemangiomas, and congenital hemangiomas.
Infantile hemangiomas[edit]
Main article: Infantile hemangioma
Infantile hemangiomas are the most common benign tumor found in children. They are
made up of blood vessels, often called strawberry marks, and are more common in girls
than in boys. They usually appear on the skin of infants in the days or weeks after birth.
They tend to grow quickly for up to a year. Most then shrink or involute without further
problem, however some can ulcerate and form scabs which can be painful. [2] Depending
on their location and size, they may also be disfiguring.
Rarely, they may be related to disorders of the central nervous system or spine. They
may also occur in the internal organs of the body, such as the liver, airway or brain. [3]
The color of the hemangioma depends on how deep it is in the skin: superficial (near
the skin's surface) hemangiomas tend to be bright red; deep (furthest from the skin's
surface) hemangiomas are often blue or purple; mixed hemangiomas may have colors
of both superficial and deep.[4]
Congenital hemangiomas[edit]
Congenital hemangiomas are present on the skin at birth, unlike infantile hemangiomas,
which appear later. They are fully formed at birth, meaning that they do not grow after a
child is born, as infantile hemangiomas do. They are less common than infantile
hemangiomas. Congenital hemangiomas can be coloured from pink to blue.
Congenital hemangiomas are classified according to whether they shrink and go away,
or do not shrink, and do not go away, or partially shrink. Those that shrink are known
as rapidly involuting congenital hemangiomas (RICH) and go away quickly. Those that
do not shrink, and remain are known as noninvoluting congenital hemangiomas (NICH).
Others that partially shrink are known as partially involuting congenital
hemangiomas (PICH).[5][6]

Other types[edit]
Main article: Vascular tumor
Other types of hemangioma include cavernous hemangiomas such as cavernous
hemangioma of the liver.
Cavernous liver hemangioma[edit]

Hemangioma of the liver as seen on ultrasound

Main article: Cavernous liver haemangioma

A cavernous liver hemangioma or hepatic hemangioma is a benign tumour of
the liver composed of hepatic endothelial cells. It is the most common liver tumour, and
is usually asymptomatic and diagnosed incidentally on radiological imaging. Liver
hemangiomas are thought to be congenital in origin. [7] Several subtypes exist, including
the giant hepatic hemangioma, which can cause significant complications.
Drug-induced hemangioma[edit]
Drug-induced hemangiomas are reported side-effects for some drugs in nonclinical
toxicology animal models, studying carcinogenesis. For example, hemangiomas of the
mesenteric lymph node were increased significantly at 700 mg/kg/day
of Empagliflozin in male rats, or approximately 42 times the exposure from a 25 mg
clinical dose. [8] It is inferred from nonclinical animal studies that some drugs can also
produce hemangiomos in humans, and careful dosing during therapeutic drug design
can ensure their safe use.

Diagnosis[edit]
Diagnosis is usually clinical. Paediatric Dermatologists are experts in diagnosing and
treating hemangiomas. Depending on the location of the hemangioma, tests such as
MRIs or ultrasounds can be done to see how far the hemangioma goes under the skin
and whether it affects any internal organs. [9]
Treatment[edit]
Hemangiomas usually fade gradually over time, and many do not require treatment.
However, Hemangiomas that may be disfiguring or that are located at sites that can
cause impairment (eyelids, airway) require early treatment intervention, typically with
beta blockers. Management options may include: [10]

 Oral beta blockers such as propranolol or atenolol

have been used since 2008 and are the first-line
treatment of hemangiomas. Beta blockers have
repeatedly been shown to be effective and safe in
treating hemangiomas that cause complications.
[11]
 Beta blockers work via multiple mechanisms
including narrowing the hemangioma's blood
vessels, stopping them from proliferating and
bringing forward their natural cell death. These
correspond with hemangiomas fading and
shrinking. [2] Approximately 97% of hemangiomas
respond to Propanalol, with patients under 2 months
old showing the greatest improvement.[3]
 Topical beta blockers such as timolol. These can
also be used in conjunction with oral beta blockers
for greater effect, which has shown to be effective
and safe for compound hemangiomas.[4]
 Corticosteroids
 Laser surgery

References[edit]
1. ^ "ISSVA Classification of Vascular Anomalies International
Society for the Study of Vascular Anomalies"  (PDF).
Retrieved 11 August  2018.
2. ^ Chang LC, Haggstrom AN, Drolet BA, Baselga E, Chamlin
SL, Garzon MC, Horii KA, Lucky AW, Mancini AJ, Metry DW,
Nopper AJ, Frieden IJ; Hemangioma Investigator Group.
Growth characteristics of infantile hemangiomas: implications
for management. Pediatrics. 2008 Aug;122(2):360-7. doi:
10.1542/peds.2007-2767.
3. ^ Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in
children. N Engl J Med. 1999 Jul 15;341(3):173-81.
4. ^ "Infantile Hemangiomas". Retrieved 11 August  2018.
5. ^ Mulliken JB, Bischoff J, Kozakewich HP. Multifocal rapidly
involuting congenital hemangioma: a link to chorangioma. Am
J Med Genet A. 2007;143A(24):3038-3046.
6. ^ Funk T, Lim Y, Kulungowski AM, et al. Symptomatic
Congenital Hemangioma and Congenital Hemangiomatosis
Associated With a Somatic Activating Mutation in GNA11.
JAMA Dermatol. 2016;152(9):1015-1020.
 7. ^ Baron R. 'Liver: Masses Part I: detection and
characterization'. The Radiology Assistant 2006
8. ^ Prescribing Information: JARDIANCE® (empagliflozin).
Section 13.1.https://docs.boehringer-
ingelheim.com/Prescribing
%20Information/PIs/Jardiance/jardiance.pdf
9. ^ "Hemangioma".
10. ^ "Hemangioma".
11. ^ [1]

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