Which of the following assessments in a child with hemophilia would lead the nurse to suspect early hemarthrosis?
A. Child’s reluctance to move a body part.
B. Cool, pale, clammy extremity.
C. Ecchymosis formation around a joint.
D. Instability of a long bone in passive movement.
Correct Answer: A. Child’s reluctance to move a body part.
Bleeding into the joints in the child with hemophilia leads to pain and tenderness, resulting in restricted movement. Therefore, an early sign of hemarthrosis would be the child’s reluctance to move a body part. Joints can become painful, swollen, inflamed, warm, and have a restricted range of motion due to bleeding. The most commonly affected joints are knees, elbows, ankles, shoulders, wrist, and hips.
Option B: If the bleeding into the joint continues, the area becomes hot, swollen, and immobile—not cool, pale, and clammy. spontaneous joint bleed incidence typically increases with age reaching up to 60% by 65 years of age. Repetitive joint bleeds often lead to hemophilia arthropathies. Usually, hemarthrosis becomes more frequent as physical activity increases.
Option C: Ecchymosis formation around a joint would be difficult to assess. Another characteristic presentation can be unexplained bruising when an infant begins crawling or walking or musculocutaneous hemorrhage after intramuscular vaccination. Sometimes extensive soft tissue contusions or hemorrhage can be mistaken for child abuse in young patients.
Option D: Instability of a long bone on passive movement is not associated with joint hemarthrosis. Brain bleeds, both intracranial and extracranial, are common, and patients can present with falls, confusion, lethargy, meningismus, and coma in severe cases. Intracranial hemorrhage is the earliest and most severe complication in the neonatal period (1 to 4% cases).
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