Hemarthrosis

Last updated
Hemarthrosis
Other namesHaemarthrosis
Lipohemarthrosis.png
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 Rheumatology
Symptoms Joint pain, swelling, and redness

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

Contents

Causes

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.[ citation needed ]

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

Synovial fluid examination [4] [5]
TypeWBC (per mm3) % neutrophilsViscosityAppearance
Normal<2000HighTransparent
Osteoarthritis <5000<25HighClear yellow
Trauma <10,000<50VariableBloody
Inflammatory2,000–50,00050–80LowCloudy yellow
Septic arthritis >50,000>75LowCloudy yellow
Gonorrhea ~10,00060LowCloudy yellow
Tuberculosis ~20,00070LowCloudy yellow
Inflammatory: Arthritis, gout, rheumatoid arthritis, rheumatic fever

Hemarthrosis is diagnosed through the methods listed below:

A physical examination is the first step, with the joints of the patient moved and bent to study possible loss of functioning.

Synovial fluid analysis is another method to diagnose Hemarthrosis. It involves a small needle being inserted into the joint to draw the fluid. [6] 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. [7] Although MRI is superior method for this assessment, the US using the HEAD-US method performed by paediatric radiologists is a reliable tool for detection and quantification of haemophilic arthropathy in children in comparison to MRI. [8]

Treatment

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

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]

Related Research Articles

<span class="mw-page-title-main">Haemophilia</span> Genetic disease involving blood clotting

Haemophilia, or hemophilia, is a mostly inherited genetic disorder that impairs the body's ability to make blood clots, a process needed to stop bleeding. This results in people bleeding for a longer time after an injury, easy bruising, and an increased risk of bleeding inside joints or the brain. Those with a mild case of the disease may have symptoms only after an accident or during surgery. Bleeding into a joint can result in permanent damage while bleeding in the brain can result in long term headaches, seizures, or a altered level of consciousness.

<span class="mw-page-title-main">Haemophilia B</span> Genetic X-linked recessive bleeding disorder

Haemophilia B, also spelled hemophilia B, is a blood clotting disorder causing easy bruising and bleeding due to an inherited mutation of the gene for factor IX, and resulting in a deficiency of factor IX. It is less common than factor VIII deficiency.

Rheumatology is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome. Doctors who have undergone formal training in rheumatology are called rheumatologists.

<span class="mw-page-title-main">Septic arthritis</span> Medical condition

Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved, especially in neonates, younger children and immunocompromised individuals. In neonates, infants during the first year of life, and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.

<span class="mw-page-title-main">Baker's cyst</span> Medical condition

A Baker's cyst, also known as a popliteal cyst, is a type of fluid collection behind the knee. Often there are no symptoms. If symptoms do occur these may include swelling and pain behind the knee, or knee stiffness. If the cyst breaks open, pain may significantly increase with swelling of the calf. Rarely complications such as deep vein thrombosis, peripheral neuropathy, ischemia, or compartment syndrome may occur.

<span class="mw-page-title-main">Synovial fluid</span> Fluid found in the cavities of synovial joints

Synovial fluid, also called synovia,[help 1] is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its egg white–like consistency, the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement. Synovial fluid is a small component of the transcellular fluid component of extracellular fluid.

<span class="mw-page-title-main">Coagulopathy</span> Condition involving impaired blood clotting ability

Coagulopathy is a condition in which the blood's ability to coagulate is impaired. This condition can cause a tendency toward prolonged or excessive bleeding, which may occur spontaneously or following an injury or medical and dental procedures.

<span class="mw-page-title-main">Hemothorax</span> Blood accumulation in the pleural cavity

A hemothorax is an accumulation of blood within the pleural cavity. The symptoms of a hemothorax may include chest pain and difficulty breathing, while the clinical signs may include reduced breath sounds on the affected side and a rapid heart rate. Hemothoraces are usually caused by an injury, but they may occur spontaneously due to cancer invading the pleural cavity, as a result of a blood clotting disorder, as an unusual manifestation of endometriosis, in response to pneumothorax, or rarely in association with other conditions.

<span class="mw-page-title-main">Calcium pyrophosphate dihydrate crystal deposition disease</span> Medical condition

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy, is a rheumatologic disease which is thought to be secondary to abnormal accumulation of calcium pyrophosphate dihydrate crystals within joint soft tissues. The knee joint is most commonly affected. The disease is metabolic in origin and its treatment remains symptomatic.

<span class="mw-page-title-main">Synovitis</span> Medical condition

Synovitis is the medical term for inflammation of the synovial membrane. This membrane lines joints that possess cavities, known as synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to synovial fluid collection.

<span class="mw-page-title-main">Knee replacement</span> Surgical procedure

Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. It may also be performed for other knee diseases, such as rheumatoid arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation, and is not a reason to perform knee replacement.

<span class="mw-page-title-main">Hypoprothrombinemia</span> Medical condition

Hypoprothrombinemia is a rare blood disorder in which a deficiency in immunoreactive prothrombin, produced in the liver, results in an impaired blood clotting reaction, leading to an increased physiological risk for spontaneous bleeding. This condition can be observed in the gastrointestinal system, cranial vault, and superficial integumentary system, affecting both the male and female population. Prothrombin is a critical protein that is involved in the process of hemostasis, as well as illustrating procoagulant activities. This condition is characterized as an autosomal recessive inheritance congenital coagulation disorder affecting 1 per 2,000,000 of the population, worldwide, but is also attributed as acquired.

Felty's syndrome (FS), also called Felty syndrome, is a rare autoimmune disease characterized by the triad of rheumatoid arthritis, enlargement of the spleen and low neutrophil count. The condition is more common in those aged 50–70 years, specifically more prevalent in females than males, and more so in Caucasians than those of African descent. It is a deforming disease that causes many complications for the individual.

<span class="mw-page-title-main">Synovial chondromatosis</span> Medical condition

Synovial chondromatosis is a locally aggressive bone tumor of the cartilaginous type. It consists of several hyaline cartilaginous nodules and has the potential of becoming cancerous.

Synovectomy is a procedure where the synovial tissue surrounding a joint is removed. This procedure is typically recommended to provide relief from a condition in which the synovial membrane or the joint lining becomes inflamed and irritated and is not controlled by medication alone. If arthritis is not controlled, it can lead to irreversible joint damage. The synovial membrane or "synovium" encloses each joint and also secretes a lubricating fluid that allows different joint motions such as rolling, folding and stretching. When the synovium becomes inflamed or irritated, it increases fluid production, resulting in warmth, tenderness, and swelling in and around the joint.

Arthrocentesis, or joint aspiration, is the clinical procedure performed to diagnose and, in some cases, treat musculoskeletal conditions. The procedure entails using a syringe to collect synovial fluid from or inject medication into the joint capsule. Laboratory analysis of synovial fluid can further help characterize the diseased joint and distinguish between gout, arthritis, and synovial infections such as septic arthritis.

<span class="mw-page-title-main">Shoulder replacement</span>

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.

<span class="mw-page-title-main">Joint effusion</span> Medical condition

A joint effusion is the presence of increased intra-articular fluid. It may affect any joint. Commonly it involves the knee.

Milwaukee shoulder syndrome (MSS) (apatite-associated destructive arthritis/Basic calcium phosphate (BCP) crystal arthritis/rapid destructive arthritis of the shoulder is a rare rheumatological condition similar to pseudogout, associated with periarticular or intra-articular deposition of hydroxyapatite or basic calcium phosphate (BCP) crystals. While primarily associated with the shoulder joint, it can affect any joint in the body below the head. Along with symptomatology, the disease typically presents with positive radiologic findings, often showing marked erosion of the humeral head, cartilage, capsule, and bursae. Though rare, it is most often seen in females beginning in their 50s or 60s. Patients often have a history of joint trauma or overuse, calcium pyrophosphate dehydrate crystal deposition, neuroarthropathy, dialysis-related arthropathy or denervation.

<span class="mw-page-title-main">Post-traumatic arthritis</span> Medical condition

Post-traumatic arthritis (PTAr) is a form of osteoarthritis following an injury to a joint.

References

  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): 157–161. 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. S2CID   28038692.
  4. Flynn JA, Choi MJ, Wooster DL (2013). Oxford American Handbook of Clinical Medicine. US: OUP. p. 400. ISBN   978-0-19-991494-4.
  5. Seidman AJ, Limaiem F (2019). "Synovial Fluid Analysis". StatPearls. StatPearls Publishing. PMID   30725799 . Retrieved 2019-12-19.
  6. "Hemarthrosis – What You Need to Know". Drugs.com. Retrieved 2017-11-21.
  7. 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.
  8. Plut, Domen; Kotnik, Barbara Faganel; Pusnik, Luka; Slak, Peter; Snoj, Ziga; Salapura, Vladka (20 October 2022). "Reliability of haemophilia early arthropathy detection with ultrasound (HEAD-US) in children: a comparative magnetic resonance imaging (MRI) study". Radiology and Oncology. 56 (4): 471–478. doi:10.2478/raon-2022-0040. PMC   9784372 . PMID   36259311. S2CID   252972051.
  9. Dunn AL (Sep 2005). "Management and prevention of recurrent hemarthrosis in patients with hemophilia". Current Opinion in Hematology. 12 (5): 390–394. doi:10.1097/01.moh.0000169285.66841.c8. PMID   16093785. S2CID   26117110.
  10. 1 2 3 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: 2434/231551 . ISSN   1469-493X. PMID   21901684.
  11. Goldberg A, Stansby G "Surgical Talk" 2nd edition