A 2-year-old boy with hemophilia A presents with hemarthrosis of the right knee. Factor VIII level is 3% of normal. What is the most appropriate immediate treatment?

• A Tranexamic acid alone
• B Fresh frozen plasma
• C Recombinant factor VIII infusion ✓
• D Desmopressin infusion

Explanation

Hemarthrosis in hemophilia A requires prompt replacement with recombinant factor VIII to achieve hemostatic levels. Desmopressin releases stored factor VIII from endothelium and works in mild hemophilia A and von Willebrand disease, but it is ineffective when baseline levels are severely low, as here with 3 percent. Fresh frozen plasma contains insufficient factor VIII concentration to correct severe deficiency safely. Tranexamic acid is an adjunct for mucosal bleeding and does not treat joint hemorrhage adequately by itself.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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