Home treatment is the ideal method of treatment from a medical viewpoint as a minimum amount of time is lost between the recognition of a bleed and treatment. This has many advantages. It reduces the disruption caused by a bleeding episode to the person with haemophilia and their family, and the patient feels more able to control his condition.
The benefits of home treatment not only include increased independence and the bonus of not having to travel to the hospital for treatment, but school and work attendance are more regular and participation in social activities is easier. If bleeds are treated promptly the period of incapacity caused by each episode is reduced.
In adults and teenagers, this procedure is usually carried out by the patient. In children, this will be taught to parents and in young children, a device called a port a cath can be used to facilitate venous access.
On-demand and prophylaxis
Treatment for severe factor VIII or factor IX deficiency can be either on-demand treatment or treatment can be given prophylactically to prevent bleeding.
On-demand treatment is where factor concentrate is infused when a bleed occurs. Again this is very often carried out in the home setting to allow for early treatment of a bleeding episode.
The optimum treatment for a person with haemophilia is prophylactic therapy. This is where factor concentrate is infused on a regular basis to prevent bleeding from actually occurring. For factor VIII deficiency, prophylactic therapy requires an infusion of factor VIII concentrate three times per week. For factor IX deficiency, prophylactic therapy requires an infusion of factor IX concentrates twice a week. However, recent advancements in treatment will soon lead to less frequent infusions (i.e. once per week), allowing for improved vein care in all patients. The aim of prophylactic therapy is to maintain the trough (lower) level of the factor in the blood at greater than one percent at all times. This is a sufficient level of factor to prevent most, if not all spontaneous bleeding.
Prophylactic treatment is recognised as the optimum therapy for haemophilia, as it prevents the vast majority of joint and muscle damage and allows the child or person with haemophilia to have a normal quality of life.