Horatiu VulturGiurgiu District Emergency Hospital, Romania
Title: MSK ultrasonography in haemophilia - individualised management in paediatric patients
Haemophilia, defined as a clotting factor VIII or IX deficiency causes frequent hemartrosis, between a wide spectrum of hemorrhages. Ultrasonography plays a major role in individualizing the treatment by shaping an accurate haemostatic protocol, evaluating the remission, confirming the blood absorption and shaping a point of care rehabilitation protocol. The comprehensive team in our debate includes the radiology, orthopedics and rehabilitation department, the coagulation laboratory, all under the guidance of the pediatric department regarding the pathology. The team is permanently evaluating the frequency, cause, place and remission of the acute hemorrhage in order to implement the adequate treatment but most important adapting the prophylactic protocol to this bleeding history besides the clinical signs and the severity of Haemophilia, following a regular ultrasound joints evaluation. The impact of evolving from an initial ultrasonography when hospitalized and a follow up programmed scan when possible, to a daily routine whenever is needed in the pediatric department due to fast scan procedures and HEAD-US protocol, has reached the point of a 92% remission in spontaneous non traumatic hemorrhages on the same joint/muscle in a period less than 8 months when the replacement treatment with factor VIII or IX was daily evaluated during hospital admission and the blood accumulation when discharged was aimed at < 1 mm or none. MSK Ultrasonography turns out to be the widest imaging procedure used in the daily medical practice for Haemophilia patients with two major roles, identifying and confirming acute elements or chronic complications due to bleeds, and secondary, adjusting the haemostatic therapy; prophylactic and curative.
Horatiu Vultur, Ph.D. has experience of more than 5 years in the European Comprehensive Treatment and Care Centre for Haemophilia from Bucharest-Romania and specialist doctor in pediatrics, relocated himself as a National Health Program Coordinator for Haemophilia and Rare Disease, in the Giurgiu District Emergency Hospital and head of Haemophilia Rehabilitation Clinic -ArtMedical from Bucharest. He is a member of several national and international in-field associations and an advisory board member regarding Haemophilia. The clinical work has always been completed by research with results presented in more than 60 articles and books, permanent lectures and workshops; the know-how is reaching places as Uganda-Africa and remote areas of Asia as a volunteer doctor for difficult cases.