Healthcare management of the developing child with hemophilia presents several difficulties.
Determining the optimum medication dose is complicated by the difficulty of performing
pharmacokinetic studies in children and the fact that extrapolation from data collected
in adults is generally unsatisfactory. Even when pediatric pharmacokinetic data are
available, accumulating evidence suggests that there can be wide interindividual differences;
age and size are important contributing factors. Achieving the venous access necessary
for blood factor administration is frequently difficult in the small child. Preliminary
results suggest that an arteriovenous fistula may be an appropriate option in some
patients. Finally, there is the question of whether prophylactic therapy should be
discontinued as patients enter adulthood. This article provides insights for managing
this challenging patient population.
Pediatric patient - adolescent/adult transition - venous access - prophylactic therapy
