Case 1: 15-Year-Old Male With Pain and Swelling 4 Weeks After Spraining His Right Ankle

15-year-old male with moderate FVIII-deficient hemophilia managed by a community hematologist

– Past medical history is unremarkable except for bleeding episodes

• No known family history of hemophilia, although mother and sister report they "bruise easily"
• Diagnosed at 1 year of age related to maternal reports of increased lower extremity bruising
• First bleeding episode: mouth bleed at 2 years of age, which oozed for several days before resolving (he did not receive factor concentrate for this bleed)
• Sprained right ankle at age 8 resulted in pain and swelling for 6 months

– Father’s employment status frequently changes, making it difficult to maintain access to consistent care

Current complaint

• Twisted right ankle 4 weeks ago (X-ray taken in the emergency room [ER] was negative for fracture)
• Reports pain and swelling with any weight bearing
• Returned to the ER for re-evaluation
• Received an infusion in the ER that provided some relief (first lifetime infusion), but unsure of the type or dose of product used