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Orthopedists Help Diagnose Hemophilia in Seven-Year-Old

June 12, 2019

Morristown, NJ – A case study published in The Journal of Bone and Joint Surgery by Barbara Minkowitz, MD, a pediatric orthopedist at Atlantic Health System’s Morristown Medical Center, highlights the importance of orthopedists in diagnosing blood clotting disorders.

In the case study, a 7-year-old boy presented to the emergency department, unable to put weight on his hip. Imaging by MRI showed fluid and bleeding in his hip joint. The fluid was immediately removed in the operating room, and tested for infection, which came back negative. Back on the floor, the patient bled heavily, despite compression.

After a consultation with a hematologist and normal bloodwork, the patient was discharged, but returned one week later with continued pain and a limp. After treatment for additional fluid in the hip, the patient was discharged, only to return four days later (11 days after initial presentation in the emergency department) with severe hip pain.

A repeat magnetic resonance imaging (MRI) showed a large bleed in the hip. A test to determine how well a person can form blood clots showed the patient took over 43 seconds to clot, slightly over the acceptable time and different from bloodwork from the first visit which was normal. The patient was given fresh frozen plasma, a blood product that helps patients with low blood clotting factors create clots to control bleeding.

Repeat bloodwork on the child showed a deficiency of Factor IX, one of the blood proteins responsible for blood clotting. The results were consistent with hemophilia B, a disease that prevents the body from clotting properly and impacts 1 in 20,000 male births, and the patient was given treatment with genetic Factor IX.

While hemophilia is often diagnosed by age 3, less severe hemophilia may be inadvertently overlooked by medical professionals. When they are undiagnosed, pediatric patients are at risk of life-threatening brain bleeds and other bleeding events, putting them at great risk.

Children with untreated hemophilia can experience frequent bleeding and bruising, bleeding into joint spaces, lifelong disabilities, or in extreme cases, brain bleeds or death.

The patient was discharged the next day, pain-free, and was fully ambulatory at a four-month follow-up.

“A hemophilia diagnosis is life-changing for pediatric patients and their families, as it makes them more educated about safe activities and heightens awareness for bleeding events in the future,” Dr. Minkowitz said. “For orthopedists, it is especially important to remain diligent in monitoring pediatric patients for unusually heavy or unexpected bleeding after a surgical procedure because 60 percent of spontaneous bleeding events occur in joints. They should always order a hematology consult if they see heavy bleeding.”

Emily Lillie, BS1, Research Assistant, Jennifer R. Ristic, PA-C, Physician Assistant at Morristown Medical Center, and John Gregory, MD, a pediatric hematology-oncology specialist at Goryeb Children’s Hospital co-authored the case study.

About Orthopedics at Atlantic Health System

Atlantic Health System’s Orthopedic program offers residents of New Jersey and the surrounding areas access to high-quality multidisciplinary treatments that span pre-surgical education through post-operative rehabilitation. With the latest diagnostic technologies and robotic equipment, many of our board-certified surgeons are experts in minimally invasive techniques that result in faster recoveries, greater range of motion, and smaller scars.

Each year, the Atlantic Orthopedic Institute performs more than 4,000 joint replacements and treats more than 1,400 traumatic orthopedic injuries, and US News and World Report recognized Morristown Medical Center as a high-performing hospital for orthopedics in 2018.

Morristown Medical Center is one of only four Level 1 trauma centers in New Jersey, designated by the American College of Surgeons.

Orthopedists at Morristown Medical Center provide assistance caring for patients with complex fractures of the pelvis and upper and lower extremities. For complex sports injuries, Atlantic Sports Health has highly-trained physicians who are experts at diagnosing and treating orthopedic and sports medicine problems and are active participants in academic and research programs. The Orthopedic Oncology program performs limb-sparing surgeries for patients with bone tumors or sarcomas.

For children with orthopaedic needs, orthopedists collaborate with pediatricians from Goryeb Children’s Hospital in all aspects of care, including state-of-the-art diagnostics, surgical treatment and assistive technology.

Atlantic Health System Orthopedics is nationally recognized for its expertise, earning numerous awards and accreditations for its services.

About Atlantic Health System

Atlantic Health System is at the forefront of medicine, setting standards for quality health care in New Jersey, Pennsylvania and the New York metropolitan area. Powered by a workforce of 17,000 team members and 4,800 affiliated physicians dedicated to building healthier communities, Atlantic Health System serves more than half of the state of New Jersey including 11 counties and 4.9 million people. The system offers 400 sites of care, including six hospitals: Morristown Medical Center in Morristown, NJ, Overlook Medical Center in Summit, NJ, Newton Medical Center in Newton NJ, Chilton Medical Center in Pompton Plains, NJ, Hackettstown Medical Center in Hackettstown, NJ and Goryeb Children’s Hospital in Morristown, NJ.

In addition to the employed workforce, Atlantic Alliance, a Clinically Integrated Network represents more than 2,500 health care providers throughout northern and central NJ. This network includes 1,000 physicians and providers comprising one of the largest multi-specialty practices in New Jersey - Atlantic Medical Group, as well as members of the Atlantic Accountable Care Organization and Optimus Healthcare Partners, which work to enhance patient care delivery.

Atlantic Health System provides care for the full continuum of health needs, including 12 urgent care centersAtlantic Rehabilitation and Atlantic Home Care and Hospice. Facilitating the connection between these services on both land and air is the transportation fleet of Atlantic Mobile Health.

Atlantic Health System leads the Healthcare Transformation Consortium, a partnership of seven regional hospitals and health systems dedicated to improving access and affordability, and is a founding member of the PIER Consortium – Partners in Innovation, Education, and Research – a streamlined clinical trial system expanding access to groundbreaking research across seven health systems in New Jersey.

Atlantic Health System has a medical school affiliation with Thomas Jefferson University and is home to the regional campus of the Sidney Kimmel Medical College at Morristown and Overlook Medical Centers and is the official health care partner of the New York Jets.