Hemophilia and Intensive Physical Activity Are Not Mutually Exclusive − Case Report of a Top Athlete
Traditionally, many doctors have been reluctant to allow men with hemophilia to engage in more intense physical activity, mainly due to concerns about bleeding caused by overexertion or injury. Today's prophylactic modalities, however, allow for prevention to be set in such a way that the risk of bleeding is significantly reduced. Modern treatment thus brings hope for hemophiliacs to participate in some sports that were previously not recommended. In addition to effective prophylaxis, appropriate training activities, developed with the participation of a physiotherapist and sports doctor, are also crucial.
A Hemophiliac Basketball Player Who Didn't Miss a Single Game
The case of a 20-year-old man with moderate hemophilia playing basketball in a college league illustrates that a well-crafted protocol for treatment and training activities can enable a hemophiliac's participation even in top sports competitions. Over the two years this protocol was applied, the man did not miss a single game due to bleeding or injury. He was a key player for the team, earning many valuable points.
A Model Protocol
The basic points of the protocol, which can be applied in similar cases, include the following:
- The athlete must not have a history of spontaneous bleeding, and the style of play must not cause bleeding in the knees or ankles.
- The athlete or their family representative must be fully aware of the risks associated with the sport.
- Doctors must know the baseline levels of FVIII and the presence or absence of FVIII inhibitors.
- A clear treatment plan must be developed: Typically, FVIII concentrate is given prophylactically at a dose of 25−30 IU/kg 3 times a week, with an additional extra dose of 40 IU/kg before games. The prophylactic dose is administered 1−2 hours before the game. If the dose is scheduled on a training day, prophylaxis is given 1−2 hours before training.
- All medications must be administered in the presence of the coach or team doctor to ensure good cooperation.
- At least six doses of FVIII must be taken along when traveling to a game.
- The athlete must not participate in a game if a hemophilia center is not within reach of the match venue (approximately within 100 km).
- In case of injury, FVIII concentrate is administered. The so-called RICE protocol (rest, ice, compression, elevation) is also important. The dose of FVIII concentrate for emergencies must be predetermined:
- Severe injury: 40 IU/kg immediately and then as needed (usually at least once daily for a minimum of 3 days);
- Joint bleeding: 40 IU/kg twice daily for 3−4 days;
- Head injury: 40 IU/kg immediately and a CT scan of the head as soon as possible.
Conclusion
There is no doubt that some sports are associated with higher risks of injury and bleeding. However, with improving prevention and treatment options, it is possible (with cooperation between specialists, coaches, physiotherapists, and sports doctors) to allow hemophilic athletes to take on higher levels of activity, provided that predefined rules are adhered to.
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Source: Maffet M., Rotom J. Hemophila in sports: a case report and prophylactic protocol. J Ath Train 2017; 52: 65−70, doi: 10.4085/1062-6050-51.11.14.
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