Editorial |

Collision Sports and Risk of Bleeding in Children With Hemophilia

Marilyn J. Manco-Johnson, MD
JAMA. 2012;308(14):1480-1481. doi:10.1001/jama.2012.13303.
Text Size: A A A
Published online


In this issue of JAMA, Broderick and colleagues1 report results of their study of the association of vigorous sports with bleeding rate in 104 children and adolescents with moderate or severe hemophilia. Most participants were receiving prophylactic infusions of replacement clotting factor, which has been established as the standard of care for children and adolescents with hemophilia.2,3 Activities were scored as category 1, 2, or 3, depending on the expected trauma related to frequency and severity of collisions associated with the activity; category 2 and 3 activities can be referred to as collision sports. The study results indicate that the risk of bleeding events requiring acute factor replacement was increased following collision sports, with an odds ratio of 2.7 for category 2 activities (such as basketball or baseball) and 3.7 for category 3 activities (such as wrestling or US football). However, because exposure time to the higher-risk activities was a small percentage of total life hours and because the annual rate of bleeding was low, the absolute increase in risk was low. Additional statistical modeling, in which factor level was inferred from infusion schedule and known recovery and half-life, revealed that each 1% increase in plasma factor activity was associated with a 2% lower bleeding risk, thus suggesting therapeutic strategies that might further reduce the bleeding risk associated with collision sports.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles

The Rational Clinical Examination
What Adverse Events Can Result From a Paracentesis?