Which are the drugs to be avoided for a haemophilic child?

BCCL kharkhanda Staff Nurse - 2015

Pediatric Nursing

Medium

Appeared in: BCCL kharkhanda Staff Nurse - 2015

Explanation

Acetylsalicylic acid, commonly known as aspirin, has antiplatelet effects.
It works by irreversibly inhibiting the cyclooxygenase (COX) enzyme in platelets, which prevents the formation of thromboxane A2, a substance that promotes platelet aggregation.
In a child with haemophilia, the clotting cascade is already impaired due to a deficiency in clotting factors.
Adding an antiplatelet agent like aspirin further compromises hemostasis, drastically increasing the risk of spontaneous or prolonged bleeding.

Option B: Magnesium hydroxide is an antacid and laxative. It works locally in the gastrointestinal tract and does not have systemic effects on blood coagulation or platelet function.
Option C: Acetaminophen (paracetamol) is the recommended analgesic and antipyretic for individuals with bleeding disorders. It reduces pain and fever through central mechanisms without affecting platelet function.
Option D: Iron is a mineral supplement. Children with haemophilia may experience chronic or acute blood loss, leading to iron-deficiency anaemia. Therefore, iron supplementation is often a necessary part of their treatment, not a drug to be avoided.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological contraindications in haemophilia as background academic context rather than a clinical decision trigger.
A key nursing responsibility is patient and family education. The nurse must teach the family of a haemophilic child to read the labels of all over-the-counter (OTC) medications to ensure they do not contain aspirin or other NSAIDs.
Before administering any medication in a hospital setting, the nurse must verify the patient's diagnosis and cross-reference it with potential drug contraindications, especially for patients with known bleeding disorders.
What if the child has a fever and painful, swollen joints (hemarthrosis)? The nurse should administer the prescribed clotting factor concentrate first, followed by acetaminophen for pain and fever. Cold packs can be applied to the joint, but aspirin or ibuprofen must be avoided as they would worsen the bleeding.

How to Approach the Question

First, identify the core condition mentioned in the question: 'haemophilic child'. Recognize that haemophilia is a serious bleeding disorder.
Understand the primary implication of this condition: the child is at high risk for uncontrolled bleeding because their blood doesn't clot properly.
Evaluate each drug option based on its known mechanism of action and side effects, specifically focusing on how it might affect bleeding or clotting.
Acetylsalicylic acid (aspirin) is a well-known antiplatelet agent. This action would be dangerous in a patient who already has trouble forming clots.
Magnesium hydroxide, Acetaminophen, and Iron do not interfere with the clotting process. Acetaminophen is a safe alternative for pain, and iron is used to treat resulting anaemia.
Conclude that the drug which further impairs the body's ability to stop bleeding is the one to be avoided.

Concept Tested & Keywords

Concept Tested: Pharmacological contraindications in haemophilia
Stem keywords: drugs to be avoided, haemophilic child
Lead-in keywords: Which
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

QCFtynYWVBpOAzHG0iTuNO

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 725-727

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 840-842