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Sports only small risk in rare bleeding disorder

By Frederik Joelving

NEW YORK (Reuters Health) - Participating in sports such as basketball or wrestling appears to increase the bleeding risk in boys with a rare blood clotting disorder, but the overall risk remains small, according to new research from Australia.

"This study provides the first estimates of the risk involved in various sports activities and will enable children with hemophilia and their parents to make more informed decisions regarding sports participation," Dr. Carolyn Broderick of the University of New South Wales in Sydney told Reuters Health by email.

About 18,000 people in the U.S. have hemophilia, according to the National Institutes of Health, putting them at risk for serious bleeding that would have stopped quickly in people without the disorder.

Broderick and her colleagues followed 104 children and teens at three hemophilia centers for one year on average, interviewing them or their parents each time they had a bleeding episode.

According to findings in the Journal of the American Medical Association, there were 336 distinct bleeds, most commonly from knees, ankles and elbows.

Contact and collision sports such as rugby and wrestling were linked to a four-fold increase in risk compared with being inactive, whereas the risk was about three times greater for sports with less contact, such as soccer and basketball.

"Sport and physical activity is beneficial for children with hemophilia but the benefits must be balanced against the increased risk of bleeding episodes, particularly bleeding into muscles and joints," Broderick said.

Still, the overall bleeding risk from sports was relatively small, the researchers found.

For instance, a kid who bleeds five times a year and participates twice weekly in basketball and once weekly in wrestling, only one of the bleeds would be associated with those sports.

The researchers say their findings are relevant whether or not children take medication to help their blood clot.

"For children who do not receive prophylactic clotting factor, however, the implications may be different," they said in an emailed statement. "Physical activity may not greatly increase their risk of bleeding, but when bleeds do occur they may be more severe and the consequences of even small numbers of severe bleeds may be undesirable."

In an editorial, Dr. Marilyn Manco-Johnson of the University of Colorado calls for guidelines on full-contact sports participation for children with hemophilia.

SOURCE: http://bit.ly/MvXYT6 Journal of the American Medical Association, online October 9, 2012.

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