An ice pack can be applied to the injection area for 5 min before injection. The smallest gauge needle available (usually 25–27 gauge) should be used. Pressure should

be applied to the injection site for at least 5 min [18]. Live virus vaccines (such as oral polio vaccine, MMR) may be contraindicated in those with HIV infection. People with hemophilia who have HIV should be given pneumococcal and annual influenza vaccines. Immunization to hepatitis A and hepatitis B is important for all persons with hemophilia. These immunizations may not be as effective in those with HIV infection. (Level 4) [ [19, 20] ] Patients and their families should be provided with psychological and social support [21, 22]. Hemophilia is also a financial burden that places restrictions on several aspects of normal living [23]. The PLX3397 social worker and/or

other members of the comprehensive care team should: provide as much information as possible about the physical, psychological, emotional, and economic dimensions of hemophilia, in terms the patient/parents can understand. be open and honest about all aspects of care. allow the patient/parents to work through their emotions and ask questions. Provide care and support patiently. talk to affected children, not just their parents. Children can often understand a good deal about their illness and can work with the physician if properly informed and educated. buy Dabrafenib remind parents Glutamate dehydrogenase not to ignore siblings that are healthy. be able to recognize warning signs of burnout and depression, which are common with chronic illness, and provide suggestions for coping. recognize that cultural background may affect patients’ views

of illness. encourage patients to engage in productive and leisure activities at home and in the workplace. work in partnership with the patient organization to advocate for hemophilia care and to provide education to families and members of the community. enlist the assistance of local groups and organizations where social workers are unavailable. Patients with hemophilia can have normal sexual intercourse [24]. Muscle bleedings (e.g., iliopsoas) may sometimes be the result of sexual activity. Complications of hemophilia can be accompanied by sexual dysfunction, which may include lack of libido or impotence. Pain or fear of pain may affect sexual desire, and hemophilic arthropathy may place limitations on sexual intercourse. Sexuality is also affected by chronic HCV and HIV infection, age-related diseases like hypertension and diabetes mellitus, and certain medications. In some cases, oral phosphodiesterase-5 inhibitors (sildenafil, tadalafil) may be helpful. These medications mildly inhibit platelet aggregation in vitro, and may cause epistaxis due to nasal congestion. Aging patients with hemophilia will inevitably suffer from age-related diseases [24, 25].