Researchers reported in the International Journal of Hematology that iliopsoas hemorrhage complicated by femoral neuropathy is common among patients with hemophilia.

Excessive bleeding in patients with hemophilia typically occurs in the musculoskeletal system. Bleeding in this area is typically brought on by trauma, but it can also occur spontaneously. The iliopsoas is one of the major muscles of the lower body, and iliopsoas bleeding can result in lower back and hip pain. 

“Femoral neuropathy complicated from iliopsoas hemorrhage is one of the common adverse events found amongst neuropathies in the peripheral nervous system, before sciatic and common peroneal nerves, consecutively,” the authors of the study wrote. 

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The research team hence decided to identify the prevalence of iliopsoas bleeding and resulting femoral neuropathy among patients with hemophilia. They retrospectively recruited 188 patients with hemophilia aged 20 or fewer years who were seen at the Department of Pediatrics at the Ramathibodi Hospital in Thailand between 2007 and 2020. Their clinical data were assessed to identify episodes of iliopsoas hemorrhage and resulting femoral neuropathy. 

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A total of 20 patients fit the criteria the researchers set. Between these patients were 44 episodes of iliopsoas hemorrhage, with femoral neuropathy observed in 28 of the episodes. The mean age of iliopsoas hemorrhage episode was 15.2 years, while the mean hospitalization was 13.7 days. The mean duration of follow-up was 3.5 years.

The high incidence of femoral neuropathy among patients who suffered from iliopsoas hemorrhage demonstrated the importance of managing bleeding episodes quickly and efficiently to prevent further damage. Femoral neuropathy is typically caused by a hematoma applying prolonged pressure to the iliopsoas muscles. 

“The earlier the iliopsoas hemorrhage is detected, the sooner prompt adequate replacement therapy would result in better outcomes,” the authors of the study wrote. 


Panuwannakorn M, Jiravichitchai T, Lertthammakiat S, Jaovisidha S, Sirachainan N, Chuansumrit A. Iliopsoas haemorrhage complicated by femoral neuropathy in patients with haemophilia: a case series reportInt J Hematol. Published online September 23, 2022. doi:10.1007/s12185-022-03456-z