Managing the pediatric patient and the adolescent/adult transition.

Healthcare management of the developing child with hemophilia presents several difficulties. Determining the optimum medication dose is complicated by the difficulty of performing pharmacokinetic studies in children and the fact that extrapolation from data collected in adults is generally unsatisfactory. Even when pediatric pharmacokinetic data are available, accumulating evidence suggests that there can be wide interindividual differences; age and size are important contributing factors. Achieving the venous access necessary for blood factor administration is frequently difficult in the small child. Preliminary results suggest that an arteriovenous fistula may be an appropriate option in some patients. Finally, there is the question of whether prophylactic therapy should be discontinued as patients enter adulthood. This article provides insights for managing this challenging patient population.