ORIGINAL ARTICLE Low dose prophylaxis in Tunisian children with haemophilia E. GOUIDER,* † L. JOUINI, † M. ACHOUR,* † H. ELMAHMOUDI, † K. ZAHRA,* † W. SAIED* ‡ and B. MEDDEB* † *Hemophilia Center Aziza Othmana Hospital; †Tunis Medical University of Tunis, UR14ES11; and ‡Orthopedy Department, Children Hospital Bechir Hamza, Tunis, Tunisia Introduction: Low dose prophylaxis could be recommended in countries with limited resources. Aim: We report our single centre experience in children with haemophilia. Patients: Fifty-five children were included in our study with a weekly median dose of 30 UI kg 1 given once, twice or thrice a week. Age of initiation of prophylaxis is 5.32 years (0.64–11.44). Outcome assessment used were number of bleeding before and after initiating prophylaxis, haemophilia joint health score (HJHS), functional independence score in haemophilia (FISH) and quality of life with the Haemo-QoL. Results: Reduction of number of bleeding was clear in all patients; HJHS, FISH and Haemo-QOL were satisfactory. Conclusion: Low dose prophylaxis is effective and better than on- demand therapy. It should be the starting point for prophylaxis in countries with limited resources. Keywords: functional independence score in haemophilia, haemophilia, haemophilia joint health score, low dose prophylaxis, prophylaxis Introduction Prophylaxis is the gold standard treatment for haemo- philia [1]. It prevents bleeding and consequently joint disease [2,3]. It was initiated since the sixties [4–6]. Different protocols are used, with different doses and numbers of injections, and the optimal regimen remains to be defined. In countries with limited resources, prophylaxis regimen used should be expen- sive, whereas initiating prophylaxis with low dose could be recommended. We report our single centre experience with low dose secondary or tertiary pro- phylaxis in children. Patients and methods Data were extracted from patient diary and medical files of children with haemophilia. We include all children (<15 years) receiving low dose prophylaxis with a regular follow up and out- come measurement available. The age at initiation low dose prophylaxis should be less than 15 years. Children with inhibitor were not included in the study. The protocol of low dose prophylaxis used is illus- trated in Fig. 1. Outcome measurement was number of bleeding before and after initiating prophylaxis, in order to evaluate the efficiency. We also performed once a year, evaluation of the joint status with the haemophilia joint health score (HJHS) version 2.2 [7] and functional independence score in haemophilia (FISH) [8]. Quality of life with the Haemo-QoL was performed one year after initiat- ing prophylaxis [9]. SPSS 16 was used for statistical analysis, using the comparison means in paired samples with P < 0.05. Results Fifty-one children met the inclusion criteria. Forty-two were haemophilia A. Median age was 9 years (4–17) and median age at initiating the low dose prophylaxis is 5.32 years (0.64–11.44) (Fig. 2). Median follow up is 5 years (1–9). Number of injections per week, was once, twice and three times for, respectively, 31%, 51% and 18% of children with a weekly median injection dose of 31 UI kg 1 . Median dose per injection is 20 UI kg 1 (8–50). Details of median doses used according to the Correspondence: Emna Gouider, Hemophilia Center, Aziza Oth- mana Hospital, Place du gouvernement, 1008, Tunis, Tunisia. Tel.: +21698341985; fax: +21671568228; e-mail: emna.gouider@gmail.com Accepted after revision 25 June 2016 © 2016 John Wiley & Sons Ltd 1 Haemophilia (2016), 1–5 DOI: 10.1111/hae.13048