This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Wounds, Tissue Repair & Scars, Subject name: Surgery
An 18-month-old boy slipped and hurt his right knee while walking. He presents with a tender, swollen, warm knee with significant hemarthrosis. His PT is 12 (normal, 13 seconds), PTT is over 100 (normal, 25 seconds), platelet count is 300,000/mm3, and bleeding time is normal. Initial management should consist of which of the following? 
Select and explain. 
A. Fresh-frozen plasma, B. Aspiration of knee, C. Factor VIII concentrate, D. Passive exercise
C: Factor VIII concentrate
Answer: C: Factor VIII concentrate 
Explanation: The boy has hemophilia. Management consists of infusion of factor VIII concentrate. Bed rest and local cold packs are helpful. Aspiration of the knee to remove blood and passive exercise are not recommended for fear of recurrent bleeding. In contrast, active exercise is beneficial because movement beyond the point when bleeding can recur is limited owing to pain. Fresh-frozen plasma has a low level of factor VIII (0.6 U/mL) and is not useful because the required volume is excessive. Patients can use long leg splint.