HackitRx 2026 source library
The WFH Files
Named for the World Federation of Hemophilia, whose guidelines anchor this file: a primer, then the shelf. The argument lives in the problem statement files and the solution files.
A primer, then the documents it stands on
First, the essentials: what haemophilia is, how each bleed site behaves, and the doctrine a bleed-guidance tool must respect. Then the documents: WFH guidelines, emergency protocols, peer-reviewed evidence, and Singapore's institutional and government sources, each linked to its source with a note on what the project takes from it.
Haemophilia 101
A reference primer, not medical advice: care decisions belong with the treatment centres.
Haemophilia is an inherited bleeding disorder: a missing or low clotting factor stops blood forming a stable clot. Haemophilia A (factor VIII) is three to four times more common than haemophilia B (factor IX); both need different products. Bleeding is slower to stop and can restart days later, so the real risk is bleeding nobody can see, into a joint or muscle, or after a bigger injury. Both genes sit on the X chromosome, so haemophilia affects mostly males; about 30% of cases have no family history.
Severity bands
Severe, under 1%
Can bleed spontaneously, most often into joints and muscles.
Moderate, 1 to 5%
Usually bleeds after an injury, occasionally without one.
Mild, 5 to 40%
Bleeds mainly after trauma, surgery or dental work, sometimes not diagnosed until adulthood.
Bleed sites and danger signs
The doctrine
- Treat first, test later. Suspicion is enough; a normal exam does not rule one out.
- Factor before imaging. Clotting factor goes before X-ray, CT or MRI.
- Assume 0% if unknown. Treated as 0% by default.
- When in doubt, treat. "If in doubt, treat": Singapore's own hospital-network rule, echoed by international guidance.
- One-hour ED target. Factor expected ready within one hour of arrival.
Rules families live by
- Paracetamol yes, NSAIDs and aspirin never. They add to bleeding risk.
- No intramuscular injections. Vaccines go under the skin wherever possible.
- PRICE first aid. Protect, rest, ice, compression, elevation, alongside factor, not instead of it.
- Vaccination goes ahead as normal. Fine needle, firm pressure afterwards.
- Factor storage: 2 to 8°C. Freezing destroys it.
Treatment in brief
- Prophylaxis vs on-demand. On-demand treats a bleed after it starts; prophylaxis (regular infusions) prevents it, now standard of care.
- Extended half-life. Standard factor VIII lasts around 12 hours; extended half-life versions last up to about 19 hours.
- Emicizumab. A preventive injection, not a factor VIII replacement; it does not treat an active bleed, and patients still need factor or a bypassing agent on hand.
- Tranexamic acid (TXA). Stabilises a clot already formed, useful for mouth, nose and gum bleeds; never for a urinary bleed, where it can cause a dangerous blockage.
- Inhibitors. Antibodies against infused factor that change which product treats a bleed; status must travel with the patient on a card or letter.
The Singapore layer
Three centres treat haemophilia here: Singapore General (adults), KKH (children), NUH (both). Recombinant factor VIII sits on MOH's Standard Drug List (50 to 75% subsidy); from October 2025 MediShield Life also covers it as a high-cost outpatient drug, plus HSS's S$400 to $1,200 a month subsidy. Treated early, severe haemophilia here carries a near-normal lifespan.
Condenses the WFH Guidelines, MASAC 257 and Singapore's sources below, plus NIH NHLBI, National Bleeding Disorders Foundation, NHS UK, NORD and MedlinePlus Genetics.
World Federation of Hemophilia, primary documents
The clinical backbone: the primer above traces to these three documents.
WFH Guidelines for the Management of Hemophilia, 3rd edition
2020World Federation of Hemophilia (Srivastava et al.), published in Haemophilia
Severity bands (severe under 1%, moderate 1 to 5%, mild 5 to 40%); Chapters 6-8 and 10: prophylaxis, bleed rules, inhibitors, musculoskeletal complications.
Emergency Care Issues in Hemophilia
monographWorld Federation of Hemophilia
ED standards with MASAC 257: factor within one hour of arrival, urgent triage, treatment on history, not consult or imaging.
Report on the Annual Global Survey 2023
2023World Federation of Hemophilia
Roughly 280 Singapore patients (230 haemophilia A, 50 B); 42% of haemophilia A patients are 45 or older.
Emergency doctrine
Sets the doctrine the off-hours case rests on, and the ED protocol Singapore lacks.
MASAC Document 257: Guidelines for Emergency Department Management of Individuals with Hemophilia and Other Bleeding Disorders
2019National Bleeding Disorders Foundation (MASAC)
The doctrine used across the site: treat first, test later; factor before imaging; assume 0% if unknown; one-hour ED factor target.
Management of Patients with Haemophilia in Emergency Departments
January 2026Royal College of Emergency Medicine, UK
The national best-practice ED guideline Singapore has no equivalent to: no Singapore ED publishes a haemophilia protocol, fast-track or alert-card scheme.
Definitions and key evidence
The peer-reviewed papers behind the site's sharpest numbers.
Definitions in Hemophilia: Communication from the SSC of the ISTH
2014Blanchette et al., International Society on Thrombosis and Haemostasis, Journal of Thrombosis and Haemostasis
Severity bands and the target-joint definition: three or more spontaneous bleeds into one joint within six months.
Improving Time to Bleeding Disorder Treatment in the Emergency Department
2025Littner, Thomas, Mooney, Doyle, Hendrickson, Tarango, Pediatric Blood & Cancer
The 110-to-42-minute time-to-factor figure, a US benchmark: no Singapore time-to-factor data is published.
Factor First: An Assessment of Emergency Department Care of Patients with Hemophilia
2023Uminski, Rydz, Goodyear, presented at ASH 2023, published in Blood
A Canadian audit: 393 ED visits, 191 haemophilia patients, time to haemostatic treatment fell outside care standards.
Goal 100, Goal 0
2024Merrill, Webber, Merrill, Shmookler, Research and Practice in Thrombosis and Haemostasis
A rural US Hemophilia Treatment Center project: preventable ED visits fell 83%, factor cost per patient fell over $11,000, saving roughly $982,000 a year.
The Diagnostic and Triage Accuracy of Digital and Online Symptom Checker Tools
2022npj Digital Medicine (Nature)
Generic symptom checkers: 19 to 38% diagnostic accuracy, documented safety failures; the case for keeping a haemophilia tool narrow, not a general triage app.
Systematic Review and Meta-Analysis of Intracranial Haemorrhage in Haemophilia
2021Blood (American Society of Hematology)
Pooled figures: 20 to 34% mortality from intracranial haemorrhage, about half of survivors permanently disabled.
Singapore: the partner's documents
HSS's own research and reporting, the project's closest thing to a client brief.
Living with Haemophilia in Singapore, 2026 national study and companion infographic
2026Haemophilia Society of Singapore, with Blackbox Research
Shared with the project team by HSS: 85% bled last year, six breakthrough bleeds a year, S$7,004 average family burden, the quote "I will actually delay my Factor VIII treatment to see if the bleed can contain itself," and HSS's own call for a centralised information hub, the mandate PS2 answers.
Treatment in Singapore
undatedHaemophilia Society of Singapore
Singapore's three treatment centres; HSS's monthly subsidy caps (S$400 to S$1,200); factor-cost anchors (a bottle above S$100, an ankle bleed up to six bottles); funding order: subsidy, MediShield Life, MediSave, HSS aid.
HSS Annual Report, FY2021 to 2022 and FY2023 to 2024
2022 / 2024Haemophilia Society of Singapore
HSS: zero paid staff, 95% of FY2021/22 budget on treatment subsidies, "promotes home treatment," cannot staff an after-hours hotline.
Singapore: institutions and government
Singapore's actual care pathway, hospital by hospital, agency by agency.
Haemophilia (Childhood Illnesses)
undatedSingHealth
Only published after-hours instruction in Singapore's system: go to KKH Children's Emergency, notify the Haematology Resource Nurse next working day. Source of "if in doubt, treat" and the one-to-two-hour window.
Children's Emergency and U-PAL (Urgent Paediatric Advice Line)
undatedKK Women's and Children's Hospital
Children's Emergency: 24 hours. U-PAL (KKH's AI-rebuilt advice line): around the clock for common paediatric conditions under 18, refers chronic-condition families to their care team; doesn't cover haemophilia or over-18s yet.
Haemostasis and Bleeding Disorder Programme, and Our Location (Haematology Centre hours)
undatedSingapore General Hospital
SGH's urgent factor walk-in for adults: office hours only, Monday to Friday 8am to 6pm, Saturday 8am to 1pm, closed Sunday and public holidays; no overnight option.
Haemophilia (Children)
undatedNational University Hospital
NUH's paediatric and adult haematology pathway, home-therapy training including Portacath support, and the local treat-within-one-to-two-hours doctrine.
Nation-wide Trial to Refer Non-Life-Threatening 995 Calls to the NurseFirst Helpline
30 May 2025Ministry of Health
NurseFirst: nationwide six-month trial from June 2025, 8am to 11pm hours, a generalist triage layer not protocolised for rare disorders.
GPFirst
undatedMinistry of Health
Cut self-referred walk-in ED attendances at Changi General by 36 to 40%, pairing GP referral with a fee offset and queue priority.
Emergency Medical Services
undatedSingapore Civil Defence Force
995 ambulance policy: free for a genuine emergency, a flat S$274 fee if SCDF assesses it non-emergency.
Healthcare Institution Statistics: Waiting Time for Admission to Ward
updated weeklyMinistry of Health
Singapore's official ED wait-time dataset: no P3 (ambulant, minor) wait-to-consultation figures are published, the triage category an early joint bleed likely falls into.
Regulatory
The rules a tool built on this research would have to satisfy: device classification, insurance coverage, drug-formulary status.
Regulatory Guidelines for Software Medical Devices, and Guidelines on Risk Classification of Standalone Medical Mobile Applications and Qualification of Clinical Decision Support Software (updated July 2025)
2022 / Jul 2025Health Sciences Authority
Likely classification: regulated Software as a Medical Device, Class B or C; the clinical decision support exemption needs a healthcare professional as end user.
Government Accepts MediShield Life Council's Recommendations
2025Ministry of Health, with the MediShield Life Scheme Act subsidiary legislation
MediShield Life expanded 1 October 2025 to cover haemophilia A and B treatment as a high-cost outpatient drug.
Factor VIII (Advate / Adynovate) and emicizumab listings
currentNational Drug Formulary
Recombinant factor VIII: MOH Standard Drug List, 50 to 75% subsidy depending on means-testing; emicizumab has separate formulary status.
What this page leaves out
This is a curated shelf. The complete claim-level knowledge base, every claim traced to a specific source with the page or chapter cited, sits with the project research notes.
A HackitRx 2026 entry by Team Bleedwise: Ariel Tan, Rachel Koh, Myo Myo Swe Oo and Gerald Ho. See the team.
Every link checked live in August 2026. Compiled 31 Aug 2026 for HackitRx 2026 research. Companion to the problem statement files and the solution files. Illustrations AI-generated (Codex CLI), art-directed to the Patient Files design system.