Haemophilia
& Treatment
Types of Bleeds
Minor bleeds
Minor bleeds are caused by everyday injuries such as cuts, slips, trips and other scrapes. Bleeding from the nose or mouth also tends to come into this category.
Small cuts and grazes usually respond well to a little pressure and the application of a plaster and are not generally a problem. After you have experienced a few bleeds like this, you will know how long they usually take to stop, and can therefore judge whether or not you are bleeding for longer than usual. If so, you should treat with factor or seek medical help.
Bleeding from the mouth, for example from biting a sharp object or biting your lips or tongue — is usually fairly harmless but, again, there are exceptions and sometimes these bleeds may be serious. If the mouth bleed continues for over two hours or if the tongue is involved, i.e. there is a cut and/or swelling or bruising under the tongue, this may be a serious bleed and you should contact your doctor. Also, if there is bleeding from the tissue connecting the gums to the lips or the tissue connecting the tongue to the mouth (the frenulum) this is serious and, particularly in young children, will require urgent attention and medical advice.
Nose bleeds are often caused by breathing very dry air, nose-picking, nose-blowing or sneezing and factor is not usually necessary. The best way to treat a nose bleed is to tilt the head forward so that the blood does not run down the throat (this also makes it easier to tell when the bleeding has stopped). The sides of the nose should be pressed together firmly until the bleeding stops (this could take between five and 20 minutes) and you might want to put an ice-pack over the top (bridge) of the nose as the cold will help to close the blood vessels.
Moderate bleeds
Moderate bleeds include things like joint and muscle bleeds and large bruises which can be worrying. However, although factor may be required, these bleeds may not actually be too serious. It is important to keep an eye on the area to make sure the bleed is not getting worse and that it is healing properly.
Bruises are caused by bleeding under the skin's surface. In general, you will know that bruises do not need treatment because important parts of the body are not affected by the bleed, although bruises can take anything up to two weeks to completely disappear. To help with pain, swelling and discolouration it can be useful to apply ice to the affected area. However, if a bruise continues to get bigger or darker, treatment may be necessary. A black eye in particular is cause to seek medical advice.
Joint bleeds can occur in any joint as a result of even very trivial twists and strains. As the joint begins to fill with blood, the pressure causes pain and, without treatment, there is a chance that the joint may become permanently damaged. When a joint is bleeding it is not always possible to see signs of bruising so it is important to be aware of other symptoms; heat, a fizzing pain in the area, limping etc.
Any suspected joint bleed should be treated with factor as soon as possible as this will limit the size of the bleed and greatly reduce the risk of damage to the joint. The joint should also be kept elevated and rested with an ice-pack applied to ease any pain (although the ice-pack will not stop the bleeding) and pain killers can also be taken.
Remember, a joint that has been affected repeatedly by bleeds can become more susceptible to future bleeds. When this happens the joint becomes known as a ‘target joint', or ‘T-joint', and is prone to long-term damage if not treated effectively.
To prevent target joints from occurring patients use what is known as ‘prophylaxis'. This is when regular treatment with clotting factor is taken (usually around three times a week) aiming to prevent bleeds from happening in the first place (click here for more information).
This approach means that many people with haemophilia do not suffer such problems with severe joint damage and they can also live a more normal active life due to the increased level of factor in their system. However, even with prophylaxis, factor levels will be below normal most of the time and therefore excessive sporting activity may be best avoided. The amount of prophylaxis can vary considerably from patient to patient.
Muscle bleeds can happen at any time but usually occur after an injury such as a hit or sprain. Bleeds into big muscles can cause the nerves to get compressed due to the pressure of the blood that has built up and this can cause serious damage. These bleeds should be treated as quickly as possible.
Severe bleeds
Severe bleeds are the most serious kind of bleeds, tending to occur with any kind of injury to the head, neck, throat or stomach.
Head bleeds caused by injury can mean bleeding into the brain, which is serious. Although all head bleeds need medical help, it's important to realise that the 'egg on the head' type of bleed that you might get (a bleed between the skin and scalp) is less serious than an internal bleed, even though there may be no obvious outward signs. Immediate medical help should be sought for any of the following situations, even if the symptoms have developed without a known head injury:
- Headache
- Vomiting
- Sleepiness
- Difficulty walking or unsteadiness
- Difficulty waking from sleep
- Difficulty seeing clearly or other vision problems
- Dizziness
- Unusual behaviour
Neck and throat bleeds (different to mouth bleeds, which are generally gum bleeds and involve less blood) are caused by injury to the neck or throat (even sometimes by tonsillitis or severe coughing) and should also be considered serious. These bleeds should be treated as soon as possible because if blood is present in the throat there is a chance that it could block the airways. Medical help should be sought for any of the following situations:
- Swelling in the neck, the back of the mouth and/or under the tongue as this can cause an airway blockage
- Difficulty in swallowing saliva
- Discoloration of the skin around the neck
- Coughing or vomiting blood without a mouth bleed
Stomach bleeds in the intestines are extremely rare but can result in severe anaemia or shock. Injuries to the stomach can sometimes cause internal bleeds and it is important that you are aware of the following symptoms to speed up the treatment process:
- Coughing up blood, which can appear like a dark fluid or like coffee grounds
- Swelling or pain in the stomach
- Vomiting
- Black, bloody or tar-like stools (parents should remember that certain medicines can cause darker stools so they should check labels for this side effect)
- Unusual weakness or having a paler skin colour than usual
It is also important not to take non-steroidal anti-inflammatory drugs (for example ibuprofen or aspirin) which irritate the stomach and may cause bleeding.
