NHF | Bleeding Disorders Information Center | Newly Diagnosed: Bleeding Sites

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Bleeding Sites
This section describes symptoms of various bleeds. If you're not already, you'll soon be an expert at spotting and treating bleeds quickly. Children on prophylaxis or those with mild hemophilia may not be able to spot a bleed while it is happening. Until then, you can always call your doctor or HTC for advice. They are just a phone call away.

Other bleeds, such as bruises, mouth and nose bleeding, generally don't require emergency medical attention, although if a person with a bleeding disorder has a bleed and is not on a home therapy program, you should always promptly consult with the doctor or HTC to decide whether factor treatment is required.

Click on the topic below to learn more:
Head Injury
Eye Bleeding
Neck/Throat Bleeding
Abdominal, Stomach and Intestinal Bleeding
Kidney/Bladder Bleeding
Bruises
Joint Bleeding
Mouth Bleeding
Deep Muscle Bleeding
Nose Bleeding

Head Injury
Because of the danger of brain hemorrhage, all head injuries are considered serious. If a person with a bleeding disorder receives a significant head injury they should be infused with factor immediately. Call the doctor or HTC right away, even if they have no bumps or bruises. Find out about your HTC's system, they provide information about how to get medical advice after hours or on the weekend.

Symptoms of a head bleed are similar to symptoms of flu. They include headache, dizziness, and vomiting. In cases of severe hemophilia, some doctors recommend factor treatment any time the person complains of these symptoms. Talk to the healthcare provider about recommendations for the person.

Brain hemorrhage can occur with no visible bruise, and sometimes symptoms take awhile to appear. That's why it is so important to have the person carefully examined by a medical professional following any head injury. Specialized tests such as CT scans or MRIs check for early bleeding in the head. The doctor may also want the person admitted to the hospital to observe them for a day or two. Follow-up factor infusions may be prescribed for days, weeks, or even months after a confirmed head bleed.

Following a head injury, there are several symptoms to watch for. If any of these symptoms appear, call your doctor or HTC immediately:
• Unusual sleepiness
• Nausea and/or vomiting
• Dizziness o Irritability (acting more tearful, upset, agitated, or "fussy" than normal)
• Lethargy (difficulty waking up and staying awake)
• Dilated or unequal pupils
• Headache
• Confusion

These symptoms are easier to spot in an older person than in a young child. If something seems wrong to you, call the doctor or HTC.
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Eye Bleeding
If a person with a bleeding disorder has an injury to his eye(s), or if you notice that his eye(s) are swollen or appear discolored, take them to your doctor or HTC right away. Untreated eye bleeds can lead to infection and even blindness.
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Neck and Throat Bleeding
Neck and throat bleeds, though relatively rare, are serious because they can interfere with breathing. Any injury to the neck and/or complaints of tenderness, pain, or swelling in the neck or the throat may be signs of neck or throat bleeding.

Another symptom of throat bleeding is vomited blood. Swallowed blood may irritate the stomach and cause vomiting. If there is fresh or "coffee ground" blood in the vomit, and there is no bleeding from the nose or mouth to account for it, there may be bleeding from the throat.
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Abdominal, Stomach and Intestinal Bleeding
Symptoms of abdominal, stomach, and intestinal bleeding include coughing or vomiting blood (unless caused by swallowing blood from the nose or mouth); bloody, black, or tarry stools (unless caused by swallowing blood from the nose or the mouth); and/or pain in the stomach or abdomen. The person may also appear pale and weak. If any of these symptoms appear, or if they receive an injury to the abdomen or stomach (e.g. falling on tricycle handlebars) have your doctor or HTC evaluate them right away.
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Kidney or Bladder Bleeding
Symptoms of kidney or bladder bleeds include red or reddish-brown urine, back pain, and frequent or painful urination. Kidney bleeds are usually spontaneous--that is, they occur without known cause. They are usually seen only in people with severe hemophilia, not those with mild or moderate hemophilia.
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Bruises
It's natural for anyone to fall and get some bumps and bruises, especially children. Bleeding into soft tissue areas of the arms and legs is common and not usually serious. Surface bruises and lumps do not generally require any treatment. However, if the person is having pain and you feel a hard lump developing underneath the bruise, or if you have any other concerns, call the doctor for advice.

Some people might suspect child abuse when they see heavy or unusual bruising in a child. Tell the adults caring for your child that children with hemophilia bruise much more easily than children without hemophilia. With your consent, staff at the HTC can provide information to concerned caregivers. Additional information can also be found in the brochure, Inherited Bleeding Disorders and Child Abuse Investigations, available through NHF.
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Joint Bleeding
Early symptoms of a joint bleed include limping and a reluctance to use the limb (e.g., "switching" hands for eating to avoid using the painful joint), complaints of a bubbling or tingling feeling inside the joint; and swelling. As more blood leaks into the joint, it feels warm to the touch, and the swelling feels "spongy." Later, the person may start holding the limb in a bent position to ease the pain. If untreated, bleeding will continue until the joint feels hot and tense and the person is in pain.

The quicker treatment (i.e. factor) is given, the more rapid the recovery. Other benefits are reduced pain and joint damage. When bleeding is well controlled, the risk of permanent damage and/or arthritis is reduced.

Keep an up-to-date journal or calendar of bleeding episodes and treatment. This will help you and the team of hemophilia professionals recognize chronic joint problems. Keeping track of bleeding patterns can help the treatment team plan a program to prevent joint damage or other problems later in life.
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Mouth Bleeding
Mouth bleeds (e.g. during teething or tooth loss) are messy. Blood mixed with saliva makes the bleeding look worse than it actually is. Usually these are minor as long as the area under the tongue is not swollen, cut, or bruised. Cuts on the lips, tongue, or inside of the cheek require treatment and observation.

Encourage a child to spit rather than swallow blood to avoid an upset stomach. Blood irritates the stomach lining and can cause one to vomit fresh or "coffee ground" blood, or pass bloody, black, or tarry stools.

Bleeding in the mouth as a result of teething in a child usually stops by itself. However, check a baby's mouth frequently to make sure a small blood clot is not growing larger. This is a sign that bleeding is continuing underneath, and should be checked out by a doctor.

Minor mouth bleeding which goes on for several days can become a problem because slow, constant loss of blood can lead to anemia. If you notice mouth bleeding that lasts longer than a few hours, contact your doctor or hemophilia treatment center.

A cool, soft diet such as jello or yogurt may be recommended for a week or two until the mouth bleeding has completely healed. Straws, pacifiers, frozen teething rings, and nipples are discouraged as they may dislodge a clot in the mouth and cause the bleeding to start again. Once a blood clot has formed the oral medication Amicar can be used to keep the clot in place longer.
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Deep Muscle Bleeding
Deep muscle bleeding is fairly common in people with severe hemophilia. If a child is too young to talk, and he cries or is fussy for no apparent reason or he is reluctant to move one of his limbs, he may have a deep muscle bleed.

If you notice these symptoms, examine the affected limb carefully. Do not force the child to move the limb if he resists. It may help to observe and examine the opposite limb so you can detect differences in swelling, skin temperature, etc. If there is any uncertainty about whether he's having a bleed, consult your hemophilia provider.

As a child grows older, he will probably be able to recognize the symptoms of a deep muscle bleed and report his discomfort. Some children may mistake the pain of a bleed with the pain of a "pulled muscle." A pulled muscle complaint is considered a deep muscle bleed unless proven otherwise.

A bleeding episode in a muscle can spread through the muscle length, often before you notice any obvious symptoms. When muscle bleeding occurs in small spaces, such as the forearm, calf, or groin, swelling can create pressure on the nerves which can result in numbness, pain, or even inability to move the limb. The most serious deep muscle bleed occurs in the iliopsoas (the muscle which flexes the hip) and nearly always requires complete bed rest.

Bleeding into a large muscle such as the thigh can be serious, because a large amount of blood can accumulate before any swelling is noticed. Untreated bleeds into a large muscle can result in anemia, so always see that the person is given factor treatment at the first sign of any muscle pain.

Until you become experienced at identifying bleeds, it's important to have a medical professional knowledgeable about hemophilia check any suspicious symptoms as soon as possible. Deep muscle bleeding often requires follow-up treatment. Slings, splints, or crutches and sometimes bed rest may be prescribed to help support the injured muscle.
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Nose Bleeding
Nose bleeds are usually not serious. Tilt the head forward to avoid swallowing blood and apply firm pinching pressure to the bridge of the nose for at least fifteen minutes. If the bleeding stops, the oral medication Amicar can be used to keep the clot in place longer. If bleeding continues, repeat the procedure twice more. If bleeding still persists, call your doctor or HTC.

Hot, dry, or windy weather, air conditioning, and air heating can all dry nasal secretions and make a person more likely to pick their nose and cause bleeding. A clean cool-mist vaporizer in the room at night can help keep nasal secretions moist and thin. A small amount of Vaseline or Neosporin placed in the nostrils twice a day may help. Many pharmacies also carry saline nose sprays to increase moisture in the nasal linings.
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Disclaimer
The information contained on the NHF web site is provided for your general information only. NHF does not give medical advice or engage in the practice of medicine. NHF under no circumstances recommends particular treatment for specific individuals and in all cases recommends that you consult your physician or local treatment center before pursuing any course of treatment.
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