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Identifying Types of Bleeds

Hemophilia may be diagnosed early after birth, or sometimes it may not be diagnosed until later in life when more obvious signs or symptoms appear. One of the earliest signs of hemophilia is more than normal bleeding following circumcision. Or, it may first be recognized during toddlerhood when a child gets bruises from crawling or learning to walk.

This section of The Basics of Bleeding Disorders will cover the different kinds of bleeds that hemophilia can cause and give you tips on how to recognize them.

Here are important rules when dealing with any type of bleed:

Prevent bleeding when possible; treat immediately if it occurs. Depending on the severity of the underlying bleeding disorder, bleeding episodes vary in frequency; or they may occur only during surgery or other procedures. When possible, preventing bleeding is the goal. However, when bleeding does occur, it is important to recognize its signs and symptoms as early as possible so appropriate treatment can begin.

Some bleeds are more serious than others. Common bleeds, such as bruises, nosebleeds, and mouth bleeds, generally do not require emergency medical attention. If a person with a bleeding disorder has a bleed and is not on a home-therapy program, be sure to consult immediately with a health care provider or Hemophilia Treatment Center (HTC) to determine whether treatment is needed.

Some types of bleeds are emergency situations. The five major sites of serious bleeding episodes in hemophilia that threaten life, limb, or function are intracranial (head) bleeds, ocular (eye) bleeds, neck or throat bleeds, abdominal bleeds, and kidney or bladder bleeds. All of these bleeds require a call to your health care provider, immediate intervention, a call to 911, or a trip to your local emergency department.

identify different types of bleeds

  • head

  • eye

  • nose

  • mouth

  • throat

  • gastro

  • urinary

  • soft tissue

  • joint

  • muscle

  • deep cuts

 
Head Bleeds

Head Bleeds

Bleeding in and around the brain. May be caused by an injury or occur for an unknown reason. Because you cannot see bleeding inside the head, it is important to look for a combination of signs.

Signs:

  • Prolonged headache (a young child may hold his or her head indicating pain)
  • Confusion, lethargy, and/or slurred speech
  • Double vision (a young child may say things look “funny”)
  • Dislike of bright light
  • Dilated (enlarged) pupils or pupils that are different sizes
  • Sudden or projectile vomiting not necessarily due to an upset stomach
  • Dizziness
  • Stumbling
  • Loss of consciousness (it may be difficult to wake up a sleeping child)
  • Stiff neck or back
  • Seizures
  • Loss of appetite
  • Irritability

Steps to Take

Factor levels should be raised based on your medical team’s recommended treatment.

Head bleeds are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.

 
Eye Bleeds

Eye Bleeds

Bleeding inside the eye. May be caused by an injury to the eye or occur for an unknown reason. Because some signs of an eye bleed may involve a change in vision, a baby probably can’t tell you something is wrong; a child who can talk may simply say that objects look “funny.”

Signs:

  • Pain and swelling in and around the eye
  • The white of the eye (called conjunctiva) becomes reddish
  • Double or blurred vision
  • Change in vision

Steps to Take

Factor levels should be raised based on your medical team’s recommended treatment.

In the meantime, hold an ice pack on the eye to slow the bleeding and reduce swelling.

Eye bleeds are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.

 
Nosebleeds

Nosebleeds

A nosebleed occurs when the small blood vessels inside the nasal cavities are damaged, which can occur from a hard bump to the nose, nose picking, sneezing, nose blowing, and even breathing very dry air.

Signs:

  • Bleeding out of the nostrils, particularly for a long time
  • Vomiting (if your child has swallowed a lot of blood, he or she may vomit; the vomit may be dark or look like coffee grounds)
  • Darkened stools (especially if your child has swallowed a lot of blood)
  • A bad taste in the back of the mouth (a young child may say food tastes “funny” or may not want to eat)

In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and take your child to the emergency department or call 911.

Steps to Take

Discuss with your HTC medical team simple home treatments for nosebleeds so you will know what to do if a nosebleed occurs.

Here are some simple treatments for a nosebleed:

  • Tilt your child’s head forward and apply pressure to the bridge of the nose with a cool cloth
  • If your child is able, have him or her gently blow loose clots and mucus from the nose
 
Mouth Bleeds

Mouth Bleeds

Bleeding from the gums, tongue, lips, or the inside of the cheek can result from an accidental bite, a tooth coming in or out, a fall, or from putting objects into the mouth.

Signs:

  • Blood in and around the mouth
    • Blood may be less visible if it is swallowed

Sometimes the amount of blood loss can be underestimated, particularly if a child swallows the blood. In these cases, the child might become nauseated or vomit, or lose his or her appetite. In the most severe cases, children might vomit blood and have dark stools. In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and take your child to the emergency department or call 911.

Steps to Take

Discuss with your HTC medical team simple home treatments for mouth bleeds so you will know what you should do if one occurs.

  • Apply pressure with a clean cloth or gauze to area of bleed, if accessible
  • Use cool foods, such as popsicles, to reduce blood flow to the bleeding site
  • Offer soft foods, such as ice cream, which help protect new clots
  • Avoid having your child suck hard on anything; especially anything hard (for example, teething rings, bagels)
  • Don’t have your child use straws and pacifiers; they can dislodge a clot or prevent one from forming
  • Continue cleaning your child’s teeth and gums with a cotton swab while they are healing
  • Tea bags can help stop bleeding after dental work (When black tea bags are applied to a bleeding surface, the tannin in tea causes bleeding to decrease. In fact, many hemophilia camps still have tea bags in their first aid kits!)
 
Throat Bleeds

Throat Bleeds

A more severe type of mouth bleed. Severity depends on how much blood is being lost and if it causes swelling that can hamper breathing.

Signs:

  • Swelling or discoloration in the neck
  • Trouble swallowing or breathing
  • Choking
  • Coughing or throwing up blood
  • Change in tone of voice

Steps to Take

Factor levels should be raised based on your medical team’s recommended treatment.

Throat bleeds are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.

 
Gastrointestinal Bleeds

Gastrointestinal Bleeds

Bleeding in the stomach or intestines.

It is important to look for these specific signs, which may indicate a GI bleed:

  • Weakness
  • Paleness (called pallor)
  • Bloody or black, tar-like stool
  • Vomiting or coughing up blood. Sometimes the vomit may be a dark fluid or look like coffee grounds
  • Stomach or abdominal pain (a child with GI bleeding may be able to tell you he or she has stomach pain or may indicate nonverbally that he or she has a “tummy ache”)
  • Distended, firm abdomen

Steps to Take

Factor levels should be raised based on your medical team’s recommended treatment.

GI bleeds are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.

 
Urinary Tract Bleeds

Urinary Tract Bleeds

Blood in the urine can come from any one or several places along the urinary tract, which includes the ureters, bladder, and urethra. Signs of blood in urine can be either obvious or more subtle. Young children may not be able to tell you they are having these signs.

Signs:

  • Pink urine (in the diapers or in the potty)–may be a sign of an early urinary tract bleed
  • Bright red or brown-colored urine (in the diapers or in the potty)–may be a sign of a later, more serious bleed
  • Lower back pain (for example, a child may appear uncomfortable in a particular position in a crib, high chair, or car seat)
  • Frequent urination
  • Pain when urinating (for example, a potty-trained child may wince when urinating or refuse to go to the potty)

In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and take your child to the emergency department or call 911.

Call your HTC for advice if your child has a urinary tract bleed. Treatment depends on where the bleeding is coming from.

 
Soft Tissue Bleeds

Soft Tissue Bleeds

Bleeding that occurs under the skin, commonly near the surface (called a bruise); bleeding in the soft tissue causes a raised area (called a hematoma). This is a very common bleed as young children become more active. For example, “baby butt bruises” are common in children first learning to walk–even with diaper padding. Bruises may disappear slowly and may be more noticeable, but they are usually not cause for any great concern.

Common signs:

  • Darkening of the skin, possibly with a raised center
  • Discomfort sitting or walking

In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and take your child to the emergency department or call 911.

Steps to Take

Discuss with your HTC medical team some simple home treatments for soft tissue bleeds so you’ll know what to do if one occurs.

A simple treatment for a joint bleed is:

R.I.C.E. (Rest, Ice, Compress, Elevate).

 
Joint Bleeds

Joint Bleeds

Blood seeping into the space between two bones. The elbows, knees, and ankles are common places for joint bleeds. But bleeding can occur at any other joints, including the wrists, hips, fingers/toes. Because young children may not know they are having a joint bleed or may not be able to communicate that to you, it can be difficult to tell a joint bleed is occurring.

Common signs:

  • A bubbling or tingling sensation in the joint
  • Joint pain (if your child is very young, crying for no apparent reason may be a sign)
  • Skin over the affected joint is warm to the touch (your child may say his or her joints “feel warm inside”)
  • Joint swelling
  • Reduced ability to move the joint (your child may limp or have trouble walking or using his or her hands)
  • Reluctance to use an arm or leg (your child may not be able to reach for an object or may reach for an object with the hand he or she doesn’t usually use; a young child might not be able to kick a ball or ride a tricycle)

In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and take your child to the emergency department or call 911.

Steps to Take

Discuss with your HTC medical team some simple home treatments for joint bleeds so you will know what to do if a joint bleed occurs.

A simple treatment for a joint bleed is:

R.I.C.E. (Rest, Ice, Compress, Elevate).

Factor levels should be raised based on your medical team’s recommended treatment.

 
Muscle Bleeds

Muscle Bleeds

Bleeding into any muscle, but most frequently the arms and legs. Muscle bleeds into the larger muscles such as the thigh and pelvis can be particularly troublesome because of the great amount of blood lost and the pressure that the bleed can place on nerves and blood vessels, creating more problems.

Signs:

  • An ache or pain in and around the joints
  • Crankiness
  • Limping or an unwillingness to use the affected arm or leg (your child may refuse to crawl or walk)
  • Decrease in motion (your child may do physical activities slower)
  • Muscle swelling or tightness (one limb may be larger than the other)
  • Skin over affected area is warm to the touch
  • Skin appears tight, shiny, or blue
  • Veins appear larger than usual
  • Numbness or tingling (your child may say a part of his or her body is “tingly” or had “fallen asleep”)

In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and take your child to the emergency department or call 911.

Steps to Take

Discuss with your HTC medical team some simple home treatments for muscle bleeds so you will know what to do if a muscle bleed occurs.

A simple treatment for a muscle bleed is:

R.I.C.E. (Rest, Ice, Compress, Elevate).

Factor levels should be raised based on your medical team’s recommended treatment.

 
Deep Cuts or Lacerations

Deep Cuts or Lacerations

An injury that causes a break or opening in the skin. Deep cuts or lacerations are seen fairly easily, and may be near the surface of the skin or may be deep and have either smooth or jagged edges.

Steps to Take

Compress and hold an ice pack on the area to slow the bleeding and reduce swelling.

Treatment may also be needed when any stitches or bandages used to treat the wound are removed.

Factor levels should be raised based on your medical team’s recommended treatment.

Deep cuts and lacerations are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.