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Emergency Room Visits

Some types of bleeds require prompt medical attention. This may mean an immediate call to 911 or to a Hemophilia Treatment Center (HTC). Knowing the signs of these different types of bleeds and what action you should take are critical. Persons with hemophilia or other bleeding disorders and their caregivers can also make a trip to the ER more efficient by being prepared with important documents and supplies.

For more information on bleeding sites, go to Identifying Different Types of Bleeds

Bleeding Sites and Types of Bleeds Requiring Prompt Medical Attention

  • Head
  • Throat or tongue
  • Spinal cord
  • Gastrointestinal
  • Eye
  • Deep cuts or lacerations
If you think that the bleed is an emergency, first call 911. Next, contact your Hemophilia Treatment Center (HTC) immediately after talking with the 911 operator. The HTC can also help with the emergency care of a bleed until Emergency Medical Services (EMS) arrives. If EMS determines a trip to the ER is needed, the HTC can contact the hospital and provide important medical information.

Bleeding Sites That Require Special Attention


In all age groups, bleeding into the head (called intracranial hemorrhage) is the most common cause of deaths from bleeding. It may occur spontaneously or after a minor or major trauma. Headache, neck ache, sleepiness, extreme sensitivity to light, nausea, vomiting, or loss of consciousness could indicate bleeding into the head. However, there may be no symptoms at all.

Steps to take:

Contact your HTC immediately if there is a head injury or headache. Call 911 immediately if there is a change in consciousness or vision, a seizure, or sudden projectile vomiting.

Throat or Tongue

Bleeding in the throat or tongue can cause them to swell, blocking the airway and interfering with breathing. Treatment should begin immediately. This type of swelling usually occurs after an injury, but it may also be caused by some medical or dental procedures.

Steps to take:

Call 911 immediately if breathing is difficult.
Contact your HTC immediately if you detect bleeding in the throat or tongue.

Spinal Cord

Spinal cord bleeding is rare but serious because it can cause permanent paralysis. Signs include weakness, tingling or pain in the arms or legs, and difficulty urinating or having a bowel movement.

Steps to take:

Call 911 immediately if you suspect spinal cord bleeding.
Contact your HTC immediately if a leg or arm becomes weak, numb, or tingles.


Bleeding from the stomach or intestine can lead to serious complications if it is not treated. Blood in vomit, vomit that looks like coffee grounds, or black or tar-colored stools are signs that bleeding may be occurring.

Steps to take:

Contact your HTC immediately if these symptoms are present.
Call 911 immediately if there are large amounts of blood in the vomit or stool, the abdomen is distended or painful, the person feels weak or dizzy.


Signs of an eye bleed include pain and swelling in and around the eye; a change in vision, including double or blurred vision; and the white of the eye (called the conjunctiva) becomes reddish. Because some signs of an eye bleed may involve a change in vision, it may be impossible for a baby to tell you something is wrong.

Steps to take:

Call your Hemophilia Treatment Center (HTC) immediately if you suspect an eye bleed.

Deep Cuts or Lacerations

Deep cuts or lacerations are fairly easy to see. They can occur near the surface of the skin or have deep, smooth, or jagged edges.

Steps to take:

Call your Hemophilia Treatment Center (HTC) immediately if a deep cut or laceration occurs.

Remember: When in doubt, treat—even before waiting for test results.

Be Prepared for an Emergency Room (ER) Visit

The Hemophilia Treatment Center (HTC) may instruct you to go to the ER. They can offer guidance for the proper steps to take, advise you where to go, and often will pave the way to make the ER visit go more smoothly by alerting the ER in advance of your arrival.

If you are unable to contact the HTC or your phone call is not returned quickly enough, go straight to the ER.

Proper planning for an emergency begins well in advance. It is recommended that a person with a bleeding disorder get a Hemophilia Emergency Care Letter from their health care provider or HTC. This letter should include:

  • An explanation of the bleeding disorder
  • The physician’s description of the type and severity of the bleeding disorder
  • Possible inhibitor status
  • Basic treatment guidelines
  • Dosage chart for clotting factor replacement for specific injuries or types of bleeds
  • Current treatment plan
  • Factor prescription

The letter should also include important phone numbers for the HTC. Be sure to carry proof of your insurance coverage and a contact number for your health plan.

A good idea is to know the route to the hospital before an emergency occurs. Driving at your leisure gives you the opportunity to learn the route if you have not been to the ER before, or to discover new landmarks or traffic patterns that have changed since your last visit.

Here are some items to bring with you to the ER:

  • Hemophilia Emergency Care Letter from your physician
  • Clotting factor and infusion supplies
  • Insurance card
  • Ice pack
  • HTC contact information
  • Toys (books, crayons, stuffed animal, games)
  • Snacks and drinks
  • Change of clothes

What to Expect in the Emergency Room (ER)

When it comes to emergencies, you may have to educate the ER doctors, nurses, and other members of the health care team. You should bring medical literature that explains hemophilia and the emergency treatment of it to show health professionals in the ER.

The National Hemophilia Foundation’s Medical and Scientific Advisory Council (MASAC) has issued the important document, Guidelines for Emergency Department Management of Individuals With Hemophilia (Number 175), which provides a concise but comprehensive overview of hemophilia for health professionals. The guidelines instruct medical personnel on how to assess patients with hemophilia, what diagnostic tests should be performed, and how to treat emergencies.

To see the Guidelines, go to MASAC Guidelines.

Another MASAC document related to emergency care is MASAC Recommendations on Improved Access to Emergency Medical Care for Persons With Inherited Bleeding Disorders (Number 113).

Many parents of children with hemophilia have learned to expect the unexpected. If you have to visit the ER, you should anticipate having to stay for hospitalization. This includes having a change of clothes and other items you may need for at least a day or two, and making arrangements for the care of other children in the family.

To see the Recommendation, go to MASAC Recommendations.