Common Place of Bleeding

Common Bleeding site

Most bleeding in hemophilia occurs internally, into the joints or muscles. The joints that are most often affected are the knee, ankle and elbow. Repeated bleeding without prompt treatment can damage the cartilage and the bone in a joint, leading to chronic arthritis and disability. The most serious muscle bleeds are the iliopsoas muscle (the front of the groin area), the forearm and the calf. Some bleeds can be life threatening and require immediate treatment. These include bleeds in the head, throat, gut, or iliopsoas.

Internal bleeding is common in people with severe hemophilia. If not treated promptly, internal bleeding can lead to damaged joints, muscles, or other parts of the body.

The extent of bleeding depends on the type and severity of the condition:

• Children with very mild hemophilia may not have noticeable symptoms for years.Often, the first sign is heavy bleeding from a dental procedure, an accident, or surgery.
• Children with mild to moderate hemophilia may not have any signs or symptoms at birth.
• Males with severe hemophilia may bleed heavily after circumcision.

In most children, the first signs are:

• Heavy bruising and bleeding from the gums as they cut their baby teeth
• Bumps and bruises from frequent falls as they learn to walk
• Swelling and bruising from bleeding in the joints, soft tissue, and muscles
• Females who are carriers usually have enough clotting factors from their one normal gene to prevent serious bleeding problems.

The most common signs or symptoms in older children and adults are:

• Bleeding in the joints (hemarthrosis)
• Bleeding and bruising in the soft tissue and muscles
• Bleeding in the mouth from a cut or bite or loss of a tooth
• Nosebleeds for no obvious reason
• Blood in the urine (from bleeding in the kidneys or bladder)
• Blood in the stool (from bleeding in the intestines or stomach)
• Bleeding in the joints is the most common problem in persons with severe hemophilia. Bleeding often occurs without an injury. It can go on for days if not treated. However, people with hemophilia can learn to recognize early symptoms of bleeding in the joints and get treatment quickly. Early treatment can help limit damage to the joints.

The signs and symptoms of bleeding in the joints are:

• Tightness in the joint with no real pain is usually the first sign.
• Tightness and pain may occur before any visible signs of bleeding.
• The joint becomes swollen and hot to touch as time passes. Bending or extending the joint is painful.
• Swelling continues as bleeding continues, and all movement in the joint is lost. Pain can be severe.
• The bleeding slows after several days when the joint is full of blood. If not treated, the bleeding can lead to disabling arthritis in the joints.
• Bleeding in the brain, a very serious complication of hemophilia, requires emergency treatment. This bleeding can happen after a simple bump on the head or a more serious injury.

The signs and symptoms are:

• Long-lasting painful headaches
• Vomiting many times
• Changes in behavior or being very sleepy
• Sudden weakness or clumsiness of the arm or leg
• Neck pain or stiffness
• Double vision
• Difficulty walking
• Convulsions or seizures