Bleeds

Bleeds and Blood Clots

The blood-clotting process is what makes bleeding stop at the site of an injury. Normally, when bleeding occurs, the blood responds in two phases to stop it.

  • In phase one, the blood vessel shrinks and platelets become sticky, clumping together at the site of the injury to form a temporary plug
  • In phase two, the temporary platelet plug is replaced by a fibrin clot, which seals the opening. This phase involves a chain reaction of clotting factors to create this clot

fibrin clot

Figure 1: The Formation of a Fibrin Clot
[images of damaged vessel wall, platelet plug, and then fibrin clot over it]

If there is an insufficient amount of clotting factor, the reaction needed to make a fibrin clot breaks down, and bleeding continues. The longer—and more often—a bleed remains uncontrolled, the more likely it is that the bleed will result in permanent damage, especially to joints and muscles.

Bleeds and Hemophilia

Symptoms of hemophilia include easy bruising, and, at times, uncontrollable bleeding. People with hemophilia do not bleed faster than people who don't have hemophilia. But they bleed for a longer time and may bleed more often and spontaneously—especially those with severe hemophilia.

The most serious bleeding associated with hemophilia tends to be internal bleeding because, unlike external bleeding caused by injuries, it can't be seen and is difficult to anticipate. Bleeding in hemophilia can occur almost anywhere in the body and can damage joints, muscles, nerves, and other tissues.

The most serious and potentially life-threatening bleeding sites are in the head, neck, eyes, abdomen, and spinal cord. Many people with severe hemophilia experience repeated bleeding in joints such as the knee, elbow, and ankles, which can also have serious consequences.

Recognizing and Treating Bleeds

It is important for anyone with hemophilia to recognize signs and symptoms of bleeds quickly. The earlier that bleeding is treated, the faster it may stop, which means that recovery time may be shortened and risk of complications may be reduced.

Different bleed sites have different symptoms. Joint bleeds are painful and may cause the joint to become swollen, painful to move, or stiff. Muscle or other soft tissue bleeds can feel like a pulled muscle. Bleeding in the forearm, calf, or groin can cause swelling and pressure on the nerves, resulting in numbness, pain, or difficulty in moving.

All bleeds require immediate medical attention. Bleeding can be treated at a local hospital, Hemophilia Treatment Center (HTC), or at home if the patient is on a home therapy program.