Understanding bleeding episodes

The most troublesome bleeding episodes associated with haemophilia can be divided into four main categories:

Joint bleeds
The joints most commonly affected are the knees, elbows, ankles, shoulders, hips and wrists.

Individuals are usually aware that a bleed has started as the joint feels tingly and warm. As blood fills the joint capsule, the joint swells and becomes painful and difficult to move. Over time, if bleeding happens often at the same joint, the joint weakens and becomes prone to further bleeds. It is then known as a ‘target joint’.

Muscle bleeds
The muscles most commonly affected are in the calves, thighs, upper arms, front of the hips and forearms.

Bleeding into the muscle can go unnoticed for some time before discomfort develops. Some bleeds will cause the limbs to swell and become warm and painful to the touch. Bruising can occur if the bleed is near the skin surface. In deeper muscles, the swelling may press on nerves or arteries, which will cause tingling and numbness. This may eventually lead the muscle to spasm and temporarily cease up.
 
Brain bleeds
Bleeding into the brain (intracranial bleeds) are not very common, but can be serious. Mild head trauma can cause a major bleed in people with haemophilia, but spontaneous bleeding may also occur. Symptoms of brain bleeds include dizziness, vomiting, headache, neck stiffness, clumsiness or weakness of an arm or leg, double vision, excessive sleepiness or loss of consciousness. A brain bleed is considered a major medical emergency.

Bleeding from wounds
Surgery, childbirth, or major trauma can be especially dangerous for people with haemophilia if they are undiagnosed or inadequately treated. Even dental extractions can lead to hard-to-control persistent bleeding that can last days or even weeks.