Photo of Bruised hand

Treatment

How to prevent bleeding and how to treat a bleed

 

The small knocks, twists, bruises, minor cuts and scratches that are part of everyday living are not usually a problem with mild haemophilia. They can be treated with normal first aid, such as putting on a plaster/bandage and applying some pressure at the site of bleeding. To reduce bruising, pain and swelling for larger bruises, strains, sprains, muscle/joint pain you should start the PRICE procedure quickly:

  • PROTECTION – use a sling for an arm injury and crutches if you have them for a leg injury
  • REST –   no strenuous activities and rest to reduce increased circulation.
  • ICE – apply a cold pack (e.g. ice pack or frozen vegetables in a towel) for about 10-15minutes, then remove and reapply every two hours
  • COMPRESSION – after icing, wrap the injury with a light elastic compression bandage.  Make sure this is not too tight and remove it at night or if resting with the part elevated.
  • ELEVATE – where practical, raise the injured body part above the level of the heart to reduce blood flow and therefore swelling

A more severe injury affecting the head or abdomen might result in internal bleeding. Other possible internal bleeds are those affecting a muscle or joint, which usually occur as a result of direct trauma/accident to the area. If bleeds are not treated quickly, they can take longer to stop and to heal.  Serious bleeds can be dangerous and need medical attention immediately. These bleeds can be managed with appropriate treatment and you should always contact your Haemophilia Centre as soon as possible. 

If bleeding symptoms, pain or swelling get worse in the first 24 hours or keep you awake overnight, contact your Haemophilia Centre for assessment and advice. 

 

When to seek help

 

After a significant injury or accident or before having medical or dental procedures you should contact the Haemophilia Centre as these can be complicated by prolonged bleeding in people with mild Haemophilia, especially if treatment is not given. Serious bleeding can cause lasting damage and sometimes can be life-threatening.

  • Seek emergency treatment
  • Where possible, contact the Haemophilia Centre
  • The Haemophilia Centre may be able to call ahead to the Emergency Department and prepare for your arrival.
  • Haemophilia is a rare condition and doctors or hospital staff may not be familiar with it.  Ask them to make contact with the Haemophilia Centre and liaise with them regarding your or your child’s treatment.  You can give them direct contact numbers which are on the back of the Bleeding Disorder ID card which you should carry at all times.
  • Most major acute hospitals in Ireland should have product for treatment available for emergencies and the Haemophilia Centre can advise hospitals on its use if necessary.
  • Where possible it may be more time efficient to attend a hospital with a Comprehensive Care Centre or a Haemophilia Centre

If you are at all uncertain about when or how to treat injuries or bleeding, contact your Haemophilia Centre for advice. Learning to self-manage treatment for your bleeding disorder happens over time.

 

How is it treated?

 

Your Haemophilia Centre will advise you on the best treatment for you. There are several types of treatment. Certain treatments may be useful in different situations and at different times. The Haematologist will look at all of this when they work with you or your child to decide the best treatment option. They will need to reassess the situation each time treatment is needed.

  • Desmopressin (DDAVP) – is a synthetic hormone used to treat haemophilia A.  It works by releasing the body’s stored factor VIII into the bloodstream to help blood clot. 
  • Tranexamic Acid (Cyclokapron) – acts by strengthening blood clots that have formed.  This prevents the blood clot from being dislodged and bleeding restarting. 
  • Clotting factor Concentrates – Clotting factor concentrates containing either FVIII or FIX are available depending on which factor is low. 

For women

  • Hormone Treatment, can help women who have heavy menstrual bleeding. Some of these hormones can increase factor VIII levels.

 

Treatment Complications

 

After treatment with clotting factor concentrate, occasionally people with mild haemophilia may develop antibodies – known as “inhibitors”, which make the treatment less effective.  There are a number of ways to treat inhibitors and many people are successful in overcoming them while others have ongoing problems. (Read more)

 

Do I need to learn to treat at home?

 

Treatment that needs to be injected, such as DDAVP or factor concentrate, can be given in the Haemophilia Centre or it may be possible to learn to treat at home. This decision will be made by your Haemophilia Centre depending on your situation and if it is appropriate. The Haemophilia Centre will then train you if it you require treatment in your home. (Read more)

 

Medications to be avoided

 

Some medicines, vitamins and herbs interfere with the way clots are formed and may delay healing. If you have mild haemophilia, consult your Haematologist before taking:

  • Medicines containing Aspirin
  • Other drugs which affect platelets such as Clopidogrel (Plavix)
  • Non-steroidal anti inflammatory drugs unless prescribed by a doctor with expertise in haemophilia (e.g. Ibuprofen, Neurofen, Brufen, Difene)
  • Blood thinners such as Warfarin, Heparin or newer blood thinners (anticoagulants)