If you, your child, or a loved one has a bleeding disorder, it is important to know about the signs and symptoms of different types of bleeds. Below is a list of different types of bleeds, how to identify them and what to do for each. Always contact your healthcare provider and Hemophilia Treatment Center (HTC) with any questions or concerns. If you are dealing with a serious bleed, go to the closest emergency department or call 911 if you are in the U.S.

This section covers the following:

Steps to Take When Dealing with a Bleed

Different Types of Bleeds

Steps to Take When Dealing with a Bleed

Prevent bleeding when possible and treat immediately if it occurs. The frequency of bleeding incidents usually depends on the severity of the bleeding disorder. Some may happen spontaneously while others may happen only during surgery or other medical procedures. When bleeding does occur, it is important to recognize the signs and symptoms as early as possible so that appropriate treatment can begin.

Some bleeds are usually less serious than others. Common bleeds, such as bruises, nosebleeds, and mouth bleeds, generally do not require emergency medical attention. If a person with a bleeding disorder has a bleed and is not on a home-therapy program where you are treating your bleeding disorder at home, talk with your health care provider or your Hemophilia Treatment Center (HTC) immediately to determine the best plan of care. If bleeding does not stop, or you are ever concerned, always call your healthcare provider or HTC.

Some types of bleeds are emergency situations.  There are five major sites of serious bleeding episodes that threaten life, limb, or function. They are intracranial (head) bleeds, ocular (eye) bleeds, neck or throat bleeds, abdominal bleeds, and kidney or bladder bleeds. All of these bleeds require calling your health care provider, immediate intervention, calling 911, or going to your local emergency department (ED).

Different Types of Bleeds

Head Bleeds

Bleeding in and around the brain may be caused by an injury or occur for an unknown reason. Because you cannot see bleeding inside the head, it is important to be aware of the following signs.

Signs:

  • Prolonged headache (a young child may hold their head indicating pain)
  • Confusion, lethargy, and/or slurred speech
  • Double vision (a young child may say things look “funny”)
  • Dislike of bright light
  • Dilated (enlarged) pupils or pupils that are different sizes
  • Sudden or projectile vomiting (not necessarily due to an upset stomach)
  • Dizziness
  • Stumbling/difficulty walking, sudden weakness, or balance issues
  • Sleepiness
  • Loss of consciousness (it may be difficult to wake up a sleeping child)
  • Stiff neck or back
  • Seizures
  • Loss of appetite
  • Irritability

Steps to Take:

Head bleeds are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.

Eye Bleeds

Bleeding inside the eye(s) may be caused by an injury to the eye or occur for an unknown reason. Some signs of an eye bleed may involve a change in vision which can be hard to detect in a baby or young child who can’t tell you that something is wrong. A child who can talk may simply say that objects look “funny.”

Signs:

  • Pain and swelling in and around the eye
  • The white of the eye (called conjunctiva) becomes reddish
  • Double or blurred vision
  • Change in vision

Steps to Take:

Eye bleeds are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911. In the meantime, hold an ice pack on the eye to slow the bleeding and reduce swelling.

Nosebleeds

A nosebleed happens when the small blood vessels inside the nasal cavities are damaged. This can occur from a hard bump to the nose, nose picking, sneezing, nose blowing, and even breathing very dry air.

Signs:

  • Bleeding out of the nostrils, particularly for a long time
  • Vomiting (from swallowing a lot of blood and the vomit may be dark or look like coffee grounds)
  • Darkened stools (from swallowing a lot of blood)
  • A bad taste in the back of the mouth (a young child may say food tastes “funny” or may not want to eat)

Steps to Take:

Discuss home treatments for nosebleeds with your HTC so you are prepared for a nosebleed.

Here are some home treatments for a nosebleed:

  • Tilt your head forward and apply pressure to the bridge of the nose with a cool cloth
  • If you’re able, gently blow loose clots and mucus from the nose

Additional treatment specific to your bleeding disorder may be needed depending on the severity of the bleed. Always contact your HTC for questions on treatment.

Mouth Bleeds

Bleeding from the gums, tongue, lips, or the inside of the cheek can result from an accidental bite, a tooth coming in or out, a fall, or from putting objects into the mouth.

Signs:

Blood in and around the mouth (blood may be less visible if it is swallowed). Sometimes the amount of blood loss can be underestimated, especially if a person swallows the blood. It can be hard to know, especially if the person is a child. Watch to see if your child becomes nauseated, vomits or loses their appetite. In the most severe cases, children might vomit blood and have dark stools.

Steps to Take:

Discuss home treatments for mouth bleeds with your HTC so you will feel prepared when one occurs.

Here are some home treatments for a mouth bleed:

  • Apply pressure with a clean cloth or gauze to area of bleed, if accessible
  • Use cool foods, such as popsicles, to reduce blood flow to the bleeding site
  • Offer soft foods, such as ice cream, which help protect new clots
  • Avoid having your child suck on anything hard like teething rings
  • Avoid using straws or pacifiers for children as they can dislodge a clot or stop one from forming
  • Continue cleaning teeth and gums with a cotton swab while healing
  • Tea bags can help stop bleeding after dental work (when black tea bags are applied to a bleeding surface, the tannin in tea causes bleeding to decrease. Many hemophilia camps have tea bags in their first aid kits!)

Additional treatment specific to your bleeding disorder may be needed depending on the severity of the bleed. Always contact your HTC for questions on treatment.

In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and go to the emergency department or call 911.

Throat Bleeds

A throat bleed is a more severe type of mouth bleed. Severity depends on how much blood is being lost and if it causes swelling which can affect breathing.

Signs:

  • Swelling or discoloration in the neck
  • Trouble swallowing or breathing
  • Choking
  • Coughing or throwing up blood
  • Change in tone of voice

Steps to Take:

Throat bleeds are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.

Gastrointestinal Bleeds

Gastrointestinal (GI) bleeds happen when there is bleeding in the stomach or intestines.

It is important to look for specific signs, which may indicate a GI bleed:

Signs:

  • Weakness
  • Paleness (called pallor)
  • Bloody or black, tar-like stool
  • Vomiting or coughing up blood. Sometimes the vomit may be a dark fluid or look like coffee grounds
  • Stomach or abdominal pain (a child with GI bleeding may tell you they have stomach pain or may indicate nonverbally that they have a “tummy ache”)
  • Distended, firm abdomen

Steps to Take:

GI bleeds are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.

Urinary Tract Bleeds

Blood in the urine can come from any one or several places along the urinary tract, which includes the ureters, bladder, and urethra. Signs of blood in urine can be either obvious or more subtle. Young children may not be able to tell you they have these signs.

Signs:

  • Pink urine (in diapers or in the toilet). This may be a sign of an early urinary tract bleed
  • Bright red or brown-colored urine (in diapers or in the toilet). This may be a sign of an already progressing, more serious bleed
  • Lower back pain (for a child, they may appear uncomfortable in a particular position in a crib, highchair, or car seat)
  • Frequent urination
  • Pain when urinating (for a potty-trained child, they may wince when urinating or refuse to go to the bathroom)

Steps to Take:

Call your HTC for advice if you or your child has a urinary tract bleed. Treatment depends on where the bleeding is coming from. In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and go to the emergency department or call 911.

Soft Tissue Bleeds

Soft tissue bleeds occur under the skin near the surface and are commonly called a bruise. Bleeding in the soft tissue causes a raised area called a hematoma. This is a very common bleed especially as young children become more active. Baby butt bruises are common in children first learning to walk, even with diaper padding. Bruises may disappear slowly.

Signs:

  • Darkening of the skin, possibly with a raised center
  • Discomfort when sitting or walking

Steps to Take:

Discuss home treatments for soft tissue bleeds with your HTC so you’ll know what to do if one occurs.

A simple treatment for a soft tissue bleed is: P.R.I.C.E. (Protection, Rest, Ice, Compress, Elevate)

Additional treatment specific to your bleeding disorder may be needed depending on the severity of the bleed. Always contact your HTC for questions on treatment. In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and go to the emergency department or call 911.

Joint Bleeds

Joint bleeds happen when blood leaks into the space between two bones. The elbow, knee and ankle joints are common places for joint bleeds, but bleeding can occur at any other joint. This includes the wrists, fingers, and toes. Young children may not know they are having a joint bleed or may not be able to communicate it to you. It can sometimes be hard to tell if a joint bleed is occurring. It is important to look for the following signs and educate your child on them.

Signs:

  • A bubbling or tingling sensation in the joint
  • Tight feeling in the joint
  • Joint pain (if your child is very young, crying for no apparent reason may be a sign)
  • Skin over the affected joint is warm to the touch (your child may say his or her joints “feel warm inside”)
  • Joint swelling
  • Reduced ability to move the joint (your child may limp or have trouble walking or using their arms or hands)
  • A child may not want to use an arm or leg (they may not be able to reach for an object or use a hand they usually use. They may not be able to do activities like kicking a ball or riding a tricycle)

Steps to Take:

Discuss home treatments for joint bleeds with your HTC so you will know what to do if one occurs.

A simple home treatment for a joint bleed is: P.R.I.C.E. (Protection, Rest, Ice, Compress, Elevate)

Additional treatment specific to your bleeding disorder may be needed depending on the severity of the bleed. Always contact your HTC for questions on treatment. In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and go to the emergency department or call 911.

Muscle Bleeds

Muscle bleeds (bleeds into any muscles) happen most often in the arms and legs, but any muscle can be affected. Bleeds into larger muscles, such as thighs and pelvis can be particularly serious. This is because of blood loss and the possibility of pressure on nerves and blood vessels in the area.

Signs:

  • An ache or pain in and around the area
  • Crankiness (in children)
  • Limping or an unwillingness to use the affected arm or leg (your child may refuse to crawl or walk)
  • Decrease in motion (your child may do physical activities slower)
  • Muscle swelling or tightness (one limb may be larger than the other)
  • Skin over affected area is warm to the touch
  • Skin appears tight, shiny, or blue
  • Veins appear larger than usual
  • Numbness or tingling (your child may say a part of their body is “tingly” or has “fallen asleep”)

Steps to Take:

Discuss simple home treatments for muscle bleeds with your HTC so you will know what to do if a muscle bleed occurs.

A simple treatment for a muscle bleed is: P.R.I.C.E. (Protection, Rest, Ice, Compress, Elevate)

Additional treatment specific to your bleeding disorder may be needed depending on the severity of the bleed. Always contact your HTC for questions on treatment.

Muscle bleeds, especially in the thighs or pelvis can be serious.

In the event of a serious bleeding episode, call your Hemophilia Treatment Center (HTC) and go to the emergency department or call 911.

Deep Cuts or Lacerations

A deep cut or laceration is an injury that causes a break or opening in the skin. Deep cuts are seen fairly easily. They may be near the surface of the skin or may be deep and have either smooth or jagged edges.

Steps to Take:

Compress and hold an ice pack on the area (not directly on the skin) to slow the bleeding and reduce swelling. Treatment may be needed when stitches or bandages are put on to the wound or taken away.

Deep cuts and lacerations are serious.

Contact your Hemophilia Treatment Center (HTC) immediately or call 911.

Different Types of Bleeds

Head Bleeds

Bleeding in and around the brain is most often due to an injury to your head. Because you cannot see bleeding inside the head, it is important to know some of the signs and symptoms of a brain bleed.

Signs:

  • A headache that lasts a long time
  • Confusion, feeling very sluggish, and/or not being able to speak clearly
  • Not being able to see clearly
  • Bright lights might hurt your eyes
  • Very large pupils (the middle part of your eye) or pupils that are different sizes
  • Intense vomiting (not due to a stomach flu)
  • Dizziness
  • Stumbling/difficulty walking, sudden weakness, or balance issues
  • Sleepiness
  • Loss of consciousness
  • Stiff neck or back
  • Seizures
  • Loss of appetite
  • Feeling frustrated, annoyed, or angry

Steps to Take:

Brain bleeds are very serious. Tell an adult if you have any of these signs or symptoms and contact your Hemophilia Treatment Center (HTC) immediately or call 911.

Eye Bleeds

Bleeding inside the eye(s) most often happens due to an injury to your eye(s). It is important to know the signs and symptoms of an eye bleed.

Signs:

  • Pain and swelling in and around the eye
  • The white of the eye (called conjunctiva) becomes reddish
  • Suddenly not being able to see clearly
  • Change in your normal vision

Steps to Take:

Eye bleeds are serious. Tell an adult if you have any of these signs or symptoms and contact your Hemophilia Treatment Center (HTC) immediately or call 911. In the meantime, hold an ice pack on your eye. This slows the bleeding and reduces swelling.

Nosebleeds

A nosebleed happens when the small blood vessels inside your nose, or nasal cavities, are damaged.  This can happen from a hard bump to the nose, nose picking, sneezing, nose blowing, and even breathing very dry air.

Signs and Symptoms:

  • Bleeding out of the nostrils for a long time
  • Vomiting (from swallowing a lot of blood and the vomit may be dark or look like coffee   grounds)
  • Darkened stools (from swallowing a lot of blood)
  • A bad taste in the back of the mouth

Steps to Take:

Talk with your HTC about home treatments for a nosebleed so you are prepared. Here are some home treatments for a nosebleed:

  • Tilt your head forward and apply pressure to the bridge of the nose with a cool cloth
  • If you’re able, gently blow loose clots and mucus from the nose

You may need additional treatment specific to your bleeding disorder. This can depend on how bad your bleed is.  Always tell an adult and contact your HTC for questions about treatment.

In the event of serious bleeding, you may need to go to the emergency department or call 911.

Mouth Bleeds

Mouth bleeds are bleeding from the gums, tongue, lips, or the inside of the cheek. Mouth bleeds can happen from an accidental bite, a tooth coming in or out, a fall, or from putting objects in your mouth.

Signs and Symptoms:

  • Blood in and around the mouth. Blood may be harder to see if it is swallowed. Sometimes the amount of blood loss is more than you think, especially if you swallow the blood.
  • If you swallowed blood, you may feel nauseated, vomit or lose your appetite, or have dark stools.

Steps to Take:

Talk with your HTC about how to treat mouth bleeds, so you are prepared when it happens.

Here are some home treatments for a mouth bleed:

  • Apply pressure with a clean cloth or gauze to area of the bleed
  • Use cool foods, such as popsicles. This will help to decrease blood flow
  • Eat soft foods, which help protect the injured area
  • Avoid sucking on anything hard
  • Avoid using straws. They can damage a blood clot or prevent it from building
  • Clean your teeth and gums with a cotton swab while healing
  • Tea bags can help stop bleeding after dental work. When black tea bags are applied to a bleeding surface, the tannin in tea causes less bleeding. Many bleeding disorder camps have tea bags in their first aid kits!

You may need additional treatment specific to your bleeding disorder. This can depend on how bad your bleed is. Always tell an adult and contact your HTC for questions on treatment.

In the event of serious bleeding, you may need to go to the emergency department or call 911.

Throat Bleeds

A throat bleed is a more severe type of mouth bleed. How severe it is does depend on how much blood you are losing. This type of bleed can also be serious if it causes swelling which can affect your breathing.

Signs and Symptoms:

  • Swelling or changes in skin color in the neck
  • Trouble swallowing or breathing
  • Choking
  • Coughing or throwing up blood
  • Change in tone of voice

Steps to Take:

Throat bleeds are serious. Tell an adult if you have any of these signs or symptoms and contact your Hemophilia Treatment Center (HTC) immediately or call 911.

Gastrointestinal Bleeds

Gastrointestinal (GI) bleeds happen when there is bleeding in the stomach or intestines. It is important to know specific signs and symptoms of a GI bleed.

Signs and Symptoms:

  • Weakness
  • Paleness (called pallor)
  • Bloody or black, tar-like stool
  • Vomiting or coughing up blood. Sometimes the vomit may be a dark fluid or look like coffee grounds
  • Stomach or abdominal pain
  • Big, firm belly

Steps to Take:

GI bleeds are serious. Tell an adult if you have any of these signs or symptoms and contact your Hemophilia Treatment Center (HTC) immediately or call 911.

Urinary Tract Bleeds

The urinary tract includes different body parts like the ureters, bladder, and urethra. A bleed in the urinary tract can come from any of these places. Usually, this type of bleed is found by seeing blood in the urine. Signs of blood in urine can be either obvious or more unclear.

Signs and Symptoms:

  • Pink urine, this may be a sign of an early urinary tract bleed
  • Bright red or brown-colored urine, this may be a sign of an already progressing, more serious bleed
  • Lower back pain
  • Having to go to the bathroom often
  • Pain when urinating

Steps to Take:

GI bleeds are serious. Tell an adult if you have any of these signs or symptoms and contact your Hemophilia Treatment Center (HTC) immediately.  In the event of serious bleeding, you may need to go to the emergency department or call 911.

Soft Tissue Bleeds

Soft tissue bleeds happen under the skin near the surface. They are commonly called bruises. Bleeding in the soft tissue causes a raised area called a hematoma. This is a very common bleed. Bruises may disappear slowly.

Signs:

  • Darkening of the skin, possibly with a raised center
  • Unable to sit or walk comfortably

Steps to Take:

Discuss home treatments for soft tissue bleeds with your HTC so you’ll know what to do if one happens.

A simple treatment for a soft tissue bleed is: P.R.I.C.E. (Protection, Rest, Ice, Compress, Elevate)

Additional treatment specific to your bleeding disorder may be needed depending on how severe your bleed is.  Always tell an adult and contact your HTC for questions on treatment.

In the event of a serious bleeding episode, tell an adult, call your Hemophilia Treatment Center (HTC) and go to the emergency department or call 911.

Joint Bleeds

Joint bleeds happen when blood leaks into the space between two bones. The elbow, knee and ankle joints are common places for joint bleeds. However, bleeding can occur at any other joint. This includes the wrists, fingers, and toes. It can sometimes be hard to tell if a joint bleed is happening. It is important to look for the following signs.

Signs:

  • A bubbling or tingling sensation in the joint
  • Tight feeling in the joint
  • Joint pain
  • Skin over the affected joint is warm to the touch or it may ‘feel warm inside’
  • Joint swelling
  • Hard to move the joint

Steps to Take:

Talk about home treatments for joint bleeds with your HTC so you will know what to do if one happens.

A simple home treatment for a joint bleed is: P.R.I.C.E. (Protection, Rest, Ice, Compress, Elevate)

Additional treatment specific to your bleeding disorder may be needed depending on how severe your bleed is.  Always tell an adult and contact your HTC for questions on treatment.

In the event of a serious bleeding episode, tell an adult, call your Hemophilia Treatment Center (HTC) and go to the emergency department or call 911.

Muscle Bleeds

Muscle bleeds (bleeds into any muscles) happen most often in the arms and legs, but any muscle can be affected.  Bleeds into larger muscles, such as thighs and pelvis can be serious. This is because of blood loss and the possibility of pressure on nerves and blood vessels.

Signs:

  • An ache or pain in and around the area
  • Limping or unable to use the affected arm or leg
  • Unable to move well
  • Muscle swelling or tightness (one limb may be larger than the other)
  • Skin over affected area is warm to the touch
  • Skin appears tight, shiny, or blue
  • Veins appear larger than usual
  • Numbness or tingling

Steps to Take:

Discuss simple home treatments for muscle bleeds with your HTC so you will know what to do if a muscle bleed occurs.

A simple treatment for a muscle bleed is: P.R.I.C.E. (Protection, Rest, Ice, Compress, Elevate)

Additional treatment specific to your bleeding disorder may be needed depending on the severity of the bleed. Always contact your HTC for questions on treatment.

Muscle bleeds, especially in the thighs or pelvis, can be serious. In the event of a serious bleeding episode, tell an adult, call your Hemophilia Treatment Center (HTC) and go to the emergency department or call 911.

Deep Cuts or Lacerations

A deep cut or laceration is an injury that causes a break or opening in the skin. Deep cuts are seen easily. They may be near the surface of the skin or may be deep and have either smooth or jagged edges.

Steps to Take:

Compress and hold an ice pack on the area (not directly on the skin) to slow the bleeding and reduce swelling. Treatment for your bleeding disorder may be needed when stitches or bandages are put on to the wound or taken away.

Deep cuts and lacerations are serious. Tell an adult, contact your Hemophilia Treatment Center (HTC) immediately or call 911.