Assessment of Bleeding Episodes
Certain bleeding sites are more serious than others for patients of hemophilia, as illustrated in the image shown on the right. Be sure to select each lighted area to view more information. The PDF chart that is linked below provides a summary of the seven major types of bleeding episodes. You can print the chart for future reference.
For this part of your training, we will go through how to assess bleeding episodes. To begin, let’s take what we’ve covered here to answer the following questions about a patient from the previous module.
Intracranial bleeding is the leading cause of death from bleeding. Bleeding can occur spontaneously or after any trauma and can be present without obvious external bruising or lacerations. Therefore, all incidents of head trauma should be treated and evaluated.
Signs and symptoms: Can occur after any head trauma or spontaneously. Signs include increasing headache, vomiting, drowsiness, seizures, and change in speech.
While mouth bleeding is obvious, the amount of blood loss can be underestimated because large amounts of blood might be swallowed.
Signs and symptoms: pallor, lethargy, nausea, and vomiting.
GI bleeding requires aggressive factor replacement and careful monitoring of hemoglobin levels.
Signs and symptoms include coffee grounds emesis; pallor; black, tarry stools; and decreased hemoglobin.
Bleeding episodes in large muscles, such as the thigh, can lead to significant blood loss, thus warranting monitoring of the patient’s hemoglobin level.
Signs and symptoms include aching, swelling, pain, heat, and decreased motion.
Bleeding into joints can occur as frequently as once or twice a week in a patient with severe hemophilia. Patients are often alerted to the onset of hemarthroses by the presence of a tingling or bubbly sensation before visible signs appear. Pain, swelling and temperature increase, and motion decreases because the joint space becomes more distended with blood.
Signs and symptoms: observation of a limp or unwillingness to use an arm or leg. The presence or absence of bruising is not helpful in assessment.