Bleeding should be treated as soon as it is suspected — ideally within the first 2 hours. Early treatment reduces joint damage and complications.
In trauma or suspected intracranial bleeding, administer clotting factor immediately before imaging or tests.
Dosage depends on body weight, site of bleed, and target factor level. Higher factor levels are needed for life-threatening bleeds or surgery.
Target Factor Level: 30–50%. Duration: 1–2 days. Also use R.I.C.E protocol (Rest, Ice, Compression, Elevation).
Target Factor Level: 50–80%. Duration: 2–5 days. May require repeated infusions or antifibrinolytics for mucosal sites.
Target Factor Level: 100% initially, maintain at 80–100% for 7–14 days. Emergency treatment required. Often hospitalized.
Most common type. Signs: tingling, warmth, swelling, limited motion. Treat immediately with factor. Use R.I.C.E. Avoid weight-bearing until pain/swelling subsides. Follow with physiotherapy.
Deep bleeds (e.g., iliopsoas) can cause nerve compression. Signs: pain, swelling, stiffness. Treat as moderate to severe bleed. Monitor for compartment syndrome.
Medical emergency. Signs: headache, vomiting, drowsiness, seizure, stiff neck, difficulty breathing. Give full dose factor immediately, even before hospital transport.
Signs: abdominal pain, vomiting blood, black tarry stools. Requires hospitalization. Maintain high factor levels and monitor vitals.
Often require antifibrinolytics (e.g., tranexamic acid) along with factor. Avoid NSAIDs and trauma. Use soft toothbrushes and gentle oral hygiene.
Support clot stability. Used in mucosal bleeds, dental procedures, or minor surgery. Do not use with aPCC (risk of thrombosis).
Use paracetamol (acetaminophen). Avoid aspirin, ibuprofen, or other NSAIDs as they increase bleeding risk.
Essential to restore joint function and prevent contractures. Begin once pain and swelling have resolved.
Ensure target levels are maintained during treatment. Adjust dosing if inadequate response or inhibitor is suspected.
If bleeding persists despite adequate dosing, test for factor inhibitors (neutralizing antibodies).
Maintain a bleed log for future reference. Helps in evaluating prophylaxis needs or recurrent target joints.
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