In An Emergency 
University Campus Emergency Room
University of Minnesota Medical Center, Fairview
500 Harvard Street, SE
Minneapolis, MN 55455
612-273-2700

Emergencies in Hemophilia
With all hemophilia emergencies, you should treat with factor concentrate first and seek medical evaluation immediately. Any severe physical trauma should be evaluated immediately even if you don't have symptoms.

Head Injury/Bleeding
All head injuries are considered to be serious. Please seek medical evaluation immediately. Signs of a head injury/bleeding include:

• Drowsiness
• Dizziness
• Irritability
• Lethargy
• Nausea and/or vomiting
• Seizures
• Dilated or unequal pupils
• Stiff neck and/or back
• Headache
• Double vision
• Confusion

Throat/Neck Bleeding
All swelling in this area should be considered to be the result of bleeding unless proven otherwise. Bruising in the mouth or under the tongue can spread down the tissues of the neck and block the airway (this can happen after dental work if not adequately treated with factor/Amicar). Causes of bleeding include:

• Tonsillitis or strep throat
• Severe coughing spell
• Injury to the neck area

Abdominal Bleeding
Any complaint of abdominal pain should be investigated by a doctor. Signs of abdominal bleeding include:

• Vomiting blood
• Bleeding from the rectum or black, tarry stools. Large amounts of blood can be lost in this area with little or no swelling. 

Iliopsoas Muscle Bleeding (Thigh/Groin/Hip Area)
Large amounts of blood can be lost in this muscle group with little or no swelling. Signs include:

• Difficulty and pain when straightening leg
• Groin pain
• Numbness/tingling in quadriceps muscle
• Lower back/front of thigh pain

Compartment Syndrome
Compartment syndrome usually happens 12 hours to three days after an injury. Surgery may be required to relieve pressure on the blood vessels and nerves. Signs:

• An increase in pressure within the muscle, which can cut off the circulation to the area
• Numbness/tingling to the affected area or below (such as fingers or toes)

Situations Leading to Emergencies
The following types of bleeds aren’t always emergencies, but left untreated or treated incorrectly, they can lead to emergencies:

• Mouth/nose bleeding
• Minor mouth bleeding that continues for several days can become serious. Slow, constant loss of blood could quickly lead to severe anemia and require blood transfusion.
• Coughing up or vomiting blood, which may be a result of continued swallowing of blood.
• Bleeding from the rectum or black, tarry stools, which may be from continued swallowing of blood.

Hematuria (Blood in Urine)

• Amicar should not be used in patients with hematuria to avoid risk of clotting in the kidneys.
• In most instances, increasing fluids and decreasing activity or bedrest are the only treatments necessary.
• Seek medical attention if hematuria is associated with significant pain, urine is bright red and recurs frequently or if bleeding continues following factor infusion. 

Head Injury Emergencies with Bleeding Disorders
A head injury is a blow or trauma to the head. The signs of an injury may be found right after the injury, or they may develop one to four days afterward. It's possible that a soft bump to the head will cause bleeding. It's more likely that a hard bump to the head will cause bleeding. It's most likely that the following will cause bleeding:

• Motor vehicle accident
• Tripping and striking head on a hard surface: most likely
• Falling and hitting head on hard surface or sharp corner
• Loss of consciousness

Signs of Bleeding In or Around the Brain:

• Any loss of consciousness, even brief
• Headache
• Irritability
• Tingling of numbness in hands or feet
• Nausea with or without vomiting
• Pale skin color
• Blurred or double vision
• Sensitivity to light
• Drowsiness; difficult to wake from sleep
• Sluggishness (not interested in play)
• Clumsiness
• Stumbling
• Slurred speech
• Confusion
• Change in usual behavior

If You Have Any of These Signs:

• Call 911 for an ambulance to the emergency room.
• Give 100 units/kg of factor VIII or IX right away. If you do not know your weight, give three times the usual dose used to treat a joint bleed. If you are unable to give the factor, bring it with you to the emergency room.
• After calling 911, call your hematologist.

If You Have No Neurologic Changes

• Give 100 units/kg of factor VIII or IX right away if possible. If you do not know your weight, give three times the usual dose used to treat a joint bleed.
• Call your hemophilia nurse or doctor to report what happened and to arrange to be seen in the emergency room.

Emergencies with Children
After your child returns home from the hospital or emergency room...

• Watch your child closely for any neurologic changes for the next few days. Wake your child every three hours during the night for the first 24 hours after the injury.
• If there are any neurologic changes, give the factor again and return to the emergency room right away.

What Else Do You Need to Know?

• Any significant head injury or history of a head bleed requires factor replacement and a CT scan.
• Signs of head injury may be subtle. If your child does not look normal to you or is not acting right, please contact the Hemophilia & Thrombosis Center right away.