In the case of internal bleeding, prolonged blood flow creates a hematoma in the tissue surrounding the blood vessel. This hematoma can become a source of inflammation and thus cause long-term tissue damage. However, if the right treatment is given immediately, the hematoma will be absorbed faster and the inflammation will not cause serious damage. For this very reason, timely administration of the treatment is very important.

Although we cannot see the hematoma itself, we can understand its presence from the "effects" that it brings to the tissue.

Contusions (big bruises), edema, skin heat, pain, numbness and restriction of mobility of a joint, are all indications of internal bleeding.

More specifically:

Bleeding inside the skin (intradermal bleeding):
They appear as contusions or large bruises on the skin.

Bleeding in the joints (intraarticular hemorrhages), mainly of the lower and upper limbs (knees, ankles and elbows):
The area around the joint swells and becomes warm and painful. In addition, due to the pain, the mobility of the joint is limited. It is important to remember that individuals with haemophilia can perceive bleeding into the joint already from the moment it starts, because it causes a tingling feeling (tickle) and heat sensation.

Bleeding into the muscles (intramuscular bleeding):
The muscle becomes hard and sore. The skin gets warm and a bruise may appear. Nerves are very close to the muscles and if pressed by the hematoma, a feeling of numbness at that area is caused. As time passes, the muscle becomes stiffer and more cumbersome and cannot support the joint.

Bleeding in organs or cavities of the body:
Black or red stool indicates bleeding in the digestive tract. Urine blood means bleeding in the urinary tract, coughing blood may mean respiratory bleeding, and vomiting blood may mean stomach bleeding. Very serious is bleeding in the brain which can be recognized by symptoms such as headache, nausea, photophobia, confusion, behavioral changes.

The age of the individual is an important factor in the early recognition of an internal bleeding. An adult immediately realizes the symptoms, but this is not the case for infants and young children. Infants cannot express themselves verbally, and children may not recognize the symptoms or may hesitate to inform an adult about the bleeding episode.

Learning how to recognize a bleeding

Thoroughly check the entire body and especially the joints for bruises and swelling, especially if a fall or injury has occurred. In the case of an infant or toddler, a good opportunity is during bathe or when changing clothes.

Examine whether a person's arms and legs differ in their length or width.

Observe if the child suddenly avoids using one hand to handle objects or if they reflexively protect a part of their body.

Observe the child's behavior. Sudden changes in behavior such as crying, insomnia, or a change in appetite may be an indication of bleeding, which the child may not be able to express.

Check for urine, stool, or vomiting of infants or children for blood.

Encourage the child to talk about the pain without fear and showing the area where it hurts.

Always pay attention to symptoms such as confusion, vomiting, photophobia, headache, shortness of breath, especially if there has been a fall or a head injury.

References:

1. Srivastava A, Santagostino E, Dougall A, et al. WFH Guidelines
for the Management of Hemophilia, 3rd edition. Haemophilia. 2020: 26(Suppl 6): 1-158. https://doi.org/10.1111/hae.14046
2.Mulder, K. Exercise for people with hemophilia. World Federation of Hemophilia. 2006.
Available at: https://elearning.wfh.org/resource/exercises-for-people-with-hemophilia . Accessed June 2021

Signs of internal bleeding

Handling instructions

Initiated by:

#askhemilios

This information is intended to inform and update the public and may in no way serve as a substitute to consultation with a doctor or other professional health service.

M-SG-00000340-06-2021