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Handling instructions

What do we do in case of injury or internal bleeding?

Bleeding episodes should be treated as quickly as possible, for three main reasons:

The faster the appropriate treatment is given, the more effective it is.

Long-term damage of joints and muscles are avoided.

Some bleeds, which fortunately occur less frequently, can be life threatening, such as those occurring in the skull or in the throat.

In the event of a bleed, remain calm and help the person bleeding to feel comfortable and safe. If it is a child, contact their parents immediately.

Both haemophiliacs and their families must know how to handle a bleeding episode correctly and in a timely manner so as not to waste valuable time. That is:

To know First Aid for less serious bleeds.

To know where to turn for immediate medical care, either at their place of residence or when traveling.

When traveling, always carry the necessary documents (insurance card, medical report, contact details of the Haemophilia Center and the physician who monitors them).

To have immediately available the medical information on the type of haemophilia, treatment administered, and if there are any allergies.

Ensure access to appropriate treatment as well as dispensing equipment.

First Aid for less serious bleeds:

Small and superficial bleeds

For minor and superficial bleeds, such as bruises and cuts that do not require treatment, you can take care of the wound until the bleeding stops on its own. Initially, wear gloves and clean the area with antiseptic liquid. Then, apply constant pressure and lift the part of the body that is bleeding , until it stops. After the bleeding has stopped, cover the area with an antiseptic or sterile gauze.

Nosebleed

For nosebleed, the person must be seated with their head bowed, applying steady pressure in the nostril that is bleeding at least 20 minutes.

Oral bleeds

For oral or tooth bleeds, apply ice at constant pressure for 20 minutes.

It is good to keep in mind that for a bleed that does not stop, while initially appearing small and superficial, may eventually require administration of treatment.

REST – ICE – COMPRESSION – ELEVATION: The 4 “magic words” for dealing with a serious bleed

In the case of internal bleeding in the muscle or joint, in addition to the intravenous administration of the appropriate treatment, there are a number of measures that help speed up tissue repair. It is very important for people with haemophilia and their families to be aware of those precautionary measures and apply them immediately until treatment is given.

Rest

The injured arm or leg should be able to rest on pillows or splinters or, if necessary, be immobilized. The person should not lean or walk on it. If the injured area has to be rested for longer, the person may need crutches or other mobility aids.

Ice

Applying ice or an ice pack causes contraction of the bleeding vessel, slowing the bleeding and reducing inflammation and pain. On the contrary, hot pads should be avoided. Direct contact of ice with skin is harmful, so ice cubes or ice packs must be wrapped in a clean towel first. For example, wrap the ice in a clean towel and put it on the bleeding joint. Keep the ice for 5 minutes and then remove for at least 10 minutes. Repeat the treatment for as long as the joint is warm.

Compression

Applying mild pressure to the joint or placing a rubber bandage squeezes the bleeding vessel and reduces the rate of bleeding. You should not put pressure on a bleeding muscle if you suspect that a nerve has been injured.

Elevation

Raising the limb above the level of the heart reduces blood pressure and therefore the rate of bleeding while relieving swelling.

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

Signs of internal bleeding

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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