Bleeding disorders is a general term for a wide range of medical problems that lead to poor blood clotting and continuous bleeding. Doctors also refer to this as "coagulopathy," "abnormal bleeding" and "clotting disorders."

When someone has a bleeding disorder, he or she has a tendency to bleed longer than the average person. The disorders can result from defects in blood vessels or from abnormalities in the blood itself. The abnormalities may be in blood-clotting factors or in platelets.

Blood clotting (also called coagulation) is the process that controls bleeding by changing blood from a liquid to a solid. It’s a complex process involving as many as 20 different plasma proteins, or blood-clotting factors.

Within seconds of an injury, tiny cells in the blood called platelets bunch together around the wound. Blood proteins, platelets, calcium and other tissue factors react together and form what’s called a clot, which acts like a net over the wound. Over the next several days to weeks, the clot strengthens and then dissolves when the wound is healed.

Normally, a complex chemical process occurs using these clotting factors to form a substance called fibrin that stops bleeding. When certain coagulation factors are deficient or missing, the process doesn’t occur normally.

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 include:

• 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.