Different types of treatments are available for managing haemophilia and may vary depending on how severe it is. Prompt, effective treatment and prevention of bleeding significantly reduces the risk of complications and disruptions to school, work and family life.
Clotting factor concentrates (CFCs)
Bleeding can be controlled or prevented by replacing the missing clotting factor in the blood through an infusion of clotting factor concentrate. The level of factor VIII or factor IX is increased temporarily, so infusions need to be repeated. For some minor bleeding episodes, one infusion may be enough to stop bleeding. For more serious bleeding or where the first infusion has been delayed, treatment may be needed once or twice a day until the bleeding stops.
Recombinant factor VIII and factor IX concentrates are made using genetic technology and aren’t made from blood.
Treatment can be given in two ways
| On-demand | Treatment is given when bleeding occurs, such as after an injury. | – very young children– some adults with severe haemophilia – people with mild or moderate haemophilia |
| Prophylaxis | Treatment is given regularly to prevent bleeding before it starts. | – children with severe haemophilia– most adults with severe haemophilia– some people with moderate haemophilia who have frequent bleeding problems |
Treatment will be needed by everyone with haemophilia if they are bleeding. It will also be necessary to prevent bleeding if they need an operation or have an injury where there is a risk of bleeding.
Clotting factor concentrate is given intravenously (into a vein) into the bloodstream through a needle. Children can have anaesthetic cream rubbed onto the skin before an injection to reduce any pain. The puncture caused by the needle is small and does not result in excessive bleeding.
Standard half-life (SHL) treatment
Standard half-life factor concentrates stay in the blood for a relatively short time and require repeat injections for prophylaxis – every 2-3 days for haemophilia A and twice a week for haemophilia B.
Extended half-life (EHL) treatment
These are factor VIII or FIX products that can stay in the bloodstream for longer. If this treatment is suitable for your child, they may be able to have injections to prevent bleeds (prophylaxis) less often or may stay on the same dose/schedule and have higher trough levels. They are likely to need fewer injections to control any bleeds they have. Half-lives are shorter in children and young people than adults.
Subcutaneous treatment
Emicizumab is a subcutaneous (under the skin) treatment used to prevent or reduce bleeding in people with severe haemophilia A that is given weekly, two weekly or once a month. It is an antibody which mimics the action of factor VIII. Emicizumab can be prescribed for very young babies. However, the clotting system doesn’t fully mature until 6 months of age, so you will need to discuss with your haemophilia team what the best option for you and your child is. Emicizumab is not a treatment for bleeds, serious injury or major surgery; factor VIII would need to be given to treat bleeds.
For more information please visit our website //haemophilia.org.uk/resources/publications/factsheets/
Bleeding must be treated as soon as possible. Prompt treatment helps relieve pain quickly, shortens recovery time and reduces the chance of permanent damage.
Prophylaxis
Treatment with regular infusions of clotting factor aims to prevent the long-term damage caused by bleeding into joints and muscles. Prophylaxis works by stopping the bleeding that occurs without any obvious injury, often called spontaneous bleeding. It also reduces the risk of bleeding from minor injuries. Research has shown that prophylaxis gives children the best chance to reach adulthood without damage to their joints. How often the infusions need to be given is decided for the individual but is typically every other day for haemophilia A and 2-3 times a week for haemophilia B because factor IX lasts a bit longer in the blood.
Home treatment
Most people with severe haemophilia and some with moderate haemophilia learn to treat themselves/their children with clotting factor at home. Home treatment has many advantages:
- makes regular treatment possible
- treatment can be given as soon as possible after bleeding starts
- there is less disruption to home, school and working life
- greater independence and control for the parent/person with haemophilia
- reduced need for hospital attendances
- early treatment reduces recovery time and risk of permanent damage
At first parents are taught by a specialist haemophilia nurse how to give treatment to their child. In time children will learn how to self-treat – most can do this by the time they reach secondary school.
A butterfly needle is inserted into a vein in the hand or arm, the clotting factor is infused and the needle is removed. Alternatively, in very small children or those whose veins are quite difficult to access, an implantable port-a-cath (see below) can be inserted to make having the injections easier. This is a small device inserted under the skin (under general anaesthetic in the operating theatre). Part of the port has a small container called a reservoir and this is placed under the skin. A special needle can be put into the port through the skin so the factor can be injected.
Other treatments
Desmopressin (DDAVP®)
DDAVP® is a synthetic drug that can be suitable for some people with milder forms of haemophilia A. It releases factor VIII stored in the lining of blood vessels, increasing the amount of factor VIII circulating in the blood. This increase can be enough to control minor bleeding episodes and to prevent bleeding from minor operations including dentistry. It is given as a subcutaneous injection (under the skin like a vaccination) or as a nasal spray. It can’t work for severe haemophilia as there are no stores of factor VIII.
Tranexamic acid
Tranexamic acid is a medicine that helps to hold a clot in place once it has formed. It comes as a liquid or tablet and can also be used in a mouthwash. It can be particularly helpful for bleeding in the mouth, nosebleeds or heavy periods. It’s often used at the same time as clotting factor or DDAVP® but can be used on its own.
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Occasional bleeding is inevitable, whether you have hemophilia A or not. However, if you do have this lifelong condition, extra care is required to help prevent bleeds. A workout-related injury can cause scrapes and bruises, while more serious falls and bumps can lead to open cuts. Having surgery or dental work can cause bleeds, too.
No matter what the cause of a bleed, you need to know what steps to take to stop the bleeding and prevent complications. More significant bleeds may require medical attention. Here are eight tips for managing bleeds with hemophilia A.
Hemophilia A may cause both internal and external bleeding. According to the National Human Genome Research Institute, bleeding in the joints is the most common in the more severe form of hemophilia A. You may also have minor bleeds from sites of recent injury to your limbs. Both minor internal and external bleeding may be treated with home remedies. Bandages can help minor cuts, while ice can help with internal bruising.
However, some types of internal bleeding need immediate medical treatment, including bleeding in the head, throat, or GI tract (stomach and intestines). Signs and symptoms of bleeding in the head include:
- severe, prolonged headache
- repeated vomiting
- sleepiness
- sudden weakness
- double vision
- seizures
Signs and symptoms of bleeding in the throat or GI tract include:
- vomiting blood
- black or bloody stools
If bruising is accompanied by any severe or persistent pain, enlargement, or numbness, see your doctor right away.
Severe hemophilia A is the most common type.
- Spontaneous bleeding occurs at least once or twice a week with the severe form of hemophilia A, according to the World Federation of Hemophilia.
- If you have moderate hemophilia A, you may still bleed spontaneously, but only occasionally. You will usually have prolonged or excessive bleeding after any significant injury or surgery.
- Mild cases tend to cause bleeding only after an injury or surgical procedure.
If the bleeding appears to be minor and you have mild hemophilia A, then you can likely treat the injury at home without having to see a doctor.
Minor external bleeding is treatable with the help of bandages and applying mild pressure to the site.
- First, clean any debris out of the way with a soft cloth and warm water.
- Next, use gauze to place pressure on the wound and then put a bandage on top. You may need to swap out bandages if any bleeding soaks through.
Since hemophilia A can cause internal bleeding, you may be more prone to bruises from minor bumps than someone without the condition. These are likely to occur on your arms and legs, but you can get bruises anywhere on your body. Minor internal bleeding may be minimized with the help of an ice pack. Place the ice pack on the area as soon as you get injured.
You don’t necessarily need to see a doctor if you get bruised. However, any severe or persistent pain, enlargement, or numbness should be addressed with your doctor right away.
Not all injuries require pain medications. Before you take any over-the-counter (OTC) pain medications for bleeding or pain, be sure you’re not putting yourself at risk for complications. Common OTC pain medications, such as aspirin and ibuprofen, can make bleeding worse. You might consider acetaminophen (Tylenol) instead — just be sure to ask your doctor first.
According to the National Heart, Lung, and Blood Institute, mild bleeding from hemophilia A doesn’t usually require replacement therapy. However, if you continue to experience bleeding, it may be time to replace your factor VIII concentrations. Depending on your treatment plan, you may be able to take these therapies at home. In some cases, you may need to go to a medical facility for treatment.
If you have mild to moderate hemophilia A, you may be able to prevent bleeds before they happen. Your doctor may recommend desmopressin (DDAVP). DDAVP is a prescription medication that contains hormones that stimulate the release of clotting factor VIII. It’s administered via injection or nasal spray and helps to make sure your blood clots in case of injury.
The downside to DDAVP is that it can become less effective over time if you take it too often. You may want to use it sparingly, saving it for high-risk situations such as playing sports. Some people also choose to use DDAVP before getting dental work done.
Sometimes, minor bleeds from hemophilia A can lead to muscle and joint pain. Frequent bleeds in the joints can also wear down bones over time. Rather than relying on steroids and pain medications, physical therapy may help alleviate some of the inflammation. For physical therapy to work, you need to go to regular sessions. If you have an external wound, make sure it’s properly bandaged before attending a session.
Any type of bleeding from hemophilia should be discussed with a doctor, especially if it worsens or doesn’t improve with home treatment. Also, see your doctor if you notice any blood in your stools or urine, or if you’re throwing up blood. These symptoms may indicate more severe cases of bleeding that can’t be treated at home.