Bleeding may occur anywhere in the body for no clear reason. When babies start to walk, they bruise easily. They also bleed longer than usual after an injury, especially in the mouth and tongue. They may bleed for a long time after circumcision. As children grow, spontaneous bleeding becomes more common. Shedding of milk teeth may lead to bleeding in the mouth for days, unless properly managed.
Bleeding affects the joints and muscles. The most common joint bleeds happen in ankles, knees, and elbows. Bleeds into other joints can also happen, including the toes, shoulders, and hips. Repeated bleeding into joint may cause hemophilic arthritis. Hundreds of PWHs have become handicapped because they are very poor and hence could not afford right treatment at right time. Infection in the areas of bleeds may necessitate amputation!
During muscle bleeds, the muscle feels stiff and painful. There may be bruising if the bleed is near the skin. After repeated bleeds, muscles can become weak, scarred, and shorter than normal (sometimes permanently). If nerves are damaged during muscle bleeds, the muscle may become weak or even paralyzed.
Bleeding into the throat may result from infection, injury, dental extractions, or surgery. Throat bleeds cause swelling, as well as difficulty swallowing and breathing. Other bleeds may also be very serious such as bleeds into the eyes, spine, and psoas muscle. Hematuria is common in severe hemophilia.
Bleeding within the head (usually resulting from injury, but not always so) is a major cause of death in hemophilia, especially in children. Head bleeds can cause headache, nausea, vomiting, sleepiness, confusion, double vision, clumsiness, weakness, fits, and loss of consciousness.