Care and rehab after a bleed
First aid for bleeds
When you start taking part in a sport, it is important to tell someone who does sport with you that you have haemophilia. It may also be useful to give them some information about what to do if you have a bleed.
If you are worried that you have an internal bleed, the first and most important thing to do is to treat yourself with adequate factor replacement therapy and continue treatment until your injury is resolved. If you feel severe pain, swelling, numbness or pins and needles, it is important that you seek medical attention.
| For a minor bleed, the first-aid rule is Protection, Rest, Ice, Compression and Elevation (PRICE) | |
| PROTECTION | Reduce weight bearing or stress on the affected joint or muscle by using crutches or other supports. You may need to avoid putting weight on the affected side completely for the first 24 to 48 hours. |
| REST | The affected area should initially be rested completely. This allows the swelling to go down (which usually happens in around 48 hours) and prevents further bleeding. The injured area should not be forced into any position, but instead rested in the most comfortable position possible. |
| ICE | Ice packs can help to reduce swelling, prevent further bleeding and ease pain. Use a ‘Kold Blue' wrap or a ‘Cryocuff' if you have one or a frozen bag of peas wrapped in a damp towel. Apply the ice pack to the affected area little and often, usually for around 10-15 minutes every two hours. Do not apply a cold wrap or ice pack for more than 20 minutes at a time and do not place ice directly on the skin as it can burn. |
| COMPRESSION | Due to the increased volume of fluid in the area, the more swollen an injury becomes, the more pain you will feel. Compression reduces swelling, and therefore pain. Your physiotherapist will provide you with an elasticated bandage or pad and will make sure it fits correctly, as additional damage can be caused where the bandage is too tight. Try not to allow wrinkles in the bandage and remember to remove it at night. If you feel any pins and needles or tingling as a result of using the bandage, remove it and consult your physiotherapist. |
| ELEVATION | This helps to reduce swelling and relieve pain by increasing the blood flow away from the injured area. The injured area should be raised above the level of your heart. When you elevate your leg, remove the compression stocking to allow normal, healthy circulation. Elevate ‘little and often', for around 20 minutes at a time. |
You MUST treat the following situations as an emergency:
- You hit your head badly
- You feel nauseous, have blurred or double vision or a persistent headache following a knock to the head
- You notice bleeding in your nose or throat cavity
- You feel any sudden, severe pain such as headache, vomiting or abdominal pain
Get someone to phone the ambulance to take you to your haemophilia centre or local hospital immediately. Head injuries can be extremely serious so it is important that you get them checked out as soon as possible.
Other things can also be done to limit the permanent effects of a bleed. These are:
- Electrical stimulation of the muscles around the joint (to avoid wasting of the muscles while the joint is recovering)
- Active physiotherapy (to regain movement in the joint and avoid the formation of fibrous build-ups in the joint)
Endorsed by Andrew Clements, Haemophilia Physiotherapist, Leicester Royal Infirmary
