How severe haemophilia symptoms are depends on the level of clotting factors in the blood compared to the normal amount:
- mild haemophilia – someone has 5–50% of the normal amount of clotting factors.
- moderate haemophilia – someone has 1–5% of the normal amount of clotting factors.
- severe haemophilia – someone has less than 1% of the normal amount of clotting factors.
The different severities of haemophilia are described below.
Mild haemophilia
Children born with mild haemophilia may not have any symptoms for many years. The condition usually only becomes apparent after a dental procedure, such as a filling, a significant wound or surgery. These events could cause unusually prolonged bleeding.
Moderate haemophilia
Children born with moderate haemophilia have skin that bruises very easily. They may also have symptoms of internal bleeding around their joints, particularly if they have a knock or a fall that affects their joints. Internal bleeding around the joint is known as a joint bleed.
The symptoms of a joint bleed usually begin with a tingling feeling of irritation and mild pain in the affected joint. The most commonly affected joints are the ankle joints, knee joints and elbow joints. Less commonly, the shoulder and hip joints can also be affected.
If a joint bleed is not treated, further symptoms can develop such as:
- more severe joint pain
- stiffness
- the site of the bleed becoming hot, swollen and tender
As with mild haemophilia, children with moderate haemophilia will also have prolonged bleeding after dental and surgical procedures and accidents that break the skin.
Severe haemophilia
The symptoms of severe haemophilia are similar to those of moderate haemophilia. However, joint bleeding is more frequent and severe.
Children with severe haemophilia have spontaneous bleeding. This means that they start bleeding for no apparent reason. Spontaneous bleeding can take the form of nosebleeds, bleeding gums, joint bleeds and muscle bleeding.
If they do not get treatment, people with severe haemophilia can develop:
- joint deformity, which may require replacement surgery
- soft tissue bleeding, which could lead to further complications
- serious internal bleeding
When to seek emergency medical help
There is a small risk that bleeding inside the skull can occur. This is known as an intracranial haemorrhage. It is estimated that 3% of people with moderate or severe haemophilia will have an intracranial haemorrhage.
Bleeding in the skull can be very serious and should be treated as a medical emergency. However, spontaneous bleeding inside the skull is very uncommon and usually only occurs as a result of a head injury.
The symptoms of an intracranial haemorrhage include:
- severe headache
- stiff neck
- vomiting
- a change in mental state, such as confusion
- speaking difficulties, such as slurred speech
- changes in vision, such as double vision
- loss of co-ordination
- loss of balance
- paralysis of some or all of the facial muscles
Call 999 for an ambulance if you think that you or your child has bleeding inside the skull.
