Easy bruising is often one of the first symptoms of bleeding disorders like hemophilia. Bruises happen when bleeding occurs under the skin. In people with hemophilia, the blood may not clot properly because the body doesn’t make enough clotting factors — proteins that help stop bleeding.

Although usually harmless, bruises can be upsetting for parents and caregivers of children with bleeding disorders, as well as adults who feel self-conscious about visible bruises.

Keep reading to learn more about bruising with hemophilia and ways to manage it.

Understanding How Bruises Develop and Where They Appear

With bleeding disorders like hemophilia, even minor injuries can lead to big bruises because the bleeding takes longer to stop. Sometimes, blood collects under the skin or in the body and forms a hematoma. Hematomas can develop under the skin, in joints, or in muscles.

Bruises fade as they heal, usually turning from blue or burgundy to green or yellow. These color changes may be easier to see on lighter skin tones.

When blood collects somewhere outside of a person’s blood vessels — such as within or among the skin, joints, or muscles — it’s called a hematoma. Hematomas sometimes can be felt as lumps or masses. (Adobe Stock)

Bruises fade as they heal, turning from blue or burgundy to green or yellow. (Adobe Stock)

Bruising may appear as different shades on different tones of skin. (CC BY-NC-ND 4.0/DermNet)

In hemophilia, bruises can appear anywhere on the body but are most common in areas that are prone to injury. “I’ve been noticing some bruising in arthritic joints, especially my knees and elbows,” a MyHemophiliaTeam member shared.

“I woke up with a bruise on the surface of my right foot,” another member said. “I think I just got it from standing in one place for six hours.”

Patterns of Bruising in Children

In children, bruising often becomes more noticeable as they become more active. In infants and young babies with hemophilia, bruises may develop during natural handling, such as being lifted, hugged, or held during diaper changes or bath time.

“This morning, there was a bruise and bump on my son’s stomach,” one member said. “The doctor said it could be caused by him rolling over onto a toy (he’s 7 months old). These bumps and bruises make me so paranoid.”

Bruising may appear under the arms, around the chest or torso, or on the buttocks. As children begin to roll, crawl, and walk, bruises become more common on areas like the knees, elbows, shins, and buttocks.

“Bruising was the first sign I had as a kid,” a member said. “Then I started waking up to nosebleeds on my pillow.”

If a bruise quickly gets larger, contact your doctor to discuss the best treatment options.

Children with bleeding disorders tend to bruise more easily, and their bruises may be larger than usual. (CC BY-NC-ND 4.0/DermNet)

Hemophilia Bruising vs. Typical Bruising in Children

Bruises related to hemophilia can look different from typical childhood bruises. Children with hemophilia may develop:

• Large bruises without a known injury
• Bruises that feel lumpy
• Hematomas

These bruises may cause swelling, pain, or reluctance to use the affected body part.

In children without a bleeding disorder, bruises are usually linked to a specific injury and heal within about two weeks. In hemophilia, bruises may take longer to heal and may occur along with unusual bleeding, such as in the mouth after brushing teeth.

It can be hard to tell whether a bruise is harmless or a sign of a deeper bleed. Parents and caregivers should contact their child’s doctor if they’re unsure.

Preventing Bruises

Some people with bleeding disorders use prophylactic (preventive) treatment. This treatment replaces missing clotting factors or uses other therapies to help prevent bleeding before it starts.

Prophylaxis is especially important for reducing the risk of joint bleeds, which can cause permanent joint damage over time. Even if someone still bruises easily, prophylaxis remains a key part of hemophilia care because it helps prevent more serious bleeding episodes.

Preventing bruises in people with bleeding disorders, especially infants and children, can be challenging. To help reduce bruising in infants, lift them by supporting their bottom and back instead of picking them up under the arms.

As toddlers start to explore and climb, provide them with soft toys and create a safe environment. Protective padding during sports and other activities may also help children and adults avoid bruises.

Finding a balance between protecting a child with a bleeding disorder and allowing them to play and develop independently can be difficult. Swimming is often recommended for children with hemophilia because it allows them to stay active with a lower risk of bruising. Children with bleeding disorders should avoid contact sports.

Living With Bruising From Bleeding Disorders

Having a chronic disease like hemophilia A or hemophilia B can add extra stress to parenting and everyday life. Some severe bruises may need medical care or require an infusion of clotting factor replacement. Understanding the difference between a common bruise and a medical emergency can help you feel more confident about what to do.

Accidents happen, and with bleeding disorders, bruises may look worse than they feel. One MyHemophiliaTeam member wrote, “We were at the store today when my son tripped over his own feet. He bumped his head pretty hard. I hate the looks we get based on the bruises he has on his body. My first reaction is to run, get his meds, and go straight to the hospital for an infusion.”

Because there’s no cure for most bleeding disorders, learning to manage them is a lifelong process. With experience and support from your healthcare providers, you can learn what kinds of bruising are normal for you or your child and when to seek medical care.

If you feel anxious about you or your child getting hurt, a mental health counselor may help you develop coping strategies and feel more prepared during emergencies.

Treating Bruises at Home

Since bruises are common with hemophilia, it’s important to know how to treat them quickly and safely.

The RICE Method

The RICE method — which stands for “rest, ice, compression, and elevation” — is a common way to care for injuries.

Start by resting the injured area. Avoid using the affected arm or leg until it begins to heal. Don’t massage the bruised area, because this may increase damage and bleeding.

Next, apply a cold compress to help slow bleeding and reduce swelling. During the first 24 to 48 hours after the injury, apply ice for 15 to 20 minutes every two to three hours.

Don’t put ice directly on the skin. Instead, use an ice pack made for first aid, or wrap ice in a towel.

Compression can also help reduce swelling and bleeding. Wrap it in a bandage that applies some pressure without cutting off circulation. If possible, raise the injured area above the level of the heart to help prevent blood from pooling and making the bruise larger.

Nutrition and Healing

Eating a healthy diet may also support healing. Vitamin C hasn’t been shown to prevent bruising, but low vitamin C levels may make easy bruising worse.

Eating fruits and vegetables with vitamin C can help prevent deficiency. These include:

• Sweet bell peppers
• Broccoli
• Brussels sprouts
• Citrus fruits such as oranges and grapefruits
• Strawberries
• Papayas

When Home Care Isn’t Enough

For large bruises or hematomas, home care might not be enough. Some people may need clotting factor treatment as part of their care plan.

Avoid medications that can raise the risk of bleeding — especially blood thinners, aspirin, and traditional nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen — unless your hemophilia specialist says they’re safe for you.

When To Call the Doctor

Contact your healthcare provider if a bruise:

• Is painful
• Keeps getting larger
• Limits movement
• Doesn’t improve after about two weeks

When Bruising Needs Emergency Care

Some bruises and injuries need urgent medical attention, including:

• Head injuries, especially with headache, vomiting, confusion, sleepiness, or vision changes, which may be signs of bleeding in the brain
• Possible bleeding, pain, or swelling in the neck or throat
• Severe pain or swelling in the lower back or abdomen, which may be signs of internal bleeding
• Chest pain or trouble breathing

In these situations, follow your hemophilia treatment center’s emergency plan and seek medical care right away.

Join the Conversation

On MyHemophiliaTeam, people share their experiences with hemophilia, get advice, and find support from others who understand.

How do you decide when you need medical treatment for bruises and when you can treat them at home? Let others know in the comments below.