One of the first symptoms of a bleeding disorder like hemophilia is often bruising easily. Bruises result from bleeding under the skin. Depending on a person’s specific condition, their blood may not clot as easily because of low or abnormal platelet counts, insufficient clotting factor proteins, or an issue with the blood vessels.

On MyHemophiliaTeam, members often share their experiences of bruising and excessive bleeding. “I woke up with a bruise on the surface of my right foot. I think I just got it from standing in one place for six hours,” said one member.

Although usually harmless, bruising can be a sore issue for parents and caregivers of children with clotting disorders or adults who feel self-conscious about what others will think of their bruises.

“This morning, there was a bruise and bump on my son's stomach,” shared another member. “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.”

A chronic disease like hemophilia A, hemophilia B, or von Willebrand disease (VWD) adds 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 confident about what to do.

How and Where Bruises Develop

With clotting disorders like hemophilia, small injuries can result in big bruises because the bleeding takes longer to stop. Sometimes, a collection of clotted blood forms, called a hematoma. Hematomas can appear under the skin, in the joints and muscles. Bruises fade as they heal, turning from blue or burgundy to green or yellow. This discoloration may be more noticeable on lighter skin tones.

Bruises can develop anywhere 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,” shared a MyHemophiliaTeam member.

Read about ways to protect your joints when living with severe hemophilia.

Patterns of Bruising in Children

Before babies start crawling, those with bleeding disorders most often develop bruises on their upper arms, feet, and back and the front of their thighs, as well as below their knees. Studies show that babies and children with bleeding disorders are less likely to have bruising near their ears, neck, cheeks, eyes, and genitalia compared to other parts of the body.

“My 9-year-old daughter with von Willebrand disease had been complaining of body aches, and we have just noticed bruising around her knee, ankle, and wrist,” shared another member.

Not only do children with bleeding disorders have more frequent bruising, but their bruises tend to be larger than those of children without bleeding disorders. Children with bleeding disorders need to be properly diagnosed so their parents and caregivers aren’t mistakenly suspected of abuse. Connecting with others who understand what you’re going through can help you feel less alone.

“Raising three sons with fluctuating VWD was a challenge, to say the least,” reflected a member of MyHemophiliaTeam. “My youngest has always dealt with issues from even minor cuts. Any injuries as children meant more of an alert compared to ‘average’ others. Some people thought I overreacted, but unless they’ve dealt with hyper children with clotting disorders, they have no idea.”

Preventing Bruises

Some people with bleeding disorders take prophylactic (preventive) infusions of replacement clotting factor. In at least one study of preschool-age children, researchers found there was no difference in the amount of bruising between children with bleeding disorders who took prophylaxis and those who didn’t. Still, if you’re concerned about the amount or severity of bruises you or your child sustains, talk to your doctor about whether there are other treatment options that might benefit you.

Preventing bruises in people with bleeding disorders, especially infants and children, can be difficult. Babies with bleeding disorders may bruise simply from being picked up. To reduce bruising, lift your child by scooping them up from their underneath rather than grabbing around their chest and underarms.

As toddlers start to explore and climb, they may end up with more bumps and bruises. Parents can take precautions by providing soft toys and a safe environment. Protective padding during sports and activities can help children and adults avoid bruises.

When raising a child with a bleeding disorder, striking a balance between being protective and allowing your child to develop and play can be difficult. Swimming is a physical activity for children with hemophilia to participate in, providing an environment with minimal risk of bruising. Children with bleeding disorders should avoid contact sports.

Living With Bruising From Bleeding Disorders

Accidents happen, and with bleeding disorders, bruises often look worse than they feel. One member of MyHemophiliaTeam wrote, “I fell over my dog and hurt my left hand and left knee. My friends are shocked at how bad my bruises are. But I keep reminding them that with von Willebrand disease, I bruise easily since I can’t form a clot. I’m in very little pain. It just looks very bad.”

Another member shared, “We were at the store today when my son tripped over his own feet. He’s one and a half. 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.”

Since there’s no cure for blood disorders, learning to live with them is a lifelong endeavor. With experience and the support of your health care providers, you’ll learn to recognize the severity of your bruising and what’s normal for you. If you find yourself struggling with anxiety about you or your child getting hurt, mental health counseling can help you put things into perspective and learn coping strategies to stay calm in an emergency.

Treating Bruises at Home

Since bruises are so common with hemophilia, it’s important to know how to treat them quickly and effectively. The RICE method — in which RICE stands for “rest, ice, compression, elevation” — is a tried-and-true procedure for dealing with injuries.

The RICE method starts with resting the injured area. The person should avoid using their hurt arm or leg until it begins to heal. Avoid massaging the area, as this may increase damage and bleeding.

Next, apply a cold compress to slow blood flow and bleeding. In the first 24 to 48 hours of the injury, use ice for 15 to 20 minutes every two to three hours. Don’t put ice directly on the skin. Instead, use cold ice packs that are meant for first aid or wrap the ice in a towel.

You can reduce swelling and bleeding by compressing the area. Wrap it in a bandage that applies some pressure but isn’t tight enough to cut off circulation.

If possible, elevate the injury above the heart to prevent blood from pooling and producing larger bruises.

A healthy diet rich in vitamin C, found in citrus fruits, can also reduce the severity of bruising in people living with bleeding disorders.

When To Call the Doctor

Don’t hesitate to contact your health care provider if you’re unsure whether an injury warrants the use of clotting factor concentrate or other treatment. Injuries to the head or stomach present greater risks and should be discussed with your doctor.

Other signs that you or a loved one may need medical attention include:

• Bruises that hurt or limit the person’s ability to move freely
• Bruising on the head or neck
• Lumps that get worse or fail to heal
• Swelling, numbness, or tingling in the bruised area

Ask your doctor about any bruises that don’t go away after two weeks.

Talk With Others Who Understand

On MyHemophiliaTeam — the social network for people with hemophilia and their family members — more than 6,100 members come together to ask questions, give advice, and share their tips with others who understand life with hemophilia.

Do you experience easy bruising from minor injuries, or even when you aren’t aware of an injury? How do you decide when you need medical treatment for bruises and when you can treat them at home? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.