1. Bleeding Disorders Caring for children with bleeding disorders in a community program 2014-04-30

2. Bleeding Disorders 1. Blood vessel is injured & bleeding starts. 2. Blood vessel tightens. 3. Platelets make a plug. 4. Clotting factors form a clot. With bleeding disorders, blood does not clot normally Bleeding does not occur faster or more profusely

3. Hemophilia Clotting factor is missing or low –Factor VIII – Hemophilia A –Factor IX – Hemophilia B 3 levels of severity –Mild –Moderate –Severe Inherited

4. Von Willebrand Disease Problem with the Von Willebrand Factor (VWF) clotting factor Most common inherited bleeding disorder 3 types –Type 1 - most common form, mild –Type 2 VWD – moderate symptoms –Type 3 VWD - rare, most severe Inherited

5. Idiopathic Thrombocytopenic Purpura (ITP) Involves immune system Antibody coats the platelets and causes them to be destroyed Cause is unknown Majority of ITP cases in children are temporary

6. Treatment Basic treatment is to stop or prevent bleeding Medical treatment is not always necessary for minor bleeds Joint & muscle bleeds require treatment Types of treatment –Factor replacement therapy –Other

7. Precautions Restrict activity after injury Contact sports may be restricted Do not use –Aspirin –non-steroidal anti-inflammatory drugs –blood thinners MedicAlert® identification is recommended

8. Surface cuts 1.Put on protective gloves. 2.Clean skin. 3.Apply firm continuous pressure until bleeding stops. 4.Apply a band-aid or dressing. 5.Encourage ice.

9. Nosebleeds 1.Put on protective gloves. 2.Encourage the child to gently blow his/her nose to remove mucous and unstable clots. 3.Position the child sitting with head slightly forward. 4.Apply firm continuous pressure for a minimum of 10 minutes or until bleeding stops. Use a cold cloth if possible. Once bleeding has stopped, encourage the child to NOT blow his/her nose again for as long as possible (at least 1-2 hours)

10. Mouth Bleeds 1.Put on protective gloves. 2.Apply firm continuous pressure ( when applicable) until bleeding stops. Use a cold cloth if possible. 3.Encourage popsicles or ice.

11. Surface cuts Nose bleeds Mouth bleeds 1.Call parent/guardian if bleeding does not stop after 20 minutes. 2.If unable to reach parent/guardian or emergency contact, call 911/EMS. 3.Provide medical personnel with copy of FactorFirst card, if available.

12. Bruising Notice must be paid to the child who expresses ongoing pain at a bruised site. Notify parent/guardian if a bruise is increasing in size. It may be helpful to mark the outline of the bruised area with a pen.

13. Muscle & Joint Bleeds Child may be reluctant to use limb Muscle or joint may feel tight Swelling Hot to touch Pain

14. Joint and Muscle Bleeds 1.Have the child rest. Keep the child still to avoid further injury. 2. Apply ice to injury. Do not leave it longer than 20 minutes. 3. Elevate the injury body part. 4. Contact parent/guardian. 5. If unable to contact parent/guardian or emergency contact after 15 minutes, call 911/EMS. 6.Provide medical personnel with copy of FactorFirst card, if available.

15. Head Injury Loss of consciousness Drowsiness Dizziness Irritable Confused Nausea and/or vomiting Dilated or unequal pupils Headache Unsteady gait Injury to eye or surrounding area Pain Swelling Life-threatening Bleeds

16. Neck injury Pain in neck or throat Swelling Difficulty swallowing Difficulty breathing Chest injury Pain in chest Difficulty breathing Coughing up blood Pale skin Lack of energy Abdominal injury Pain in abdomen or lower back Nausea or vomiting Blood in urine Black or bloody stool Life-threatening Bleeds

17. If a child has a significant injury to the head, eye, neck, chest or abdomen (with or without signs) 1.Call 911/EMS. 2.Notify parent/guardian. 3.Provide medical personnel with copy of Factor First card, if available.

18. Child specific information Type of bleeding disorder Precautions/restrictions, if any Health Care Plans are located in child file and binder