Why do people nose bleed

What Is Hemophilia?

Overview

Hemophilia happens when you don’t have enough clotting factors to help control how much you bleed. People with hemophilia may bleed for no apparent reason. They may bleed more than normal after being injured or having surgery. Clotting factors are proteins in your blood that work with your platelets (top) to stop or slow bleeding. Without clotting factors, you may have excessive or uncontrollable bleeding.

What is hemophilia?

Hemophilia is a rare, inherited blood disorder that causes your blood to clot less, which results in an increased risk of bleeding or bruising.

Hemophilia happens because your body doesn’t make enough protein (clotting factors) to help your blood form clots. Clotting factors are proteins in your blood. They work with your platelets to form blood clots that control bleeding. Low clotting factor levels increase bleeding risk.

There are several types of hemophilia. Hemophilia may be severe, moderate or mild based on the amount of clotting factor in your blood.

Healthcare providers treat this condition by replacing the missing clotting factor. There isn’t a cure for hemophilia, but people who receive treatment generally live nearly as long as people who don’t have hemophilia. Providers are researching gene therapy and gene replacement therapy as new ways to treat and possibly cure hemophilia.

Can people develop hemophilia?

Yes, but that rarely happens. Acquired hemophilia, or hemophilia that isn’t inherited, develops when autoantibodies start to attack a specific clotting factor. (Antibodies are protective proteins your immune system makes. Autoantibodies attack antibodies, essentially attacking your body’s own cells, tissues and proteins.)

Is hemophilia a common disease?

No, it’s not. According to the U.S. Centers for Disease Control and Prevention (CDC) in August 2022, about 33,000 people in the U.S. have hemophilia. Hemophilia typically affects men and people assigned male at birth (AMAB). Rarely, women and people assigned female at birth (AFAB) may have clotting factor levels that are so low that they develop symptoms such as having very heavy periods.

What are hemophilia types?

There are three types of hemophilia:

Hemophilia A: This is the most common type of hemophilia. It happens when you don’t have enough clotting factor 8 (factor VIII). The CDC estimates about 10 in 100,000 people have hemophilia A.
Hemophilia B: Hemophilia B happens when you don’t have enough clotting factor 9 (factor IX.) The CDC estimates about 3 in 100,000 people in the U.S. have hemophilia B.
Hemophilia C: Hemophilia C is also known as factor 11 (factor XI) deficiency. This hemophilia type is very rare, affecting 1 in 100,000 people.

Is hemophilia a serious illness?

It can be. People with severe hemophilia may develop life-threatening bleeding, but they’re more likely to develop bleeding in their muscles and joints.

Symptoms and Causes

What are hemophilia symptoms?

The most significant symptom is unusual or excessive bleeding or bruising.

People with hemophilia may develop large bruises after minor injuries. This is a sign of bleeding under their skin.
They may bleed for an unusually long time, whether that’s bleeding after surgery, bleeding after dental treatment or simply bleeding from a cut finger.
They may start bleeding for no apparent reason, such as sudden bloody noses.

How much bruising or bleeding people have depends on whether they have severe, moderate or mild hemophilia:

People with severe hemophilia often have spontaneous bleeding or bleeding for no apparent reason.
People with moderate hemophilia who have serious injuries may bleed for an unusually long time.
People with mild hemophilia may have unusual bleeding, but only after major surgery or injury.

Other symptoms may include:

Joint pain from internal bleeding. Joints in your ankles, knees, hips and shoulders may ache, swell or feel hot to the touch.
Bleeding into your brain. People with severe hemophilia very rarely develop life-threatening bleeding into their brains. Brain bleeds may cause persistent headaches, double vision or make you feel very sleepy. If you have hemophilia and have these symptoms, get help right away.

What are hemophilia symptoms in babies and children?

Sometimes, babies assigned male at birth with hemophilia are diagnosed because they bleed more than usual after being circumcised. Other times, children develop symptoms a few months after they’re born. Common symptoms include:

Bleeding: Babies and toddlers may bleed from their mouths after minor injuries, like bumping their mouths on a toy.
Swollen lumps on their heads: Babies and toddlers who bump their heads often develop goose eggs — large round lumps on their heads.
Fussiness, irritability or refusal to crawl or walk: These symptoms may happen if babies and toddlers have internal bleeding into a muscle or joint. They may have areas on their bodies that look bruised and swollen, feel warm to your touch or make your child hurt when you gently touch the area.
Hematomas: A hematoma is a mass of congealed blood that gathers under babies’ or toddlers’ skin. Babies and toddlers may develop hematomas after receiving an injection.

What causes hemophilia?

Certain genes create clotting factors. In inherited hemophilia, the genes carrying instructions for making normal clotting factors mutate or change. The mutated genes may give instructions that end up making abnormal clotting factors or not enough clotting factors. That said, about 20% of all hemophilia cases are spontaneous, meaning someone has the disease even though there’s no family history of abnormal bleeding.

How do people inherit hemophilia?

Hemophilia A and B are both sex-linked disorders that are inherited in an X-linked recessive manner. Here’s how that happens:

Everyone receives one set of chromosomes from their biological mother and one set of chromosomes from their biological father. If you get an X chromosome from your mother and an X chromosome from your father, you are assigned female at birth. If you get an X chromosome from your mother and a Y chromosome from your father, you are assigned male at birth. In other words, a mother will always pass an X chromosome to her offspring. The father will determine the assigned sex at birth by providing either an X or a Y chromosome.
If a woman has an abnormal factor gene on one of their X chromosomes, they carry hemophilia but may not have symptoms. That’s because there’s a normal factor gene on their second X chromosome.
If a woman who carries an X chromosome with a defective gene for producing factor 8 (or factor 9) has a male child, that child has a 50% chance of inheriting the X chromosome that carries the abnormal factor gene.
If that same woman has a female child, that child has a 50% chance of inheriting the faulty chromosome and abnormal factor gene. That child likely wouldn’t have symptoms because they’ll also inherit a normal X chromosome from their father.
In other words, a woman who inherits a faulty X chromosome and abnormal factor gene will carry hemophilia. They may not have symptoms, but they can pass the condition on to their children. There’s a 50% chance that any children they have — boys or girls — will inherit hemophilia. Boys who do inherit hemophilia are more likely to have severe symptoms. That’s because they don’t get a healthy X chromosome from their father.

Do women ever develop hemophilia symptoms?

They can, but those symptoms tend to be mild. For example, a woman carrying the hemophilia gene may not have the normal clotting factors or not enough clotting factors. When that happens, they may have unusually heavy menstrual periods and they may bruise easily. They may bleed more after childbirth and they may develop joint problems if they have internal bleeding into their joints.

Diagnosis and Tests

How do healthcare providers diagnose hemophilia?

A healthcare provider will start by doing a complete history and physical examination. If you have hemophilia symptoms, the provider will ask about your family’s medical history. Providers may do the following tests:

Complete blood count (CBC): Providers use this test to measure and study blood cells.
Prothrombin time (PT) test: Providers use this test to see how quickly your blood clots.
Activated partial thromboplastin time test: This is another blood test to time blood clot formation.
Specific clotting factor test(s): This blood test show levels of specific clotting factor levels (such as factor 8 and factor 9).

What are clotting factor levels?

Clotting factors help control bleeding. Healthcare providers categorize hemophilia as being mild, moderate or severe based on the amount of clotting factors in your blood:

People who have 5% to 30% of the normal amount of clotting factors in their blood have mild hemophilia.
People with 1% to 5% of the normal level of clotting factors have moderate hemophilia.
People with less than 1% of the normal clotting factors have severe hemophilia.

Management and Treatment

How do healthcare providers treat hemophilia?

They treat hemophilia by boosting clotting factor levels or replacing missing clotting factors (replacement therapy).

In replacement therapy, you receive human plasma concentrates or lab-made (recombinant) clotting factors. In general, only people with severe hemophilia need regular replacement therapy. People with mild or moderate hemophilia who need surgery may receive replacement therapy. They may also receive antifibrinolytics, a medication that keeps blood clots from breaking down.

Blood factor concentrates are made from donated human blood that’s been treated and screened to reduce the risk of transmitting infectious diseases, such as hepatitis and HIV. People receive replacement factors via intravenous infusion (IV).

If you have severe hemophilia and frequent bleeding episodes, your healthcare provider may prescribe prophylactic factor infusions to prevent bleeding.

What are treatment complications?

Some people who have replacement therapy develop antibodies, called inhibitors, which attack the clotting factors that control bleeding. Healthcare providers use a technique called immune tolerance induction (ITI). ITI involves clotting factors given on a daily basis to bring down inhibitor levels. ITI may be a long-term treatment, and some people may need this treatment for months or years.

Prevention

Can people prevent hemophilia?

No, they can’t. If you have hemophilia and have children, your healthcare provider may recommend genetic testing so you and your children know whether they might pass hemophilia on to their children.

Outlook / Prognosis

What can I expect if I have hemophilia?

If you have hemophilia, you’ll need medical treatment for the rest of your life. How much treatment you’ll need depends on your condition type, severity and if you develop inhibitors.

What is the lifespan expectancy for someone with hemophilia?

According to 2012 data from the World Federation of Hemophilia, the lifespan for men and people AMAB with hemophilia is about 10 years fewer than the lifespan for men/people AMAB without hemophilia. The federation also states that children diagnosed with and treated for hemophilia have a normal life expectancy.

But everyone is different. What’s true for one person with hemophilia may not be true for others. If you or your child has hemophilia, ask your provider what you can expect. They know your/your child’s situation, including overall health, and they’re your best resource for information.

Living With

How do I take care of myself?

People with hemophilia may need ongoing medical treatment to prevent bleeding. They may need to avoid certain activities and medications. But there are many things you can do to manage the impact hemophilia may have on the quality of your life.

Activities to avoid

Bumps, falls and hard knocks that other people shake off may be serious issues for people with hemophilia. They may need to avoid activities that increase their risk of being hit or falling down after being hit. Examples include:

Playing football, hockey or rugby.
Participating in boxing or wrestling.
Riding motorcycles.
Riding skateboards.

Participating in other sports such as soccer, basketball and baseball may increase your risk of injuries. Ask your healthcare provider what you can do, like using protective gear, so you can play these sports.

Medications to avoid

Pain medications like aspirin, ibuprofen and naproxen keep your blood from clotting well. You should also avoid anticoagulants such as heparin or warfarin.

Activities and actions to improve quality of life

There are many things you can do to limit the impact hemophilia may have on your quality of life:

Develop an exercise routine: You may worry about hurting yourself during exercise. Talk to your provider about ways to reduce the risk of bleeding while staying active.
Manage your stress: Hemophilia is a lifelong illness. It may take extra effort to balance your obligations to your family and work.
Have good dental hygiene: Brushing, flossing and regular visits to your dentist reduce the risk that you’ll need dental treatment that may cause bleeding. Be sure your dentist knows about your medical condition.
Aim for a weight that’s healthy for you: Managing your weight may help if you’re having trouble getting around because internal bleeding damaged your joints.
Educate those around you: If you have a severe form of hemophilia, you may have spontaneous bleeding that’s hard to control even if you’re taking medication. Make sure your family knows what to do if you have spontaneous bleeding. If your child has hemophilia, make sure care providers and school officials know what to do if your child has bleeding issues.

When should I see my healthcare provider?

Contact your healthcare provider if you notice changes in your body, like increased bleeding or bruising.

When should I go to the emergency room?

You should go to the emergency room if:

You have severe headaches or double vision. These symptoms may mean you have bleeding in your brain.
You have joint swelling and/or pain and you don’t have access to factor replacement medication.

What questions should I ask my healthcare provider?

If you or your child is diagnosed with hemophilia, you may want to ask your provider some of the following questions:

What type of hemophilia do I/does my child have?
What treatments do you recommend?
What are treatment side effects?
Will I/my child always need treatment?
What activities will I/my child need to avoid?
What medications will I/my child need to avoid?
What are things I can do to manage the impact this condition may have on my/my child’s life?

A note from Cleveland Clinic

Hemophilia is a rare, inherited blood disorder that changes people’s lives. People with hemophilia may need medical treatment for the rest of their lives. Parents of children with hemophilia may feel anxious about protecting them from accidental injuries. They may worry about helping their children learn to live with hemophilia. At this time, healthcare providers can’t cure hemophilia. They can provide treatment to prevent or reduce hemophilia symptoms. And they can make recommendations for steps people can take to limit hemophilia’s impact on daily life.

Nosebleeds (for Teens) - Nemours KidsHealth

Nosebleeds are usually harmless and easily controlled, but they can look scary. Try not to worry — most nosebleeds are easy to stop.

How Can I Stop a Nosebleed?

Try these simple tips to stop a nosebleed:

Get some tissues or a damp cloth to catch the blood.
Sit up or stand.
Tilt your head forward and pinch your nostrils together just below the bony center part of your nose. Applying pressure helps stop the blood flow and the nosebleed will usually stop with 10 minutes of steady pressure. Don't stop applying pressure to keep checking if the bleeding has stopped.

If you get a nosebleed, don't blow your nose. This can cause more bleeding. Also, don't tilt your head back. This common practice will cause blood to run into your throat. This can make you cough or choke, and if you swallow a lot of blood, you might vomit.

If you've tried the steps above twice and the bleeding continues after the second attempt, you'll need to see your school nurse or a doctor.

After you've stopped the initial nosebleed, don't lift heavy objects or do other activities that cause you to strain, and try not to blow your nose for 24 hours.

Now that your nosebleed is over, let's take a look at what a nosebleed is and what can cause it.

Different Kinds of Nosebleeds

The most common kind of nosebleed is an anterior nosebleed, which comes from the front of the nose. Capillaries, or very small blood vessels, that are inside the nose may break and bleed, causing this type of nosebleed.

Another kind of nosebleed is a posterior nosebleed, which comes from the deepest part of the nose. Blood from a posterior nosebleed flows down the back of the throat even if the person is sitting or standing. Teens rarely have posterior nosebleeds. They're more common in older people, people who have high blood pressure, and people who have had nose or face injuries.

What Causes Nosebleeds?

The most common cause of anterior nosebleeds is dry air. A dry climate or heated indoor air irritates and dries out nasal membranes, causing crusts that may itch and then bleed when scratched or picked. Colds may also irritate the lining of the nose. Bleeding may happen after repeated nose-blowing. When you combine a cold with dry winter air, you have the perfect formula for nosebleeds.

Allergies can also cause problems, and a doctor may prescribe medicine such as antihistamines or decongestants to control an itchy, runny, or stuffy nose. The medicine can also dry out the nasal membranes and contribute to nosebleeds.

An injury to the nose may cause bleeding and isn't usually cause for alarm. If you ever have a facial injury, use the tips outlined earlier to stop the nosebleed. If you can't stop the bleeding after 10 minutes or you are concerned about other facial injuries, see a medical professional right away.

Nosebleeds are rarely cause for alarm, but frequent nosebleeds might indicate a more serious problem. If you get nosebleeds more than once a week, you should see your doctor. Most cases of frequent nosebleeds are easily treated. Sometimes tiny blood vessels inside the nose become irritated and don't heal. This happens more frequently in teens who have ongoing allergies or frequent colds. A doctor may have a solution if you have this problem.

If your doctor rules out a sinus infection, allergies, or irritated blood vessels, he or she may order other tests to see why you're getting frequent nosebleeds. Rarely, a bleeding disorder or abnormally formed blood vessels could be a possibility.

Cocaine (or other drugs that are snorted through the nose) can also cause nosebleeds. If you suspect a friend is using cocaine, try talking about it and get help from a trusted adult.

Can I Prevent Nosebleeds?

When you blow your nose (especially when you have a cold), do so gently into a soft tissue. Don't blow forcefully or pick your nose.
Your doctor may recommend a cool-mist humidifier to moisten your indoor air.
Keep the inside of your nose moist with saline (saltwater) nasal spray or gel, or dab petroleum jelly or antibiotic ointment gently around the opening of the nostrils.
Wear protective athletic equipment when playing sports that could cause injury to the nose.

An occasional nosebleed may make you worry, but there's no need to panic — now you know what to do!

Reviewed by: Michelle P. Tellado, MD

Date reviewed: September 2019

Nosebleed: what to do?

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September 1, 2021

Nosebleed, or epistaxis, is an unexpected and even frightening phenomenon.

Should one be alert when such an unpleasant symptom appears, what factors provoke it and how can one help in such a situation? Let's figure it out further.

Why does the nose bleed?

Bleeding from the nose is classified into "anterior" and "posterior". In the first case, the cause is damage to small blood vessels, this type is usually easy to stop. The second case is considered more dangerous, bleeding occurs due to injury to large vessels located deeper in the nose, so it cannot be dealt with at home. If the blood is "in full swing" - this is a reason for an urgent call for an ambulance.

Causes of nosebleeds include:

nose injury;
thinning of the mucous membrane;
inflammatory processes in the nasal cavity;
vascular fragility, diseases of the heart and blood;
sudden increase in blood pressure;
uncontrolled intake of certain drugs (anticoagulants, NSAIDs, vasoconstrictor drops for the common cold).

What should I do if my nose bleeds?

At the moment when the bleeding starts, it is important to try not to be nervous, because the excitement makes our heart beat faster, which leads to more blood loss.

The bleeding stop algorithm is as follows:

Sit straight, tilt your head forward.
You should be comfortable: loosen the belt and collar, if necessary, open the window.
Place a cold, wet towel or ice on your nose and a warm heating pad on your feet. This will help constrict the vessels in your nose and dilate them in your legs, which will reduce bleeding.
Clamp the bleeding vessel: squeeze the wings of the nose with your fingers for 3-5 minutes, the blood should stop. Also for this purpose, you can enter a gauze swab previously moistened with hydrogen peroxide into the nostril.

If you have completed all of the above and the blood continues to flow, call an ambulance immediately, as even a small loss of blood can lead to fainting.

What to remember about nosebleeds?

Do not lie down and do not let your feet be above your head - this will increase bleeding;
Do not tilt your head: a large amount of blood in the stomach can cause vomiting, and blood can flow into the windpipe and make breathing difficult.
After the bleeding has stopped, refrain from eating and caffeinated drinks to avoid high blood pressure and new bleeding.

Prevention of nosebleeds

Remember, frequent nosebleeds are a reason to see a doctor. The specialist will identify the cause of the problem and prescribe treatment, which may include the use of hemostatic agents, as well as drugs that improve blood circulation.

To prevent rebleeding, your specialist may recommend:

Taking medications and vitamins to strengthen blood vessels.
Proper diet. Adding foods rich in vitamin K and C to the menu. Vitamin K is responsible for blood clotting, they are rich in parsley, spinach, basil, bananas, avocados, broccoli, bran, etc. Vitamin C strengthens the walls of blood vessels, it is found in large quantities in rose hips, sweet peppers, currants, citrus fruits, etc.
Activity and moderate physical activity: light exercise in the morning, daily walks in the fresh air, swimming pool, etc.

Be healthy!

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Frequent nosebleeds: what are the causes and what to do?

Bleeding from the nose due to trauma usually does not raise questions, but if it occurs without any mechanical impact, and even often, this should alert

What can be the causes of frequent nosebleeds and how they can be cured - tells otorhinolaryngologist of the clinic "Semeynaya" Olga Pavlovna Soloshenko.

If the bleeding does not occur from trauma and recurs periodically, it is better not to delay the visit to the ENT. After all, bleeding can be anterior and posterior - the second happens less often, but it is much more dangerous. With anterior bleeding, blood only goes out, with posterior bleeding, it flows into the mouth or stomach along the back of the pharynx. Posterior is usually caused by damage to larger vessels that are located deep in the nasal cavity. It is very difficult to stop back bleeding without a doctor.

Causes of nosebleeds:

Injuries. Injury to the nose is often fraught with cartilage fractures. As a rule, this is accompanied by swelling and pain.
High blood pressure. Very common cause. Due to a sharp jump, the walls of the capillaries easily burst. Pressure rises due to overload, as well as in the presence of diseases of the cardiovascular system.
Sunstroke and any sudden increase in body temperature.
Overwork.
Hormonal changes. Bleeding may occur in women during the months of pregnancy or menopause, and in adolescents at puberty.
Dry air. It causes dryness of the mucous membranes.
Poor blood clotting.
ENT diseases. Sinusitis, sinusitis, rhinitis - all of them can cause bleeding, especially with the constant use of drugs that thin the mucosa.
Vascular problems. Even infectious diseases such as chickenpox, measles, influenza, etc. can lead to them.
Polyps, adenoids, tumors. In addition to occasional bleeding, they simply make breathing difficult.
Foreign body - can damage the mucous membranes and blood vessels.
Deficiency of vitamins K, C and calcium.

First aid rules for nosebleeds:

Lie down (or position the patient) with legs down
Tilt head forward
Place a cold compress on the bridge of the nose for a few minutes
Cover nose with hand or insert swab pre-moistened with hydrogen peroxide
Drops can be instilled to constrict blood vessels

Attention, this must not be done!

Throwing the head back (contrary to popular belief) - blood can enter the respiratory tract
Blow your nose - so as not to increase bleeding without it.

Which cases require an immediate call to a doctor and an ambulance

In case of loss of consciousness
For excessive bleeding
Blood flows with clear fluid (this may occur after trauma and indicate a skull fracture)
If vomiting of blood occurs (possibly indicating bleeding in the esophagus or stomach)
Foamy blood (possible with lung injury)
In case of diabetes mellitus in a patient
If the patient is known to have poor blood clotting

Treatment

Treatment of bleeding is carried out in a complex manner. Often, an otorhinolaryngologist works in conjunction with a general practitioner, neurologist, endocrinologist, and hematologist.

At the first examination, the doctor determines the type of bleeding - anterior or posterior. Also, the patient is required to pass a general blood test and a coagulogram (analysis of blood coagulation indicators). In addition, it is important to measure the pressure, because if it is above the norm (the absolute norm is 120/80 mm Hg, but these figures change depending on age), the blood will not stop until it decreases.

In case of significant blood loss, the patient may be left in the hospital.

As a treatment for bleeding, it is possible to pack the nasal cavity, cauterize vessels (with drugs, laser, ultrasound, etc.), remove polyps. If there is no result, surgical ligation of vessels in problem areas is performed. In addition, drugs are prescribed that increase blood clotting.

Prevention

Taking drugs that strengthen the walls of blood vessels
Nutrition rich in vitamins and minerals
Air humidification during the heating season
Injury Prevention
Monitoring blood pressure and taking medications to lower it

Nosebleeds are not only unpleasant, but also dangerous. Therefore, as soon as it begins to bother you regularly, it is important to see a doctor as soon as possible. It is better to exclude all the most terrible causes of such a phenomenon as soon as possible and then it is already calmer to engage in further treatment.

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