Patients with hemophilia are at risk of continued bleeding following an injury. In some cases, this bleeding is visible or apparent from bruising of the skin. The first signs of hemophilia often appear when a newborn experiences significant bleeding following circumcision. In milder cases, or when there is no circumcision, bruising or bleeding may appear on the gums when the infant’s teeth appear. Another sign of hemophilia is frequent bumps and bruises that a child accumulates while learning to walk.

Hemophilia may not be as evident in children who have a mild form of the disorder. The condition may go undetected for years until the child’s first dental procedure or surgery, or until an accident occurs.  

Bleeding that is internal may not be visible. Joints in the knees, ankles and elbows are particularly vulnerable to internal bleeding. When not treated promptly, internal bleeding can cause damage to joints, muscles or other body tissues. Internal bleeding may create a tingly or bubbly sensation in the joint. The joint also may be warm to the touch.

Severe hemophilia is most evident in bleeding in the joints, a condition known as hemarthrosis. In most cases, this bleeding is not the result of an injury, though it can continue for days if left untreated. Patients are urged to learn to recognize the signs of internal bleeding so that it can be treated before it damages the joints (e.g., causes arthritis) or other tissues.

Bleeding into a joint typically follows a sequence that begins with tightness in the joint that initially occurs without pain. As bleeding continues, pain may accompany this tightness, followed by a swelling of the joint, which becomes hot to the touch. At this point, patients often cannot bend or extend the joint without pain due to the swelling, which presses on the nerves.

As bleeding continues, swelling of the joint may continue until there is complete loss of motion in the joint. Pain may become severe at this point. Eventually, bleeding will stop as the joint becomes filled with blood. 

Other common signs or symptoms of hemophilia include:

• Excessive bleeding or bruising in soft tissue and muscle
  
• Excessive bleeding in the mouth after a cut, bite or tooth loss
  
• Blood in the urine or stool
  
• Regular nosebleeds that occur for no apparent reason

Some young children with hemophilia may try to hide or deny that they are bleeding to avoid treatment. Parents should be sure to learn the signs and symptoms of hemophilia so they can identify a potential bleeding incident in their child.

In some cases, a bump on the head or other head injury may cause bleeding in the brain in a hemophilia patient. This is a very dangerous condition that demands emergency medical treatment. Symptoms of bleeding in the brain may include:

• Convulsions or seizures
• Double vision
• Extended, painful headaches
• Repeated vomiting
• Sleepiness
• Stiffness or pain in the neck
• Sudden weakness or awkwardness in an arm or leg
• Walking difficulties