How Does Hemophilia Cause Joint Bleeding?

Hemophilia affects your body’s ability to produce the proteins responsible for blood clotting, which are called clotting factors. There are multiple types of hemophilia that affect different clotting factors. These proteins are essential for blood clot formation, which stops bleeding. Without them, even minor injuries can cause extensive bleeding.

In people with hemophilia, joint bleeding (also known as hemarthrosis) occurs when blood leaks into the spaces within a joint. This typically happens in weight-bearing joints such as the knees and ankles, as well as in the elbows.

The bleeding can occur spontaneously (without a known injury), or it can be triggered by minor trauma or physical activity. In severe cases of hemophilia, bleeding into joints can happen as often as once or twice per week.

Repeated joint bleeds can lead to chronic (long-term) joint damage. If left untreated, hemarthrosis can eventually destroy the cartilage (the tissue that makes up the joint), leading to a condition known as hemophilic arthropathy. People with severe hemophilic arthropathy may need joint replacement.

Joint bleeding may not cause obvious symptoms right away. Occasionally, you may feel bubbling or tingling inside the joint. Some people with hemophilia experience an “aura” during bleeding that they may describe as warmth or tingling.

If blood builds up in the joint space for a long time, it can cause:

• swollen joints that may feel warm to the touch
• sharp or throbbing pain in the affected joint, which can increase with movement
• joint stiffness (difficulty moving)
• redness or other discoloration of the skin around the joints

These symptoms can occur without any obvious injury. They usually affect the knees, elbows, and ankles but can also affect your hips, shoulders, fingers, and toes.

Hemophilia can lead to bleeding in other organs in tissues besides your joints, such as:

• intracranial hemorrhage (bleeding in your head and brain), which can cause long-term seizures and paralysis
• gastrointestinal bleeding (bleeding in your digestive tract)
• extensive bleeding due to cuts, dental work, or surgery
• other types of internal bleeding

If bleeding can’t be stopped or if it affects a vital organ such as your brain, it can be life threatening.

Treating joint bleeding promptly is essential to minimize joint damage. Treatment may include:

• clotting factor replacement therapy, which involves replacing the missing clotting factor to improve blood clotting
• rest, ice, compression, and elevation (RICE therapy)
• physical therapy to help maintain joint function and prevent stiffness

Long-term untreated joint bleeding can eventually require surgery to replace the damaged joints.

Contact a medical professional if you or a loved one with hemophilia experiences:

• any injury
• symptoms of a joint bleed
• bleeding from a cut or nosebleed that lasts longer than 20 minutes

Medical emergency

Go to an emergency room if you experience any of the following:

• a serious vehicle collision, fall, or other injury
• severe stomach pain
• blood in your stool or urine
• severe headache, vomiting, dizziness, or confusion

To diagnose joint bleeding, a doctor will first ask about your medical history and perform a physical exam. They will also likely order the following imaging studies:

• an ultrasound to look for blood in the joint
• an MRI scan to assess the extent of joint damage and inflammation
• X-rays to check for joint deformities and bone changes

While it’s not always possible to prevent joint bleeds, certain strategies can help reduce the risk:

• Prophylactic treatment: Regular administration of clotting factor concentrates can help prevent spontaneous bleeds in people with severe hemophilia.
• Exercise: Engaging in low impact activities such as swimming and cycling can strengthen your muscles and help protect your joints.
• Protective gear: Wearing knee pads, elbow pads, and other protective equipment during physical activities can reduce your risk of injury.
• Weight management: Maintaining a moderate weight, or losing weight if your doctor recommends it, can help limit or reduce the stress on your joints.

Learning about hemophilia and knowing how to recognize early symptoms of bleeding can also help you manage your condition more effectively.

Joint bleeding is a common complication of hemophilia that requires prompt attention and management. By recognizing the symptoms, seeking timely medical help, and following the treatment plan your doctor recommends, you can help prevent long-term joint damage.

While hemophilia affects everyone differently, proper care and support can reduce its impact on your life.