People with hemophilia get nosebleeds, which can usually be treated at home. However, it’s a good idea to know how to prevent them and how to deal with them when they occur.
Nosebleeds happen for different reasons, such as living in or visiting high altitudes or cold and dry climates; being exposed to smoke or being hit on the nose; and/or hard sneezing or nose-blowing. High blood pressure or an abnormal structure (such as a nasal polyp) can also cause problems. Winter and the allergy seasons in the spring and autumn are times of the year that often make this problem worse. People with platelet disorders or von Willebrand disease often experience nosebleed problems either equal to, or greater than, those suffered by people with hemophilia.
Fortunately, a number of medical and in-home treatments are available. “Whenever a patient calls with this concern, we try to delve into what might be precipitating the nosebleeds,” says James Munn, program coordinator of the University of Michigan’s Hemophilia and Coagulation Disorders Program in Ann Arbor, Michigan. “From there we work to strategize treatment and prevention for that individual.”
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Stopping the Flow of Blood
Once a nosebleed starts, there’s one simple and effective way to slow or stop the nose bleed. “Usually it’s a matter of pinching the nose—at the bridge, close to where the glasses might sit—and tilting the head down, and then putting an ice pack on the nose,” says Adam L. Wilmers, an NHF national youth leader who’s seen a lot of nosebleeds while he was working at summer camp. As with small cuts and scrapes, regular nosebleeds don’t usually require an infusion of factor unless the person has severe hemophilia.
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Additionally, “more patients have been using Nosebleed QR,” says Munn, referring to an over-the-counter topical powder that retards bleeding when applied directly to the nostril with a special swab. The powder forms a protective scab. There is also a version of the product for children.
For many with bleeding disorders, preventing nosebleeds is a matter of diligence. “I am supposed to use saline nasal spray or gel at least once a day and use a humidifier year-round. What I actually do is use saline nasal spray if I notice I am getting frequent nosebleeds and use a humidifier at night during the winter,” says Megan Procario, 20, a junior at the University of Pittsburgh, who has von Willebrand disease type 2A and experiences frequent nosebleeds. “These preventive measures help somewhat to reduce the number of nosebleeds I have in the winter.
“At the start of any nosebleed, I apply pressure to my nose, occasionally checking for clots,” she adds. “If the bleeding doesn’t stop in about 15 minutes, I use Stimate nasal spray and continue to apply pressure until the bleeding stops.” If that doesn’t work, her next step is to infuse with factor.
Aside from pressure and a cold compress to the nose, there are other solutions for people with hemophilia who experience frequent severe nosebleeds, including the use of Amicar, a drug that blocks the breakdown of clots. It can be injected or taken by mouth during bleeding treatment. Procario says she takes Amicar if her nosebleeds are severe or frequent, and for prevention. Always discuss treatment options with your doctor or hematologist if your nose bleeds become more frequent or difficult to manage.
“Prevention most often centers around keeping mucous membranes moist,” says Munn. “You can do this with humidification, nasal saline spray, Vaseline or other moistening topical ointments, including triple antibiotic ointment.” If the mucous membranes dry out and crack, bleeding occurs.