Bleeding and clotting disorders: haemophilia, ITP and watching for DIC
- Safe practice
In bleeding disorders the nurse prevents injury, adapts injections, recognises bleeding early, including in joints and the head, and spots DIC.
What it is
People with haemophilia, von Willebrand disease or a low platelet count from ITP bleed more easily and for longer, sometimes inside joints, muscles or the head. Disseminated intravascular coagulation (DIC) is different: it complicates severe illnesses such as sepsis, trauma, some leukaemias and obstetric problems, and causes bleeding from many sites together with clots. Nursing care prevents injuries, adapts injections and procedures, recognises bleeding early and, in DIC, notices oozing and organ changes in a very sick patient. The diseases themselves are explained on the linked condition pages.
What it requires
- Knowing the diagnosis, the treatment plan for bleeds and the treating haematology team's contact.
- An injury-prevention plan and adapted injections and procedures.
- Regular checks of joints, skin, gums, urine, stool and neurological status.
- Pressure and cold applied promptly to any bleeding point, as the protocol says.
- In severe illness: the risk of DIC and the signs that suggest it.
How it is applied (and why)
- Ask about the person's usual bleeds and treatment plan — many people with haemophilia treat their own bleeds with a plan from their treatment centre.
- Check joints for swelling, pain, tightness or reduced movement and report them — repeated joint bleeds lead to chronic joint disease.
- Avoid intramuscular injections when another route is allowed; if one is needed, use a fine needle and press firmly without rubbing — this limits haematoma.
- After any needle puncture, press firmly with gauze and check the site again — report bleeding that does not stop after about 10 minutes of pressure.
- Check with the team before any medicine, especially aspirin and anti-inflammatories — they worsen bleeding.
- Prevent injuries: shoes, care with knives and scissors, soft toothbrush, electric razor, no heavy lifting or contact sports — small injuries can bleed a lot.
- Treat any head injury, or a severe or persistent headache, as urgent and call at once — bleeding in the head can be life-threatening.
- In a very ill patient, look for oozing from lines, wounds or gums and new bruising, and report — this can be the start of DIC.
- Watch blood pressure, breathing, urine output and mental state in suspected DIC — clots and bleeding can damage organs.
In nursing practice
- Some people with haemophilia develop inhibitors, antibodies that make factor treatment less effective; bleeds then need specialist plans.
- If the person receives factor replacement, vaccines given by injection into the muscle can be scheduled shortly after a factor dose, as the team decides.
- In ITP, look for small red or purple spots on the skin, bruising and mouth or nose bleeding, and report them.
- In DIC there is no single treatment; the team treats the cause and supports the patient, often with blood products given under the transfusion procedure.
- Encourage regular follow-up at a specialised haemophilia treatment centre, which also provides education.
Common mistakes
- Rubbing the site after an injection in a person with a bleeding disorder.
- Giving an over-the-counter anti-inflammatory medicine for joint pain without asking the team.
- Waiting for bruising to appear before acting on a head injury.
- Missing slow oozing from line sites in a septic patient.
- Not checking the puncture site again after a blood test.
Test yourself
Think of the answer, then tap the question to see it.
Which are the typical signs of a joint bleed in haemophilia?
Swelling, pain or tightness and reduced movement in a joint, most often the knee, elbow or ankle.
How is an intramuscular vaccine given to a person with a bleeding disorder, when the doctor judges it safe?
With a fine needle, followed by firm pressure on the site without rubbing for at least 2 minutes, after telling the person about the risk of haematoma.
Which signs suggest DIC in a very ill patient?
Bleeding from many sites such as lines, wounds and gums, bruising, blood in urine or stool, falling blood pressure, breathlessness and confusion.
Why is a head injury urgent in a person with a bleeding disorder?
Because bleeding in the head can cause long-term problems such as seizures and paralysis, and bleeding in the brain can be fatal.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: About Hemophilia (Centers for Disease Control and Prevention (CDC), 2024); Special Situations: Vaccinating Persons with Increased Bleeding Risk (General Best Practice Guidelines for Immunization) (Centers for Disease Control and Prevention (CDC), 2024); Disseminated intravascular coagulation (DIC): MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Bleeding during cancer treatment: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.