To ER or not?

Deciding when to take your bleeding child to the ER can sometimes be challenging. How much blood loss is too much?  Yesterday was one of those days when we had to decide whether or not to bring Star to the ER.

Shortly after waking up around 9-ish in the morning, she nosebled for almost 30 minutes and puked blood. (Which was probably caused by excessive bleed in her nostrils).   These days, the humidity of summer has been causing more frequent bleeds not only to Star but to a number of people within our bleeders community.

Lately, we’ve been noticing big blood clots when Star nosebleeds or vomits. Yesterday for instance, a clot as big as half her palm came out of her nose.   And unlike in most of her episodes, blood dripped on both her nostrils yesterday. So upon consultation with her hematologist, we decided to take her to the ER.   By the time we arrived at the ER, her nosebleed had already stopped. Thankfully, after physical check-up and some questions, we were allowed to go home without having to infuse factor concentrates.

The sight of blood may sometimes seem scary.  But once a child is diagnosed with a bleeding disorder, in Star’s case — von Willebrand Disease — expect bleeding to become part of your life. With two or more episodes of nosebleeds and other kinds of bleed every week, it is too exhausting to take your child to the ER every time. So you have to discern when to go or when not to go.

In developed countries, bleeding episodes of people with bleeding disorders can easily be stopped by infusing medicines called factors — usually derived from human plasma.

There are many different types of bleeds and nose-bleeding is one of the mildest forms.  The more life threatening ones have something to do with bleeding in internal organs like the brain, stomach, kidneys, liver, etc.  That is why it is important to ask the child which part of his/her body hurts. Vomiting of blood can sometimes be a symptom of internal bleeding.  But it can also be merely caused by the back-flow from excessive nosebleed.

Unfortunately for us in developing countries, factor concentrates are not only hard to find, they are also very expensive. That is why while Star would have been normally infused with factor concentrates in her bleed yesterday had we lived in a more advanced country, the doctor advised us to save our medicines for a more serious bleed.

Here are some practical tips on dealing with a nosebleed:

* Be calm.
* Let the child sit comfortably.
* Tilt the forehead forward and pinch the nose for at least 15 minutes.
* Apply cold compress (ice pack) on the forehead.

If bleeding persists after 15 minutes, call your child’s hematologist.

So back to the question — should you go to the ER or not?   As always, it is better to err on the side of precaution. So go, take your child to the ER.

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About Andrea Echavez

I am an advocate for people with bleeding disorders. My daughter Star and I were diagnosed with von Willebrand's Disease Type 2M.

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