Bleeding Disorders at School
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Be sure to tell the parent about any injuries that happen at school. Early, immediate communication is key.
What do school personnel most need to know?
Bleeding disorders are treatable. Most bleeding problems are preventable. Some students with bleeding disorders take medicines to prevent bleeding.
When bleeding happens, the key to proper treatment is communication with the student and parent. Though a bruise or injury may seem minor, it is important to consider treatment early and report all school incidents to parents. Always believe a student when they say, “I have a bleed,” or when they have complaints of pain.
What are the most common bleeding disorders?
The 3 most common bleeding disorders are:
- Hemophilia - A protein required to stabilize blood clots is lacking. There
are 2 main types of hemophilia (A and B), and it can range in severity
from mild to severe. This condition can be associated with bleeding into
joints and muscles. - Von Willebrand disease - A condition of either 1) low levels of Von
Willebrand protein or 2) Von Willebrand protein that is not working
normally. This is a protein in the blood that helps platelets to stick
together. This is the most common type of inherited bleeding disorder. - Platelet disorders - Platelets are not working properly. Platelets are cells
that stick together to form a plug to stop bleeding after an injury.
Are there any activity restrictions for this student?
Students with bleeding disorders live normal lives. There is no way to ensure that a student won’t ever get hurt. However, we advise against some activities due to their increased risk of internal bleeding (for example, highimpact contact sports such as contact football, wrestling, hockey and lacrosse).
Common first aid needs
Most students with bleeding disorders respond to general first aid. Communicate with the parents whenever a student with a bleeding disorder gets any injury at school.
Treat minor scrapes and bruises like you would for any other student but use lots of ice early on for most injuries. See “RICE” below.
Bleeding minor cuts, scrapes
Use standard universal precautions when handling any blood as you would with any student. Follow school district first aid procedures.
Treatment of bleeding and injuries
For a student with a bleeding disorder, Rest, Ice, Compression and Elevation (known as the acronym RICE) for treatment. Do not apply warm packs to a student with bruising or give a warm drink to student with a mouth bleed. The earlier the RICE treatment is started after an injury, the better it works:
- Rest the injured area. If moving the injured area causes pain, this is the body's way of saying stop. Rest the affected area. Do not use or bear weight (such as standing or walking).
- Ice packs to the injured area will help to prevent or reduce swelling and bleeding. Apply a cloth-covered ice pack to the injured area for no more than 20 minutes at a time, 4 to 8 times a day.
- Compression (e.g., use of an Ace wrap) may also help to prevent or reduce swelling. Wrap the injured area with an Ace bandage snugly but not tight. It should not hurt or throb. Fingers or toes beyond the bandage should remain pink and not become "tingly." The Ace wrap should be taken off every 4 hours and reapplied.
- Elevation means raising the injured area above the level of the heart. The affected part should be elevated so it is 12 inches above the heart, to help reduce swelling
Problem |
Recommendation |
| Bruising | May not need intervention as long as it is flat and painless. Use ice pack if painful. Communicate with parents. |
| Nose bleeds | Wear gloves. Tilt head forward so blood is not swallowed. Pinch the soft part of the nose for 10 to 15 minutes. Call parents to report if heavy bleeding or if it does not stop after 15 minutes. May use Amicar or Tranexamic Acid medicine if prescribed and kept at school. |
| Cuts and scrapes | Wear gloves. Hold pressure. Clean with soap and water as per school protocol. |
| Mouth bleeds | Wear gloves. Apply direct pressure with gauze. Tongue cuts can be more serious. Give cold things like ice or popsicle. Call parents if bleeding does not stop after 15 minutes or re-bleeds. May use Amicar or Tranexamic Acid medicine if prescribed and kept at school. |
| Menorrhagia (heavy or prolonged bleeding during menstruation) | Girls should not be restricted on use of bathroom during their period. Other accommodations may be needed depending on the student. Contact parents as needed especially if complaining of heavy periods or symptoms such as fatigue or dizziness. |
| Fever | If a student has a central line, call parents immediately for a temperature of 100.4° F (38° C) or higher. This student may need to go to the emergency room for evaluation. |
| Head injury | Call 911 for loss of consciousness. Call parents immediately for any head trauma. Watch for symptoms such as nausea, vomiting, severe pain, blurred vision or sleepiness. |
| Throat/neck injury | Call 911 for any breathing trouble due to trauma to neck. Call parents immediately for any trauma to throat or neck injury. Internal bleeds to neck area can be serious. |
| Stomach/abdominal injury | Call parents immediately. Watch for skin color changes, abdominal pain, tightness of the stomach muscles, swelling in the belly area (distended abdomen), increased pulse, and decreased blood pressure. |
Signs and symptoms of a central line infection
- Fever
- Redness, swelling, pain or draining of central line site
- Important to note: most students with a bleeding disorder do NOT have a central line.
Signs of bleeding that may need treatment
- After an injury, monitor for:
- A reported “tingling” or other kind of sensation in a joint such as the knee or ankle
- Decreased range of motion in a joint
- Student refusing to use injured arm or leg
- Arm or leg held in an abnormal position
- Obvious signs of discomfort or pain
- Area of injury warm to touch
- Swelling at the site of injury
- Muscles in the area of the injury are tight or tender to the touch
- Mouth or nose bleeding that is gushing or does not stop after 15 minutes
- Menstrual bleeding that requires having to change feminine hygiene products more than every 2 hours
- More bleeding than is expected for the type of injury
For support, or when unable to reach parent or emergency contact
If a parent or emergency contact cannot be reached, for any need, urgent or not, call:
Seattle Children's Hematology Team
Cancer and Blood Disorders Center 206-987-2106
Ask to speak with a nurse.
To Learn More
- Cancer and Blood Disorders Center
206-987-2106 - Ask your child’s healthcare provider
- seattlechildrens.org/patient-education
Free Interpreter Services
- In the hospital, ask your nurse.
- From outside the hospital, call the toll-free Family Interpreting Line, 1-866-583-1527. Tell the interpreter the name or extension you need.
