When Clark’s older brother got a nosebleed, we quickly calmed him down, pinched his nose and tilted his head forward. The bleeding usually stopped within a minute and we would then dust him off, and send him out into harms way again.
With our second child, Clark, it is amazing how different this simple injury has changed for us.
Clark woke up the other day with bloody sheets and a nose slowly oozing red. There are lots of reasons he might have a nosebleed:
- banging his head accidentally when he was sleeping
- itching his nose
- dry summer air
As well, of course, spontaneous nose and/ or gum bleeds from his Aplastic Anemia. Low platelets is one example of something that might cause this.
Nosebleeds can also be difficult for someone with hemophilia since it is difficult to stop the bleeding. Couple this with low platelets, and we figured we were just seeing a little more active bleed than normal.
Clark was scheduled to get his platelets that day, so at first we weren’t concerned at all. Our first thought was: get him his regular platelet transfusion, and it should help stop the bleed. Clark received the platelets, and all was looking well. He had a little more color in his cheeks, and the bleeding has stopped.
Until the drive home. :(
When I arrived home and took Clark out of his carseat, I noticed that his nose had started bleeding again and blood was all over his face. I immediately gave him a dose of Amicar knowing that this drug helps to prevent saliva/ mucous from breaking down a clot. Unfortunately, an hour later and his nose was still bleeding. A quick call to the hematologist has us trying to squeeze Clark’s nose shut for 15 minutes. (This, let me tell you, Clark did not like! I think he may never let us touch his nose again.)
Squeezing didn’t help either. So I ended up driving back to the clinic for Clark to get an infusion of Factor VIII, hoping this might be the issue. (Factor VIII gives him the clotting factor that hemophiliacs are missing.) While at the clinic getting the factor treatment, we did another CBC.
This is where things got interesting.
It turns out Clark’s hemoglobin (red blood cells) were low. He was at 6.7 and the doctors like to transfuse at 7 or less (normal healthy people are closer to 10).
At the time, my first thought was what would this have to do with it? Red blood cells aren’t used for clotting. When you are low on red blood cells, you are getting less oxygen (carried by red blood cells) to your organs, which can manifest itself in a child being lethargic. No signs of that with Clark at this point.
But what we didn’t think about, was the fact that while Clark’s energy appeared normal, he was maintaining this energy by having his heart work twice as hard to get oxygen around his body. Which means his blood pressure was also elevated. As such, his nose wasn’t able to heal due to the pressure of his blood circulating around his body. Think of it this way, if you had a bloody nose, and then started to sprint as hard as you could – would your nose heal? No, it would probably start to gush. This was effectively what was happening to him.
Sure enough, once he got his blood transfusion, his nose stopped bleeding altogether, and he (and I) could finally calm down and relax. Once again proving, that with a Hemophiliac / Aplastic Anemia child, even the simplest of issues can cause huge problems.