Alternatively you can view a full listing of the Haemophilia - General Questions questions and their answers here.

What is haemophilia?

Haemophilia is incurable and without proper treatment, can be life threatening. It is a blood clotting disorder where there is not enough clotting factor VIII (8) or IX (9) in the blood. A clotting factor is a protein in the blood that helps control bleeding.

Haemophilia is an inherited condition and occurs in families. However in 1/3 of cases it appears in families with no previous history of the disorder. The genetic alteration causing haemophilia is passed down from parent to child through generations. Men with haemophilia will pass the gene on to their daughters but not their sons. Women who carry the altered gene can pass the gene on to their sons and daughters. Sons with the gene will have haemophilia. Some women and girls who carry the gene may also experience bleeding problems.

How many people have haemophilia in Australia?

Currently in Australia there are more than 2,700 people with varied degrees of severity.

Who gets haemophilia?

Haemophilia is found in all races and all socio-economic groups.

Are there different types of haemophilia?

Yes. Each 'type' refers to the lack of a specific clotting factor. Factors VIII and IX are the most common deficiencies, however others do exist. Factor VIII deficiency is known as haemophilia A while haemophilia B refers to deficiency of Factor IX. Haemophilia can be mild, moderate or severe, depending on the degree of the deficiency (ie how much factor is missing).

Mild Haemophilia - 5-40% factor VIII or IX activity
Moderate Haemophilia - 1-5% factor VIII or IX activity
Severe Haemophilia - Less than 1% factor VIII or IX activity

Don't people with haemophilia bleed to death if they get scratched?

It is a common myth that people with bleeding disorders will bleed to death if they are cut or scratched. People with haemophilia may find their cuts bleed a little longer than others - but under most conditions they will not bleed to death! Actually, internal bleeding is the biggest concern for people with haemophilia.

What's that about internal bleeding?

People with haemophilia can bleed internally (ie have 'bleeds'). This can happen as a result of injury or surgery, or may happen for no apparent reason.

Can you tell me about bleeds?

Most bleeds are into joints, such as knees and elbows. In other words, blood enters the knee/elbow etc. The blood does not actually leave the body, but fills cavities within the joint. These bleeds are uncomfortable and require treatment, but are rarely fatal. The person with the bleeding disorder will often be able to tell they are having a bleed before signs are visible. They get to know the way a bleed 'feels'. There are many signs of a bleed. These include but are not limited to: warmth, swelling from the affected area and bruising.

Is haemophilia a Royal Disease?

Haemophilia is not a link to Royalty. Haemophilia is, however, sometimes referred to as the Royal Disease because several members of the Royal Family were affected by it in the 1800s. In fact, Queen Victoria of England carried the altered gene causing haemophilia.

Can people with haemophilia play sport?

Yes. Exercise is good for everyone. People with haemophilia will find that sport strengthens joints and muscles, helping prevent bleeds. Care needs to be taken when choosing a sport as rough high contact sports such as football and boxing aren’t usually recommended as they may cause bleeds. People learn to manage their condition and now what is good for them to do and are recommended to speak to their doctor.

Should a child with haemophilia wear protective gear, helmets etc?

Current treatments mean that protective gear for every-day living is not necessary. Like all people, protective gear/helmets should be worn for activities such as riding motorbikes and bicycles, skateboarding and football.

Do people with haemophilia die young?

No, not any more. Treatments currently available in Australia allow people with haemophilia to live a normal lifespan.

Can people with haemophilia travel?

Yes. They just have a little more organising and packing to do. They need to contact their Haemophilia Treatment Centre to organise enough treatment product and equipment for the time they are away. They also need to find out where the nearest Haemophilia Treatment Centres are to where they will be staying. They may also need documentation to carry medication and treatment equipment through security and customs - it is important to talk to their Haemophilia Treatment Centre about this well in advance and allow plenty of time to prepare the documentation.

Alternatively you can view a full listing of the Parents questions and their answers here.

Will my child be okay?

Yes. While haemophilia can’t be ignored, it does not have to rule your life – or your child’s. With correct treatment, your child will be okay.

As you learn more about managing haemophilia, you will become more confident.

What is haemophilia?

Haemophilia is a rare blood clotting disorder in which there are low levels of one of the essential factors, factor VIII (8) or factor IX (9), or the factor in the blood is malfunctioning. These factors help blood clot. When factor levels are significantly reduced, as in haemophilia, bleeding occurs. Cuts may take a little longer to stop bleeding and bleeding may sometimes restart. Internal bleeding into joints and muscles (bleeds) is also experienced.

How serious is it?

While haemophilia is not curable, it is most certainly treatable. With proper treatment, as outlined by your haematologist or Haemophilia Centre staff, there will be very little your child cannot do.

Your child will have a normal life expectancy.

There are a few bleeds (internal bleeding episodes), particularly into the head and throat, that can be very serious – even life threatening. A fall from a height is one of the main causes of head bleeds. Should you suspect your child has a head bleed, take your child to hospital for immediate medical attention. Chapter 3 of the Newly Diagnosed Haemophilia Folder talks more about serious bleeds.

What is the treatment?

Treatment involves injecting the missing clotting factor into a vein. Depending on how severe your child’s haemophilia is, treatment may be required every few days to prevent bleeds from occurring (this is called prophylaxis) or just whenever he has a bleeding episode (on demand). Your haematologist or Haemophilia Centre will tell you more about the right treatment for your child. Chapter 4 of the Newly Diagnosed Haemophilia Folder discusses treatment in more detail.

How will it change our lives?

Haemophilia will mean that you will need to make some changes to your life. However, it shouldn’t alter everything you and your family do, and most importantly you should always treat your child as a little boy or girl first, and a child with haemophilia second.

As your child grows, so will your understanding of haemophilia and how to manage it.

What can I expect?

Each person with haemophilia has his own experience with the disorder. What happens with your child may be different from another child’s experience. Likewise, if you hear about something that has happened to another child, your child may not have the same problem.

Over time you will become skilled at recognising your child’s patterns and when there are problems. However, there are a few generalisations that can be made.

It will take a little while to come to terms with your child’s diagnosis. While things may seem unsettled now, you will learn to deal with it. Many parents who thought they couldn’t cope have been surprised months later when they realise they are coping very well.

Babies usually have very few problems, with the exception of circumcision. As your child becomes mobile, there will be more bruises and bleeds. They are often caused by tumbling as he learns to crawl and walk. This is normal and your Haemophilia Centre will advise you on the appropriate treatment. Older children also get bleeds from rough play and sometimes for no reason at all (spontaneous bleeds). Again, your Haemophilia Centre will advise on appropriate treatments.

There are very few things your child will not be able to do. He will be able to go to regular schools, join in most activities, get a job and have a family.

He may have a lot of bruises, which may take weeks to fade. They are a bit lumpier than usual and don’t look very nice, but they are not harmful.

When your child has a bleed, he will need to have it treated promptly. Frequency of treatment depends upon how severe your child’s haemophilia is and his individual tendency to have bleeds. Treatment is initially given in hospital. If your child requires regular treatment (prophylaxis) and you are comfortable to do so, you can learn to treat at home. Children are generally treated by their Haemophilia Centre initially. Don’t worry about treating at home yet. If home treatment is appropriate for your child, the Centre staff will discuss this with you at some point in the future.

Your child will be able to have babysitters, attend day care and so on. You will just need to ensure that whoever is in charge is aware that your child has haemophilia and knows what to do in an emergency.

Your child CAN travel. Children with haemophilia can holiday with the family, go overseas, attend camps and so on.

Health professionals outside of Haemophilia Centres generally have little or no experience with haemophilia. It is possible that you will know more about haemophilia than your GP. As the parent, you may need to advocate for your child’s needs.

If you have any questions or are not sure of something, contact your Haemophilia Centre. The staff is always happy to help. Please don’t think your questions may seem silly – the staff understand that you are learning about haemophilia and respect that you want what is best for your child. You are entitled to ask questions.

What does mild, moderate and severe haemophilia mean?

Your haematologist will have told you whether your child’s haemophilia is mild, moderate or severe. This is directly related to the percentage of factor VIII (8) or IX (9) in the blood. Knowing factor levels will help determine appropriate treatment and can give you some guide as to what you can expect. In general, people with severe haemophilia can expect more frequent bleeds.

However, each individual is unique and sometimes people with mild haemophilia can have more bleeds than expected, while people with severe haemophilia may have relatively few bleeding episodes. Over time, you will become familiar with your child’s bleeding patterns and be able to predict what is likely to cause a bleed.

How did my child get haemophilia?

Haemophilia is caused by a change (mutation) in the genes. Once a gene has mutated, the change is passed on to future generations through pregnancy. Inheritance is discussed further in chapter 2 of the Newly Diagnosed Haemophilia Folder

Most people with haemophilia have a family member who also has haemophilia. However, around a third of children born with haemophilia have no previous family history of the condition.

Did I do something wrong during pregnancy to cause this?

No, certainly not. Haemophilia is caused by changes in the genes that are beyond our control. Drinking alcohol, smoking, taking drugs and so on during pregnancy do not cause haemophilia.

Haemophilia is caused by genetic changes beyond your control. There is nothing you or your partner could have done to prevent your child having haemophilia.

Will it go away?

Haemophilia is a lifelong condition. It will not just go away. It can, however, be treated effectively.

The severity of haemophilia (i.e. mild, moderate, and severe) does not change and runs true in families. If your father has mild haemophilia, your child will too.

Is haemophilia contagious?

No. People do NOT get haemophilia from living with, being near or sharing a meal with a person with haemophilia. It is only passed on through genetics.

Will my other children have haemophilia?

You may ‘carry’ the gene responsible for haemophilia. In this case, your other children may have haemophilia also. There are tests available to determine whether a woman carries this gene. Your Haemophilia Centre will be able to tell you more about these tests.

What do I do when my child has a bleed?

Your treating doctor or Haemophilia Centre will have outlined what to do in the event of a bleed.

How common is haemophilia?

Haemophilia affects 1 male in 5,000 (or 1 person in 10,000 in the general population). Haemophilia is rare, which explains why you may not have known much about it before you found out your child has the disorder.

Haemophilia A is approximately five times more common than haemophilia B.

Can girls have haemophilia?

Females can ‘carry’ the gene responsible for haemophilia and some may have a bleeding tendency. These females are called ‘symptomatic carriers’. It is very rare for a female to have severe haemophilia. However, some females have factor levels in the range for mild haemophilia (5-40% of normal clotting factor) and may also be described as having "mild haemophilia".

Do NOT give your child aspirin

People with haemophilia should NOT take aspirin as it promotes bleeding. Paracetamol is a suitable alternative.

Some prescription medications and over-the-counter chemist preparations contain aspirin. Cold and flu medications are one example. If your child is given a prescription, or if you purchase an over-the-counter medication, check whether it is suitable for a person with haemophilia. Your clinician or pharmacist will be able to advise you on suitable products.

Alternatively you can view a full listing of the Adults questions and their answers here.

I have had a lot of bleeds in the same joint recently. What is happening and what can I do to stop it?

It sounds as though what you have is called a "target joint". Even though you may have had the "correct" treatment for joint bleeds, almost every adult today has some degree of joint damage. Once a joint has had a bleed it may take up to six weeks for the blood to be fully re-absorbed into the system. This is when it is most likely to bleed again because as the joint is healing more blood flows to the site and so a vicious cycle is set up. The way to stop this happening, once it starts, is to have prophylactic (preventative) treatment 2-3 times weekly to keep the factor level high enough to prevent that spontaneous re-bleeding. If this treatment fails, there are some other more complicated treatment options which should be discussed with your haemophilia specialist.

How do I tell the difference between a bleed and arthritis?

If you have had a lot of bleeding into a particular joint over many years, it is likely there will be a degree of arthritis there. Arthritis tends to be at its worst first thing in the morning and eases slightly as the day progresses and with movement. A bleed, even if it is not acute, gets gradually worse, more swollen and painful. If factor replacement is making no difference then it probably is arthritis. An x-ray and visit to your rheumatologist would confirm this. There are medications available for people with haemophilia and arthritis, so consult your Haemophilia Centre.

What is the shelf life of Factor VIII and IX, and how should they be stored?

Factor VIII and IX have a shelf life of two years. Recombinant products have a shelf life of three years. It is recommended that a close eye is kept on the expiry dates and when the product goes close to this date people should bring it into the Haemophilia Centre and it will be exchanged for fresher product. It is recommended that all products are best stored in the refrigerator, but time in normal room temperature will do no harm.

Will my children inherit haemophilia?

Haemophilia is an inherited condition and occurs in families. However in 1/3 of cases it appears in families with no previous history of the disorder. The gene causing haemophilia is passed down from parent to child through generations. Men with haemophilia will pass the gene on to their daughters but not their sons. Women who carry the gene causing haemophilia can pass the gene on to their sons and daughters. Sons with the gene will have haemophilia. Some women and girls who carry the gene may also experience bleeding problems.

The diagrams below may assist in understanding this. The solid red males are those with haemophilia; the red and blue females carry the gene.

Haemophilia Genetic Inheritance Diagram

I can't find a General Practitioner who knows anything about haemophilia. How do I do this?

This is not surprising considering there are very few people with haemophilia in Australia. Most GPs will never meet anyone with haemophilia unless they have worked in a hospital where there is a Haemophilia Centre of some kind. People with haemophilia are encouraged to keep themselves as educated about current trends in haemophilia and to find a GP who is interested enough to learn more about haemophilia and liaise with your Haemophilia Centre regarding your care. Your GP can also be placed on a mailing list to receive regular information on haemophilia from HFA. For people in rural areas, it is often better to establish a long-term relationship with a well informed GP than depend upon assistance from small hospitals with rotating staff.

I am having problems with my veins. What can I do?

This is sometimes a problem in older people who have had many, many venepunctures over the years, made worse by the use of "cut downs" (surgical exposure) of the veins which means they cannot be used again. It also can be because of poor health, hydration, obesity or lack of muscle tone. If you have tried to take measures in all these areas and cannot find a new vein, contact your Haemophilia Centre to discuss the options of venous access devices such as a port-a-cath. This is a small box attached to a tube which is inserted under the skin and directly into a vein. It can then be readily accessed with a special needle. This does, however, have some complications so it should be discussed at length with your specialist.

I have blood in my urine. How should I treat myself?

Blood in the urine is medically called haematuria. It is a common occurrence in some people with haemophilia and usually seems to be for no reason at all. (In people without haemophilia, it can be a sign of serious disorders.) A small amount of blood in the urine can look far more frightening than it actually is, but it needs to be investigated nevertheless. Sometimes the haematuria can be stopped by increasing the fluid intake to 3-4 litres per day and "flushing out" the system. If it continues, factor treatment will be required, but only do this with consultation with your Haemophilia Centre. It is also important not to take antifibrinolytic medication such as Cyclokapron or Amicar as these can cause small clots which can block the urinary tract and cause intense pain.    

Alternatively you can view a full listing of the Children questions and their answers here.

Should I tell my friends that I have haemophilia?

That's something you might want to talk to your parents about or your Treatment Centre, but it is your choice. Sometimes the best explanation is for you to tell them, but you could also ask the nurse from your Treatment Centre to go to the school and talk to your teachers and/or the kids in your class.

Can I go on school camp?

Yes. When your teachers are planning the camp or any excursions they will speak to your parents about any help you might need while you are away. Before you go away your Haemophilia Centre can write to the nearest hospital or GP in the area that you are going to, to explain what care you might need while you are there. You can take your treatment product and sterile supplies with you and the GP or a doctor at the hospital can give you your treatment or contact your Haemophilia Centre if they have any queries. Sometimes your mum and dad might come on the camp to help out as one of the parent helpers.

What is a "port"?

A port or infusaport is a special device that is put under the skin on your chest. It has a tube that goes into one of your big veins in the neck. You can use this port for your treatment instead of seeking out a new vein in your arm. You need a small operation to have the port put in.

Does it hurt when you use the port?

No. When you have your treatment through your port we put "magic cream" or special numbing cream on the skin that is over the port so you don't feel the needle. Sometimes you can feel a little pushing when the needle goes in, but that doesn't hurt.

Can I play football?

Yes, you can play non-contact football. It is good to learn skills and how to play safely. Talk to your Haemophilia Centre about it.

What happens if I have a bleed when I have exams at school?

Usually schools are very helpful about rescheduling exams if medically necessary. They will probably need a letter from your doctor and an estimated time as to when you will be back at school. In the senior years at high school you can apply for consideration of disadvantage in advance so that, should you need it, arrangements are made on your behalf.

Alternatively you can view a full listing of the Von Willebrand Disorder questions and their answers here.

What is Von Willebrand Disorder (VWD)?

Von Willebrand disorder (VWD) is a bleeding disorder in which people do not have enough of a protein called von Willebrand factor in their blood or the von Willebrand factor does not work properly. Because of these problems, it takes longer for bleeding episodes to stop. VWD is common but not well known, affecting approximately 1% of the population. However, many people will experience few symptoms and many are currently undiagnosed.

VWD affects approximately 200,000 people in Australia. Numbers of those known to have VWD are ever increasing as more people are diagnosed. Most people with VWD have a mild form with few or no symptoms. Unlike haemophilia, von Willebrand disorder occurs in males and females equally.

Symptoms may include frequent nose and gum bleeds, bleeding after dental surgery, easy bruising, heavy menstrual periods or severe bleeding after trauma or surgery. In some cases, bleeding occurs into joints and muscles.

Is von Willebrand disorder only an inherited condition?

There is not always a family history. Some children have VWD because there was a mutation, or change in the gene, during the foetal stage. When this happens the person's chances of passing von Willebrand disorder on to his/her children are the same as those of a parent who has inherited the condition. VWD can also be acquired rather than inherited, but this is very rare.

Can women get VWD?

Yes. Because the VWD gene is linked to an autosome (a chromosome that is not a sex chromosome), not an X or Y chromosome, both males AND females can carry - and be affected by VWD.

I'm a woman with VWD. Can I have children?

Yes, you can have children. For more information on go to the Women with Bleeding Disorders section.

What is von Willebrand factor and what does it do?

When blood vessels are damaged, platelets (tiny particles in the blood) clump together at the site of injury; von Willebrand factor is like glue that makes these platelets stick to the areas of blood vessel that are damaged. Von Willebrand factor also acts as a protector of clotting factor VIII. This means some people with von Willebrand disorder may also have a lower amount of factor VIII.

What are the types of von Willebrand disorder?

VWD is divided into "types" according to whether a person has a low amount of von Willebrand factor or has a type of von Willebrand factor that does not work properly, or both. Knowing the type of von Willebrand disorder helps the doctor decide what kind of treatment would be best for that person.

  • Type 1: This is the most common form of von Willebrand disorder and is usually of mild severity. A person with type 1 von Willebrand disorder has low levels of von Willebrand factor but the von Willebrand factor present functions normally. People with type 1 make up more than 75% of cases of this disorder.
  • Type 2: A person with type 2 often has a normal amount of von Willebrand factor in their blood but has an irregularity in the von Willebrand factor they produce. This type is divided into sub-type 2A, 2B, 2M and 2N. Certain sub-types might require different treatment, which makes knowing the exact type of VWD you have very important.
  • Type 3: A person with type 3 has a total or near total absence of von Willebrand factor. A person with type 3 has severe von Willebrand disorder. He or she will experience regular and/or severe bleeding problems. These could include frequent nose bleeds or heavy periods that require treatment to limit the bleeding. Bleeds into joints and muscles are also common in this type of von Willebrand disorder. People with severe von Willebrand disorder will need treatment before and after any type of surgical or dental procedure. Type 3 is the rarest form of von Willebrand disorder.

How common is VWD?

Figures vary greatly. Some studies indicate it could affect up to 1% of the population. This is one person in 100.

If VWD is so common, why haven't I heard of it?

VWD is usually less severe than haemophilia. For many, it is often so mild that it is not diagnosed at all unless the person has surgery or a major accident.

Why is the condition called VWD?

VWD was discovered in 1925 by, and named after, the Finnish doctor Erik von Willebrand. Professor von Willebrand described this new type of bleeding disorder after observing families living on the Aaland Islands between Sweden and Finland who had bleeding problems. It is also known as von Willebrand disease.

How is VWD different from haemophilia?

The disorder affects both males and females in equal numbers whereas haemophilia tends to mainly affect males. Most people with VWD do not have bleeding symptoms, except during or after surgery or accidents. Those who do bleed, do so mainly from the nose, the intestinal tract and into the skin. People with haemophilia bleed mainly into joints and muscles.

Does everyone carrying the VWD gene have bleeding symptoms?

No. Many people have no symptoms. In fact, they may not even realise they have it. However, the condition can still be passed on to children.

Do I have VWD?

A few bruises do not necessarily indicate the presence of VWD. However, if you think you may have VWD, talk to your doctor about your concerns.

What about surgery?

Surgery, including tooth extractions, can cause bleeding for people with VWD. It is important you tell your surgeon you have VWD well before your surgery date so he/she can work with your haematologist and other key staff to ensure you receive the best possible treatment and care.

Alternatively you can view a full listing of the Women questions and their answers here.

Don’t bleeding disorders just affect males?

No. Bleeding disorders can affect females as well as males.

Which bleeding disorder most commonly affects women?

Von Willebrand disorder (VWD) is the most common bleeding disorder. It affects males and females equally, though women tend to have the added issue of menstruation. For more information click here.

Can females have haemophilia?

Many girls or women who carry the altered gene causing haemophilia do not have symptoms of a bleeding disorder. But some do have a bleeding tendency. They are often described as “symptomatic carriers”. If their factor levels fall in the range for mild haemophilia (5-40% of normal clotting factor), they have mild haemophilia. In some very rare cases girls and women have particularly low factor levels causing them to have moderate or severe haemophilia. Some women with factor levels between 40% and 60% of normal also experience abnormal bleeding. For more information click here.

Alternatively you can view a full listing of the Travel questions and their answers here.

What do I need to do if I am travelling?

Everyone has individual needs regarding travel, and it would be valuable to contact your Haemophilia Treatment Centre a few months before departure to plan ahead.

  • Talk to your Haemophilia Centre beforehand if you are travelling interstate or overseas. They can help you prepare depending on your individual situation. They can also advise on documentation, medication and travel insurance
  • Discuss with your Haemophilia Centre if you need to take treatment with you
  • You may not need them, but just in case, find out the contact details of Haemophilia Centres along your route
  • You will need to obtain travel insurance for overseas travel
  • Consider telling your travelling companions what to do to help you in case of an emergency
  • With airplane and overseas travel you may need further documentation to carry medication and treatment equipment through security and customs – talk to your Haemophilia Centre about this well in advance and allow plenty of time to prepare the documentation.

Useful travel web sites:

Smarttraveller – Australian Government. Dept of Foreign Affairs and Trade
Australian Haemophilia Centres
World Federation of Hemophilia Global Treatment Centre Directory
Australians Overseas - Australian Government. Dept of Human Services

Date last reviewed: October 2011