Head Injury with a Bleeding Disorder

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What is a head injury?

A head injury is a blow or trauma to the head. The signs of an injury may be found right after the injury, or they may develop anytime within 2 weeks afterward.

Bleeding disorders increase the risk of problems following a head injury. Bleeding in or around the brain can be life-threatening or result in permanent nerve damage. For this reason, any significant head, neck, or spine injury requires factor replacement right away, a CT scan, and evaluation by a health care professional.

Please note: though it is less likely that a child will have a head bleed while on factor prophylaxis, it is still possible and should be treated accordingly.

How likely is it that bleeding would occur?

Possible	soft bump
Probable	hard bump to the head
Highly likely	motor vehicle accident hard bump to the head on a hard surface falling and hitting head on hard surface or sharp corner loss of consciousness

What are the signs of bleeding in or around the brain?

Watch for the following neurologic (brain or spinal cord) changes:

• any loss of consciousness (even if brief)
• headache
• irritable
• tingling or numbness in hands or feet
• nausea with or without vomiting
• pale skin color
• blurred or double vision
• sensitive to light
• drowsy, difficult to wake from sleep
• sluggish (not interested in play)
• clumsy, stumbling
• slurred speech
• confused
• oss of appetite
• any change in behavior

If your child has NO neurologic changes:

1. Give 100 units/kg of factor VIII or IX right away if possible. If you do not know your child's weight, give 3 times the usual dose used to treat a joint bleed.
2. Call your hemophilia nurse or doctor to report what happened and to arrange to be seen in the emergency room.

If your child has ANY of the neurologic changes listed above:

1. Call 911 for an ambulance to the emergency room at                                              .
2. Call the hematologist on call at 612-813-5940. Tell the staff that it is an emergency and to page the hemophilia doctor or nurse, or the doctor on call. The doctor can then arrange for more efficient care in the emergency room. If this is not possible, please contact the hemophilia nurse or doctor once you arrive at the hospital.
3. Give 100 units/kg of factor VIII or IX right away. If you do not know your child's weight, give 3 times the usual dose used to treat a joint bleed. If you are unable to give the factor, bring it with you to the emergency room. Bring treatment recommendations with you to the emergency room. Remember "Factor First" in the emergency room, which means factor is given first before testing is done.

What should I do after my child goes home from the hospital or emergency room?

Watch your child closely for any neurologic changes for the next few days. Wake your child every 3 hours during the night for the first 24 hours after the injury. If there are any neurologic changes, give the factor again and return to the emergency room right away.

What else do I need to know?

Any significant head injury or history of a head bleed requires factor replacement and a CT scan.

Signs of head injury may be subtle. If your child does not look normal to you, or is not acting right, please contact us right away! These are some questions you may be asked by the nurse or doctor when you call:

• What happened?
• When did it happen?
• Are there any signs of head injury?
• Where on the head did the injury occur?
• Is a bump or bruise on the head? If so, where is it, and what does it look like?
• What treatment have you given?

Be sure to discuss with your hemophilia team which emergency department to use. Post this information by your phone, to be used if you need to call 911.

Questions?

This is not specific to your child, but provides general information. If you have any questions about your child's condition, please call the Hematology/Oncology clinic.

Children's Hospitals and Clinics of Minnesota
Patient/Family Education
2525 Chicago Avenue South
Minneapolis, MN 55404

Last Reviewed Hematology 7/2015 ©Copyright

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