What are the symptoms of hemophilia?

Hemophilia does not make people bleed faster. It interferes with the blood's ability to form stable clots, so bleeding may continue longer than expected, occur after minor injuries, or be more severe than the situation would normally cause.

Hemophilia symptoms can include:

• Bleeding that is difficult to stop
• Bleeding after an injury or procedure
• Frequent hard-to-stop nosebleeds
• Easy bruising
• Bleeding into joints, muscles, or soft tissue

Bleeding into a joint may cause swelling, pain, or tightness, often in the knees, elbows, or ankles. Over time, repeated joint bleeds can affect how joints feel and function, which may lead to mobility challenges as a person ages with hemophilia. Learn more about Aging with hemophilia: What changes after 40?

Women and girls with hemophilia may also experience heavy menstrual bleeding. Learn more about How does hemophilia affect women and girls?

Some of these symptoms also occur in other bleeding disorders. Easy bruising, heavy menstrual periods, and frequent nosebleeds can be signs of a bleeding disorder, but not necessarily hemophilia.

Any unexpected or persistent bleeding is worth discussing with a healthcare professional. A clinician may review the pattern of bleeding, medical and family history, medicines, and blood clotting tests to reach a diagnosis.

Is von Willebrand disease the same as hemophilia?

No, von Willebrand disease and hemophilia are different conditions, caused by different proteins. Von Willebrand disease is the most common inherited bleeding disorder, and it’s more common than hemophilia. It is caused by low or malfunctioning von Willebrand factor (VWF), a protein that helps blood clot properly. This is different from clotting factor VIII in hemophilia A and clotting factor IX in hemophilia B.

The kinds of bleeding tend to differ between hemophilia and von Willebrand disease, too. In hemophilia A and B, bleeding is often musculoskeletal, meaning bleeding into joints and muscles, although bleeding patterns can vary.

In von Willebrand disease, bleeding is more often mucocutaneous, meaning it is associated with easy bruising, frequent nosebleeds, heavy menstrual bleeding, and bleeding after a procedure or injury.

Joint bleeding is uncommon in von Willebrand disease and mainly occurs in the most severe form of the disease. Symptoms can overlap, so testing is needed to distinguish one condition from another.

It is possible for more than one bleeding disorder to be considered during an evaluation. Only a healthcare professional can interpret symptoms and test results in context.

Why are these bleeding conditions so often confused?

A few things work together to make these bleeding conditions easy to mix up: the names sound alike, some of the symptoms overlap, and most sources explain each condition separately rather than discussing how they relate to one another. Here’s a summary to help.

The first thing that helps is understanding the family structure. A “bleeding disorder” is the umbrella term. It is a broad family that includes hemophilia A, hemophilia B, hemophilia C, von Willebrand disease, and acquired hemophilia. These are separate disorders that affect how the body controls bleeding. They are not versions of the same condition.

Hemophilia A, B, and C, along with von Willebrand disease, are inherited bleeding disorders involving different clotting factors. Acquired hemophilia is different. It is an autoimmune condition that develops when the immune system mistakenly attacks a clotting factor, rather than a condition inherited through a genetic change.

The second piece is understanding that symptoms can overlap. Easy bruising, prolonged bleeding, and heavy menstrual bleeding can be present in hemophilia, von Willebrand disease, and other bleeding disorders. Because of that overlap, symptoms alone are not enough to distinguish one condition from another. Healthcare providers look at the overall pattern of bleeding, including where it occurs, how often it happens, and what seems to trigger it.

Diagnosing a specific bleeding disorder ultimately requires clotting factor tests, which are also called factor assays. If you have symptoms that could point to a bleeding disorder, a healthcare provider can help determine whether testing is appropriate and what disorder, if any, may be present.

How Hemophilia Types and von Willebrand Disease compare

Hemophilia A, hemophilia B, and hemophilia C are types of hemophilia distinguished by clotting factors VIII, IX, and XI, respectively. Von Willebrand disease is a separate inherited bleeding disorder, and acquired hemophilia A develops when antibodies interfere with clotting factor VIII.

Here are the similarities and differences at a glance:

Bring the right questions to your care team

If you've noticed unusual bleeding in yourself or a loved one, a few details can help your healthcare provider understand what's happening. Consider writing down when the bleeding happened, how long it lasted, whether it followed an injury, dental work, surgery, pregnancy, or childbirth, and whether relatives have had similar bleeding patterns. Bring a list of medicines and supplements as well because a clinician may need the full context. For help preparing for the conversation, use the Doctor Discussion Guide.

Questions to consider asking include:

• Could my bleeding pattern suggest a bleeding disorder?
• Would screening or clotting factor tests help clarify the cause?
• If I have hemophilia, which factor and severity are involved?
• Could von Willebrand disease or a platelet problem be part of the evaluation?
• Should I take any precautions before a dental or medical procedure?

Ready to have a conversation with your doctor? Visit Connect to Care to get started.