Treatment plans

Most women and girls with bleeding disorders don’t need regular treatment, but it is important that they have a treatment plan (“action plan”) in case urgent treatment is needed (e.g., for urgent surgery or following an injury).

There are a number of situations where treatment may be required:

  • To reduce or manage bleeding problems with your periods
  • To reduce or manage other bleeding problems (eg. recurrent nosebleeds)
  • In preparation for surgery, medical procedures, dental treatment or giving birth
  • After an injury or accident

There are several different types of treatment for bleeding disorders.

The type of treatment that will be most useful may vary at different times and will depend on your individual diagnosis and situation. Your haematologist will look at all of this and will involve other doctors (for example a gynaecologist) and members of the Haemophilia Team (for example a physiotherapist). If you have a lot of problems with bleeding symptoms, the Haemophilia Treatment Centre may ask you to visit regularly to develop and monitor a treatment plan, but this will depend on your individual situation.

What are the types of treatments used?
  • Protection, Rest, Ice, Compression and Elevation (PRICE): These steps are important to minimise swelling or bruising. PRICE is a simple treatment for minor soft tissue injuries that may lead to bruising or haematoma (large bruises with a lump).
     
  • Tranexamic acid is an oral medication (anti-fibrinolytic) that can be useful in managing heavy periods, nosebleeds and after minor injuries or procedures in the mouth, eg dental work.
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  • Hormonal therapies (for example, the contraceptive pill or the Mirena IUD/ intrauterine device) for problematic menstrual bleeding are prescribed with input from a gynaecologist.
     
  • DDAVP (Desmopressin) is a laboratory-made version of a hormone that raises the levels of factor VIII and von Willebrand factor. It may be useful in managing bleeding or before surgery in girls and women who have a reduced factor VIII level or who have certain subtypes of VWD. It sometimes works well in treating platelet storage pool deficiencies. Not all young women and girls respond to this medication, so your Haemophilia Treatment Centre may arrange for you to have a test dose first with some blood tests afterwards to check your response.
     
  • Clotting factor concentrates may be required to treat bleeds, or before surgery in girls and women with haemophilia and with some rare clotting factor deficiencies. It’s also given to young women and girls with VWD who do not respond adequately to DDAVP. These are given into a vein. Multiple infusions may be needed over a number of days depending on your clotting factor level and the procedure being done.  Some girls and women with severe bleeding disorders have ‘prophylaxis’, which is regular treatment to prevent bleeds.

Factor concentrates for haemophilia A and B are “recombinant”, which means they are synthetic, made by genetic engineering. The factor concentrate that is currently available for VWD in Australia is made from the plasma (pale yellow fluid part) in human blood, but is then highly purified and treated.

In some rare bleeding disorders a specific clotting factor concentrate has not yet been developed or is not suitable for treatment. Other blood products may be used:

  • Fresh frozen plasma is made from the plasma (pale yellow fluid part) in human blood. It contains the range of proteins (factors) needed to help blood to clot. It is stored frozen and thawed for treatment, when it is infused (injected) into a vein. In Australia it is sometimes used to treat rare clotting factor deficiencies, such as factor V (5) deficiency.
  • Cryoprecipitate is also made from the plasma (pale yellow fluid part) in human blood and is infused (injected) into a vein. It contains specific blood clotting proteins (factors) including fibrinogen, factor VIII (8), factor XIII (13) and von Willebrand factor. In Australia it would only be used in an emergency when other suitable products are not available.
  • Platelet transfusion may be required for more severe inherited platelet function disorders. To avoid reactions to platelets, the transfusions are often carefully matched to the individual person. This requires specialised testing which can take some weeks.
More information

Contact details of Haemophilia Treatment Centres in Australia are available on the HFA website. [link to https://www.haemophilia.org.au/support-services/treatment-services]

For more information on bleeding disorders in young women read our full Female Factors resource

If you’d like to know more about treatment plans and bleeding disorders download our Female Factors – Working with your Haemophilia Treatment Centre resource here. This contains more information on treatment and bleeding disorders including:

  • How does your treatment plan help you?
  • What are the types of treatments used?
  • Other forms of treatment
  • Registering with your Haemophilia Treatment Centre
  • ABDR and an ABDR patient card