What are the key management strategies for a patient with mild haemophilia presenting with a bleeding episode?

Key management strategies for a patient with mild haemophilia presenting with a bleeding episode include:

• Initial assessment and local measures: Promptly assess the bleeding severity and apply local measures such as direct pressure and immobilisation to control bleeding. Mild haemophilia patients often respond to these simple interventions initially NICE CKS.
• Replacement therapy: Administer clotting factor concentrates (factor VIII or IX depending on haemophilia type) to raise factor levels and control bleeding. In mild haemophilia, factor replacement is typically given if bleeding is significant or not controlled by local measures Mahlangu et al. 2008Chowdary et al. 2025.
• Use of adjunctive agents: Consider antifibrinolytic agents such as tranexamic acid to support haemostasis, especially for mucosal bleeding sites, unless contraindicated NICE CKS; Franchini et al. 2010.
• Monitoring and specialist involvement: Monitor haemodynamic status and bleeding progression closely. Referral to or consultation with a haematologist is essential for guidance on factor dosing and further management, especially if bleeding is severe or recurrent NICE CKS; Chowdary et al. 2025.
• Avoidance of medications that increase bleeding risk: Non-steroidal anti-inflammatory drugs should be avoided as they can exacerbate bleeding NICE NG121.
• Admission criteria: Admit the patient if bleeding is significant, uncontrolled by initial measures, or if there is haemodynamic compromise NICE CKS.
• Patient education: Inform patients about the importance of early treatment of bleeding episodes and when to seek urgent care NICE CKS.

These strategies integrate UK clinical practice emphasizing early local control, specialist referral, and cautious use of factor replacement with evidence from haemophilia literature supporting factor concentrate use and adjunctive antifibrinolytics in mild haemophilia bleeding episodes Mahlangu et al. 2008Franchini et al. 2010Chowdary et al. 2025.