In caring for a child with hemophilia, which history finding would you expect?

• A. Lymphadenopathy
• B. Acute chest syndrome
• C. Hematuria
• D. Nosebleeds

Answer: (D)

In hemophilia, the intrinsic coagulation pathway is defective, so bleeding tends to occur more readily and last longer, especially from mucosal surfaces. The nose is rich in small blood vessels and is easily injured, so frequent or prolonged nosebleeds (epistaxis) are a classic history finding in a child with a bleeding disorder. Lymphadenopathy isn’t tied to a clotting problem, and acute chest syndrome is a complication seen with sickle cell disease, not hemophilia. Hematuria can occur with bleeding disorders but nasal bleeding is a more characteristic and common historical clue in this context.