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CION Cancer Clinics
Head injury with haemophilia or a low platelet count: go to hospital now | CION Cancer Clinics
Any knock to the head is an emergency if you have haemophilia or a very low platelet count, even when you feel well. Call 108 or go to the nearest emergency department now, and say the diagnosis at the door. A bleed inside the head can grow slowly before symptoms appear. This page covers what to do first, the warning signs to watch and what the hospital should do. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Is a small knock to the head really an emergency?
- What should you do in the first few minutes?
- Which signs after a head injury mean the bleed may be growing?
- What should the hospital do?
- What do the words on the hospital notes mean?
- What do families often believe that delays help?
- What can this page not tell you?
- Common questions about head injury with a bleeding disorder
The short answer
Is a small knock to the head really an emergency?
Yes. If you have haemophilia or a very low platelet count, any knock to the head needs an emergency department the same hour, even if you feel fine. Call 108 or go to the nearest hospital, and say the diagnosis as soon as you arrive.
Why it is different for you
In most people, a small bleed inside the head stops on its own because the blood clots. In haemophilia, a clotting protein is missing or low. With a low platelet count (thrombocytopenia, meaning too few of the cells that plug a bleeding blood vessel), the first seal does not form well. A slow bleed can then keep growing and press on the brain.
Why feeling well is not enough
A bleed inside the head can take time to cause symptoms. A child may play normally for hours and then become sleepy or start vomiting. By then, treatment is harder. This is why doctors often give clotting treatment before the scan, not after it.
A bump on the forehead, a fall from a bed, a cricket ball or a minor road accident all count. Size of the bump does not tell you what is happening inside.Right now
What should you do in the first few minutes?
Stop and stay calm
Sit or lie the person down. Stop the game, the ride or the work. Press gently on any cut with a clean cloth. Note roughly when the knock happened.
Call 108 or leave for hospital
Go to the nearest emergency department that can start treatment. Do not wait to see whether a headache or vomiting appears first. Someone else should drive.
Take the card and reports
Bring the emergency card, recent blood reports, any inhibitor result and the haematology team's number. If factor is kept at home, follow your written plan and bring the vial label.
Ask before any painkiller
Some common painkillers make bleeding worse. Ask the emergency doctor what is safe, and tell them about every medicine already taken today.
Not sure whether this applies to you?
Ask an oncologistWatch closely
Which signs after a head injury mean the bleed may be growing?
These can appear soon after the knock or later. Any one of them means going back to the emergency department straight away, even if a scan was normal.
In adults and older children
Symptoms often start quietly and grow worse over time.
- A headache that gets worse
- Vomiting more than once
- Unusual sleepiness or confusion
- Blurred or double vision
In babies and small children
A child cannot tell you about a headache, so watch behaviour.
- Crying that will not settle
- Refusing feeds or repeated vomiting
- A tense or bulging soft spot on the head
- Floppy, unusually quiet or hard to wake
Signs that need 108 now
These mean pressure on the brain may be rising fast.
- A fit or seizure
- Weakness or numbness on one side
- Slurred speech
- Passing out, even briefly
In older adults
Changes can be slow and look like tiredness or a bad mood. Unusual forgetfulness, unsteady walking or loss of interest after a fall should be checked, especially in someone with a low platelet count.
At the emergency department
What should the hospital do?
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See you quickly
Show the card and name the disorder at the triage desk. A head injury in someone with a bleeding disorder should not wait in the general queue.
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Start clotting treatment early
For haemophilia, this is usually the missing clotting factor. For a very low platelet count, it may be a platelet transfusion or another medicine, depending on the cause. It is often started before the scan.
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A CT scan of the head
A CT scan looks for bleeding inside the skull. A normal first scan is reassuring, but it does not end the watching, because some bleeds show up later.
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Blood tests and advice from haematology
A blood count, clotting tests and sometimes a factor level. The emergency doctors should talk to a haematologist about how much treatment is needed and for how long.
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Watching before and after going home
Many people are kept for observation. If you are sent home, a responsible adult should stay with the person, and you should be told clearly which signs mean coming straight back.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
On the discharge summary
What do the words on the hospital notes mean?
- Intracranial bleed
- Bleeding anywhere inside the skull. The notes may name where it is.
- Subdural haematoma
- A collection of blood between the brain and its outer covering. It can grow slowly over days.
- Factor level
- How much clotting factor is in the blood, shown as a percentage of normal. It guides how much treatment is given.
- Inhibitor
- An antibody that blocks factor treatment. If present, a different treatment is needed.
- Platelet count
- The number of clotting cells in the blood. Reference ranges differ between laboratories, and a single result is read with symptoms and repeat tests.
- GCS
- A score doctors use to record how awake and responsive someone is. A falling score is a warning sign.
Commonly believed
What do families often believe that delays help?
"There is no bump or cut, so nothing happened inside."
A bleed inside the head can start without any mark on the outside. With a bleeding disorder, the force of the knock matters more than what you can see. Go to hospital anyway.
"Let him sleep it off and see how he is in the morning."
Sleepiness can be the first sign of a growing bleed, and a sleeping person cannot tell you their headache is worse. Get checked first. If doctors send you home, they will tell you how to watch overnight.
"The scan was normal, so we can stop worrying."
An early scan can miss a bleed that is still starting. Keep watching for the warning signs over the following days, and go back at once if any of them appear.
"His haemophilia is mild, so a head knock is less serious."
Mild haemophilia still slows clotting after a real injury. People with mild disease sometimes delay because they bleed rarely. A head injury is treated as urgent whatever the severity.
Being straight with you
What can this page not tell you?
This page cannot tell you whether a particular knock caused a bleed. Only an examination, a scan and blood tests can answer that, and sometimes only after a period of watching. When in doubt, go.
It is not a treatment plan
We give no doses here. Nobody should start, stop or change clotting treatment, platelet treatment or a blood thinner on their own. How much treatment is needed depends on the disorder, its severity, any inhibitor and the injury itself, and the treating team decides that.
Where CION fits
CION is not an emergency department. In a head injury, the nearest hospital that can start treatment comes first. Afterwards, CION's haematology team, led by Dr. Basudev Pokhrel, can review the admission, look at why the counts or factor levels were low, and help plan care with qualified centres. Ask whether your home plan should change, whether a helmet or activity advice would help, and how to keep an up-to-date emergency card.
If you care for a child with a bleeding disorder, tell the school and anyone who looks after them what a head knock means.Questions we are asked
Common questions about head injury with a bleeding disorder
My child with haemophilia hit his head but is playing normally. Must we go?
Yes. Playing normally does not rule out a bleed inside the head, because symptoms can appear later. Call your haematology team on the way if you can, follow your written plan for home treatment, and go to the nearest emergency department now. Tell them he has haemophilia as soon as you arrive.
How low does a platelet count have to be for a head knock to be risky?
There is no single safe line that fits everyone. The risk depends on the cause of the low count, how fast it fell, other medicines and the injury. Reference ranges differ between laboratories. If you have been told your count is low and you hit your head, go to hospital and let the doctors judge.
Will they give treatment before the CT scan?
Often, yes. For a person with haemophilia and a possible head bleed, emergency teams commonly give clotting factor first, because waiting for the scan wastes time if a bleed is growing. For a low platelet count, the decision depends on the cause and the blood test results.
Is a CT scan safe for a child?
A CT scan uses a small amount of radiation, and doctors try to use it only when it is needed. In a child with a bleeding disorder and a head injury, missing a bleed inside the skull is a much greater danger. Ask the doctor to explain why the scan is being done.
What if we live far from a big hospital?
Go to the nearest emergency department that can assess you, and call 108 if the person is unwell. That hospital can start treatment, speak to a haematologist by phone and arrange a transfer if needed. Travelling hours to a preferred hospital first can cost valuable time.
Can I take a painkiller for the headache?
Ask a doctor first. Some common painkillers affect platelets and make bleeding worse. A headache after a knock is also a warning sign that doctors need to hear about, not something to hide with tablets. Tell the emergency team about everything already taken today.
How long should we keep watching after coming home?
The hospital should tell you exactly, because it depends on the injury, the scan and the treatment given. Some bleeds show up days later. Ask for written advice before you leave, and go back at once if headache, vomiting, sleepiness, weakness or confusion appear.
Does insurance or Aarogyasri cover an emergency admission?
Often some or all of it. Aarogyasri, PM-JAY, CGHS, ECHS, EHS and many cashless insurance policies cover emergency admissions, and some state programmes supply clotting factor. Rules change, so check the current terms. Never delay care in a head injury to sort out paperwork.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Where to find us
Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. A haematology consultation can be booked at any of these centres through one helpline, and your team will tell you where each test or treatment takes place.
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Sources
- NHS — Head injury and concussion
- NHS — Haemophilia
- National Heart, Lung, and Blood Institute — Thrombocytopenia
- American Society of Hematology — Bleeding Disorders
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
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Severe Bleeding With a Bleeding DisorderWhich other bleeds need the emergency department nowEmergency Card for Blood Disorder PatientsThe card that gets you seen faster at triageBlood counts during chemotherapyWhy platelet counts drop during cancer treatmentBenign Haematology EmergenciesEvery blood disorder emergency in one place
Talk to us
Need a haematology review after a head injury?
In an emergency, go to the nearest hospital or call 108 first. Afterwards, tell us what happened and we will help you reach CION's haematology team.