When you bleed, your body kicks into action with a series of reactions to help blood clots form to stop it. Called the coagulation cascade, this involves up to 20 different proteins known as clotting factors, according to the U.S. National Library of Medicine. But when you don’t have one or more of these clotting factors, you have a higher chance of excess bleeding. Hemophilia A and B are the result of the lack of certain clotting factors. And some of the symptoms of these conditions may seem a bit odd.

Hemophilia A is caused by the lack of blood clotting factor VIII, per the U.S. National Library of Medicine. Hemophilia B happens when the body doesn’t make enough of coagulation factor IX.

While both conditions are slightly different, the symptoms are generally the same. (However, they may vary based on how severe your condition is.) Most people with hemophilia are diagnosed at a young age, according to the Centers for Disease Control and Prevention (CDC). But it’s possible to have a mild case of hemophilia A or B that goes undiagnosed until later in life, per the U.S. National Library of Medicine.

Meet the experts: Allyson Pishko, M.D., a hematologist with the Penn Blood Disorders Center at Penn Medicine; Asefeh Faraz, Ph.D., A.P.R.N., associate professor at The George Washington University School of Nursing

Hemophilia isn’t a condition that’s well-known to the general population and the exact number of people living with hemophilia isn’t known, per the CDC. What is known is the condition is much more common in genetic males than females, and that hemophilia A is three to four times as common as hemophilia B.

Both types can cause long-term complications like joint issues, and severe cases may be life-threatening, especially if they go untreated. With that in mind, these are some lesser-known symptoms of hemophilia A and B doctors want you to keep in mind.

Excessive bleeding

Having hemophilia means that you may end up bleeding for a longer time after an injury than if your blood clotted properly, explains Allyson Pishko, M.D., a hematologist with the Penn Blood Disorders Center at Penn Medicine. There is some variation here, though, and that can influence when someone is diagnosed.

“If severe, hemophilia is often diagnosed during infancy,” says Asefeh Faraz, Ph.D., A.P.R.N., associate professor at The George Washington University School of Nursing. “Otherwise, it’s diagnosed later in life if a patient has excessive bleeding after injury or surgery.” Dr. Pishko also points out that someone with hemophilia may have “excessive bleeding” after their wisdom tooth is removed or they have a tonsillectomy. “Excessive bleeding is more than would be expected with a typical cut or injury, and [is] unable to be stopped using typical first aid,” Faraz says.

Easy bruising

People with hemophilia may develop larger bruises after having injuries that are relatively minor, according to the Cleveland Clinic. This is a sign of bleeding under the skin. “There are not enough clotting factors in the blood” to help slow down the bleeding that can lead to these large, noticeable bruises, Faraz says.

Heavy periods

While hemophilia is much more common in men than women, females can inherit the condition, Dr. Pishko says. “This diagnosis is sometimes missed in females as they have been told that hemophilia only affects males,” she says. But Dr. Pishko says that women with hemophilia may end up dealing with heavy periods or heavy bleeding with childbirth. “It is important for females to have testing of their blood clotting levels if they have a family history of hemophilia or symptoms,” she says.

Bleeding after vaccination

It’s not common for anyone to experience bleeding from the injection site after getting a vaccine, but there is a slightly increased risk of bleeding after getting a shot in people who have hemophilia. People with hemophilia also have higher odds of developing a hematoma, or closed wound where blood collects, after being vaccinated, too, per the Mayo Clinic.

Joint pain and swelling

Hemophilia can cause bleeding in the joints, too, Dr. Pishko says. “This presents as sudden pain and swelling in the joint,” she says. “It can occur repeatedly within the same joint.” If left untreated, frequent bleeding in the joints can raise the risk of arthritis.

Lower range of motion

Because hemophilia can impact the joints, it can also limit your range of motion. This is more common in females with hemophilia compared to those who don’t have a bleeding disorder, according to the CDC.

Nosebleeds

Everyone experiences nosebleeds at some point, but nosebleeds with no known cause can be a sign of hemophilia, according to the American Academy of Pediatrics (AAP). This can happen when a blood vessel in the nose breaks and doesn’t clot easily.

Blood in the urine or stool

Blood in the urine or stool can be a sign of internal bleeding. In the case of hemophilia, it can be spontaneous—meaning, it comes on suddenly. If you happen to notice blood in your urine or stool, it’s important to get it checked out right away, whether you suspect that you have hemophilia or not.

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