Disclaimer: This toolkit is intended to provide resources for school nursing practice as it relates to the care of students with Bleeding Disorders in Oregon schools. This is not medical nor nurse practice advice and is not prescriptive as it relates to individual students or individual nursing practice. These resources do not override individual assessment, and clinical judgement. Nurses are responsible for their own assessment and practice.

Bleeding disorders are a group of conditions resulting in improper blood clotting. These conditions can be acquired or inherited and are characterized by a lack of clotting factors in the blood. The severity of a bleeding disorder is determined by the amount of the deficient clotting factor in the blood, ranging from mild to severe (American Society of Hematology [ASH], 2023).

Hemophilia, while probably the most well known bleeding disorder, is relatively rare and mostly affects males. The most common inherited bleeding disorder is von Willebrand Disease, which can affect both biological  males and females (ASH, 2023).

Bleeding disorders can also be acquired, caused by a disease or medication (ASH, 2023). Diseases and conditions that can cause bleeding disorders include pregnancy, cancer, multiple sclerosis, and autoimmune conditions (Mayo Clinic, 2021). Examples of acquired bleeding disorders include Disseminated Intravascular Coagulation (DIC), vitamin K deficiency bleeding, liver disease associated bleeding, and arteriovenous malformations, along with deficiencies of certain clotting factors, named for the deficient factor (ASH, 2023).

It is important that school staff provide reasonable protection for all students. Treatment, response, and considerations for students with bleeding disorders while at school should address:

  • Basic first aid with use of universal precautions
  • Bleeding symptoms, especially bleeding into joints or the brain
  • Appropriate response after serious injury or with symptoms of bleeding
  • Accommodation considerations, i.e. physical education, field trips, extended absences, 504 or IEP
  • Self-Management
  • Absenteeism and Academic impact
  • Psychosocial Implications of chronic disease
    (Steps for Living, 2020; Schrijvers, Schuurmans &  Fischer, 2016; Shapiro et al, 2001; Cyagan, Maier & O’Neill, 2012)

Evidence Based Practice

Literature Review

Basic Disease Information

Legal Practice Standards

At the forefront of nurse case management for school nurses, is the understanding of scope of practice as it relates to case management and delegation of  nursing tasks in a community setting:

Public Access Resources

Note: the following are national or regional resources that serve as a reference, they may or may not be consistent with Oregon law and do not supersede Oregon Nurse Practice.

Hemophilia Federation of America

National Hemophilia Foundation

School Nursing 101

Centers for Disease Control and Prevention(CDC)

National Hemophilia Foundation

Professional Development




National Hemophilia Foundation

Hemostasis and Thrombosis Resource Center


Learning in Ten (LIT)

UAP Training Resources

In the state of Oregon there are specific training required for care of students with diabetes that are prerequisite to individualized training. These include medication administration and glucagon administration.

Oregon Department of Education (ODE)

Hemophilia Federation of America


The following templates are modifiable for use by school nurses as it relates to their practice and should be used consistently with Oregon State Board of Nursing, Delegation Laws and local school policy.

Individualized Health Plans

An individualized health plan is the totality of the plan that includes all applicable procedures for students with chronic disease. Because these are intended to be individualized, the attached is an example of a compiled IHP:


Procedures also greatly vary by student health status, needs, level of care and type of regimen. The following are sample templates for specific procedures. A complete student  assessment should be made to determine appropriate procedures.

Teachers Notification

Self Management

Medication Administration and Self-Medication Agreement



Tiffany Bass
Kathring Carney
Jan Olson

Editorial Reviewer: Ann Occhi