Internal or external bleeding would be especially severe in a patient:

• A. Takes aspirin.
• B. With hemophilia.
• C. Who is hypotensive.
• D. With heart disease.

Answer: (B)

Bleeding severity in trauma is heavily influenced by the body's ability to form a stable clot. In hemophilia, there is a deficiency of clotting factors necessary to convert fibrin and complete the clotting cascade. Because this step is impaired, even small injuries can lead to prolonged, uncontrollable bleeding—whether internal, such as into joints and muscles, or external. The inability to stop bleeding promptly makes any trauma more dangerous in someone with a clotting disorder.

Aspirin impairs platelets, which can worsen bleeding but doesn’t create the full clotting-factor deficiency seen in hemophilia; it’s a risk factor rather than a defining cause of severe bleeding. Hypotension reflects blood loss that has already occurred and indicates shock risk, but it doesn’t inherently cause more severe bleeding. Heart disease doesn’t by itself increase the tendency to bleed.

So, the most concerning scenario for severe internal or external bleeding is a patient with a coagulation disorder like hemophilia.