Hemophilia is an inherited disorder of blood coagulation, which can range from a very severe problem to a relatively mild, controllable bleeding disorder. Persons with the highest risk for bleeding would not be good candidates for scuba diving for several reasons. The most likely risk areas for a scuba student with hemophilia are sinus, middle ear and pulmonary barotrauma. While a sinus or ear squeeze may result in a small amount of inconsequential bleeding in a person with normal coagulation, such bleeding could be severe in a person with hemophilia. Certain types of decompression illness (DCI) can also cause bleeding. DCI of the spinal cord can cause bleeding within the cord itself, and inner ear decompression sickness can cause bleeding in the organs responsible for hearing (cochlea) and balance (vestibular apparatus, or semicircular canals). The response to therapy in a person with a blood clotting disorder after such bleeding is unknown.
Finally, many individuals with hemophilia have had repeated bleeding into joints, causing pain and joint damage. In such individuals it may be difficult to distinguish pain due to bleeding from the pain triggered by DCI. Individuals who are well-informed about their disorder and who have undergone proper treatment to minimize bleeding problems can probably dive. Still, they should use conservative profiles, be able to equalize middle ear and sinus pressures, and be instructed on the possible risks of bleeding into these areas. One final concern is that many popular dive sites are remote locations where the appropriate level of medical care may not be available. Individuals with any chronic disease requiring specific medication cannot always rely on local medical facilities. If you have a chronic ailment, have a contingency plan before diving at a remote site. A prospective diver with hemophilia should be evaluated by a physician with these specific issues in mind.