Bleeding disorders include a wide range of medical problems that lead to poor blood clotting and excessive bleeding.
Blood clotting occurs when blood changes from a liquid to a semisolid state. Normal blood clotting should occur after trauma that causes bleeding. Within seconds of an injury, tiny cells in the blood, called platelets, bunch together at the site of the wound. Blood proteins, platelets, calcium, and other tissue factors react together and form what is called a clot. A clot acts like a net over the wound. Over the next several days to weeks, the clot strengthens, then dissolves when the wound is healed.
Bleeding disorders occur when the blood cannot clot normally. These disorders can be present at birth or be acquired from other conditions.
Bleeding disorders can range from mild to severe. Mild disorders may not even be noticed. Symptoms of mild clotting problems can include: bruising easilyheavy menstrual periodsoccasional nosebleedsproblems with unexpected bleeding after surgery
Severe bleeding disorders usually do not occur before birth but can cause problems at birth. These problems can include: bleeding into joints with minimum traumabruising easilyother life-threatening bleedingspontaneous internal bleeding
Some clotting problems cause immediate bleeding, while others result in bleeding several days after trauma or surgery.
There are many causes of bleeding disorders. Some examples of causes include: bone marrow disorderscancer, such as leukemiadisseminated intravascular coagulation (DIC), which is a condition in which the body's clotting system functions abnormallypregnancy-associated eclampsia, also known as severe toxicity of pregnancyexposure to snake venomhemophilia A and B, which are inherited blood disordersimmune system disorders, such as allergic reactions to medicine or abnormal reactions to an infectionliver diseasemedicines used as blood thinners, such as aspirin, heparin, and warfarinmedicines used to break up blood clotsorgan transplant rejectionvon Willebrand disease, which is an inherited blood disorder
Genetic defects cannot be prevented. Medical conditions that cause clotting problems are sometimes preventable. Correct use of anticoagulant medicines is important. Major advances in the treatment of infections, organ transplants, and cancer can help prevent some cases. Special surgery techniques and medicines to stop bleeding can also minimize problems from bleeding disorders.
Diagnosis of a bleeding disorder begins with a history and physical exam. Blood tests are essential in diagnosing suspected bleeding disorders. These include a complete blood count (CBC), clotting studies, and chemistry tests. More detailed tests can be done if these tests indicate one or more defects.
Mild clotting problems usually have no long-term effects. They may become evident only with major surgery. More severe problems may require lifelong treatment. These can cause fatal bleeding as well as a need for close medical and surgical monitoring.
Chronic or serious bleeding problems have many risks, including: chronic anemia, or a low red blood cell countneurological or psychiatric problemsdamage to the jointsvisual impairments from bleeding into the eye
In general, bleeding disorders are not contagious and pose no risk to others. Some bleeding problems are related to infections that may be contagious. For example, HIV, some upper respiratory infections, hepatitis, and infectious mononucleosis ("mono") can occasionally lead to bleeding problems.
Treatment can include: aminocaproic acid (i.e., Amicar) to stabilize abnormal immature blood clotsintravenous drugs such as vasopressin (i.e., Pitressin) or desmopressin (i.e., DDAVP) to correct platelet defectsmedicines to reverse excessive bleedingpatches that contain thrombin to treat excess bleedingtransfusions of blood components, such as platelets or clotting factors
Treatment of the associated or underlying illness might include intravenous gamma globulin, corticosteroids, chemotherapy, and various treatments for infection.
Treatment for bleeding disorders can be simple or complex and often requires a team of medical specialists.
Transfusion of blood components can cause a transfusion reaction. This reaction can include fever, skin rash, destruction of red blood cells, or severe allergic reactions. Transfusion also carries a very small risk of infection with serious diseases, such as HIV and hepatitis. All medicines have side effects, such as allergic reactions and stomach upset. Specific side effects depend on the medicine used.
Some people may need repeated transfusions or infusions of medicine.
The individual will have repeat visits to the healthcare professional until the blood disorder is resolved. The healthcare professional may order regular blood tests. Any new or worsening symptoms should be reported to the healthcare professional.
