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Bleeding Disorders

Alternate Names

  • clotting disorders

Definition

Bleeding disorders include a wide range of medical problems that lead to poor blood clotting and excessive bleeding.

What is going on in the body?

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.

Risks

What are the causes and risks of the condition?

There are many causes of bleeding disorders. Some examples of causes include:
  • bone marrow disorders
  • cancer, such as leukemia
  • disseminated intravascular coagulation (DIC), which is a condition in which the body's clotting system functions abnormally
  • pregnancy-associated eclampsia, also known as severe toxicity of pregnancy
  • exposure to snake venom
  • hemophilia A and B, which are inherited blood disorders
  • immune system disorders, such as allergic reactions to medicine or abnormal reactions to an infection
  • liver disease
  • medicines used as blood thinners, such as aspirin, heparin, and warfarin
  • medicines used to break up blood clots
  • organ transplant rejection
  • von Willebrand disease, which is an inherited blood disorder

Prevention

What can be done to prevent the condition?

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.

Diagnosed

How is the condition diagnosed?

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.

Long Term Effects

What are the long-term effects of the condition?

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 count
  • neurological or psychiatric problems
  • damage to the joints
  • visual impairments from bleeding into the eye

Other Risks

What are the risks to others?

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.

Treatments

What are the treatments for the condition?

Treatment can include:
  • aminocaproic acid (i.e., Amicar) to stabilize abnormal immature blood clots
  • intravenous drugs such as vasopressin (i.e., Pitressin) or desmopressin (i.e., DDAVP) to correct platelet defects
  • medicines to reverse excessive bleeding
  • patches that contain thrombin to treat excess bleeding
  • transfusions 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.

Side Effects

What are the side effects of the treatments?

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.

After Treatment

What happens after treatment for the condition?

Some people may need repeated transfusions or infusions of medicine.

Monitor

How is the condition monitored?

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.

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