Bleeding Disorder

What is a Bleeding Disorder

Bleeding disorder causes abnormal bleeding or bruising. There are many kinds of bleeding disorders. They develop when the blood does not clump together (clot) properly.

Normally, when you are injured and you bleed, special blood cells (platelets) and certain blood proteins (clotting factors) form a gel-like plug (blood clot). The clot forms at the site of the injury to help stop the bleeding. The injured blood vessel also tightens (constricts) to help stop bleeding.

When you cannot form blood clots, it may be hard to stop bleeding, and even mild injuries can cause serious bleeding. Bleeding can result in you not having enough red blood cells (anemia). Sudden and severe bleeding can cause a dangerous loss of blood.

What are the causes of Bleeding Disorder?

There are many causes of bleeding disorders. A bleeding disorder may result from conditions that cause:

  • Too few or abnormal platelets.
  • Too few or abnormal clotting factors.
  • Abnormal or weak blood vessels that bleed easily and do not constrict normally.

Bleeding disorders may be passed from parent to child (inherited), or they may develop on their own (acquired). Acquired bleeding disorders are most common. They can affect platelets, clotting factors, or blood vessels. Examples of acquired bleeding disorders include:

  • Liver diseases that affect clotting factors.
  • Allergic or immune diseases that attack blood vessels.
  • Infections that damage blood vessels.
  • Lack (deficiency) of vitamin C or vitamin K.
  • Bone marrow cancers that decrease platelet production.
  • Immune system diseases that attack platelets.
  • An enlarged spleen that traps platelets.
  • Long-term (chronic) kidney disease that decreases platelet function.
  • Disseminated intravascular coagulation (DIC). This condition is caused by severe diseases and conditions that use up platelets and clotting factors, such as an overwhelming infection, severe injury, or cancer.
  • Cancer treatments that damage bone marrow, where blood cells are formed.
  • Medicines that increase bleeding. These include blood thinners, aspirin, NSAIDs, some antibiotics, some heart medicines, and quinine.

Examples of inherited bleeding disorders include:

  • Von Willebrand disease (VWD).
  • Hemophilia.
  • Hemorrhagic telangiectasia.
  • Ehlers–Danlos syndrome.

What are the signs or symptoms?

Easy bruising and bleeding are the most common signs of a bleeding disorder. Minor cuts may bleed for a long time, and lightly bumping your skin may cause large bruises from bleeding under the skin (hematomas). Other symptoms include:

  • Heavy menstrual bleeding.
  • Frequent nosebleeds.
  • Prolonged bleeding from gums after brushing or flossing.
  • Blood in the stool (feces).
  • Prolonged bleeding after a dental procedure or a blood draw.
  • Anemia. This may cause pale skin, weakness, and fatigue.
  • Red spots or purple blotches under the skin.
  • Joint pain and swelling.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms.
  • Your medical history, including:
    • What medicines you are taking.
    • Any procedures you have had, including surgery, childbirth, and dental procedures.
  • Your family history of bleeding disorders.
  • A physical exam.

In some cases, a bleeding disorder is discovered during routine blood testing. You may be referred to a blood specialist (hematologist) for more tests, such as:

  • Complete blood count (CBC). This checks red blood cell and platelet levels.
  • Peripheral smear. This examines blood cells under a microscope and checks for abnormal blood cells.
  • PT (prothrombin time) and PTT (partial thromboplastin time) tests. These measure clotting times and test for clotting factors.
  • Imaging tests, such as a CT scan. These check for internal bleeding.
  • Genetic tests. These check for abnormal genes that you inherited.

How is this treated?

Treatment for a bleeding disorder depends on the cause, and may include:

  • Treating the cause of acquired bleeding disorders, such as immune system disorders, infections, or diseases. Treating the cause may reduce or reverse bleeding problems.
  • Changing or stopping medicines you take.
  • Taking vitamin supplements.
  • Receiving one or more of the following through an IV (IV infusion):
    • Clotting factors.
    • Plasma. Plasma is the liquid part of the blood that helps move platelets and clotting factors throughout the body.
    • Platelets.
    • Red blood cells, if you have severe blood loss.
  • Taking hormone medicine (desmopressin acetate, DDAVP) that increases certain clotting factors associated with bleeding disorders.

There is no cure for inherited disorders, but treatment may prevent or control bleeding.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Talk with your health care provider before you take any new medicines. Certain medicines may increase your risk for dangerous bleeding. These include:
    • Over-the-counter medicines that contain aspirin.
    • NSAIDs such as ibuprofen.

Preventing falls

Follow instructions from your health care provider about ways that you can help prevent falls and injuries at home. These may include:

  • Removing loose rugs, cords, and other tripping hazards from walkways.
  • Installing grab bars in bathrooms.
  • Using night-lights.

General instructions

  • Tell all your health care providers, including your dentist, that you have a bleeding disorder. Make sure to tell providers before you have any procedure done, including dental cleanings.
  • Limit activities as told by your health care provider. Ask your health care provider what activities are safe for you. You may need to avoid activities that could increase your risk of injury or bruising, such as contact sports.
  • Brush your teeth using a soft toothbrush.
  • Use an electric razor to shave instead of a blade.
  • Wear a medical alert bracelet that says that you have a bleeding disorder. This can help you get the treatment you need in case of emergency.

Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

  • Any symptoms of a bleeding disorder.

Get help right away if you have:

  • Bleeding that does not stop.
  • Sudden, severe bleeding.

Summary

  • A bleeding disorder causes abnormal bleeding or bruising. There many kinds of bleeding disorders.
  • Bleeding disorders may be passed from parent to child (inherited) or may develop on their own (acquired).
  • Easy bruising and bleeding are the most common signs of a bleeding disorder.
  • Treatment for a bleeding disorder depends on the cause.
  • Talk with your health care provider about what medicines and activities are safe for you.
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