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bleeding disorders Alternative Names
bleeding diatheses, abnormal bleeding, 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.
What are the signs and symptoms of the condition?
Bleeding disorders can range from mild to severe. Mild disorders may not even be noticed. Symptoms of mild clotting problems can include: - bruising easily
- occasional nose bleeds
- heavy menstrual periods
- problems with unexpected bleeding after surgery
Severe bleeding disorders usually do not occur before birth but can cause problems at birth. These problems can include: - bruising easily
- bleeding into joints with minimum trauma
- spontaneous internal bleeding
- other life-threatening bleeding
Some clotting problems cause immediate bleeding, while others result in bleeding several days after trauma or surgery.
What are the causes and risks of the condition?
There are many causes of bleeding disorders. Some examples of causes include: - von Willebrand's disease, which is an inherited blood disorder
- immune system-related diseases, such as allergic reactions to medications, or reactions to an infection
- cancer, such as leukaemia, which is a blood cancer
- liver disease
- bone marrow problems
- disseminated intravascular coagulation, which is a condition often associated with child bearing, cancer, or infection, in which the body's clotting system functions abnormally
- pregnancy-associated eclampsia, also known as severe toxaemia of pregnancy
- organ transplant rejection
- haemophilia A and B, which are inherited blood disorders
- exposure to snake venom
- antibodies, a type of immune system protein, that destroy blood clotting factors
- medications, such as aspirin, heparin, warfarin, and drugs used to break up blood clots, such as alteplase
Chronic or serious bleeding problems have many risks, including: - scarring of the joints
- vision loss from bleeding into the eye
- chronic anaemia from blood loss. Anaemia is a low red blood cell count
- neurologic or psychiatric problems
- death, which may occur with large amounts of blood loss or bleeding in critical areas, such as the brain
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 drugs is important. Major advances in the treatment of infections, organ transplants, and cancer can help prevent some cases. Special surgery techniques and drugs to stop bleeding can also minimise problems from bleeding disorders.
How is the condition diagnosed?
Blood tests are essential in diagnosing suspected bleeding disorders. These include a full blood count (FBC), clotting studies and chemistry tests. More detailed tests can be done if these tests indicate one or more defects.
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 life-long treatment. These can cause fatal bleeding, as well as a need for close medical and surgical monitoring.
What are the risks to others?
The only diseases that cause contagious bleeding problems are those related to infections. For example, HIV, some upper respiratory infections, hepatitis and infectious mononucleosis ("mono"), or glandular fever, can all occasionally lead to bleeding problems.
What are the treatments for the condition?
Treatment can include: - transfusions of blood components, such as platelets
- intravenous drugs such as vasopressin, to correct platelet defects
- medications to reverse excessive bleeding
- a drug called aminocaproic acid to stabilise abnormal immature blood clots
- patches that contain thrombin to treat excess bleeding
Treatment of the associated or underlying illness might include intravenous gamma globulins, which are special immune system proteins, corticosteroids, chemotherapy and various treatments for infection. Treatment for bleeding disorders can be simple or complex, and often requires a team of medical specialists.
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 medications have side effects, such as allergic reactions and stomach upset. Specific side effects depend on the drug used.
What happens after treatment for the condition?
Doctors often use blood tests for monitoring. Sometimes more detailed tests are done. Some people may need repeated transfusions or infusions of medication.
How is the condition monitored?
Monitoring is done by evaluating sites of blood loss and performing blood-clotting tests.
Author:
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
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