Definition and Overview
Bleeding disorders refer to various blood-related conditions characterized by the body’s inefficiency to form a clot.
Different situations such as injuries, surgeries, and childbirth result in blood loss. If the loss becomes uncontrolled, the body can go into a state of shock, and the patient can go into a coma or die. Fortunately, the body has its own mechanism to significantly reduce or avoid massive blood loss and even reduce infection. It’s called blood clotting.
The body has three general kinds of blood cells: red, white, and platelet. The red blood cells contain the oxygen that is needed by other cells to function properly. The white blood cells, on the other hand, create antibodies and other forms of protection to prevent or decrease the risk of infection and diseases. The platelet is the one that plays a significant role in blood clotting.
When the body is injured, for example, and there’s blood coming out of it, platelets gather at the entry site and produce a “plug” to eventually close the site and prevent any harmful microorganism from getting in. However, platelets are not the only ones that are doing the job. The body also needs protein factors that hold the platelets together.
Those with bleeding disorders have either low or insufficient platelets or protein factors. They can also have both but they don’t function the way they should. In this cases, bleeding disorders develop.
Causes of Condition
There are many possible causes of bleeding disorders, including the following:
Genetics – Hemophilia is one of the known types of bleeding disorder, although it’s rare. It can be traced to heredity but more often, it develops due to a genetic mutation. There are three different kinds of hemophilia: A, B, and C. They are distinguished by their missing or deficient protein factor. Of the three, A is the most common and it’s referred to as classic hemophilia. The severity of the bleeding is indicated by their factor level. Most of the diagnosed are in the severe range, which means they can bleed heavily. Only 10% can be considered as mild bleeders. Von Willebrand’s disease is another kind of bleeding disorder that is related to genetics. This is more common than hemophilia. Further, while hemophilia often occurs in males, this disease can be found in both men and women and is caused by a deficiency of the Von Willebrand factor.
Deficiencies in protein factors – Some patients may have the protein factors but they are deficient, so they still have problems with clotting or coagulation. The most common deficient factors are V, X, II, and XII.
Medications – Blood clots can sometimes form in areas where they should not such as the blood vessels or arteries. To avoid this, doctors often provide anticoagulants or blood thinners so platelets don’t “stick together.” However, this may also prevent the platelets from plugging into the injury site. Some drugs, meanwhile, may not be anti-coagulants but they have a blood thinning effect. These include cancer drugs like chemotherapy. As the treatment affects blood count, it can also bring down the quantity of platelets that circulate in the body.
Liver disease – A liver failure, whether acute or chronic, can prevent the organ from producing sufficient clotting factors.
Deficiency in vitamin K – This vitamin helps the blood to form a clot. It is so essential that babies, who have less of it, need to receive supplementation.
- Heavy bleeding during an injury
- Frequent nosebleeds and bleeding in general
- Long bleeding time
- Presence of bruises in various parts of the body
- Heavy menstruation
- Low blood cell count
- Low iron
- Joint bleeding
- Arthritis due to complications of bleeding joints
Who to See and Treatments Available
A hematologist is a doctor who specializes in anything related to blood including blood disorders. If the doctor suspects a possible deficiency in protein factors or if the patient is showing key symptoms, he or she immediately refers the patient to the hematologist.
There are many tests that can help diagnose a bleeding disorder. These include:
- Blood cell count, which determines the quantity of red, white, and platelet in the body
- Bleeding time, which indicates how fast the blood vessels close to stop the bleeding
- Partial thromboplastin (PT), which measures the length of time it takes to form a blood clot
- Platelet aggregation, which assesses the efficiency of platelets to form a clot
- Prothrombin time, which measures the length of time it takes for the plasma in the blood to form a clot
The treatment a patient receives depends on the kind of bleeding disorder he or she has, as well as the severity of the medical condition. For example, if the bleeding disorder is described as mild, treatment may not be needed. However, these patients should still be vigilant every time they have to undergo procedures that may result in bleeding such as surgery and tooth extraction.
In more severe cases, factor replacement therapies and regular blood transfusions are necessary. The replacement therapies are now the common method of managing severe hemophilia. They involve replacing the lacking protein factors with factors that are developed in the lab. The replacements may also be plasma, or the transparent fluid in the blood.
If the cause of the bleeding disorder is something else such as deficiency in vitamin K, medication, or liver disease, treating the underlying condition will often halt the bleeding disorder. Supplementation for iron and vitamin K can also help reduce the effects of the disorder.
A person with bleeding disorder can manage the disease and live well by:
- Visiting the doctor and hematologist regularly.
- Undergoing regular physical and dental checkup.
Ragni MV. Hemorrhagic disorders: Coagulation factor deficiencies. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 177.
Gailani D, Neff AT. Rare coagulation deficiencies. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 139.