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.
There are many causes of bleeding disorders. Some examples of causes include:
Bleeding disorders can range from mild to severe. Mild disorders may not even be noticed. Symptoms of mild clotting problems can include:
Severe bleeding disorders usually do not occur before birth but can cause problems at birth. These problems can include:
Some clotting problems cause immediate bleeding, while others result in bleeding several days after trauma or surgery.
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.
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.
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:
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:
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 provider until the blood disorder is resolved. The provider may order regular blood tests. Any new or worsening symptoms should be reported to the healthcare provider.
Author:Thomas Fisher, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:09/19/01
Reviewer:Adam Brochert, MD
Date Reviewed:09/19/01