Bleeding disorders

Answer 1

Definition

Bleeding disorders are a group of conditions in which there is a problem with the body's blood clotting process. These disorders can lead to heavy and prolonged bleeding after an injury. Bleeding can also begin on its own.

See also:

• Acquired platelet function defects
• Congenital platelet function defects
• Congenital antithrombin III deficiency
• Congenital protein C or S deficiency
• Disseminated intravascular coagulation (DIC)
• Drug-induced immune thrombocytopenia
• Factor II deficiency
• Factor V deficiency
• Factor VII deficiency
• Factor X deficiency
• Factor XIIdeficiency
• Hemophilia A
• Hemophilia B
• Idiopathic thrombocytopenic purpura (ITP)
• Von Willebrand's disease (type I and type II)

Alternative Names

Coagulopathy

Causes, incidence, and risk factors

Normal blood clotting involves as many as 20 different plasma proteins, which are known as blood clotting or coagulation factors. These factors act together with other chemicals to form a substance called fibrin that stops bleeding.

Problems can occur when certain coagulation factors are low or missing. Bleeding problems can range from mild to severe.

Some bleeding disorders are present at birth and are passed through families (inherited). Others develop from:

• Illnesses such as vitamin K deficiency or severe liver disease
• Treatments such as the use of drugs to stop blood clots (anticoagulants) or the long-term use of antibiotics

Bleeding disorders can also result from having poorly working or too few of the blood cells that promote blood clotting (platelets). These disorders can also be either inherited or picked up (acquired). The side effects of certain drugs often lead to the acquired forms.

Symptoms

• Abnormal menstrual bleeding
• Bleeding into joints
• Excessive bruising
• Heavy bleeding
• Nosebleeds

Which problems occur depends on the specific bleeding disorder.

Signs and tests

• Complete blood count (CBC)
• Bleeding time
• Partial thromboplastin time (PTT)
• Platelet aggregation test
• Prothrombin time (PT)

Treatment

Treatment depends on the type of disorder. It may include:

• Factor replacement
• Fresh frozen plasma transfusion
• Platelet transfusion
• Other therapies

Expectations (prognosis)

The outcome also depends on the disorder. Most primary bleeding disorders can be managed. Those due to diseases, such as DIC, depend on how well the disease is treated.

Complications

• Bleeding in the brain
• Severe bleeding (usually from the gastrointestinal tract or injuries)

Other complications can occur, depending on the disorder.

Calling your health care provider

Call your health care provider if you notice any unusual or severe bleeding.

Prevention

Prevention depends on the specific disorder.

References

Kessler C. Hemorrhagic disorders: Coagulation factor deficiencies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 180.

Answer 2

Definition

Bleeding disorders are a group of conditions in which there is a problem with the body's blood clotting process. These disorders can lead to heavy and prolonged bleeding after an injury. Bleeding can also begin on its own.

See also:

• Acquired platelet function defects
• Congenital platelet function defects
• Congenital protein C or S deficiency
• Disseminated intravascular coagulation (DIC)
• Factor II deficiency
• Factor V deficiency
• Factor VII deficiency
• Factor X deficiency
• Factor XII deficiency
• Hemophilia A
• Hemophilia B
• Idiopathic thrombocytopenic purpura (ITP)
• Von Willebrand's disease (types I, II, and III)

Alternative Names

Coagulopathy

Causes, incidence, and risk factors

Normal blood clotting involves as many as 20 different plasma proteins, which are known as blood clotting or coagulation factors. These factors act together with other chemicals to form a substance called fibrin that stops bleeding.

Problems can occur when certain coagulation factors are low or missing. Bleeding problems can range from mild to severe.

Some bleeding disorders are present at birth and are passed through families (inherited). Others develop from:

• Illnesses such as vitamin K deficiency or severe liver disease
• Treatments such as the use of drugs to stop blood clots (anticoagulants) or the long-term use of antibiotics

Bleeding disorders can also result from having poorly working or too few of the blood cells that promote blood clotting (platelets). These disorders can also be either inherited or picked up (acquired). The side effects of certain drugs often lead to the acquired forms.

Symptoms

• Bleeding into joints
• Excessive bruising
• Heavy bleeding
• Heavy menstrual bleeding
• Nosebleeds

Which problems occur depends on the specific bleeding disorder, and how severe it is.

Signs and tests

• Complete blood count (CBC)
• Bleeding time
• Partial thromboplastin time (PTT)
• Platelet aggregation test
• Prothrombin time (PT)

Treatment

Treatment depends on the type of disorder. It may include:

• Factor replacement
• Fresh frozen plasma transfusion
• Platelet transfusion
• Other therapies

Expectations (prognosis)

The outcome also depends on the disorder. Most primary bleeding disorders can be managed. Those due to diseases, such as DIC, depend on how well the disease that is causing the bleeding disorder is treated.

Complications

• Bleeding in the brain
• Severe bleeding (usually from the gastrointestinal tract or injuries)

Other complications can occur, depending on the disorder.

Calling your health care provider

Call your health care provider if you notice any unusual or severe bleeding.

Prevention

Prevention depends on the specific disorder.

References

Coller BS, Schneiderman PI. Clinical evaluation of hemorrhagic disorders: the bleeding history and differential diagnosis of purpura. In: Hoffman R, Benz EJ Jr., Shattil SJ, et al, eds. Hoffman Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008:chap 121.

Kessler C. Hemorrhagic disorders: Coagulation factor deficiencies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 180.

Reviewed By

Review Date: 02/28/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.