Bleeding disorders, also known as coagulopathy, cause unexpected or uncontrollable bleeding. Bleeding can occur after injury, but may start out of nowhere without injury.
When blood clots, the process involves plasma proteins called coagulation factors. Coagulation factors work with chemicals to release fibrin, the “patch” that stops bleeding. Bleeding disorders are often associated with lower than normal or altered coagulation factors. Low blood platelet counts can also cause irregular bleeding.
Symptoms
Bleeding disorders vary from mild to severe. Common symptoms are present across all variances. Severe bleeding disorders tend to result in more severe symptoms.
- Bruising
- Internal Joint Bleeding
- Heavy Bleeding After Injury
- Heavy Bleeding During Menstruation
- Nosebleeds
Complications
Severe bleeding disorders can result in death if bleeding is not controlled in a timely manner. Patients are often treated to promote clotting and reduce blood loss. Other complications may include:
- Bleeding on the Brain
- Internal Bleeding – Typically Associated with the Gastrointestinal Tract
Causes
Some bleeding disorders are present at birth and are caused by rare inherited disorders. Others are developed during certain illnesses (such as vitamin K deficiency, severe liver disease), or treatments (such as use of anticoagulant drugs or prolonged use of antibiotics). They can include hemophilia and other very rare blood disorders.
There are many causes of bleeding disorders, including:
- Hemophilia A
- Hemophilia B
- von Willebrand disease, which is an inherited blood disorder thought to affect up to 1% of the US population
- Immune system-related diseases, such as allergic reactions to medications, or reactions to an infection
- Cancer, such as leukemia, 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 toxicity of pregnancy
- Antibodies, a type of immune system protein, that destroy blood clotting factors
- Medicines, such as aspirin, heparin, warfarin, and drugs used to break up blood clots
Diagnosis
Blood work, including complete blood count, partial thromboplastin time, prothrombin time and platelet aggregation, are used to diagnose a bleeding disorder. A bleeding time test will also be administered to measure time it takes to naturally stop bleeding.
Treatments
The attending physician will prescribe treatment based on the type of bleeding disorder. Common treatments include:
- Platelet Transfusion
- Coagulation Factor Replacement
- Plasma Transfusion
Bleeding Disorders and Pregnancy
Bleeding disorders pose a serious risk to pregnant women, but the severity of risk depends on the bleeding disorder and symptoms the patient experiences. For instance, women with Von Willebrand disease are at increased risk of bleeding during pregnancy ten times that of women who do not have a bleeding disorder. Infant head bleeds are also more common in infants born to patients with Hemophilia A and B. Postpartum hemorrhage is more common in women with bleeding disorders with 25% of women suffering delayed postpartum hemorrhage (beginning more than 24 hours after birth).
Factor levels will be measured and corrected prior to delivery. If postpartum hemorrhage occurs, treatment may include administration of medications to contract the uterus as most postpartum bleeding is associated with uterine contraction after birth.
Pregnant women with a bleeding disorder will require advanced prenatal care and reliable contact with the attending obstetrician. Irregular bleeding must be reported immediately.
Life Expectancy
Prognosis for patients with bleeding disorders is disease or disorder specific. If the bleeding disorder is caused by an underlying disease, the prognosis will depend on treatment of the disease.