A bleeding disorder occurs when the blood does not clot fast enough, resulting in too much bleeding or bleeding that lasts a long time. Normal blood clotting, called coagulation, is a complex process in which specialized blood cells called platelets and different proteins in the blood called clotting or coagulation factors clump together to heal broken blood vessels and control bleeding. There is a delicate balance of coagulation factors that promote bleeding and those that promote clotting. Disorders of the blood clotting system occur when clotting factors are missing or damaged, when there is a low number of platelets, or when the platelets don't work correctly. Learn more about clotting problems.
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People with bleeding disorders may experience the following symptoms:
- Cuts that bleed excessively
- Unexpected or sudden bruising
- Small purple or red spots under the skin that are called petechiae
- Blood in the vomit, often resembling coffee grounds
- Black or bloody bowel movements, or reddish or pinkish urine
- Dizziness, headaches, or changes in vision
- Joint pain
- Gum bleeding
- In women, menstrual periods that are heavier or longer than usual
Sometimes a person inherits a bleeding disorder, meaning it has a genetic cause and runs in the family. Other bleeding problems result from illness or treatment with specific drugs.
Causes of bleeding problems include the following:
- Inherited disorders. This includes hemophilia, which is a disease where the blood doesn't clot normally and von Willebrand's disease, which is a bleeding disorder where clotting factors are missing or do not work well.
- Vitamin K deficiency
- Cancer that begins in or spreads to the liver
- Other liver disorders, including an infection of the liver called hepatitis and scarring of the liver called cirrhosis
- Long-term use of powerful antibiotics or medications called anticoagulants that thin the blood
- Drugs called angiogenesis inhibitors that prevent the growth and development of new blood vessels
- Thrombocytopenia, an unusually low level of platelets
- Anemia, an unusually low level of red blood cells
- Other disorders unrelated to cancer
To diagnose a bleeding disorder, your doctor will review your medical history and perform a physical examination. You will also have blood taken for several blood tests, including a complete blood count (CBC), prothrombin time (PT or INR), activated partial thromboplastin time (APTT), platelet count, tests to check the speed of blood clotting, and tests to check for blood protein deficiencies.
The treatment of a bleeding disorder depends on the underlying cause. When possible, underlying disorders such as cancer or liver disease are treated. Additional treatments include:
- Vitamin K injections
- Drugs that help blood to clot
- Blood plasma or platelet transfusions
- Other medications, including hydroxyurea (Droxia, Hydrea), and oprelvekin (Neumega) to treat platelet problems