Bleeding Problems

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2012

A bleeding disorder occurs when the blood does not clot fast enough, resulting in prolonged or excessive bleeding. Normal blood clotting, called coagulation, is a complex process in which platelets (specialized blood cells) and different proteins in the blood (called clotting or coagulation factors) clump together to heal broken blood vessels and control bleeding. Coagulopathies (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.

Symptoms

Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. Talk with your health care team about any symptoms you may experience, including any new symptoms or a change in symptoms.

People with bleeding disorders may experience the following symptoms:

  • Cuts that bleed excessively
  • Unexpected bruising
  • Petechia (small purple or red spots under the skin)
  • 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

Causes

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, such as hemophilia (a disease where the blood doesn't clot normally) and von Willebrand's disease (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 hepatitis (an infection of the liver) and liver cirrhosis (scarring of the liver)
  • Long-term use of powerful antibiotics or anticoagulant medications (blood thinners)
  • Drugs called angiogenesis inhibitors that prevent the growth and development of new blood vessels, such as bevacizumab (Avastin) and sorafenib (Nexavar)
  • Thrombocytopenia, an unusually low level of platelets
  • Anemia, an unusually low level of red blood cells
  • Other disorders unrelated to cancer

Diagnosis

The doctor diagnoses a bleeding disorder by reviewing a person's medical history and performing a physical examination and laboratory tests. Blood tests include 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.

Treatment

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 or Hydrea), and oprelvekin (Neumega) to treat platelet problems

More Information

Managing Side Effects

Additional Resources

Oncology Nursing Society: The Cancer Journey: Bleeding