Bleeding Disorder

Overview

A bleeding disorder is a condition in which the blood does not clot the way it should, so bleeding lasts longer or happens more easily than normal. Clotting (coagulation) is a complex process that depends on platelets (tiny blood cells that plug injuries) and clotting factors (proteins that build a stable clot). A problem with either can lead to a bleeding disorder.

Bleeding disorders can be inherited, such as hemophilia and von Willebrand disease, or acquired later in life from conditions, medications, or vitamin deficiencies. They range from mild, causing only easy bruising or heavy periods, to severe, with spontaneous or dangerous bleeding. Many bleeding disorders can be effectively managed, and people with them can lead full lives with appropriate care and precautions.

Symptoms

Signs of a bleeding disorder vary with the type and severity but commonly include:

• Easy or frequent bruising, sometimes large bruises
• Prolonged bleeding from small cuts or after dental work or surgery
• Frequent or hard-to-stop nosebleeds
• Heavy or prolonged menstrual periods
• Bleeding gums
• Blood in the urine or stool
• Tiny red or purple spots on the skin (petechiae)
• In some disorders, bleeding into joints or muscles causing pain and swelling

Heavy, uncontrolled bleeding, bleeding after injury that will not stop, sudden severe headache, or signs of internal bleeding are medical emergencies and require immediate care.

Causes

Bleeding disorders result from problems with platelets, clotting factors, or blood vessels. Causes include:

• Inherited conditions: Hemophilia (low clotting factors VIII or IX), von Willebrand disease (the most common inherited bleeding disorder), and platelet function disorders.
• Low platelet count (thrombocytopenia): From immune disorders, certain medications, infections, or bone marrow problems.
• Liver disease: The liver makes many clotting factors, so liver damage can impair clotting.
• Vitamin K deficiency: Vitamin K is needed to produce several clotting factors.
• Medications: Blood thinners (anticoagulants) and some other drugs.
• Other conditions: Certain cancers and widespread clotting disorders.

Risk Factors

You may be at higher risk of a bleeding disorder if you have:

• A family history of a bleeding disorder such as hemophilia or von Willebrand disease
• Liver disease
• A condition that lowers platelets or affects the bone marrow
• Long-term use of blood-thinning medication
• Poor nutrition or conditions causing vitamin K deficiency
• Certain autoimmune diseases or cancers

Some inherited bleeding disorders affect mainly males (such as the common forms of hemophilia), while others, like von Willebrand disease, affect all sexes.

Diagnosis

Diagnosing a bleeding disorder begins with a detailed history of bleeding and bruising, family history, and medications, followed by blood tests. These may include:

• A complete blood count, including the platelet count
• Clotting tests that measure how long the blood takes to clot
• Tests for specific clotting factors and von Willebrand factor
• Tests of platelet function
• Liver function and vitamin K-related tests when relevant

A hematologist (blood specialist) often coordinates the workup to identify the exact disorder, because the specific diagnosis determines the right treatment. Genetic testing may be used for inherited conditions.

Treatment

Treatment depends on the type and severity of the disorder and aims to control and prevent bleeding. Options include:

• Replacement therapy: Infusions of the missing clotting factor for conditions such as hemophilia, given to treat or prevent bleeds.
• Medications: Drugs that boost clotting factor levels or help stabilize clots, and treatments that slow the breakdown of clots, useful for some bleeding episodes and heavy periods.
• Treating the cause: Adjusting blood thinners, giving vitamin K, treating liver disease, or addressing low platelets.
• Hormonal therapy: To manage heavy menstrual bleeding in some people.
• Precautions: Avoiding medications that increase bleeding, careful planning around surgery and dental work, and protective measures for activities.

Specialized treatment at a hemophilia or bleeding-disorder center improves outcomes for inherited disorders.

Prevention

Inherited bleeding disorders cannot be prevented, but bleeding episodes and complications often can be reduced:

• Follow your treatment and prevention plan, including preventive factor therapy if prescribed
• Avoid medications such as aspirin and certain pain relievers unless approved by your provider
• Take care to prevent injuries; wear protective gear during higher-risk activities
• Inform dentists and surgeons about your disorder before procedures
• Maintain good general health, including adequate vitamin K from a balanced diet
• Carry medical identification noting your condition

Genetic counseling can help families understand the risk of passing on inherited bleeding disorders.

When to See a Doctor

See a healthcare provider if you have unexplained easy bruising, frequent nosebleeds, heavy periods, prolonged bleeding after minor cuts or dental work, or a family history of a bleeding disorder. These warrant evaluation to identify the cause.

Seek emergency care or call your local emergency number for bleeding that will not stop, heavy bleeding after injury, vomiting or coughing up blood, a sudden severe headache, or signs of internal bleeding such as severe abdominal pain or unexplained swelling. Joint pain and swelling from bleeding also need prompt treatment in people with conditions like hemophilia.

Related Topics

Frequently Asked Questions

References

1. National Heart, Lung, and Blood Institute (NHLBI).
2. Centers for Disease Control and Prevention (CDC).
3. MedlinePlus, U.S. National Library of Medicine.