What is it about ?
Our body has 2 mechanisms to stop bleeding. On the one hand, the platelets clump together and form a clot. On the other hand, our body makes clotting proteins (clotting factors), which strengthen a blood clot and speed up the clotting process. An increased tendency to bleeding is due to a problem occurring at one or another stage of the process.
Hemorrhagic disease can be inherited or acquired.
The most common causes are:
- a lack of platelets ;
- A mild form of Von Willebrand’s disease. The latter is characterized by a lack of von Willebrand factor, one of the coagulation factors involved in blood clotting.
Other possible causes of an increased tendency to bleeding are:
- Taking medication: for example aspirin;
- Aging: ‘senile purpura’, i.e. the formation of bruising in the elderly, caused by changes in the walls of the blood vessels;
- A high blood pressure(hypertension);
- Connective tissue diseases leading to alterations in the walls of blood vessels;
- Autoimmune diseases (conditions in which the body produces antibodies that turn against itself);
- A acute leukemia ;
- Severe generalized infection blood poisoning (sepsis);
- etc.
How to recognize it?
An increased tendency to bleeding may be accompanied by superficial bleeding into the skin and mucous membranes or bleeding deep into the muscles.
The bleeding that occurs in the skin and mucous membranes are usually due to a problem with the platelets or the walls of the blood vessels. Blood and bruises can then appear spontaneously (without trauma).
The following situations may also indicate bleeding disease: nose bleeds severe bleeding from the gums, heavy periods, bleeding from the stomach and intestines or urinary tract, and bleeding problems during minor medical procedures (for example, removal of the tonsils).
These situations sometimes lead to the development of a anemia.
The deep bleeding are caused by a lack of coagulation factors, preventing the activation of the clotting process in the blood, and therefore the automatic stopping of bleeding. Spontaneous bleeding, sometimes very heavy, can therefore occur in the muscles and joints.
Other usual features are: simultaneous bleeding in several places, late bleeding (a few days after an incident or trauma) and recurrent bleeding.
How is the diagnosis made?
The doctor will ask you about:
- The underlying conditions and history;
- The drugs used;
- Family history, going back several generations;
- Details of the bleeding (he will sometimes use specific questionnaires for this purpose):
- Is the bleeding unusually heavy, prolonged, recurrent, or late?
- Does it occur in one or more places?
- Can you stop the bleeding by applying pressure?
- Have you ever had heavy bleeding or a tendency to bleed in the past?
This is very important information, even if you have never had heavy bleeding and, for example, had no problems when you had tonsil surgery. Indeed, this means that the bleeding problem is not congenital, but that it appeared during your life (acquired problem).
A blood test should confirm the diagnosis. In mild cases, the first screening tests will be normal.
- Platelets: if you have too few platelets, your blood cannot clot.
- Activated partial thromboplastin time (TCA): provides information on the activity of clotting factors in the blood.
- Prothrombin time (PT or INR): test to test for other coagulation factors. This value is increased if you use certain blood thinners.
A specialist (hematologist) may optionally perform other specific tests to find out, for example, specific coagulation factors, von Willebrand factor and platelet activity.
What can you do ?
See your doctor if you think you have a bleeding problem.
What can the doctor do?
If you have an increased tendency to bleed, your doctor should first distinguish between serious and less serious causes. The cause can be hereditary or acquired. The bleeding problem can be the consequence of different underlying conditions, which must be taken care of in the treatment.
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