Children Bleeding Disorders

By Michael K. Davis, MD
July 3, 2009

Bleeding is the leakage of blood from blood vessels.  This may be due to injury or illness.  Bleeding after a minor injury is typically quickly controlled with the normal process of blood clotting and constriction of blood vessels.  There are disorders of blood clotting that can lead to excessive bleeding from even minor injuries.  Mild clotting disorders may actually be helpful later in adulthood when strokes and heart attacks result from blood vessel damage and blood clots. 

Clotting is a complex process which involves multiple proteins in the blood and tissues as well as platelets.  Platelets are formed in the bone marrow and act as first responders to sites of blood vessel injury.  Platelets help plug blood vessel holes by sticking to the damaged areas and “spinning” a fibrin web to keep blood cells from leaking out.  Hemophilia and Von Willebrand disease are blood clotting disorders that some children are born with.
What is abnormal bleeding?
Bleeding is considered abnormal when it occurs at unexpected times, in unexpected places or lasts longer than expected.  Some examples of abnormal bleeding would include:

• excess bleeding from circumcision in a newborn male
• frequent nose bleeds
• frequent bleeding from the gums
• excess menstrual bleeding in females
• easy bruising
• blood in urine or stools
• excess bleeding after an injury or surgery
• bleeding into muscles or joints
• <>small pinpoint bruises under the skin or mucous membranes (called petechiae)

What causes abnormal bleeding?
Genetic causes

• Hemophilia and Von Willebrand disease – caused by the absence or deficiency of a clotting protein.
• Platelet deficiency or abnormal platelet function
• Abnormal blood vessel diseases or syndromes

Drugs or vitamins

• Many medications can slow down the production of platelets and other blood products
• Deficiency of vitamin K
• Deficiency of vitamin B12 or folate
• Aspirin and other medications impair the function of platelets

Illness

• Production of platelets and clotting proteins can be impaired
• Blood vessels may become leaky due to abnormal inflammation
• Abnormal uncontrolled blood clotting and bleeding may occur in severe illness (i.e., sepsis)

Low platelet count

• Decreased production (i.e., illness or genetic causes)
• Increased consumption (i.e., idiopathic thrombocytopenia, sepsis, bleeding)

Liver disease or malnutrition

• Poor production of clotting protein
• Poor absorption of vitamin K or other nutrients

How is a bleeding disorder diagnosed?

• Your doctor will perform a history and physical exam.
• Blood tests include “coags” or prothrombin time (PT), partial thromboplastin time (PTT), and a platelet count.
• More sophisticated blood tests are available if necessary

How is a bleeding disorder treated?
This depends on the cause.  Acute bleeding should be treated by applying pressure and seeking medical care.  Bleeding disorders are often referred to a hematologist (blood specialist).

Source: Dr Tummy

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Next week we will talk about: Hypothyroidism.