March is National Bleeding Disorders Awareness Month. If your patients have a bleeding disorder, are predisposed to having one, or have concerns about them, what should they know?

Types of Bleeding Disorders

Bleeding disorders are diseases that negatively affect the way the body allows blood to clot. As a result, prolonged bleeding can occur after an injury or even without any apparent reason. If not properly managed, these can be life-threatening disorders. Patients with bleeding disorders often experience joint pain, and the heavy bleeding that occurs can put them at risk of anemia.


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Commonly known bleeding disorders include the following:

  • Von Willebrand disease. This disease, the most common bleeding disorder, occurs when a person’s blood has insufficient levels of von Willebrand factor, a protein that plays a role in helping blood clot.¹ The 3 types of von Willebrand disease are based on the person’s levels of von Willebrand factor and whether the factor works effectively.
  • Hemophilia A, B, and C. Hemophilia is a rare genetic condition caused by insufficient levels of clotting proteins or factors.² Hemophilia can be managed, but it can also become life-threatening if a patient with hemophilia experiences internal bleeding. The type of hemophilia is determined by the factor that is insufficient (factor VIII is insufficient in type A hemophilia, factor IX in type B, and factor XI in type C).
  • Factor deficiencies. These bleeding disorders are caused by insufficient levels of clotting factors that differ from those that cause von Willebrand disease or hemophilia. They include deficiencies of factor I, II, V, VII, X, XII, and XIII.³

Are Bleeding Disorders Inherited?

Bleeding disorders are often but not always inherited. Von Willebrand disease is more likely to be inherited than not; Children whose parents have the disease have a 50% chance of inheriting it.⁴ Hemophilia is also often inherited, and other rare inherited bleeding disorders can cause low platelet counts.

Bleeding disorders can also develop without being inherited. They can be caused by, among other things, a vitamin K deficiency, anticoagulation therapy, and massive blood transfusions.⁵

Symptoms

Common symptoms of bleeding disorders include the following:

  • Heavy bleeding from small cuts
  • Bruising more easily
  • Heavy menstrual bleeding
  • Bleeding into joints or muscles
  • Excessive bleeding after a surgical procedure
  • Heavy or unprompted nosebleeds

Infants may also show bleeding disorder symptoms, such as heavy bleeding after the cutting of the umbilical cord or after circumcision.

Treatment

Treatment often includes an infusion or injection of whatever deficiency is causing the patient to have problems with clotting. This may include these treatments:

  • Platelet infusions
  • Plasma-derived factor concentrate injections
  • Blood transfusions

Management

With early diagnosis and proper treatment and management, patients can still lead active and productive lives even if their disorders cannot be fully cured. Some treatments can be done at home now in the form of injections and nasal sprays. For example, patients with von Willebrand disease may consider using desmopressin acetate.⁶ Iron supplementation may also be recommended for patients when heavy bleeding puts them at an increased risk of  anemia.

Recommendations for patients with bleeding disorders may also include regularly flossing and brushing their teeth because bleeding gums and oral surgery can put them at risk of complications. These patients may also need to visit their primary care provider or hematologist before a dental appointment, and they can also ask them to recommend dentists with experience treating patients with bleeding disorders.

References

  1. Von Willebrand disease – symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/von-willebrand-disease/symptoms-causes/syc-20354978. Accessed March 1, 2021.
  2. Hemophilia – symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hemophilia/symptoms-causes/syc-20373327. Accessed March 1, 2021.
  3. Other factor deficiencies. National Hemophilia Foundation. https://www.hemophilia.org/bleeding-disorders-a-z/types/other-factor-deficiencies. Accessed March 1, 2021.
  4. How von Willebrand disease is inherited. US Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/vwd/inherited.html. Reviewed October 26, 2020. Accessed March 1, 2021.
  5. Liebman HA. Acquired bleeding disorders. In: Schmaier AH, Lazarus HM, eds. Concise Guide to Hematology. 2011:131-139. doi:10.1002/9781444345254.ch12
  6. What is von Willebrand disease? US Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/vwd/facts.html. Reviewed October 26, 2020. Accessed March 1, 2021.

This article originally appeared on Hematology Advisor