Bleeding Disorder Types, Causes, and Treatments

A bleeding disorder, sometimes called a coagulopathy, is a condition that makes you more likely to bleed than the average person. The body cannot form a clot properly. This involves one of the parts of our coagulation (bleeding and clotting) system.

The coagulation system should be in balance—not too much bleeding but also not too much clotting. One part of the process involves the platelets, a type of blood cell. The second part is found in the liquid portion of blood, called coagulation factors. People sometimes refer to people with bleeding disorders as “free bleeders.”

Symptoms 

The symptoms of a bleeding disorder can vary greatly. Not all patients with bleeding disorders will have all of these symptoms.

• Frequent or prolonged nosebleeds
• Recurrent or prolonged bleeding of the gums
• Excessive menstrual periods referred to as menorrhagia as well as excessive bleeding postpartum (after delivery)
• Prolonged bleeding after a needle stick (blood draw or injection like a vaccine)
• Excessive bleeding during or after surgery that requires additional efforts to stop bleeding
• Large palpable bruises

Just because you may experience one of these symptoms does not mean you necessarily have a bleeding disorder. You should discuss your concerns with your healthcare provider.

Causes 

• Inherited: Some bleeding disorders like hemophilia and Von Willebrand disease are inherited, meaning the person is born with the disease.
• Liver disease: The coagulation factors are made predominantly in the liver. People with severe liver disease are unable to produce enough coagulation factors and therefore are more likely to experience bleeding.
• Vitamin K deficiency: Several of the coagulation factors require vitamin K to function correctly so people who are vitamin K deficient are more likely to have bleeding.
• Anticoagulation therapy: People on anticoagulation therapy (medications that prevent clotting) are at increased risk of bleeding.
• Platelet disorders: If the platelets cannot function properly, they cannot form a proper clot, which may result in bleeding.

Types 

• Hemophilia: Probably the most well known bleeding disorder is hemophilia. People with hemophilia are missing one of their coagulation factors. The name of their type of hemophilia depends on what factor is missing. The most common type is hemophilia A; these patients are missing factor 8 from their coagulation system. There is also hemophilia B (factor 9 deficiency) and hemophilia C (factor 11 deficiency). Hemophilia is inherited (passed down in families). It involves the Y chromosome so men are predominantly affected. People with hemophilia can have significant bleeding from injuries or spontaneous (without injury) bleeding.
• Von Willebrand disease: Von Willebrand disease (VWD) is the most common bleeding disorder in the world. It is estimated that 1% of the population has some form of Von Willebrand disease. VWD is also inherited but both men and women can be equally affected. The amount of bleeding can vary greatly depending on what type of VWD a person inherits.
• Liver disease: When the liver is not functioning properly, it is unable to produce coagulation factors. Without these factors, patients can have significant bleeding.
• Low platelet count (thrombocytopenia): There are numerous reasons for why the platelet count is low including ​leukemia, a side effect of chemotherapy, and immune thrombocytopenia (where the immune system destroys the platelets).
• Platelet function disorders: In addition to low platelet numbers causing bleeding, if the platelets do not function properly, bleeding may occur.

Treatment 

There are many possible treatments for bleeding in a person with a bleeding disorder. The treatment chosen is based on the cause of the bleeding disorder or the location of the bleeding.

• Factor replacement: Patients with hemophilia can infuse themselves with factor replacement products that can treat bleeding episodes. Nowadays, many patients with hemophilia infuse factor replacements on a regular basis to prevent bleeding episodes.
• Desmopressin (also identified by the brand name Stimate): Desmopressin is a replacement product for the hormone vasopressin. Taking desmopressin results in a temporary increase in von Willebrand antigen and factor 8 which may stop bleeding in patients with mild hemophilia A or von Willebrand disease.
• Platelet transfusions: If the platelet count is low or the platelets do not function correctly, a platelet transfusion may be given to prevent/treat bleeding.
• Fresh frozen plasma: Coagulation factors are found in the plasma (liquid component of blood). If a person is missing several different factors, like in liver failure, an infusion of fresh frozen plasma can be given.
• Vitamin K: If a patient if Vitamin K deficient, supplementation can be given.
• Antifibrinolytics: These medications prevent excessive bleeding by stabilizing clots. These are primarily used to control bleeding in the mouth or heavy menstrual periods.

When to See Your Healthcare Provider

If you think you have excessive bleeding, particularly if other people in your family do as well, you should discuss this with your healthcare provider. If your healthcare provider is also concerned, they may run preliminary blood work or refer you to a hematologist, a healthcare provider who specializes in blood disorders.