Tendency to bleed

Overview

A number of diseases and medicines can disrupt the functioning of (one or all of) the three main components of the blood-clotting process and cause a greater tendency to bleed. These three components are: blood-clotting proteins, blood platelets and the blood vessel wall. Bleeding lasts for longer. Patients bleed spontaneously or increasingly, incl. bleeding into the skin.

Symptoms

• Sometimes spontaneous bleeding without any discernible cause
• Small “sharp” injuries (e.g. cuts or stings) bleed heavily and longer than usual or start bleeding again after a short while
• Prolonged nosebleeds, secondary bleeding after dental treatment or an operation
• Blunt injuries such as a bruise or sprain cause bleeding in the muscles and under the skin
• Punctiform bleeding: tiny red dots indicate a disorder affecting the smallest blood vessels (capillaries) or the blood platelets (thrombocytes)
• Haematoma: larger flat areas indicate defects of blood clotting factors or platelet disorders

Causes and treatment

Causes

Disruption at the level of (one or all of) the three main components of the blood-clotting process

Blood-clotting proteins (clotting factors) in the blood plasma (fluid)

• Certain blood-clotting factors are missing in the plasma, are not present in sufficient volumes, or don't react sufficiently
• Typical diseases:
  • Haemophilia
  • Von Willebrand disease
  • Acute or chronic liver diseases, liver cirrhosis (this can cause a lack of effective blood-clotting factors)

Cells in the circulating blood (blood platelets or thrombocytes)

• Insufficient production of blood platelets
  • Congenital
  • Cancer (leukaemia, malignant lymphoma)
  • Viruses or specific poisons
• Increased consumption, breakdown or destruction
  • Immunological processes
  • Infections
  • Thrombosis
  • Enlarged spleen
• Inability to function properly, functional impairment (“thrombocytopathia”)
  • Severe general illnesses, such as kidney failure or cancer
  • Rarely, a congenital dysfunction.
  • Caused by medication as a desired effect to treat thrombosis (higher tendency to bleed is a calculated risk)
  • Caused by medication as an undesired side-effect (some painkillers, antirheumatic drugs and antibiotics)

Blood vessel wall (in particular of small and finest arteries)

• Sometimes a genetic condition:
  • Abnormal permeability
  • Increased vulnerability
  • Inflammatory vascular wall diseases
• Other congenital or acquired vascular wall changes are rare

Further treatment by your doctor / in hospital

Possible tests

• Blood test (focus on clotting times and blood cells)
• Physical examination (focus on signs of bleeding)

Possible therapies

• Preparations (delivery of missing proteins, factors or cells)
• Change dosages of or stop medication (e.g. before an operation)
• Treatment of the underlying disease

What can I do myself?

• We can't really do anything to affect the causes
• Avoid situations harbouring any potential for injury
• Inform the dentist if you have a higher tendency to bleed
• If taking medication to thin the blood (anticoagulation):
  • Stop taking the medicine and consult a doctor immediately in the event of repeated or unexplained bleeding

When to see a doctor?

• Haematomas occur more often and faster than before
• Sudden and unexplained punctiform bleeding (size of a pinhead) in the skin
• Bleeding of skin or mucous membranes that lasts unusually long (more than 30 minutes) or occurs frequently
• Sudden, unexplained bleeding while taking anticoagulants (“blood-thinning” medication)
• Bleeding from the intestines, urinary tract or respiratory tract (coughing blood)

Synonyms

increased tendency to bleed, bleeding diathesis, pathological tendency to bleed, coagulopathy