Bleeding Diathesis

Have you ever wondered why some people bruise easily or experience prolonged bleeding from minor cuts? This condition, known as bleeding diathesis, affects many individuals worldwide. Bleeding diathesis refers to an increased tendency to bleed due to various underlying factors, which can range from genetic disorders to certain medications. This article explores the causes & manifestations of this condition, shedding light on its diagnosis and treatment options. 

What is Bleeding Diathesis? 

Bleeding diathesis refers to an increased tendency to bleed or bruise easily. This condition occurs due to various underlying disorders that typically affect the blood clotting process. Clotting, or coagulation, is a normal, multistep process that creates a clump of semisolid blood to stall excessive bleeding when a blood vessel is injured. According to the underlying causative factors, there are different bleeding diathesis types, including coagulation disorders (haemophilia DIC, or vitamin K deficiency), platelet disorders (thrombocytopenia or platelet dysfunction), and vascular disorders. 

Causes of Bleeding Diathesis 

Bleeding diathesis or clotting diathesis has various underlying causes, which can be classified into two main categories: acquired & congenital. 

• Acquired Bleeding Diathesis Causes: Acquired causes develop throughout one's lifetime and include several factors. 
  • Vascular problems affecting blood vessels can lead to increased bleeding. 
  • Low platelet counts or increased platelet destruction, seen in conditions like autoimmune thrombocytopenia and systemic lupus erythematosus, impair the blood's ability to clot. 
  • Vitamin K deficiency also plays a role in disrupting the coagulation process. 
  • Chronic kidney disease may undermine platelet functioning and lead to increased bleeding. 
  • Liver disease can decrease the production of essential clotting proteins. Anticoagulant medications intentionally weaken blood clotting to reduce the risk of heart attacks or strokes. 
  • The body's immune system may sometimes attack clotting proteins, resulting in an acquired clotting antibody. 
• Congenital Bleeding Diathesis Causes: Congenital causes, present at birth, include: 
  • Bernard-Soulier syndrome 
  • Glanzmann thrombasthenia 
  • Ehlers-Danlos syndrome 

These conditions contribute to the complex nature of bleeding diathesis and its varied manifestations. 

Symptoms of Bleeding Diathesis 

Bleeding diathesis symptoms range from mild to severe. People with this condition may bruise or bleed easily. Common signs include: 

• Bleeding gums, which might be noticed when brushing or flossing teeth 
• Heavy bleeding is another symptom, in which even minor cuts bleed excessively or longer than expected. 
• Women may experience heavy menstrual bleeding, known as menorrhagia, with prolonged periods or the passing of large blood clots. 
• Haemarthrosis, where internal bleeding into joints causes them to feel achy, swollen, or warm. 
• Petechiae, which are pinpoint spots of bleeding under the skin, and purpura, more prominent red, purple, or brown blood spots, may also occur. 
• Unexplained nosebleeds, or epistaxis, can be frequent and difficult to stop. 
• In more severe cases, bleeding diathesis can cause internal bleeding, resulting in black stool (melena) due to bleeding in the upper gastrointestinal tract. 
• Some individuals may also experience blood in their urine or vomit. 

Diagnosis 

• Medical History and Physical Assessment: Doctors start by taking a detailed medical history, including past bleeding episodes and family history. They also inquire about medications and supplements that may affect clotting. A physical examination follows, focusing on skin abnormalities like purpura and petechiae. Doctors look for physical characteristics associated with congenital bleeding disorders in infants and children. 
• Blood Tests: Basic screening investigations include a complete blood count (CBC) to check for platelet abnormalities. Blood clotting capability tests help identify clotting factor deficiencies. Specific tests examine fibrinogen activity and von Willebrand factor antigen levels.

Doctors may prescribe additional investigations if they suspect liver disease or other systemic conditions. 

Treatment 

The bleeding diathesis treatment approach depends on the underlying cause and severity of the condition, including: 

• Synthetic blood clotting factors have greatly improved treatment options for individuals with haemophilia. 
• In cases of vitamin K deficiency, supplements may be prescribed along with additional clotting factors if necessary. 
• Von Willebrand's disease treatment often involves medications that increase von Willebrand factor levels in the blood or use blood factor concentrates. 
• Antifibrinolytics medications slow down the breakdown of clotting factors in the blood, making them particularly effective for bleeding from mucous membranes and during menstruation. They may also be used preventively for dental procedures. 
• Treatment options for patients with factor XI deficiency include fresh frozen plasma, factor XI concentrates, and antifibrinolytics. 
• In some cases, doctors may recommend adjusting medications contributing to bleeding diathesis. Hormone treatments, such as pills for birth control, can help manage heavy menstrual bleeding associated with the condition.

When to See a Doctor 

• If you or your child experiences more than the usual bruising or bleeding, it's essential to consult a doctor. This is especially vital if you have a family history of bleeding disorders. 
• It's essential to see a doctor about bleeding diathesis if you're planning to have surgery, give birth, or undergo extensive dental work. 
• If you notice symptoms such as blood in your urine or stool, frequent nosebleeds, or prolonged bleeding from minor cuts, don't hesitate to seek medical advice.  
• Women experiencing heavy or prolonged menstrual periods should also consult a doctor. 

Conclusion 

Bleeding diathesis has a significant impact on the lives of those affected, ranging from mild bruising to severe internal bleeding. Patients and doctors must understand its causes, symptoms, and treatment options. Early diagnosis and proper management can significantly improve the quality of life for bleeding diathesis patients, allowing them to lead normal lives with appropriate precautions. 

FAQ's 

1. Is bleeding diathesis the same as haemorrhage? 

Bleeding diathesis and haemorrhage are related but distinct concepts. Bleeding diathesis refers to an increased tendency to bleed or bruise easily due to various underlying disorders affecting the blood clotting process. On the other hand, haemorrhage is the actual act of bleeding, which can occur in anyone but is more likely and potentially more severe in those with bleeding diathesis. While haemorrhage is a symptom, bleeding diathesis is the underlying condition that makes haemorrhage more likely to occur. 

2. What are the three types of bleeding? 

Bleeding can be classified into three main types based on its location and severity: 

• External bleeding: This occurs when blood escapes through an open wound on the skin's surface. It's the most visible type of bleeding and can range from minor cuts to severe injuries. 
• Internal bleeding: This happens when blood leaks from blood vessels inside the body. It's not immediately visible and can be more dangerous as it's harder to detect and treat. 
• Interstitial bleeding: This type involves blood leaking into tissues surrounding blood vessels. It often results in bruising or swelling and can be a sign of bleeding diathesis.

Dr. Kunal Chhattani

CARE Medical Team