Published: 18 Jun 2025

ICD9: 286.9      ICD10: D68.8      ICD11: 3B4Z

Bleeding disorders, also known as coagulopathies, are a group of conditions that affect the body's ability to control blood clotting.
This can lead to prolonged or excessive bleeding after an injury, surgery, or even spontaneously.

Here's a breakdown of what you need to know about bleeding disorders:

What is Coagulation (Blood Clotting)?

First, it's important to understand how blood clotting works. It's a complex process involving:

Blood Vessels: When a blood vessel is injured, it initially constricts to reduce blood flow.
Platelets: These are small blood cells that clump together to form a temporary plug at the site of injury.
Clotting Factors: These are proteins in the blood that work in a cascade to form a stable fibrin clot. Think of it like a chain reaction.
Anticoagulants: The body also has natural anticoagulants (proteins that inhibit clotting) to prevent the clot from becoming too large or forming when it isn't needed.

What Causes Bleeding Disorders?

Bleeding disorders can be caused by problems with any of these parts of the clotting process:

Platelet disorders: Problems with the number or function of platelets.
Thrombocytopenia: Low platelet count (e.g., due to immune disorders, infections, medications, bone marrow problems).
Platelet dysfunction: Platelets don't work properly (e.g., due to medications like aspirin or clopidogrel, inherited disorders).
Clotting factor deficiencies: Missing or defective clotting factors.
Hemophilia A (Factor VIII deficiency): An inherited disorder, most commonly affecting males.
Hemophilia B (Factor IX deficiency): Also an inherited disorder, more common in males.
Von Willebrand disease: The most common inherited bleeding disorder, affecting both males and females. It involves a deficiency or dysfunction of von Willebrand factor (vWF), which helps platelets stick together and carries factor VIII.
Vitamin K deficiency: Vitamin K is needed to make several clotting factors. Deficiencies can be caused by poor diet, malabsorption, or certain medications.
Liver disease: The liver produces many clotting factors. Liver damage can lead to decreased production of these factors.
Vascular disorders: Problems with the blood vessels themselves, making them fragile and prone to bleeding. These are less common causes.
Acquired Coagulopathies:
Disseminated Intravascular Coagulation (DIC): A serious condition often triggered by sepsis, trauma, or certain cancers. It involves widespread clotting and bleeding.
Antiphospholipid syndrome: An autoimmune disorder that can cause blood clots in arteries or veins, as well as recurrent pregnancy loss. It can paradoxically cause both thrombosis (clotting) and bleeding.
Drug-induced: Certain medications (e.g., anticoagulants like warfarin, heparin, or direct oral anticoagulants (DOACs)) can cause excessive bleeding.

Symptoms of Bleeding Disorders:

Symptoms can vary depending on the severity of the disorder, but common signs include:

Easy bruising: Bruising easily or having large, unexplained bruises.
Prolonged bleeding: Bleeding longer than normal after cuts, surgery, dental work, or trauma.
Frequent nosebleeds: Especially if they are difficult to stop.
Heavy menstrual periods: (Menorrhagia) in women.
Bleeding gums: Especially after brushing or flossing.
Blood in urine or stool: This can indicate internal bleeding.
Joint pain and swelling: Caused by bleeding into the joints (hemarthrosis), particularly in hemophilia.
Bleeding after childbirth.

Diagnosis:

Diagnosing a bleeding disorder typically involves:

Medical history and physical exam: The doctor will ask about your bleeding history, family history of bleeding disorders, and any medications you are taking.
Blood tests:
Complete blood count (CBC): To check platelet count.
Prothrombin time (PT) and international normalized ratio (INR): To measure how long it takes for blood to clot.
Partial thromboplastin time (PTT): Another test to measure clotting time.
Fibrinogen level: Measures the amount of fibrinogen, a key clotting protein.
Specific clotting factor assays: To measure the levels of individual clotting factors (e.g., Factor VIII, Factor IX, vWF).
Platelet function tests: To assess how well platelets are working.
Genetic testing: May be used to confirm inherited bleeding disorders.

Treatment:

Treatment depends on the specific bleeding disorder, its severity, and the cause of the bleeding. Options include:

Desmopressin (DDAVP): A synthetic hormone that can increase levels of vWF and Factor VIII. Used for mild hemophilia A and some types of von Willebrand disease.
Clotting factor concentrates: Infusions of the missing or deficient clotting factor (e.g., Factor VIII for hemophilia A, Factor IX for hemophilia B). These can be given on demand (to treat bleeding episodes) or prophylactically (to prevent bleeding).
Von Willebrand factor (vWF) concentrates: Infusions of vWF to treat von Willebrand disease.
Antifibrinolytic medications: (e.g., tranexamic acid, aminocaproic acid) These medications help prevent clots from breaking down, stabilizing them and reducing bleeding.
Platelet transfusions: To increase platelet count in cases of thrombocytopenia.
Vitamin K supplementation: For vitamin K deficiency.
Immunosuppressants: For immune thrombocytopenia.
Treatment of underlying conditions: Addressing the underlying cause of acquired bleeding disorders (e.g., treating liver disease or sepsis).
Local measures: Applying pressure to cuts, using ice packs, and using topical hemostatic agents to stop bleeding.

Living with a Bleeding Disorder:

People with bleeding disorders can live full and active lives with proper management. This includes:

Regular monitoring by a hematologist: A specialist in blood disorders.
Avoiding activities that carry a high risk of injury.
Informing healthcare providers about the bleeding disorder before any medical procedures.
Wearing a medical alert bracelet or carrying an identification card.
Following a healthy lifestyle, including a balanced diet and regular exercise.
Knowing how to manage bleeding episodes at home.
Education about the specific bleeding disorder and its treatment.

Important Considerations:

Emergency situations: Individuals with bleeding disorders and their families need to be prepared for bleeding emergencies. This includes knowing how to apply pressure to wounds, when to seek medical attention, and having a plan for obtaining clotting factor concentrates quickly.
Medication interactions: Certain medications, such as aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs), can increase the risk of bleeding and should be used with caution.
Dental care: Good dental hygiene is important to prevent gum bleeding.
Pregnancy: Women with bleeding disorders require specialized care during pregnancy and delivery.

If you suspect you have a bleeding disorder, it's essential to see a doctor for diagnosis and treatment. Early diagnosis and management can help prevent serious complications and improve your quality of life.