Bleeding Disorders

There is no cure for most bleeding disorders. Typically, they are identified, monitored, and controlled both to prevent excessive blood loss and to prevent complications that may arise. The degree and frequency of treatment needed will depend on the severity of the deficiency or condition, whether or not there is a stimulus for bleeding – such as surgery or trauma, and whether or not the condition progresses or worsens over time.

Simply avoiding injury, limiting physical contact sports for instance, and setting up the daily environment to avoid cuts, bruises, and trauma may be enough to minimize bleeding episodes in those with mild conditions, and under most circumstances, in those with moderate bleeding tendencies. Someone with severe deficiencies, such as Hemophilia A (factor VIII), and/or someone who is having an acute bleeding episode will need to have one or more of their coagulation factors replaced. Factor VIII and a few other individual factors are available in a concentrated form that is expensive but effective. Single and multiple factor deficiencies can also be treated with transfusions of fresh frozen plasma or plasma concentrates that contain all of the coagulation factors. These concentrates and replacements can be given during a bleeding episode and as a preventative measure before necessary surgeries and dental procedures to control excessive bleeding.

If the bleeding disorder is due to dysfunctional or deficient platelets, they may also be transfused. If the disorder is due to von Willebrand’s disease or a mild form of Hemophilia A, a drug called desmopressin (DDAVP) may be given to improve clotting temporarily. It causes the release of stored factor VIII and vWF, and may temporarily raise levels high enough and long enough to allow procedures to be performed without transfusions.

If a bleeding disorder is due to an acquired condition, it may improve or worsen as the underlying condition is resolved or progresses. If, for instance, factor deficiencies are due to a lack of Vitamin K, they may return to normal with vitamin supplementation. If they are due to liver disease or to a cancer, they will likely follow the course of the disease. If a bleeding disorder is due to or exacerbated by the development of factor antibodies, such as antibodies to factors VIII or IX, increased amounts of factor replacements may need to be given, or different therapeutic products may need to be used, and/or patients may need to take corticosteroids or other immune-suppressive drugs to reduce their antibody levels.

With an acute condition, such as DIC, immediate treatment may be crucial and complicated. Since DIC involves both clotting and bleeding throughout the body, treatment may involve platelet and clotting factor transfusions as well as heparin or other anticoagulant therapy.