Bleeding occurs when a blood vessel is dam­aged. If the vessel is internal, blood seeps into surrounding tissue, and a bruise forms. Where delicate blood vessels are near the surface of tissue, as they are in the nose, for example, a very slight injury or irritation may cause bleeding.For most people, minor bleeding causes no harm because the body soon stops it. It does his by means of three main mechanisms that act together. The nearby blood vessels contract, and restrict the flow of blood to the area of the wound. The platelets in the blood gather where the blood vessels are damaged, and stick to the vessel walls and to each other to form a plug. In addition, interlacing strands of a material called fibrin form in the damaged area. Blood cells are then trapped in the fibrin mesh and form a clot that seals the break and stops the bleeding.

In diseases that cause abnormal bleeding, one or more of the mechanisms that halt blood loss does not work right. Bleeding from a cut, which would normally stop within five or ten minutes, may continue for hours, or even days. Minor injuries may cause extensive bruising. There may be internal bleeding, and bleeding in the joints may produce acute pain and eventually cause crippling damage. Two of the most common of such disorders, hemophilia and thrombocytopenia, are discussed here.

Normally your body adjusts the production of blood cells in the bone marrow, so that the number of blood cells that are made equals the number that are destroyed. If you have polycythemia, the mechanism becomes faulty and your marrow produces far more blood cells than usual.There are two main types of the disorder.

The first, polycythemia vera, is an over­production of red blood cells, granulocytes and platelets.

The second type of polycythemia is called secondary polycythemia. It occurs as a result of an underlying cause such as a severe lung disease, certain kinds of congenital heart disease cigarette and cigarrtte a king, and living at high altitudes. These conditions can prevent the red blood cells from obtaining enough oxygen to pass on to the body’s tissues, and the bone marrow responds by producing many more red blood cells.

There is a third and less important type of the disorder, which is called stress polycythemia or pseudopolycythemia. In this condition, the number of red blood cells in a blood sample is high, but the cause is a decrease in the amount of plasma in the blood. This is usually due to smoking, but it can be caused by taking diuretic drugs or by becoming dehydrated.

Currently, secondary polycythemia and stress polycythemia are not treated directly. Rather, the problems that cause them are dealt with. Polycythemia vera is the most serious form of the disease, however, and it can be treated directly.

What are the Symptoms?

The typical symptoms of polycythemia vera include recurrent headaches, dizziness, a feeling of fullness in the head, and a ruddy complexion. Sometimes there is severe itching, and hot baths make the itching worse. A physician who examines you may find that you have an enlarged spleen.

What are the Risks?

Although polycythemia vera cannot be cured, it is almost always readily controlled by treatment. Many people who have the disease live for many years. Possible complications from the disease include heart attack deep-vein thrombosis stroke peripheral arterial thrombosis, bleeding, and gout .

What Should be Done?

If you have the symptoms of polycythemia, you should see a physician. The physician will arrange for a blood test, which should show whether or not you have some form of the disease. If polycythemia is diagnosed, further tests are necessary to discover which type of the disorder you have. The tests may include additional blood tests, an intravenous pyelogram, or X-rays of the kidneys, and a measurement of blood volume. In this last test, for example, a small amount of radioactive albumin and a small quantity of your own red blood cells labelled with radioactive chromium are injected into a vein in one of your arms, and a blood sample is taken from your other arm about 30 minutes later. Then the volume of red blood cells and plasma in your bloodstream can be determined.

What is the Treatment?

If you have polycythemia vera, you may be able to receive treatment as an out-patient. The first goal of treatment is to lower the number of red cells in your blood to reduce the risk of thrombosis, or blockage from a clot. To do this, about a pint of blood is regularly taken from a vein in your arm. In some cases, this treatment is only needed once to clear up the condition.

Drugs are usually used to control the over­production of blood cells. Depending on what drug your physician prescribes, you may take it in tablet form for several weeks or it may be injected into a vein. Drug treatment may control the disease for up to several years. Treatment is repeated when the blood counts begin to increase again.

This type of anemia frequently complicates other diseases. Disorders that often bring on this type of anemia include rheumatoid arthritis hepatitis and tuberculosis. It can also occur in anyone who has an acute infection such as pneumonia .The symptoms of anemia of chronic disease are the same as those for other forms of anemia, combined with the symptoms of the underlying disease. It cannot be treated, except by transfusions, but it should improve when the disease that produces it improves in response to treatment.

What is this condition?

A shortage of white blood cells may involve granulocytes or lymphocytes.

A low granulocyte count can occur at any age and can lead to infections and sores in the throat, digestive tract, and other mucous membranes and on the skin. A low lymphocyte count, a rare disorder, is a deficiency of white blood cells produced mainly in the lymph nodes.

When the total white blood cell count falls to dangerously levels, the body is left unprotected against infection. The prognosis depends on the underlying cause and whether it can be treated.

What Causes this Condition?

A low granulocyte count may result from:

• radiation therapy or cancer drugs
• hypersensitivity to certain antibiotics and heart drugs
• disorders such as aplastic anemia, bone marrow cancer, some hereditary disorders, infectious mononucleosis, and certain viral and bacterial infections
• trapping of blood cells in the spleen.

A low lymphocyte count may result from:

• a genetic abnormality
• radiation therapy or cancer drugs
• dysfunctional lymphatic vessels in the bowel
• an excess of steroid hormones, caused by use of adrenocorticotropic hormone or steroids, stress, or congestive heart failure
• disorders such as Hodgkin’s disease, leukemia, aplastic anemia, sarcoidosis, myasthenia gravis, lupus, protein-calorie malnutrition, kidney failure, terminal cancer, and tuberculosis.

What are its Symptoms?

A low granulocyte count typically causes slowly progressive fatigue and weakness followed by sudden onset of overwhelming infection (heralded by fever, chills, rapid pulse, anxiety, headache, extreme exhaustion), mouth and throat sores, ulcers in the colon, pneumonia, and blood infection, possibly leading to mild shock. If the low count results from a drug reaction, infection symptoms develop suddenly, without slowly progressive fatigue and weakness.

A low lymphocyte count causes swollen glands, an enlarged spleen, and enlarged tonsils, along with signs of an associated disease.

How is it Diagnosed?

To diagnose a low white cell count, the doctor takes a thorough history and performs a physical exam to look for signs of an underlying disorder, orders appropriate blood cell tests, and, if necessary, obtains biopsy specimens of bone marrow and lymph node tissue for analysis.

How is it Treated?

To treat a low granulocyte count, the doctor must find and eliminate the underlying cause, then control infection until the bone marrow can generate more white blood cells. For many people, this means stopping drug or radiation therapy and starting antibiotics immediately, even while awaiting test results. Treatment may also include antifungal preparations. In a newer treatment, the person receives granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor to stimulate bone marrow production of neutrophils. Generally, white blood cell production in the bone marrow resumes spontaneously within 1 to 3 weeks.

Treatment of a low lymphocyte count aims to eliminate or manage the underlying cause.

Hemophilia - Coping up with Hemophilia

Hemophilia is the best known of the bleeding diseases. Although it is the most common of these diseases, it is still rather rare. In this disorder, there is a marked reduction in the amount of a protein called anti-hemophilia globulin, or Factor VIII, in the blood. Factor VIII is vital to the clotting mechanism of the blood. Because of the way hemophilia is inherited, only males have the disease, but it is passed from generation to generation by female “carriers.” In the United States about 1 male in 10,000 has hemophilia. In about 75 per cent of cases, there is a family history of the disease, but in the remaining cases, the hemophiliac is the first of his line, probably because of a mutation, or spontaneous change, in the genes of his mother.

What are the symptoms?

Symptoms usually appear in childhood, as soon as the affected male child becomes active. He gets bruises on his knees and elbows after he crawls, and cuts bleed for a long time. Internal bleeding caused by falls may cause large, deep bruises, which may make a limb swollen and painful for several days. Repeated bleeding into joints and accumulation of scarred tissue produce stiff joints that limit the child’s movement. There is a great deal of variation in the amount of bleeding from one patient to another.

What are the risks?

Today the risks of being crippled or dying from hemophilia are greatly reduced because of effective treatment. However, a major injury is still particularly dangerous for anyone who has hemophilia. Also, if you are a hemophiliac, special precautions must be taken before you have any operation, even a tooth extraction.

What should be done?

Any member of a family with a history of hemophilia should seek genetic counseling before starting a family. Your physician or local public health organizations can tell you where to find such counseling. If you have a male child who shows any of the symptoms described, see your physician.

If you are an adult male and you notice that you bruise or bleed in a way that seems abnormal to you, you should also see your physician. After questioning you, the physician may refer you to a hematologist, or blood specialist. If you or your child have hemophilia, you may be given a card that describes the disease. The hemophiliac should carry the card at all times, so that if an accident occurs the appropriate treatment will be given.

What is the treatment?

Self-help: If you have hemophilia, unless it is a very mild case, your physician will advise against activities that could cause even minor injury. This means that you must avoid most physical contact sports. Solitary exercise such as running or gymnastics may be advised in moderation. Your physician will also advise that you not take aspirin or any drugs that contain it. This is because aspirin increases the chance of bleeding.

Professional help: If severe bleeding or bruising does occur, you should know who to contact, usually your own physician or a special hospital. Such bleeding is treated by in­fusing a concentrated form of Factor VIII, the missing clotting factor, into a vein. Depending on the severity of the bleeding and its location in your body, it is often necessary to continue the infusions of Factor VIII regularly for five to ten days after a bleeding episode.

What are the long term prospects?

There is no question that hemophilia is, in many ways, a limiting disease. It is probably most difficult to deal with in childhood when much of normal play must be avoided. Adults with hemophilia generally work out satisfactory lives within the limitations that are imposed by the disease. Those who are extremely upset by feelings of restriction or vulnerability should seek psychiatric aid.