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.

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.