Bleeding tendency describes an increased likelihood of the body developing bleeds, or of bleeds lasting longer than usual.
What is behind a bleeding tendency?
Normally, the combined action of blood vessels, platelets, and clotting factors ensures that bleeding is stopped quickly. With a bleeding tendency, also known as haemorrhagic diathesis, this mechanism is disrupted. This can mean that even small injuries, or sometimes everyday activities with no obvious cause, lead to bleeds that are difficult to control or that last an unusually long time.
Typical signs can include frequent nosebleeds, large bruises after minor bumps, bleeding gums when brushing teeth, or unusually heavy periods. Small, pinpoint bleeds under the skin, known as petechiae, can also be a sign. In some cases, the tendency is only noticed during an operation or after a visit to the dentist, when stopping the bleeding takes longer than expected.
Possible causes and background
A bleeding tendency can have many different causes. Often, there is a problem with blood clotting. This can be inherited, such as with the well-known bleeding disorder haemophilia, or von Willebrand disease. Certain medicines, for example blood-thinning drugs such as warfarin, heparin, or aspirin, can also affect blood clotting and increase the tendency to bleed.
Sometimes an underlying condition is behind the increased tendency to bleed, such as a liver disease, as the liver produces many clotting factors. Infections, a lack of vitamin K, or a reduced number or function of platelets (thrombocytopenia) can also be responsible. In rare cases, certain autoimmune conditions or blood cancers (such as leukaemia) may be the cause.
Is a bleeding tendency dangerous?
Whether a bleeding tendency is serious depends greatly on how severe it is and what is causing it. Many people live with a mild form that causes very few problems in daily life. In other cases, however, more serious complications can occur, for example if internal organs are affected or if bleeding does not stop on its own.
If strong or unusual bleeding occurs suddenly and without a clear cause, it is important to see a doctor promptly. This is especially true if blood appears in the stool, urine, or when coughing, or if large, painful bruises develop. It is also important to tell your doctor or dentist about any known bleeding tendency before planned operations or dental procedures.
How is a bleeding tendency diagnosed?
Diagnosis usually begins with a detailed conversation about symptoms and any existing medical conditions. This is followed by blood tests to check the number of platelets, the function of clotting factors, and the time it takes for bleeding to stop. Depending on the results, further specialist tests may be needed, for example to identify rare clotting disorders or a deficiency in certain vitamins.
Sometimes the family history is also looked at, especially if an inherited condition is suspected. In some cases, additional investigations such as an ultrasound or a bone marrow examination may be helpful if a condition affecting the blood-forming system is suspected.
What to do about an increased bleeding tendency?
Treatment always depends on the cause of the bleeding tendency. If an underlying condition is present, treating that condition is the priority. With inherited clotting disorders, missing clotting factors can be specifically replaced. If a medicine is responsible, it may sometimes be stopped or changed. A vitamin deficiency can usually be addressed by taking the missing vitamin in a targeted way.
In daily life, it is sensible to avoid blood-thinning medicines and alcohol when not strictly necessary, and to minimise the risk of injury. Before any planned medical procedure, the treating doctor must always be informed about the bleeding tendency so that appropriate precautions can be taken.
People with a more significant bleeding tendency are often given an emergency card that records the diagnosis and important information about their treatment. This can be life-saving in an emergency.
Living with a bleeding tendency
An increased bleeding tendency is not always a cause for concern, but it can affect daily life. It helps to pay close attention to your own body and not to hesitate to seek medical advice if unusual or persistent bleeding occurs. With the right diagnosis and appropriate measures, the risk of complications can usually be well managed.
