0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Patient Page |

Bleeding Disorders FREE

Denise M. Goodman, MD, MS; Alison E. Burke, MA; Edward H. Livingston, MD
JAMA. 2012;308(14):1492. doi:10.1001/jama.2012.4089.
Text Size: A A A
Published online

When tissues are injured, blood cell fragments called platelets gather at the wound, providing a foundation for coagulation (clotting). Platelets are bound together by a glue-like protein named von Willebrand factor. Once the initial platelet plug is built, clotting factors gather at the injury site to seal the wound, stop bleeding, and begin the healing process. The clotting factors work in a carefully timed sequence, resulting in a sturdy clot and healed wound.

Place holder to copy figure label and caption

Graphic Jump LocationImage not available.

TYPES OF BLEEDING DISORDERS

Bleeding problems can result from diseased platelets or clotting factor abnormalities. Some bleeding problems are congenital (present at birth) while others are acquired (develop at any time during a person's life). Congenital bleeding is often associated with a family history of bleeding and results from missing or poorly functioning clotting factors. Hemophilia is an example of an inherited bleeding disorder caused by abnormal genes on the X chromosome, mostly affecting males. There are 2 types of hemophilia, resulting from missing factor VIII or factor IX. Deficiency of either of these factors can result in a severe bleeding disorder characterized by bleeding into joints and muscles. Von Willebrand disease occurs when some or all of the von Willebrand protein is missing or does not work correctly. It is the most common inherited bleeding disorder and generally results in only mild bleeding. Infections, liver and nutritional diseases (vitamin K deficiency), and some drugs can cause abnormal bleeding by interfering with clotting factor function and production.
Platelets can cause bleeding when there are not enough of them or if the platelets do not function properly. Otherwise normal platelets may function abnormally when diseases like leukemia or kidney failure are present or because of certain medications such as aspirin or nonsteroidal anti-inflammatory drugs like ibuprofen. Over-the-counter supplements such as fish oil, gingko, and turmeric can also cause platelet function problems. This issue of JAMA includes an article on hemophilia and one on neonatal blood transfusion.

SYMPTOMS

  • Bruising

  • Nosebleeds

  • Bleeding from the gums

  • Blood in urine or stool

  • Heavy or abnormal menstrual periods

  • Prolonged bleeding with cuts

  • Bleeding into joints or muscles

  • Bleeding into critical organs

The cause of abnormal bleeding can be found by blood tests for the number and function of platelets and the levels of the clotting factors. Sometimes tests for other diseases are necessary if the bleeding disorder is one of the acquired types.

TREATMENT

Treatment depends on the underlying cause. Sometimes patients receive transfusions of platelets or one of the clotting factors. In other situations, a medication may improve clotting function. If the bleeding problem is caused by an underlying illness such as leukemia, kidney failure, or liver disease, that problem must be addressed to reduce bleeding.

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA 's website at www.jama.com. Many are available in English and Spanish.

Figures

Place holder to copy figure label and caption

Graphic Jump LocationImage not available.

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Spanish Patient Page: Trastornos de la sangre

Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com

The Rational Clinical Examination
Adverse Events