Conditions That Cause Excessive Bleeding

in Human Beings
Excessive bleeding can result from
deficiency of any one of the many blood-
clotting factors. The most important types
of bleeding tendencies that have been
studied are:
(1) vitamin K deficiency,
(2) hemophilia, and
(3) thrombocytopenia (platelet deficiency).
 Vitamin K Deficiency
Almost all the blood-clotting factors are formed by
the liver.
Diseases of the liver such as hepatitis and cirrhosis,
depress the clotting system and the patient
develops a severe bleeding tendency .
Another cause of depressed formation of clotting
factors by the liver is vitamin K deficiency.
Vitamin K is necessary for liver formation of five
of the important clotting factors:
prothrombin, Factor VII, Factor IX,
Factor X, and protein C.
 Vitamin K is continually synthesized in the
intestinal tract by bacteria, so that vitamin K
deficiency does not occur in the normal person as
a result of vitamin K absence from the diet (except
in neonates before they establish their intestinal
bacterial flora).
in gastrointestinal disease, vitamin K deficiency
occurs as a result of poor absorption of fats from
the gastrointestinal tract.
 vitamin K is fat-soluble and ordinarily is absorbed
into the blood along with the fats.
One of the causes of vitamin K deficiency is failure
of the liver to secrete bile into the gastrointestinal
tract (obstruction of the bile ducts or liver
disease).
Thus, liver disease causes decreased production of
prothrombin and some other clotting factors both
because of:
1)poor vitamin K absorption.
2) because of the diseased liver cells.
 Hemophilia
Hemophilia is a bleeding disease that occurs in males.
Pathogenesis:
In 85 per cent of cases, it is caused by an abnormality or
deficiency of Factor VIII; (hemophilia A or classic
hemophilia).
Factor VIII has two active components, a large
component and a smaller component.
The smaller component is important in the intrinsic
pathway, and its deficiency causes classic hemophilia.
Another bleeding disease called von Willebrand's
disease, results from loss of the large component.
 In the other 15 per cent of hemophilia patients, the
bleeding tendency is caused by deficiency of Factor IX.
Both factors are transmitted genetically by way of the
female chromosome (X).
No woman can develop hemophilia because at least one
of her two X chromosomes will have the normal genes.
If one of her X chromosomes is deficient, she will be a
hemophilia carrier, transmitting the disease to half of her
male offspring and transmitting the carrier state to half
of her female offspring.
 Signs:
1) Bleeding usually does not occur except after trauma,
but in some patients, mild trauma can cause severe and
prolonged bleeding.
2) bleeding can last for days after tooth extraction.
Tratement:
the only therapy that is effective is injection of purified
Factor VIII.
 Thrombocytopenia
Thrombocytopenia means very low numbers of
platelets in the circulating blood.
People with thrombocytopenia have a tendency to
bleed.
bleeding is usually from many small venules or
capillaries, rather than from larger vessels as in
hemophilia.
small punctate hemorrhages occur throughout all
the body tissues.
The skin has many small, purplish blotches, giving
the disease the name thrombocytopenic purpura.
bleeding will not occur until the number of platelets
in the blood falls below 50,000/ul.
 Thrombocytopenia may be idiopathic which means
thrombocytopenia of unknown cause.
But in most cases, specific antibodies have formed
and react against the platelets to destroy them.
Relief from bleeding for 1 to 4 days can occur by
giving fresh whole blood transfusions that contain
large numbers of platelets.
Also, splenectomy sometimes causes complete cure
because the spleen normally removes large
numbers of platelets from the blood.