Bleeding Diathesis

What is bleeding diathesis?

Bleeding diathesis (pronounced “di-ah-thee-sis”) is when you have a condition that causes or increases your risk of bleeding more than usual. The term “diathesis” comes from an Ancient Greek word that refers to a state of being or condition.

In bleeding diathesis, you may have unusually heavy or frequent internal or external bleeding that requires medical attention. Internal bleeding is when there’s bleeding inside your body that you can’t see. External bleeding is blood flowing from your body. You may bruise easily and for no reason.

Many things may cause bleeding diathesis, like blood disorders or inherited conditions that increase your bleeding risk. Healthcare providers may use treatments to slow down the bleeding, as well as manage the condition that causes it.

What are the symptoms of bleeding diathesis?

If you have bleeding diathesis, you may bruise or bleed easily. Issues that could be bleeding diathesis symptoms include:

• Bleeding gums: You may also notice blood on your toothbrush or floss after you brush or floss your teeth.
• Heavy bleeding: This is bleeding a lot more than you expect, like a small cut that bleeds a lot. It may also be bleeding that doesn’t stop. You may bleed more than usual after childbirth or surgery.
• Heavy menstrual bleeding (menorrhagia): This includes having periods that last longer than usual or passing large clots of blood.
• Hemarthrosis (joint bleeding): If you have internal bleeding into your joints, they may feel achy, swollen or warm to your touch.
• Melena (black stool): This is a symptom of internal bleeding in your upper gastrointestinal (GI) tract, like in your esophagus or stomach.
• Petechiae: These are pinpoint spots of bleeding under your skin.
• Purpura: Small blood vessels leaking under your skin may cause red, purple or brown blood spots under your skin.
• Unexplained nosebleeds (epistaxis): This could be a bloody nose where you lose a lot of blood, and your nose keeps bleeding.

What causes bleeding diathesis?

Often, people have bleeding diathesis because they have an underlying condition that causes bleeding. Some healthcare providers may classify underlying conditions as being bleeding disorders, blood clotting disorders or vascular disorders (issues that affect your blood vessels).

Bleeding disorders

Bleeding disorders happen when your blood doesn’t clot normally, causing you to bleed more than usual. Bleeding disorders include:

• Fibrinogen deficiency conditions: Fibrinogen is a protein that helps your blood form clots. A healthcare provider may use the terms “clotting factor” or “coagulation factor” when talking about fibrinogens. If you don’t have enough fibrinogen or your fibrinogen doesn’t work as it should, you may bleed for no reason or have bleeding that you can’t control.
• Hemophilia: This rare genetic disorder keeps your blood from clotting.
• Liver disease: Late-stage liver disease may cause excessive bleeding and bruising.
• von Willebrand disease: This is the most common bleeding disorder in the U.S. Like hemophilia, the condition keeps your blood from making clots that slow down or stop bleeding.

Blood clotting disorders

A blood clotting disorder is a condition that makes your body more likely than normal to make blood clots. In some cases, a blood clotting disorder may cause uncontrollable bleeding that providers may call bleeding diathesis. Examples include:

• Disseminated intravascular coagulation (DIC): DIC is a complication of different serious medical conditions that can be life-threatening if you don’t receive treatment.
• Thrombocythemia: In this condition, you have abnormal platelets that may lead to excessive bleeding.

Platelet disorders

When you bleed, platelets act like natural bandages to stop the bleeding. Platelet disorders include:

• Thrombocytopenia: Low platelet count can lead to bruising and excessive bleeding.
• Thrombocytosis: High platelet count can lead to abnormal blood clotting.

Vascular bleeding disorders

Vascular bleeding disorders happen when something affects your blood vessels. Examples include:

• Cryoglobulinemia: This is a form of vasculitis that may cause purpura, which is when small blood vessels leak blood under your skin.
• Hereditary hemorrhagic telangiectasia: This inherited disorder affects blood vessel formation.
• Vascular Ehlers-Danlos syndrome: Vascular Ehlers-Danlos syndrome can cause blood vessels to rupture (tear). This can lead to dangerous internal bleeding and stroke.

How is bleeding diathesis diagnosed?

To diagnose bleeding diathesis, a healthcare provider will ask about your symptoms, including when they started. They’ll do a physical examination and ask if you’re receiving treatment for any medical conditions or have a family history of bleeding issues. They may order the following tests:

• Complete blood count (CBC).
• Peripheral blood smear (PBS).
• Prothrombin time (PT) test.
• Partial thromboplastin (PTT) test.

They may order more tests or refer you to a hematologist if your initial test results show signs of specific conditions. For example, if a provider suspects you have hemophilia, they’ll order tests to check for fibrinogen deficiencies (issues with the proteins in your blood that work with platelets to form blood clots).

How is bleeding diathesis treated?

Treatment varies depending on the cause. But first, a provider will take steps to manage blood loss. You might need a plasma infusion or blood transfusion to replace what you’ve lost. Then, they’ll take care of the underlying condition.

What can I expect if I have bleeding diathesis?

Many different conditions can cause bleeding diathesis, so it’s hard to say what you can expect. Some conditions that cause bleeding diathesis are chronic, meaning there’s no cure but there are treatments to manage symptoms like bleeding. Your prognosis, or what you can expect after diagnosis and treatment, depends on your situation, and your healthcare provider is your best resource for what you can expect.

How do I take care of myself?

Often bleeding diathesis happens because you have a medical condition that causes bleeding and bruising or increases your risk of bleeding and bruising. If you do, here are some suggested ways to manage your overall health:

• Follow your treatment plan: Take all medications as prescribed.
• Attend all follow-up appointments: Your healthcare provider will schedule regular appointments so they can check your overall health, your condition and whether treatment continues to work.
• Update your provider if things change: Don’t wait for a follow-up appointment if you notice changes in your body, like new bruising or bleeding, which may be symptoms that your condition is worsening.
• Consider some lifestyle changes: Your provider may recommend that you follow a heart-healthy food plan, stop using tobacco and manage your stress. These steps may protect your overall health.
• Get some regular exercise: Exercise helps manage stress. But be sure to ask your provider before launching into a routine. There may be activities you should avoid.

When should I go to the emergency room?

If you have bleeding diathesis, go to the emergency room anytime you have bleeding that you can’t control.

What questions should I ask my healthcare provider?

If you get medical care for bleeding, you may want to ask the following questions:

• Do you know what’s causing me to bleed?
• What other tests will I need to have to find out why I have this issue?
• Are there medical specialists I should contact because of my symptoms?