Coagulopathy

Coagulopathy involves problems with how your body makes blood clots. Your blood forms clots to stop the bleeding when you’re injured. The clot-making process is called hemostasis.

There are two main processes involved. First, platelets rush to the site of injury and form a temporary plug. Second, proteins work together to form a strong fibrin mesh that covers the platelet plug. These proteins are called clotting or coagulation factors. You need both platelets and fibrin for a strong clot.

Platelet disorders are a dysfunction of the cells that stop bleeding. Other coagulopathies result from inadequate or dysfunctional proteins.

Not all conditions that cause coagulopathy are medical emergencies. But they can be if you have severe blood loss. See a healthcare provider if you have signs or symptoms of a bleeding disorder. Seek emergency care if you have bleeding that won’t stop.

Symptoms of coagulopathies

Coagulopathy disorders can cause prolonged bleeding from cuts or wounds on your skin. But they can involve internal bleeding, too. This can look and feel different from managing a scrape or a cut.

Signs to watch out for include:

• Frequent nosebleeds or bleeding from your gums despite good oral hygiene
• Extensive bruising (a sign of blood beneath your skin)
• Heavy period bleeding (periods that last more than seven days, result in saturating a pad/tampon more often than every two hours, passing clots larger than 1 inch wide)
• Joints that are swollen, warm to the touch, stiff or harder to move
• Spitting, vomiting or coughing up blood (may look red, pink and frothy or like coffee grounds)
• Black, tarry poop
• Headaches, vision loss or confusion (may be a sign of brain bleed)

Coagulopathy causes

Coagulopathy happens when there’s a problem in the blood clotting process. Usually, this happens because you don’t have enough of a certain protein (clotting factor) to make a stable clot.

There are a range of conditions (including bleeding disorders), events and even medicines that can keep your body from making stable clots. They include:

• Cancer, especially some forms of leukemia
• Disseminated intravascular coagulation (DIC)
• Hemophilia
• Medicines like heparin, warfarin, other anticoagulants and even aspirin
• Platelet disorders (can be inherited from a family member or develop later as an autoimmune disease)
• Rare factor deficiencies (can be inherited or develop later as an autoimmune disease)
• Severe liver disease
• von Willebrand disease
• Vitamin K deficiency

Some of these conditions, like DIC, are life-threatening without emergency care. Others, like hemophilia, are chronic conditions that need lifelong management.

Risk factors

Some coagulopathies are inherited. This means that you’re at increased risk if you have a history of bleeding disorders in your biological family.

Taking blood thinners, like heparin or warfarin, may also increase your risk. These medicines prevent dangerous clots. But they may lead to excess bleeding if you’re injured.

Ask your healthcare provider to explain if any blood thinners you’re taking increase your bleeding risk.

Complications of this condition

Losing too much blood is life-threatening without prompt treatment. This is why you should go to the emergency room if you have signs of severe blood loss. Other types of bleeding, like bleeding into joints, aren’t life-threatening. But they can cause long-term problems, like permanently painful and limited joint movement.

How doctors diagnose this condition

Your healthcare provider will check for signs of bleeding and ask about your medical history. They may ask about your family’s medical history and medicines you’re taking.

Blood tests providers use to diagnose coagulopathy include:

• Complete blood count (CBC)
• Fibrinogen test
• Prothrombin time (PT) test
• Partial thromboplastin time (PTT) test

Sometimes, these tests provide enough information for providers to diagnose what’s causing the bleeding. Or they can help narrow down the list of possibilities. You may need more tests to pinpoint the cause.

How is it treated?

Treatment depends on how serious the bleeding is and what’s causing it. In emergency situations, the priority is to stop it. Usually, a healthcare provider gives you the missing or defective clotting factor. This may involve getting an IV infusion, a transfusion or taking medicine by mouth.

You may need:

• Antifibrinolytics
• Clotting factor concentrates
• Cryoprecipitate
• Desmopressin
• Fresh frozen plasma
• Platelet transfusions
• Protamine sulfate
• Vitamin K

If you have a condition that increases your bleeding risk during surgery, your provider may give you medicine beforehand to manage bleeding.

When should I see my healthcare provider?

Schedule an appointment with your provider if you notice signs of a bleeding disorder. Look out for things like bruising easily and frequent nosebleeds.

Seek emergency care if you have severe blood loss. Warning signs are:

• Wounds that won’t stop bleeding even after applying firm pressure
• Bleeding during pregnancy (call your OB, as this can sometimes be expected)
• Feeling lightheaded, weak or confused
• New paleness of your skin or inner eyelids
• Vomiting blood or bloody/tarry poop

What can I expect if I have this condition?

There isn’t a single outcome for coagulopathy. The condition causing the bleeding will shape your experience. The amount of blood loss you have matters, too.

The good news is that there are treatments to help manage chronic conditions. There are lifesaving emergency treatments available, like fresh frozen plasma and clotting factors.