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Bleeding disorders in children

Tue, Jul. 18, 2017 Posted: 01:35 PM


Bleeding disorders in children, also referred to as pediatrichemostasis or coagulopathies, are conditions that result in prolonged bleeding in this group of individuals due to defects or abnormalities that occur in the different components of blood.

Blood is important for humans as it helps to transport oxygen and nutrients from the lungs and gastrointestinal system, respectively, to the tissues and organs so that the body can function optimally. Blood is also responsible for carrying carbon dioxide back to the lungs, to be eliminated, and waste products from the organ and tissue cells to be removed by the kidneys.

Children are more prone to trauma because they are very active and tend to sustain injuries which results in bleeding. There are disorders though where children experience episodes of bleeding which are difficult to stop or may not be able to control, and this can be life-threatening.

Bleeding disorders in children can occur due to problems associated with any one of the different components of blood. These include the white blood cells, red blood cells, platelets, and clotting factors.

Blood disorders of the red blood cells

The red blood cells contain haemoglobin, which are the proteins that carry oxygen to the areas of the body that require this essential element.

Certain conditions can affect haemoglobin only, or the entire red blood cell, which affects the ability of blood to carry oxygen to the body. These conditions may include the following:

  • Anemia: This condition is characterized by a decreased amount of red blood cells in the body, and there may be various causes of this condition. Symptoms of anemia include a pale skin, gums or tongue, fatigue, and shortness ofbreath. In severe cases, patients can experience a rapid and/or irregular heartbeat, and loss of consciousness due to decreased oxygen supply to the brain.
  • Iron deficiency anemia: Anemia can be caused by decreased iron production or the decreased absorption of dietary iron by the body. This decreased amount of iron affects the production of haemoglobin, which was mentioned to be important in carrying oxygen in the blood. Iron deficiency anemia is managed by supplementing with iron or, in severe cases, with transfusion of blood.
  • Megaloblastic (pernicious) anemia: This anemia is as a result of decreased absorption of dietary vitamin B12 and/or folate by the body. Severe cases of megaloblastic anemia can lead to nerve damage, especially of the hands and feet.
  • Aplastic anemia: Decreased red blood cell production can be caused by conditions that affect the bone marrow, since this is where red blood cells are primarily produced. Causes of bone marrow failure can include certain viral infections and side effects of various medications. The treatment of this condition includes bone marrow transplantation.
  • Autoimmune hemolyticanemia: This condition is caused by the production of proteins by the body, called antibodies, which seek out and destroy the normal red blood cells.
  • Leukemia: This is a type of blood cancer where the bone marrow produces abnormal white blood cells which don’t function properly. This production of cells may occur slowly or very rapidly, depending on the type of white cells involved.

Blood disorders of the white blood cells

The function of white blood cells is to help fight foreign organisms which lead to infections.Any abnormalities of these white blood cells can lead to a compromise of the affected individual’s immune system, making them more susceptible to contracting life-threatening infections.

The following are conditions associated with defective white blood cells:

· Lymphoma: This is a form of blood cancer that develops in the body’s immune system, and may involve the lymph nodes, spleen, thymus, and even the bone marrow. The result is that the affected areas will produce abnormal white blood cells.

  • Multiple myeloma: In this condition a type of white blood cell, called a plasma cell, is specifically affected. These plasma cells are responsible for producing antibodies that recognize and attack foreign organisms. The defective and mutated plasma cells then produce abnormal proteins which cause problems for organs such as the kidneys.
  • Myelodysplastic syndromes: This is a group of conditions characterized by a defective or abnormally functioning bone marrow that results in the formation of dysfunctional white blood cells.

Blood disorders of the platelets

The role of platelets is to aid blood in being able to clot effectively enough, and to allow blood to flow properly through the vessels of the body. Dysfunctional or decreased levels of plateletsresults in the inability of the blood to be able to clot effectively, and this can lead to bruising and prolonged bleeding.

Platelet abnormalities or defects can therefore result in the following conditions:

  • Thrombocytopenia: This is the medical term for the decreased level of platelets in the body and may be caused by various other conditions.
  • Idiopathic thrombocytopenic purpura: This condition usually develops after the affected individual contract a viral infection, and this can lead to decreased levels of platelets.
  • Essential thrombocytosis (primary thrombocythemia): This condition is characterized by the production of too many platelets, and this can result in blood clots to form due to the clumping effect that they produce. Essentially, it also causes the inability to clot because the normal function of the platelets is reduced.
  • Heparin-induced thrombocytopenia: As the name suggests, the medication heparin (used to treat clots) reacts with platelets causing them to become dysfunctional.

Blood disorders of the clotting factors

Certain bleeding tendencies can be caused by clotting factors being affected and they include the following:

  • Hemophilia: This condition arises due to a genetic abnormality that results in the absence of clotting factors 7 and 8. These missing clotting factors make controlling a bleed extremely difficult.
  • Sepsis: A generalized infection can cause clotting factors to become dysfunctional and result in prolonged bleeding.
  • Von Willebrand disease: This condition is a genetic disorder caused by an abnormal gene that results in the decreased production of von Willebrand factor, an important protein needed for the effective clotting of blood.
  • Disseminated intravascular coagulation (DIC): This is a complex condition where other problems cause activation of the clotting cascade, resulting in the formation of blood clots in the small blood vessels of the body. This process consumes the clotting factors and platelets in its path, leading to a decreased ability of the blood to clot properly, thus resulting in severe bleeding from various areas of the body.

David Fournier