Bleeding
disorders are a group of disorders associated with a lack of any number
of clotting elements in the blood. These proteins work together as
a domino effect to blood clotting, so any disruption along that line
can lead to a bleeding disorder.
Hemophilia is the most well known bleeding disorder, recognized since
biblical times, occurs almost exclusively in males, although it's
inherited through the mother on the X chromosome. People with hemophilia
have problems associated with internal bleeding into the joints, muscles
and organs. Another form of hemophilia, known as hemophilia B is associated
with a missing clotting factor known as factor IX. Although it's very
rare, hemophilia can occur in women.
Von Willebrand disease, vWD, identified in 1925 by a Finnish doctor,
affects both men and women in equal numbers. It's actually more common
than hemophilia, but less well known. The disease involves an inability
of platelets to form a stable clot, which prevents a person to stop
bleeding. The most common type of vWD is Type I, a mild form of the
disease. Affected people typically have symptoms of bleeding in the
intestines and gums. In men with Type I vWD serious bleeding is not
usually a problem except in severe trauma. In women, however, because
of pregnancies or menstrual periods each month, the symptoms of even
mild von Willebrand's disease can affect the quality of life, causing
chronic anemia, reproductive problems and hemorrhage.
In women the main symptoms of Von Willebrand's Disease is menorrhagia,
which means heavy bleeding during menstruation or after childbirth.
Other causes of menorrhagia are medications, tumors, intra-uterine
devices (IUD) and other diseases. Out of the 15-20 percent of U.S.
women who suffer from menorrhagia, as many as 20 percent of them may
have a bleeding disorder.
The definition and diagnosis of heavy menstrual bleeding in women
is tricky, because how one defines "heavy bleeding" is such
a relative concept. Since bleeding disorders tend to run in families,
having a heavy menstrual flow may be considered normal in that family
and not thought as a serious medical problem. However, if your heavy
bleeding started at or near your first period, there is a high probability
that it's caused by a coagulopathy (bleeding disorder).
Because heavy periods are often considered by doctors to be a problem
with the uterus, rather then a bleeding problem, women are often misdiagnosed
and subjected to unnecessary and dangerous surgical procedures such
as dilation and curettage (D&C) and hysterectomy. In one study of
females with Von Willebrand's disease, 25 percent of these women had
undergone hysterectomy, often to alleviate the heavy menstrual bleeding.
Correct diagnosis can help a woman avoid potentially dangerous complications
and surgery. All that is needed to diagnose Von Willebrand's disease
is a simple blood test.
Luckily there is a treatment for vWD. Taking birth control pills can
control heavy menstrual periods. There is also a hormonal nasal spray,
Desmopressin, DDAVP. This synthetic hormone raises the levels of von
Willebrand's factor and factor Vlll, both of which are low in vWD.
This drug is given to a woman just prior to the beginning of their
menstrual period and before any surgery.
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