This document discusses bleeding disorders, including hemophilia A and B, von Willebrand disease, and idiopathic thrombocytopenic purpura. Bleeding disorders result from deficiencies in clotting factors or platelets that prevent proper blood clotting. Symptoms include easy bruising, heavy bleeding from minor cuts or injuries, and heavy menstrual periods. Tests can identify which clotting factor or platelet is deficient. Treatment involves replacing the missing clotting factor through transfusions or synthetic proteins. Medications can also help manage symptoms.

1. • Presentation of: Bleeding disorders
• Lecture: Dr. A/Rahman Jibril Warsame
• Subject: Heamatology
• Lecture’s presentation:
1: Shaafici Ahmed Abdi
2: Abdifitah Huuriye
3: Abdulahi Mohamed Guure
4: Abdirashiid Abdulahi Adow
5: Badel Ali Hanshi
6: Mohamed Abdulle Mohamuud

2. Bleeding disorders
• Bleeding disorders such as hemophilia and von
Willebrand disease result when the blood lacks
certain clotting factors.
• These diseases are almost always inherited,
although in rare cases they can develop later in life
if the body forms antibodies that fight against the
blood's natural clotting factors.

3. Cont.….
• Bleeding disorders are a group of conditions in which there is a
problem with the body's blood clotting process.
• These disorders can lead to heavy and prolonged bleeding after
an injury or surgery.
• Bleeding can also begin on its own and may be difficult to stop

4. What are Bleeding Disorders in Women?
• While bleeding and clotting disorders affect men
and women, these conditions pose unique problems
for women because of the impact the disorders can
have on their reproductive health and quality of life.
• Current data estimate that as many as 1% of women
in the United States may have a bleeding disorder
and many are unaware of their condition.

5. • The most common bleeding disorder affecting women
is von Willebrand disease (VWD), which results from a
deficiency or defect in the body’s ability to produce a
certain protein that helps blood clot.
• Although VWD occurs in men and women equally, women
are more likely to notice the symptoms because of heavy or
abnormal bleeding during their menstrual periods and after
childbirth.
• VWD and other blood disorders may also cause women to
experience recurrent fetal loss, heavy bleeding during
dental procedures, frequent nosebleeds, and heavy bleeding
during or after surgery.

6. • Women with heavy menstrual bleeding (menorrhagia) or VWD are at
increased risk for anemia, pain during menstruation, hospitalizations,
blood transfusions, limitations in daily activities, time lost from work
or school, and a reduced quality of life.
• In addition to VWD, other rare bleeding disorders and more common
platelet function disorders may also be responsible for bleeding
symptoms in women.
• Although there are no cures for bleeding disorders, treatment is
available to control symptoms and help women avoid complications
and invasive procedures.

7. What are the 4 bleeding disorders?
• Hemophilia A.
• Hemophilia B.
• Idiopathic thrombocytopenic purpura (ITP)
• Von Willebrand disease (types I, II, and III)

8. Acquired bleeding disorders include:
• Disseminated intravascular coagulation (DIC)
• Liver disease-associated bleeding.
• Vitamin K deficiency bleeding.
• Von Willebrand disease and hemophilia, which are most often
inherited but may develop as a result of a medical condition.

9. Hemophilia A.
• Hemophilia: is a rare disorder in which the blood
doesn't clot in the typical way because it doesn't
have enough blood-clotting proteins (clotting
factors). If you have hemophilia, you might bleed
for a longer time after an injury than you would if
your blood clotted properly.

10. • Hemophilia is almost always a genetic
disorder. Treatment includes regular
replacement of the specific clotting
factor that is reduced. Newer therapies
that don't contain clotting factors also are
being used.

11. Symptoms
• Signs and symptoms of hemophilia
vary, depending on your level of
clotting factors.
• If your clotting-factor level is mildly
reduced, you might bleed only after
surgery or trauma. If your deficiency is
severe, you can bleed easily for
seemingly no reason.

12. Signs and symptoms of
spontaneous bleeding include
• Unexplained and excessive bleeding from cuts or injuries, or after
surgery or dental work
• Many large or deep bruises
• Unusual bleeding after vaccinations
• Pain, swelling or tightness in your joints
• Blood in your urine or stool
• Nosebleeds without a known cause
• In infants, unexplained irritability

13. Bleeding into the brain
• A simple bump on the head can cause bleeding into the brain for some
people who have severe hemophilia. This rarely happens, but it's one
of the most serious complications that can occur. Signs and
symptoms include:
• Painful, prolonged headache
• Repeated vomiting
• Sleepiness or lethargy
• Double vision
• Sudden weakness or clumsiness
• Convulsions or seizures

14. • When to see a doctor
• Seek emergency care if you or your child has:
• Signs or symptoms of bleeding into the brain
• An injury in which the bleeding won't stop
• Swollen joints that are hot to the touch and painful to
bend

15. Hemophilia B
• Hemophilia B is characterized by
deficiency in factor IX clotting activity
that results in prolonged oozing after
injuries, tooth extractions, or surgery,
and delayed or recurrent bleeding prior
to complete wound healing

16. Symptoms of bleeding disorders may include:
• Easy bruising.
• Bleeding gums.
• Heavy bleeding from small cuts or dental work.
• Unexplained nosebleeds.
• Heavy menstrual bleeding.
• Bleeding into joints.
• Excessive bleeding following surgery.

17. What causes bleeding disorders
• What causes bleeding disorders? Your gene, or
other causes such as medical conditions or
medicines, can cause bleeding disorders.
• Sometimes, it may be impossible to know the
cause.
• Any problem that affects the function or number
of clotting factors or platelets can lead to a
bleeding disorder.

18. • A bleeding disorder, sometimes called coagulopathy,
is a condition that makes you more likely to bleed than
the average person.
• If you have a bleeding disorder, this means your body
does not clot properly, typically due to a defect of one
or more steps of the coagulation (bleeding and
clotting) system

19. Types and Causes
• Types and Causes
• There are many different types of bleeding disorders.
• Some are inherited with a known familial pattern, and some may
develop due to a medical condition, or from taking certain
medications.
• While some bleeding disorders may be reversible (such as vitamin K
deficiency), most bleeding disorders are chronic and require lifelong
therapy.

20. Tests that may be done include
• Complete blood count (CBC)
• Partial thromboplastin time (PTT)
• Platelet aggregation test.
• Prothrombin time (PT)
• Mixing study, a special PTT test to confirm
the factor deficiency.

21. treatment of bleeding disorders
• Patients with moderate to severe bleeding disorders may
require transfusion of blood platelets or clotting factors.
• Clotting factors may be donated human blood products or
lab-synthesized proteins.
• Patients with severe bleeding disorders may receive clotting
factor transfusions as a preventive measure.

22. Medicines
• The following medicines may help treat your bleeding disorder.
• Antifibrinolytic agents, such as tranexamic acid, help treat bleeding after
childbirth or during dental work and other procedures.
• Birth control pills can help lower heavy menstrual bleeding in VWD.
• Desmopressin (DDAVP), a human-made hormone, can help stop minor bleeding
in hemophilia or VWD.
• Immunosuppressive medicines, such as prednisone, help block production of
antibodies in acquired bleeding disorders. Side effects can include infections and
diabetes.
• Monoclonal antibodies can imitate the missing factor to help blood form clots.
For example, emicizumab is an antibody that bridges factors IX and X to mimic
the way factor VIII works, which can help treat people with hemophilia A.
• Vitamin K supplements treat vitamin K deficiency bleeding.