If you have prolonged bleeding or bruises or haematomas that develop on your body after mild injuries, you may have a bleeding disorder. Clotting factors and platelets prevent excessive bleeding. If there is a problem with your coagulation cascade (clotting factors) or an abnormality in the number or function of your platelets, you may bleed abnormally.

Normally, the blood clotting process, known as coagulation, involves the blood changing from a liquid to a solid. For the body to conduct this process, platelets in the blood are needed to clump together and form a plug at the site of the injury, in order to prevent blood from flowing from this site.
There are many different bleeding disorders, however, the most common include:

  • Hemophilia A and B – which are bleeding disorders which cause heavy or unusual bleeding into the joints.
  • Factor II, V, VII, X, or XII deficiencies are bleeding disorders which are due to problems with abnormal bleeding and blood clotting issues.
  • Von Willebrand's disease is a genetic bleeding disorder in which the blood is unable to clot as it lacks the von Willebrand factor.
  • Platelet malfunction due to renal failure.
  • Deficiency in platelets due to infections, malignancies or autoimmune diseases.

Bleeding disorders can be diagnosed, by conducting a thorough examination and appropriate investigations such as a complete blood count, platelet aggregation test and a bleeding time test.

If found that you have a bleeding disorder, treatment may vary depending on the type of disorder present. While some bleeding disorders cannot be cured, treatment is aimed at alleviating the symptoms. Treatment may include iron supplementation, blood transfusion, freshly frozen plasma transfusions or even injecting clotting factor concentrates into your bloodstream.

Problems with full blood count

Blood is made up of red blood cells, white blood cells, platelets and plasma. After a full blood count (FBC), which is a procedure done to diagnose a wide range of diseases and infections, abnormalities in the results may indicate problems with full blood count. Most full blood count tests will indicate normal results while others may indicate a blood count abnormality that may range from the presence of a simple nutritional deficiency to a more complex disease or malignancy.

Abnormalities in a full blood count (FBC) may include:

1Red blood cells and haemoglobin
Low levels of these elements are known as anaemia. It may be due to a lack of iron in the diet, blood loss or chronic diseases such as kidney disease. High levels of these elements, on the other hand, is known as polycythaemia and may be due to polycythaemia rubra vera (which is the primary type) or kidney disease, chronic lung disease or due to residing in an area of high altitude (these are secondary types).
2Red blood cell to plasma ratio
When the red blood cell to plasma ratio is low, it may suggest anaemia, or if high, it may suggest polycythaemia.
3White blood cells
Low levels of white cells (leucopaenia) is usually due to a viral infection, bone marrow disease or exposure to chemo or radiotherapy. High levels, known as leucocytosis, may indicate a bacterial infection, inflammatory disease or bone marrow disease.
Low levels of platelets, known as thrombocytopenia, is often due to certain medications, viral infection, bone marrow disorders or an autoimmune disorder. Thrombocytosis (high levels of platelets) and may suggest the bleeding, presence of bone marrow disease or infections like TB.

Treatment of full blood count problems may vary depending on the type of disease, or element lacking. Steroids and other immune-modulating therapies, transfusions or coagulation factor support, growth factor supplementation are examples of treatments that may be used. Dr Mogambery has the expertise in working up and managing patients with thrombocytopenia and other blood pathologies. Referral to a haematologist may be necessary if the problem if the cause for the abnormality is more complex or requires more specialised testing.