Pediatric bleeding disorders and thrombosis

What are pediatric bleeding disorders and thrombosis?

Bleeding disorders

Bleeding disorders are a group of conditions where the body’s blood clotting process doesn’t work properly. During the clotting process, blood changes from a liquid to a gel, which stops your body from bleeding after a cut or injury. When your body can’t make your blood clot properly, it can lead to heavy bleeding.

Thrombosis

When your blood clots too much, it can harm your blood flow. Thrombosis is a condition where a blood clot forms where it’s not supposed to, in areas like veins or arteries. If left untreated, this can block the flow of blood to the heart, brain or lungs, which can cause serious health problems like a stroke.

What are the different types of pediatric bleeding disorders and thrombosis?

Bleeding disorders

• Hemophilia is a bleeding disorder that is usually genetic. Children with hemophilia have little or no clotting factor VIII (Hemophilia A) or clotting factor IX (Hemophilia B). Children with hemophilia can experience spontaneous bleeding or bleeding with trauma in the joints. Bleeding can also occur in muscles, the mouth and nose, internal organs or in the brain. Without proper clotting factors, this can lead to complications like joint damage or even become life-threatening.

• Von Willebrand disease is a bleeding disorder that is almost always inherited. Children with von Willebrand disease either have low levels of von Willebrand clotting factor or the clotting factor does not work as it should. Children with von Willebrand disease might experience nosebleeds, mouth bleeds, blood in their stool or urine, excessive bruising, heavy menstrual bleeding, increased bleeding after medical procedures and even bleeding joints, depending on the severity of von Willebrand disease.

• Rare bleeding disorders - Children may also have other rare bleeding disorders where they're missing different clotting factors.

• Platelet disorder - This is when the number of platelets (blood cells) are reduced, impaired or both. Depending on the severity, children can experience increased bruising, nosebleeds, oral bleeding, increased bleeding with medical procedures and even serious life-threatening bleeding.

Thrombosis

• Thrombophilia - This is an inherited blood disorder. Children with thrombophilia have a greater risk of developing blood clots that spontaneously form in blood vessels.

• Deep vein thrombosis (DVT) - This is a condition where poor blood flow causes a blood clot to form in a blood vessel, most commonly in the legs but also the arms. Children who have limited activity or movement (often because of illnesses like cancer, heart disease or lung disease) are at risk for DVT. These require prompt treatment to avoid blood clots traveling to the lungs.

• Pulmonary embolism (PE) - If one of the pulmonary arteries or branches in your lungs is blocked, it’s called a pulmonary embolism. It’s caused by a blood clot that travels from a lower part of the body, like an extremity (arm or leg) to the lungs. If the clot blocks blood flow to your child’s lungs, this could be serious.

What are the signs and symptoms of pediatric bleeding disorders and thrombosis?

Bleeding disorders

• Excessive or long-lasting bleeding with minor wounds or trauma

• Several or large bruises

• Heavy periods in girls

• Frequent or long-lasting nosebleeds

• Blood in stool or urine

• Mouth or gum bleeding or long-lasting bleeding when losing a tooth

• Warmth, swelling, pain or decreased range of motion in the elbows, knees and ankles

• Warmth, swelling, pain in the arms and legs

• Excessive or long-lasting bleeding after surgeries

• Headaches, vomiting, weakness or change in alertness

It’s especially important to watch for these symptoms in your child if your family has a history of bleeding disorders.

Thrombosis

Many children with thrombosis have no symptoms, but if a child is at risk because of family history or a chronic disease, parents should watch for the following.

• Pain

• Swelling

• Tenderness

• Redness and warmth of the skin

• Chest pain or shortness of breath

• Headaches, vision changes, vomiting or change in alertness

How are pediatric bleeding disorders and thrombosis diagnosed?

If your child has a bleeding disorder or thrombosis, it’s important to diagnose the disorder promptly and accurately.

Bleeding disorders

If your child has symptoms of a bleeding disorder, your child’s doctor likely will conduct a thorough physical exam and ask about your child’s medical history and your family’s history of similar disorders.

Doctors might order blood tests, which can determine:

• How long it takes your child’s blood to clot

• If your child’s blood is missing or has reduced clotting factors

• If your child’s blood has dysfunctional clotting factors

Thrombosis

Left untreated, thrombosis can lead to serious and life-threatening complications. Your child’s doctor will do a thorough physical exam and ask about your child’s medical history and your family’s history of similar disorders.

Additional test include:

• Blood tests - To test your child's blood to see if they're missing clotting factors or have other substances in their blood that indicate a blood disorder

• Ultrasound - A test that uses sound waves to take pictures of blood flowing through the arteries and veins

• CT scan - A test that uses X-rays to take pictures of your child’s organs and tissues

• MRI - A test that uses magnetic fields to produce images of your child’s organs and tissues

• Venography - A test that injects dye into a vein to make it visible on an X-ray

What are the causes of pediatric bleeding disorders and thrombosis?

Bleeding disorders and thrombosis are often genetic conditions. This means kids are more likely to have these conditions if their parents have them. Scientists are still learning about what causes genetic problems that lead kids to be born with these conditions.

How are pediatric bleeding disorders and thrombosis treated?

Medications can help kids with conditions like hemophilia or von Willebrand disease manage their bleeding disorder. These therapies are designed to control or prevent bleeding by replacing missing or dysfunctional clotting factors and stimulating the release of more clotting factors.

Your child’s doctor will recommend treatment for thrombosis based on risk for complications. 

• Anticoagulants - Medications that thin the blood, helping the blood flow more easily

• Thrombolytics - Medications that dissolve blood clots

• Compression stockings - Tight stockings that keep blood from pooling and clotting and reduce swelling from blood clots

• Thrombectomy - Surgical procedure that involves removing blood clots from arteries or veins