I’m Bleeding Again!

Man shaving who just cut himself“Honey! I’m bleeding again!”

A man nicked himself with his razor while shaving. He and his wife are getting ready to go on a night out to the theater. Now his shirt and the sink are a bloody mess.

“Why do you bleed so much?” she cries out in frustration as she hands him another white shirt, taking the messy one to soak in peroxide. “My father nicked himself shaving and he never bled all over the place.”

“I don’t know,” he says, holding folded toilet paper against his face. “It happened all the time when I was a boy on the playground. Made for some real entertainment.”

“Well, it’s not very entertaining now!”

Most people don’t know that 1 in every 100 Americans (some 2.6 million), are afflicted with some form of von Willebrand’s disease, the most common form of bleeding disorder. We often think that a little bleeding is normal, or the wound was deeper than we thought, or we just don’t give it any thought at all. Most don’t know that what is a mild bleeding problem in some, can be life-threatening in others.

Human blood has a safety mechanism to plug up holes in blood vessels if they should spring a leak. At least twelve different proteins or chemicals in the blood interact with the platelets, which eventually forms a clot. This means that at least twelve different proteins or chemicals – called clotting factors – can be interfered with, malformed or not formed at all. Any of these can mess up this important bodily function. In addition, the platelets themselves can be malformed, unformed, or prematurely destroyed – and also prevent the blood from clotting properly.

While some forms of leukemia, hemophilia, and certain platelet malfunctions can cause this problem, the most common cause – like for the man heading to the theater – is von Willebrand’s disease.

First described in 1926, the von Willebrand factor in the blood is a glue-like protein that holds platelets in place to make the first beginnings of a clot. The other clotting factors join this initial “platelet plug” to make a more permanent clot. If the initial plug does not hold together, the other clotting factors have nothing to attach to and the person will keep on bleeding, sometimes uncontrollably.

Von Willebrand’s disease is inherited equally by men and women, so there is usually some history of excessive bleeding in family members. It takes several different forms, some more serious than others. But women have more risk because of their monthly menstruation.

Other bleeding problems that may seem normal include tooth injury/extraction that continues to bleed heavily, major bleeding after relatively minor surgery like tonsillectomy, recurrent heavy nose bleeds, heavy bruising or bleeding after every small bump. Any of these occurring over and over again is a cause for alarm and a good reason to check with a blood disease doctor – a hematologist.

Many general practitioners hear about people who have a bleeding problem but write them off as just a one time occurrence. “Everyone has a little bleeding once in a while.” “You’re probably taking too much aspirin.” “You need to be more careful.” While all of this is true, if it happens repeatedly, don’t be put off. Insist on a bleeding disorder workup or see a different doctor who will do the workup for you.

The human body is not meant to bleed out after every little injury. Recurrent bleeding is not normal. If the bleeding recurs multiple times or in multiple family members, insist that your doctor finds out why.