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Ask the Expert: What are the most common bleeding problems for kids?

What are the most common bleeding problems for kids?

Kids get bruises and can have cuts, scrapes and nosebleeds. But sometimes that bleeding is frequent or prolonged, and you or your doctor might be concerned your child has a bleeding problem. As hematologists, we consider most bleeding problems to fall into two categories: platelets and clotting proteins.

Your platelets are the cells that circulate in your blood, and when you get a cut or injury, they are the first responders to try and control bleeding. Sometimes a child or teen can have a lower-than-normal platelet count, and this can lead to increased bruising, frequent nosebleeds, bleeding gums or heavier-than-normal periods.

One example of this is immune thrombocytopenia (ITP). This is a rare problem with the immune system overreacting and attacking your normal platelets and occurs most often in young children after a viral illness. The number of platelets falls, usually temporarily, and in rare cases can require treatment. This is usually short-lived and, in most children, does not require treatment, and will resolve in a few weeks to months.

Your blood also contains proteins that circulate, waiting to activate and help your blood clot when a cut or injury occurs. Rarely, children are born with lower-than-normal levels of one of these clotting proteins. One example of this is called hemophilia.

Hemophilia is an inherited deficiency of one clotting protein, usually Factor 8 or 9. Hemophilia is an X-linked disorder, which means it’s inherited by boys, but on rare occasions girls or women who are carriers can have mild bleeding symptoms as well. Because clotting factors are essential for clot formation, people with hemophilia can have bleeding in more serious places, like joints, muscles and occasionally in their brains.

Usually, this runs in families and is diagnosed very early in life. Patients can require intravenous medication to replace the missing clotting protein, either on occasion as needed for more mild cases or sometimes every week to prevent serious bleeding for more severe cases.

One more common bleeding problem that spans both platelets and clotting proteins is von Willebrand disease. Von Willebrand factor (VWF) is a clotting protein that can be at low levels in as many as 1 in 100 people.

Most patients with von Willebrand disease have nosebleeds, easy bruising, gum bleeding or heavy periods. This occurs equally in boys and girls but is more often diagnosed in girls after they start their periods. This is usually a milder bleeding disorder, but is important to know about if you are having a surgery or in case of a serious injury or accident. During these times, or in the event of more severe bleeding, treatment to replace the missing VWF can be required. Treatment is often aimed at the underlying symptom — treatments for nosebleeds or managing heavy periods, for example.

If your child has bleeding or unusual bruising, please see your pediatrician and ask about whether further testing or a referral to a pediatric hematologist might be needed.


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