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Detangling The Clot : Understanding Bleeding Disorders In Children

Epistaxis, or nasal bleeding, is a common occurrence in children and is usually caused by benign factors. Some normal causes of epistaxis in children include exposure to Dry air or dry climate, nose picking, nasal congestion or allergies, Vigorous nose blowing and accidental trauma.

It's important to note that while these causes are usually harmless, frequent or severe nosebleeds, or nosebleeds accompanied by other concerning symptoms, should be evaluated by a healthcare professional to rule out underlying medical conditions.

It's important to recognize that recurrent prolonged nasal bleeding that does not spontaneously stop may be a sign of a potential bleeding disorders, specifically platelet and clotting factor disorders.

Understanding Bleeding Disorders:

Bleeding disorders refer to a group of conditions that impair the normal clotting process. They can be broadly classified into two categories: platelet disorders and clotting factor disorders. The clotting mechanism is the body's way of preventing excessive bleeding when a blood vessel is damaged. It involves two key processes: platelet plug formation and fibrin clot formation. First, platelets, tiny cells in the blood, gather at the site of injury and stick together to form a temporary plug. Then, a cascade of chemical reactions leads to the formation of a fibrin clot, which reinforces the platelet plug and seals the damaged blood vessel, allowing it to heal.

Platelet Disorders:

Platelet disorders are characterized by low platelet count or dysfunction, making it difficult for blood to clot effectively. Common platelet disorders include Immune thrombocytopenia (ITP) where the platelet count reduces drastically or inherited platelet disorders which may affect platelet number ,function or sometimes both and inherited platelet disorders. Children with these conditions often experience spontaneous or easy bruising, prolonged bleeding from minor cuts, and frequent nosebleeds. If your child's nosebleeds are excessive, accompanied by prolonged bleeding from other sites or unusual bruising, it's important to consult a healthcare professional.

Clotting Factor Disorders:

Clotting factor disorders, on the other hand, involve deficiencies or defects in specific clotting factors, such as hemophilia. Hemophilia is an inherited disorder, predominantly affecting males, where there is a deficiency or absence of clotting factor VIII (hemophilia A) or clotting factor IX (hemophilia B). Children with hemophilia may experience frequent and prolonged bleeding episodes, including nosebleeds, joint bleeds,bleeding into muscles after intramuscular injections and vaccinations, prolonged and excessive bleeding after surgeries. It is crucial to be vigilant about any unusual bleeding patterns in your child, especially if there is a family history of clotting disorders.

Recognizing Bleeding Disorders in Children: A Guide for Parents

1. Frequent or excessive nosebleeds: If your child experiences nosebleeds that occur frequently or are difficult to stop, it could be a sign of a bleeding disorder. Keep track of the frequency, duration, and severity of the nosebleeds.

2. Unexplained or excessive bruising: Pay attention to any unexplained bruises that appear on your child's body, especially if they occur without a significant impact or injury. Excessive or easily visible bruising may indicate an underlying bleeding disorder.

3. Prolonged bleeding from minor cuts or wounds: Normal cuts or scratches typically stop bleeding within a reasonable amount of time. However, if your child's bleeding seems to persist longer than expected or requires medical attention, it is essential to consult a healthcare professional.

4. Gum bleeding: Bleeding from the gums, especially after brushing or flossing teeth, can be a warning sign of a potential bleeding disorder. Keep an eye out for recurrent or excessive gum bleeding.

5. Blood in urine or stool: Unexplained blood in your child's urine or stool should never be ignored. It could be indicative of a bleeding disorder or an underlying condition that requires medical attention.

6. Excessive or prolonged bleeding after dental procedures or surgeries: If your child experiences significant bleeding that continues beyond the expected recovery period after dental work or surgery, it is crucial to inform their healthcare provider, as this may be a sign of an underlying bleeding disorder.

7. Joint or muscle bleeds: Swelling, pain, and limited range of motion in joints, often accompanied by warmth and tenderness, can be indications of internal bleeding in the joints or muscles. If your child experiences these symptoms without a clear cause, seek medical advice promptly.

8. Family history: Be aware of any family history of bleeding disorders, as many of these conditions have a genetic component. If there is a known history of bleeding disorders in your family, it is important to inform your child's healthcare provider.

9. Excessive or prolonged bleeding from other sites: Pay attention to any unusual or unexplained bleeding, such as prolonged or heavy menstrual bleeding in girls, frequent nosebleeds, or bleeding gums during routine activities.

10. Persistent fatigue or weakness: In some cases, children with bleeding disorders may experience fatigue or weakness due to chronic blood loss or anemia. If your child appears unusually tired or weak, consult their healthcare provider for further evaluation.

Remember, while occasional nosebleeds or minor bruises are usually harmless, persistent or concerning symptoms should be discussed with a healthcare professional. Early detection and diagnosis of bleeding disorders are crucial for appropriate management and ensuring the well-being of your child.

Dr. VASUDHA N R MBBS, MD (PAED), Clinical fellowship in Paediatric Oncology,

Consultant - Pediatric Hematology / Oncology,

Rainbow Children's Hospital, Marathahalli, Bengaluru

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Blood Disorder News And Research

Realizing the Potential of Vendor Engagement with ELRIG's Vendor Strategy Work Group Lead

Nick Clare

In this interview conducted in anticipation of ELRIG's Drug Discovery 2023 Conference, we spoke to Nick Clare, Vendor Strategy Work Group Lead for ELRIG, about what vendors can gain from attending ELRIG events, such as Drug Discovery 2023.

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