Bleeding Problems in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
A bleeding disorder occurs when the blood does not clot quickly enough, resulting in too much bleeding or bleeding that lasts a long time. Normal blood clotting (coagulation) is a complex process in which specialised blood cells (platelets) and different proteins in the blood (clotting or coagulation factors) clump together to heal broken blood vessels and control bleeding.
There is a delicate balance of coagulation factors that promote bleeding and those that promote clotting. Disorders of the blood clotting system occur when clotting factors are missing or damaged, when there is a low number of platelets, or when the platelets don’t work correctly.
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
People with bleeding disorders may experience the following symptoms:
- Cuts that bleed excessively
- Unexpected or sudden bruising
- Small purple or red spots under the skin that are called petechiae
- Blood in the vomit, often resembling coffee grounds
- Black or bloody bowel movements, or reddish or pinkish urine
- Dizziness, headaches, or changes in vision
- Joint pain
- Gum bleeding
- In women, menstrual periods that are heavier or longer than usual
A bleeding disorder can sometimes be inherited, meaning it has a genetic cause and runs in the family. Other bleeding problems result from illness or treatment with specific drugs.
Causes of bleeding problems include:
- Anaemia, an unusually low level of red blood cells
- Cancer that begins in or spreads to the liver
- Drugs called angiogenesis inhibitors that prevent the growth and development of new blood vessels
- Inherited disorders including haemophilia (a disease which causes the blood to not clot normally) and von Willebrand’s disease (a bleeding disorder wherein clotting factors are missing or do not work well).
- Long-term use of strong antibiotics or medications called anticoagulants that thin the blood
- Other disorders unrelated to cancer
- Other liver disorders, including an infection of the liver called hepatitis and scarring of the liver called cirrhosis
- Thrombocytopenia, an unusually low level of platelets
- Vitamin K deficiency
Diagnosis and Treatment
A physical examination and several blood tests, including a complete blood count (CBC), prothrombin time (PT or INR), activated partial thromboplastin time (APTT), platelet count, tests to check the speed of blood clotting, and tests to check for blood protein deficiencies will be carried out on your child by the doctor to diagnose a bleeding disorder.
How a bleeding disorder is treated will depend on the underlying cause. When possible, underlying disorders such as cancer or liver disease are treated. Additional treatments include:
- Blood plasma or platelet transfusions
- Drugs that help blood to clot
- Other medications used to treat platelet problems
- Vitamin K injections