What Are Coagulopathy Disorders?

Coagulopathy is a bleeding disorder. Many different medical conditions can cause deficits in coagulation (blood clotting), including hereditary and acquired coagulopathies. The most common symptoms are bruising and prolonged bleeding after a cut, but coagulopathies can also cause life-threatening bleeding.

Blood tests can detect the exact cause of coagulopathy. Many of these conditions can be treated with medications or procedures. This article describes the symptoms, types, causes, diagnosis, and treatments of coagulopathies. 

Coagulopathy: A Hemostasis Defect

Hemostasis is the stopping of blood loss, or bleeding. Coagulation is the process by which the body makes a blood clot, which is an important part of hemostasis. Coagulation and hemostasis involve platelets (a type of blood cell), enzymes, and proteins that work together to form a healthy blood clot and promote healing.

Coagulopathy Symptoms

The most noticeable symptoms of coagulopathy are bleeding and bruising. Sometimes the bleeding can lead to severe complications. 

Coagulopathy can cause bleeding after injuries or sometimes without any known cause. Depending on certain factors, the bleeding problems can worsen or improve at different times. These factors may include nutrition, medications, or treatment of the underlying cause.

Signs and symptoms of coagulopathy may include:

• Prolonged bleeding after a cut or scrape
• Bruising, even after minor bumps
• Bloody nose
• Bleeding gums
• Blood in the urine
• Blood in the stool
• Heavy menstrual bleeding

Usually, coagulopathy does not cause other symptoms besides bleeding, but the underlying problem can cause additional associated signs and symptoms. For example, a coagulopathy that occurs due to liver disease may be associated with jaundice (yellowing of the skin and whites of the eyes).

Complications

Coagulopathies can cause severe symptoms if bleeding is rapid or causes organ damage. Extreme bleeding may also lead to blood loss or potentially cause swelling and pressure in or around vital organs.

Signs and symptoms of coagulopathy complications include:

• Severe joint pain due to bleeding around the joints
• Severe abdominal pain due to gastrointestinal bleeding
• Coughing up blood due to bleeding in the lungs or esophagus
• Difficulty breathing due to severe bleeding obstructing airflow
• Head pain due to bleeding in or around the brain

What Causes Coagulopathy Conditions?

Hemostasis involves several steps. When the body is injured, hormones are released to signal platelets and coagulation proteins to the area of damage. This allows the blood to clot and for healing to begin.

A deficiency in platelets or proteins that are involved in the clotting cascade (the linked reactions and processes that lead to forming a clot) can cause a coagulopathy.

Conditions that cause coagulopathy include:

• Hemophilia: Hereditary bleeding disorders that include hemophilia A, hemophilia B, and hemophilia C, caused by inherited deficiencies in specific coagulation factor proteins
  
• Von Willebrand disease: An inherited or acquired deficiency in a protein needed for a coagulation factor protein to work well
• Use of blood-thinner medications (anticoagulants), such as Jantoven (warfarin)
• Severe trauma

Hereditary coagulopathies are inherited coagulation factor deficiencies.

Testing to Diagnose Coagulopathy

Diagnostic testing for coagulopathy involves assessment of the coagulation defect, identifying the underlying cause, and diagnostic tests to assess complications.

Blood tests that are used to diagnose a coagulation defect include:

• Prothrombin time (PT)
• Partial thromboplastin time (PTT)
• International normalized ratio (INR)
• Platelet count
• Blood clotting factors, such as factor V Leiden
• Bleeding time
• Vitamin K level

Often, when you are being treated for coagulopathy, periodic blood tests may be necessary to assess the effectiveness of your treatment.

It is also important to identify the cause of coagulopathy. This may include genetic tests, liver function tests, identifying an infection, and more. Usually, testing for the underlying cause is determined by your medical history and risk factors.

Sometimes other testing is necessary to determine whether there is bleeding inside the body. These tests may include imaging, such as a computed tomography (CT) scan of the abdomen if there is concern about bleeding in the gastrointestinal system. In some situations, more invasive testing might be necessary, such as bronchoscopy to examine the bronchi (airways in the lungs).

Coagulopathy Treatment

Coagulopathy can often be treated with medication. Each cause of coagulopathy has its own treatment. Typically, treatment needs to be maintained for a lifetime for some types of chronic coagulopathy.

In some instances, such as when there is severe bleeding, a blood transfusion may be necessary to replenish the blood as the body is making new blood cells to replace those that were lost.

Lifestyle Modifications

While lifestyle modification cannot cure coagulopathy, a proper diet is important for maintaining the nutrients that are necessary for the body to make platelets and proteins for hemostasis.

Nutrients that are necessary for proper blood clotting include:

• Vitamin K, which is present in leafy green vegetables
• Protein, which is present in beans, seafood, chicken, beef, and dairy products

Medication

Medications can often cause or contribute to coagulopathy, so stopping any medications that can cause bleeding, such as nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil or Motrin (ibuprofen), is often recommended.

Getting injections to replace deficient clotting factors usually is a treatment for hemophilia or Von Willebrand disease. This may be done on a scheduled basis, or it can follow blood test parameters.

Some conditions, such as severe, acute trauma, can cause both coagulopathy and hypercoagulation (excess blood clotting).

Coagulopathy that’s associated with severe medical conditions, such as trauma or infections, is usually treated based on very close observation and blood tests. Vitamin K is sometimes given during these episodes of coagulopathy.

Procedures

You may require platelet transfusions if your platelet level is very low. These transfusions may be scheduled at regular intervals in order to prevent bleeding.

In emergency situations with severe bleeding, a blood transfusion may be necessary. Another procedure is evacuating (removing) blood from the abdomen or other areas of the body where blood can accumulate due to rapid and severe bleeding.

Summary

Coagulopathy is a bleeding disorder. It causes bleeding, which can range from minor to severe. There are numerous causes of bleeding disorders. Inherited coagulopathies are the most common types of chronic coagulopathy.

Often, testing is done before any symptoms develop for people who have a known risk of inherited coagulopathy. Blood tests can include tests of bleeding time, coagulation proteins, and genetic causes of coagulopathy.

Medical management may include medications, procedures, and lifestyle management. Chronic coagulopathies require long-term treatment to prevent serious bleeding complications.