Blood Clotting & Bleeding Disorders

Blood Clotting Disorders

What is venous thromboembolism?

Venous thromboembolism (VTE) refers to both deep vein thrombosis (DVT) and pulmonary embolism (PE). These serious conditions are often underdiagnosed, but also are preventable and treatable.

What causes blood clotting disorders?

Your risk for experiencing venous thromboembolism (VTE) increases with age, obesity and a strong family history of VTE. Other conditions putting you at higher risk include:

bone fractures, severe muscle injury, major surgery
bed confinement after surgery or a medical condition and limited movement (like wearing a cast or sitting for a long time)
increased estrogen (birth control pills, pregnancy, estrogen replacement therapy after menopause)
health conditions including heart or lung disease, cancer, cancer treatment and inflammatory bowel disease
central venous catheters

You may inherit a condition that puts you at higher risk for forming blood clots. Fortunately, the more severe conditions (protein S, Protein C and Antithrombin deficiency) are rare and the more common conditions (Factor V Leiden and Prothrombin Gene mutation) are less risky.

Should I be tested for VTE?

In general, you do not need to be screened for VTE unless you have a history of blood clotting for a hereditary condition. Testing for these conditions also is not a necessary part of an initial evaluation of VTE. Test results will be falsely abnormal in the case of an acute clot or during anticoagulation therapy. A test may be helpful at the end of therapy to assist with determining the length of your treatment.

What to expect with blood clotting treatment.

Whether you experience a blood clot for the first time or have an inherited condition you need to manage, you’ll want expert care from a team of specialists who have access to the latest research and treatments. At Novant Health Hematology, you’ll be supported by a team of compassionate experts who work closely with you to diagnose your condition and develop an individualized care plan.

Preventative treatment

To prevent blood clotting and lower your risk of VTE, you may receive a low-dose anticoagulation medication following surgery, during a prolonged hospital stay or in some other high-risk situations. Sequential compression devices (SCD), cuffs worn on the legs that inflate and deflate to push blood through the veins, also reduce the risk of blood clots if you are confined to the bed. Movement is another great preventive measure. Getting up and moving around as soon as your provider allows can go a long way toward preventing VTE.

DVT & PE treatment

If you are diagnosed with DVT or PE, you will likely be treated with full dose anticoagulation therapy. These drugs keep the clot from continuing to grow and embolize. Anticoagulation drugs are sometimes called “blood thinners,” but they do not actually “thin” the blood. They make the blood less likely to clot and keep clots from growing.

Standard treatment with anticoagulation therapy for a DVT and PE lasts 3 to 6 months. By the end of 3-6 months on anticoagulation therapy, the clot matures and becomes firmer. A mature or chronic clot is much less likely to progress or embolize to the lung.

Sometimes you may need to undergo treatment to break up clots. Our vascular specialists and interventional radiologists administer these aggressive treatments for life or limb-threatening situations. While potentially lifesaving, “thrombolytic” therapies also can put you at risk of bleeding and other dangerous complications compared to standard anticoagulation medications. Our team of experts will discuss the risks and benefits of these treatments to determine the best care for you.

If you are at high risk for another blood clotting event, you may benefit from taking anticoagulation medications for a longer period of time. We’ll work closely with you to discuss your options and understand your preferences based on careful risk assessment.

Types of Blood Clotting Disorders

Deep Vein Thrombosis (DVT)

What is deep vein thrombosis (DVT)?

Deep Vein thrombosis occurs when a blood clot (“thrombus”) forms in a deep vein, usually in the leg. Blood clots also can occur in the arm, the abdomen or even a vein connected to the brain. Unless you have an unusual heart malformation, DVT would not send blood clots to the brain and cause a stroke.

DVT symptoms

If you have new (acute) DVT, your symptoms may include redness, pain and swelling of the affected leg or arm. You are likely to experience a complete recovery after treatment. Because blood flow is permanently altered in the affected vein, however, you may notice long-term issues like swelling in your leg when you are on your feet a long time, exercise vigorously, or travel long distances by car or airplane. Sometimes DVT causes more severe ongoing (chronic) pain and swelling with discoloration of the leg or leg ulcers.

Pulmonary Embolism (PE)

What is pulmonary embolism?

A pulmonary embolism, also called a lung embolism, occurs when a travelling blood clot becomes lodged in one or more of the arteries to the lung. PEs are the most serious complication of DVT and require immediate attention.

Pulmonary embolism symptoms

Typical symptoms of PE may include shortness of breath, fast or irregular heartbeat, coughing blood, or stabbing chest pain. In severe cases, low blood pressure may cause dizziness or a blackout. If you have these symptoms, you should seek help immediately. Pulmonary embolism can be life threatening and must be treated right away.

Bleeding Disorders

What is a bleeding disorder?

If you experience abnormal bleeding or bruising either randomly or following injuries or surgery, you may have a bleeding disorder that requires medical attention. Some bleeding disorders are “acquired,” which means they are not inherited and may be due to medications or an immune system condition.

Other bleeding conditions like hemophilia, von Willebrand disease and some rare platelet disorders are inherited or passed down from parents to their children. Sometimes, easy bruising or bleeding is caused by fragile connective tissues around blood vessels that makes them tear and leak blood into surrounding tissues.

Diagnosing bleeding disorders

Diagnosing why you are experiencing abnormal bleeding often takes time and patience. The hematology specialists at Novant Health go beyond traditional care, providing high-level expertise and advanced lab testing to accurately diagnose your condition and plan your care. We’ll work closely with you to solve the mysteries of your blood clotting disorder and develop an individualized treatment plan based on the latest research for medicines and procedures.

Bleeding Disorder Treatments

Finding the best treatment for your bleeding disorder can be a complex process. The experienced team of doctors, nurses, social workers, pharmacists, and other support specialists at Novant Health work together with you to determine your treatment, prepare you for procedures and prevent long-term complications.

You’ll have access to complete care at our bleeding disorders clinic, sometimes referred to as a Hemophilia Treatment Center (HTC).

If you are a young adult transitioning to adult care, our collaboration with the St. Jude Affiliate Clinic at Novant Health Hemby Children’s Hospital makes it easy for you to get the seamless care you need.

Types of Bleeding Disorders

Hemophilia

What is hemophilia?

Hemophilia is an inherited bleeding disorder that prevents your blood from clotting properly. You may experience sudden unexpected bleeding or severe bleeding following injuries or surgery. If your doctor is unable to determine the cause of bleeding concerns, we can conduct thorough testing to help diagnose your condition.

Blood typically contains many proteins called clotting factors that help stop bleeding. If you have hemophilia, you have low levels of one of Factor VIII (8) or Factor IX (9). The lower the level, the greater the severity of bleeding. Sometimes bleeding can occur within your joints, causing arthritis or chronic pain. With proper care from our dedicated team of hematology specialists, you can avoid serious health issues that sometimes occur with a bleeding disorder.

Hemophilia in women

As a female, if you carry the hemophilia gene or have any symptoms of the disorder, you’ll need the care of a highly trained hematologist. The Hematology Treatment Centers at Novant Health provide medical care and surrounding support services to help prevent serious problems.

This care is especially important if you become pregnant. Our team of specialists will work closely with your OB-GYN provider. Our hematology specialists offer prenatal genetic testing to diagnosis hemophilia before your baby is born. This is critical to avoid injury to your child during delivery and avoid serious bleeding for you after delivery.

Hemophilia therapy and support

It’s rare, but you can develop hemophilia later in life due to an abnormal immune reaction or response. While we don’t usually know why it happens, it can be related to blood cancer or pregnancy. With the right therapy, this type of hemophilia can be resolved allowing you to get back to the activities you love.

The doctors, nurses, social workers, physical therapists, and clinical pharmacists at Novant Health Hematology work together to provide comprehensive care in our bleeding disorders clinic, sometimes referred to as a Hemophilia Treatment Center (HTC). In collaboration with the St. Jude Affiliate at Novant Health Hemby Children’s Hospital, we also can provide lifetime care as young adults transition from pediatrics to the adult clinic.

Learn More About Hemophilia

Von Willebrand Disease

What is Von Willebrand disease?

Von Willebrand disease (VWD) is the most common bleeding disorder, and you are typically born with it. It is caused when the blood does not clot properly. Blood contains many proteins called clotting factors that help stop bleeding. Von Willebrand Factor (VWF) is a protein that helps platelets stick together and stick to an injury site like glue. When VWF does not work like it should or if there is not enough VWF present, you can experience abnormal bleeding.

While some people living with VWD have minor but annoying bleeding, others can experience severe complications, especially after surgery or after delivery of a newborn. Symptoms may include nose bleeding, easy bruising, and heavy bleeding with dental procedures or after surgery.

Von Willebrand Disease in women
VWD is one of the most common bleeding disorders affecting women and can cause heavy menstrual bleeding, recurrent fetal loss, and severe bleeding after childbirth. The experienced specialists at Novant Health Hematology work closely with your obstetricians and maternal fetal medicine to make childbirth a safe and comforting experience for you.

Platelet Disorders

What is a platelet disorder?

Platelets are blood cells produced in the bone marrow. They are your first line of defense against bleeding. Platelets stick together to form a plug at the site of an injury and activate your clotting system to build a more permanent patch so your injury can heal. If platelets do not work correctly or if there are not enough platelets, bleeding does not stop as it should.

With a platelet disorder, you may experience gum bleeding, nose bleeding, heavy menstrual bleeding, easy bruising or hemorrhages under the skin (petechiae). Sometimes bleeding can be severe or life-threatening.

Platelet disorders can be inherited but are more commonly caused by medications. Inherited conditions can cause low platelet number or abnormal platelet function. Some medications, including ibuprofen and aspirin, also can affect platelet function, so it's important to receive care from a hematology specialist.

Platelet Disorder Support Association

Platelet disorder treatments

At Novant Health Hematology, we treat all types of Thrombocytopenic Purpura, or bruising from low platelets. (“Purpura” means bruising; “thrombocyte” is another word for “platelet,” and “thrombocytopenia” means low platelets.) You'll have access to dedicated hematology specialists who offer the most advanced procedures to treat even the rarest forms of platelet disorders.

Immune Thrombocytopenic Purpura (ITP) is a rare condition in which your body perceives your own platelets as foreign. Your body then makes an antibody that signals the immune system to dispose of them. Your platelet count can vary from mildly low to dangerously low.

There isn’t a test for diagnosing ITP, so we first rule out any other explanation for your low platelet count such as liver disease, viral infections like Hepatitis and HIV, evidence of bone marrow failure in other blood cells, or medications that could cause low platelets.

ITP can be a challenging condition to treat, so you may undergo one or more options, including:

Immune suppression with steroids, either prednisone or dexamethasone.

Treatment options that induce the bone marrow to make more platelets, used if steroids are not enough or if we cannot stop steroids without platelets decreasing again.
Aggressive immune suppression with antibody treatment.
Chemotherapy, used rarely for difficult cases.

Receive the support you need.

Living with ITP can be challenging as it tends to get better and worse again with no apparent reason. We’re here for you with a dedicated team of experienced doctors, nurses, and other staff to provide compassionate support and the multidisciplinary care you need. New treatment options are under investigation, and we stay on top of the latest research to ensure you have access to the most advanced treatments.

Nurse drawing a woman's blood for lab tests.

Understanding Your Risks

Understanding your underlying condition can help us better treat your blood disorder. Novant Health Hematology offers genetic testing to help identify the condition that may be causing you to experience abnormal platelet production. We also offer pre-conception counseling to help minimize issues for you and the fetus during your pregnancy or delivery. Our genetic counseling team can talk with you about options for testing and whether it is right for you.

Blood Clot & Bleeding Disorders

Expert care. Effective therapies.