Those Induced by Drugs
The normal healthy person has an intact blood coagulation system. However, many patients are under treatment with certain forms of drug medication, and these may sometimes produce artificial hemorrhagic states.
Heparin is used for various conditions where excessive blood clotting is a factor or is feared. This reduces the ability of the blood to clot. However, even though regular blood tests usually monitor its use, the coagulability of the blood may fall excessively low and give rise to hemorrhage. If this occurs, the doctor will immediately stop heparin and give intravenous Protamide Sulphate, which neutralizes the effect of the heparin and checks further bleeding.
Coumarin and other drugs may also carry an increased risk of unintentional hemorrhage. This may be worse if the patient is simultaneously taking other forms of medication, particularly the Salicylates (cg aspirin and related compounds) that will further aggravate the position. It is vital when under medication to take what the doctor orders, in the prescribed quantities, and not to add additional self medication. It could prove disastrous, and in cases like this produce prolonged and heavy life endangering hemorrhage. Of course, when on medication, if any abnormal symptoms occur, and in particular bleeding, you should report this at once to your doctor. Vitamin K, given orally or intravenously, is used effectively in association with heparin.
Arvin is used for the treatment of certain clotting disorders and may have the reverse swing and overshoot the mark and produce bleeding, but the risk appears small.
Salicylates and analgesics: It has already been stressed how these can have an adverse effect on the platelets and reduce the clotting power. The non-steroidal anti-inflammatory drugs (NSAIDs) (used in gout and arthritis) similarly may produce abnormal bleeding states. They must always be taken with care, under controlled doctor supervision, and any abnormality reported at once to the physician.
Thrombolytic enzymes: Certain enzymes are used in medicine to break down clots (streptokinase and urokinase). If these are given rapidly, hemorrhagic states are possible. This is treated with “fibrinolytic inhibitors”, a drug called epsilon aminocaproic acid, and this may reverse the risks.
An excessive breakdown of the clotting mechanism occurs in a wide variety of clinical situations, including certain obstetrical cases, some major operations (often where excessive handling of the organs is necessary), mismatched blood transfusions, widespread cancer and certain snakebites. Patients suffering from these emergencies are treated by immediate blood transfusions and fibrinogen.
Following Blood Transfusions
Some patients undergoing major surgery require massive blood transfusions. This means that while they gain from the added blood, many of their own blood Factors and platelet count are diluted, and these may not be replaced by the new blood. This is often helped by giving calcium gluconate with the blood. Today many patients have autologous transfusions where their own blood is used and these problems are avoided.
Vitamin K Deficiency
Certain Factors (Factor II or prothrombin, Factors VII, IX and X) are reduced if the patient is deficient in vitamin K. Some bleeding disorders may occur under these circumstances. So called hemorrhagic disease of the newborn is one case. It is readily improved with the administration of vitamin K 1. Indeed, mothers who appear to be at risk are now given this as soon as the baby is born, and so is the baby. Prematurity, prolonged labor with instrumental delivery, birth injury, fetal distress or anoxia, or if the mother has been malnourished, may be precipitating factors requiring vitamin K1.