Managing blood clots

You may have come across a case of a loved one suddenly collapsing for seemingly no reason. One minute they are cheery and going on about their activities and the next they are unconscious. He or she is likely among the rising cases of people unknowingly suffering from blood clots. In the above case, pulmonary embolism.

There is a growing need for awareness about the risk of blood clotting disorders in the community. The risk is especially heightened during pregnancy.

Due to limited awareness, many of the patients suffering from blood-clot-related problems and unexplained recurrent miscarriages are usually seen by doctors not experienced in the problem at hand.

There is however need for these patients to be attended to by a haematologist specialised in blood clotting disorders to provide a comprehensive service and deal with them from testing to diagnosis and treatment, especially because some of these problems require life-long treatments.

How common are clotting and bleeding disorders?

In the last year alone, I have seen between 250 to 300 patients who presented with venous thromboembolism- clotting within the deep veins of the body.

Many of these will have been caused by particular risk factor such as recent surgery, long-haul travel or even pregnancy. However, there are people who experience unexplained venous blood clots and these people in particular need further investigation to prevent this from recurring.

At our clinic, we investigate bleeding disorders and provide support for patients with some of the rarer bleeding disorders such as hemophilia and von Willebrands disease, which are inherited conditions that result in a lack of specific clotting factors within the blood. There is a delicate balance of these factors within blood that prevents too much clotting or too much bleeding.

How do you manage these patients?

When a patient comes to the clinic, the history of their symptoms; severity, duration, type of bleeding and whether any other family members are affected determines how we proceed.

Some of these bleeding disorders can be detected early. In severe cases of Haemophilia, it can be detected in childhood and may need life-long treatment.

In these cases, children can have problems with bleeding into the joints when they learn to walk, or when they have dental procedures or during circumcision.

Treating these conditions very much depends on the severity of the disorder as well as the type of the disorder. Treatment for bleeding disorders is directed at preventing harm to the patient by minimising the risk of bleeding, some patients may only need treatment before surgery or dental work for example.

It is important to note that one cannot acquire these disorders from blood transfusion.

How do clotting and bleeding disorders affect pregnancy?

Pregnancy itself can be a risk factor for clotting disorders. We see patients in clinic with a variety of complications associated with pregnancy. Including patients who have a history of recurrent miscarriage; in a small percentage, there can be an underlying clotting abnormality and management of this may be helpful.

We also see patients who develop venous clots in pregnancy and we support the Obstetric team to ensure safe delivery and management post-delivery, these women will also need management in subsequent pregnancies.

It’s not only blood clots which can occur in pregnancy, some patients can be at risk of bleeding disorders as well.

Patients can also develop abnormalities in the blood during pregnancy such as low platelets which puts them at risk for bleeding. Women who have inherited a bleeding disorder also require specialist care at this time.

What other conditions do you attend to?

Haematology is a broad field, some aspects of haematology are more well-known such as blood-related cancers like leukaemia and lymphoma, blood transfusion and the anaemias like sickle cell disease.

We have excellent well established services in these areas; now we can offer a dedicated specialist service to an underserved population of patients with clotting disorders which are often not well understood. This will ensure accurate diagnosis, improve patient education on their condition and provide patient-centred management.

Dr Laura Chebet Kirui is a Consultant Haematologist at Aga Khan University Hospital, Nairobi