Minor bleeding from cuts and scrapes is a normal part of childhood, particularly after a child's play expands to include running, jumping and climbing. Children's cuts bleed only a short time, thanks to a complex system of specialized blood cells (platelets)and substances known as clotting factors,which work together to patch injured blood vessels without closing them off.
Bleeding is abnormal when the process of clot formation takes longer than it should or when there is easy bruising in the absence of trauma. When children bleed internally, there may be blood in their urine or stool, or they may vomit up blood from the stomach. (Digested blood looks black, so bloody stool or vomit usually resembles tar or coffee grounds.) In some disorders, blood accumulates in a joint or muscle.
WHAT CAUSES BLEEDING PROBLEMS?
Many different conditions can cause abnormal bleeding. In some cases, bleeding is the prominent symptom, but in others, it is only one of many. Possible causes include:
BLOOD DISORDERS: Hemophilia, a genetic disorder caused by the congenital absence of one of several clotting factors, is perhaps the most widely recognized disorder associated with abnormal bleeding. Typical sites of bleeding are under the skin and into the joints, muscles and other soft tissues. Prolonged bleeding may occur after circumcision, tooth loss or minor injury.
Leukemia, a cancer of the white blood cells, can also be associated with abnormal bleeding. This results from a severe reduction in the number of circulating blood platelets, which are the cells involved in controlling bleeding from the blood vessels. Reduction in blood platelets also characterizes immune thrombocytopenic purpura, an acquired, benign condition from which most children recover. An indication that there is a severe reduction of blood platelets is bruising and bleeding from the nose and gums, in the absence of trauma.
INFECTIONS: Viral, bacterial or parasitic infections can lead to abnormal blood loss, usually in the gastrointestinal or urinary tract. Blood may appear in the vomit or stool during the course of intestinal infections such as food poisoning or stomach viruses. By contrast, there may be small or microscopic amounts of blood in the urine during more generalized infections such as chicken pox. Blood frequently appears in the urine in the course of urinary tract infections (cystitis and pyelonephritis).
STOMACH ULCERS: These small areas of erosion in the lining of the stomach or duodenum (the first part of the small intestine) may bleed heavily or only slightly. Blood in the stool or vomit is one possible sign of a stomach ulcer.
IMMUNE SYSTEM DISORDERS:Autoimmune diseases,in which the immune system mounts an attack against the body's normal tissue, frequently involve the kidneys. Blood in the urine can be a common sign of this type of condition. One fairly common autoimmune reaction that can have this effect is poststreptoccocal glomerulonephritis , which sometimes occurs after a bout of strep throat.
INFLAMMATORY BOWEL DISEASES: These conditions, which also have an autoimmune orgin, typically cause bloody diarrhea.
Frequently, there is a simple explanation for blood in the stool or vomit. For instance, children can throw up blood after swallowing it during nosebleeds. Swallowed blood can also pass through the gastrointestinal tract and turn the stool black and tarry. Constipation can result in passage of stools streaked with red blood.
In addition, certain foods such as licorice can turn the stool black, as can medications such as Pepto-Bismol. Naturally red foods (beets for example) and foods artificially colored red (certain cereals and soft drinks) can give stool a bright, red color.
DIAGNOSING BLEEDING PROBLEMS:
Bleeding abnormalities may show themselves in any of the following ways:
• Multiple, small, purple bruises on the trunk and limbs
• Frequent, severe nosebleeds
• Frequent bleeding from the gums
• Prolonged bleeding after minor injuries
• Black, tarry stools or stools containing obvious red blood
• Cloudy or reddish urine
• Black, grainy vomit or vomit containing obvious red blood
• Laboratory evidence of blood in the stool or urine. (Small amounts of blood are invisible, so special tests are needed to detect them.)
Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, (C)1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.
