Monday, January 4, 2010

Health Care and Blood Clots

Ever have a paper cut? If you remember, they sting and hurt and cause you to bleed. More severe lacerations result in heavier blood loss, and major bleeding can be catastrophic. The human body, with its capacity to offer resistance to certain health related emergencies, automatically starts a process to stem the flow of that precious red liquid of life. Clotting is a natural mechanism that kicks in when you start to bleed. However, there are some individuals that have health issues that prevent the natural clotting process when these events take place and need medications or other medically necessary procedures that prevent "bleeding out." When severe blood loss occurs, clotting is significant in its urgency to prevent the end of life.

According to MedicineNet.com, blood is a liquid that flows within blood vessels. It is constantly in motion as the heart pumps blood through arteries to the different organs and cells of the body. The blood is propelled back to the heart in the veins. When muscles contract, they squeeze the veins and allow the blood to be pushed back to the heart. Blood clotting is an important mechanism to help the body repair injured blood vessels. Blood consists of:
--red blood cells containing hemoglobin that carry oxygen to cells and remove carbon dioxide,
--white blood cells that fight infection, and
--platelets that are part of the clotting process of the body, and
--blood plasma, which contains fluid, chemicals and proteins that are key to bodily functions.

Complex mechanisms exist in the bloodstream to form clots where they are needed, according to MedicineNet.com. If the lining of the blood vessels becomes damaged, platelets are recruited to the injured area to form an initial plug. These activated platelets release chemicals that start the clotting cascade, activating a series of clotting factors. Ultimately, fibrin is formed, the protein that crosslinks with itself to form a mesh that makes up the final blood clot. The medical term for a blood clot is a thrombus (plural= thrombi). When a thrombus is formed as part of a normal repair process of the body, there is little consequence. Unfortunately, there are times when a thrombus (blood clot) will form when it is not needed, and this can have potentially significant consequences. A very highly detailed technical explanation of clotting also is available at http://themedicalbiochemistrypage.org/blood-coagulation.html .

According to FamilyDoctor.org, there are proteins in your body that are supposed to keep your blood from clotting too much. Some people do not make enough of these proteins. In other people, these proteins are not doing their job properly, or a person may have extra proteins in their blood that causes too much clotting. Some people are born with a tendency to develop clots. This tendency is inherited (which means it runs in your family). Certain situations or risk factors can make it easier for your blood to clot too much. These situations include the following:
--Sitting on an airplane or in a car for a long time.
--Prolonged bed rest (several days or weeks at a time), such as after surgery or during a long hospital stay.
--Surgery (which can slow blood flow).
--Cancer (some types of cancer increase the proteins that clot your blood).
--Pregnancy (which increases the pressure in your pelvis and legs and can cause blood clots to form).
--Using birth control pills or receiving hormone replacement therapy (which can slow blood flow).
--Smoking (which affects clotting).

According to MedicineNet.com, blood clots form when there is damage to the lining of a blood vessel, either an artery or a vein. The damage may be obvious, such as a laceration, or may occur on the microscopic level. As well, blood will begin to clot if it stops moving and becomes stagnant, such as in the following examples:
1.) Venous thrombosis or blood clots in a vein occur when a person becomes immobilized and muscles are not contracting to push blood back to the heart. This stagnant blood begins to form small clots along the lining walls of the vein that gradually grow to partially or completely occlude the vein. An analogy to this process is a slow moving river. Over time, weeds and algae start to accumulate along the banks of the river where the water flows more slowly. Gradually, as the weeds start to grow, they begin to invade the center of the river because they can withstand the pressure of the water.
2.) Arterial thrombi (blood clots in an artery) occur by a different mechanism. For those with atherosclerotic disease, plaque deposits form along the lining of the artery and grow to cause narrowing of the vessel. This is the disease process that may cause heart attack, stroke, and peripheral artery disease. If a plaque ruptures, a blood clot can form at the site of the ruptured plaque that can completely or partially occlude the blood flow at that point.
3.) Blood clots can also form in the heart. In atrial fibrillation, the atrium or upper chamber of the heart does not beat in an organized manner. Instead, it jiggles, and blood tends to become stagnant along the walls of the atrium. Over time, this may cause small blood clots to form. Clots can also form in the ventricle after a heart attack when part of the heart muscle is injured and unable to contract normally. Since the damaged area doesn't contract with the rest of the heart, blood can start to pool or stagnate, leading to clot formation.

As people age, particularly after age 55 for men and age 60 for women, blockages in arteries and veins become more common, according to Merck.com. The reason for the increase is unclear. Atherosclerosis, which becomes more common as people age, may partly explain the increase of blockages in arteries, but not that in veins. Normally, blood clots in response to injury. Clots form to plug breaks in blood vessels and prevent blood from leaking out of the blood vessels. Platelets are crucial to clotting. When a blood vessel breaks, platelets are activated. They become sticky and change from rounded to spiny. These changes enable platelets to stick to the broken blood vessel wall and to each other, helping form a plug at the break. At the same time, platelets release proteins and other substances that promote further clotting. After an injured blood vessel heals, other reactions help stop the clotting process and dissolve clots. These reactions also involve proteins dissolved in the blood. Without this control system, minor blood vessel injuries could trigger widespread clotting throughout the body, which occurs in some disorders.

Symptoms depend on which blood vessels are blocked by the clots, according to Merck. For example, an arm or a leg may swell or become painful and red. If a leg remains severely swollen, the skin on the lower leg may become itchy and turn a reddish brown. This skin is easily injured, often resulting in an ulcer. These symptoms may result when clots permanently damage the deep veins in a leg (a disorder called chronic venous insufficiency). Less commonly, the abdomen or face swells. People with disseminated intravascular coagulation can have symptoms related to both clotting and bleeding. Shortness of breath may develop as small blood vessels of the lungs leak or clots form in them. The skin, lining of the mouth, and whites of the eyes (sclera) may become yellowish (jaundice) if clotting and bleeding occur in the liver. Often, many tiny red dots appear in the skin on the lower legs. People may bruise easily. The gums may bleed, and blood may appear in the stool or urine. Small blackened areas may develop in the fingers and toes if fibrin, a component of clots, is deposited in the blood vessels there. Gangrene can result.

According to Physorg.com, a key protein that causes the blood to clot is produced by blood vessels in the lungs and not just the liver, according to new research published in the journal PLoS One, led by scientists at Imperial College London. The findings may ultimately help scientists to develop better treatments for conditions where the blood's ability to clot is impaired, including deep vein thrombosis, where dangerous blood clots form inside the body, and haemophilia A, where the blood cannot clot sufficiently well.

According to Merck, a blood clot may be detected when it causes symptoms or when a routine examination is done. An imaging test is usually needed to confirm the presence of clots. If clotting in veins is suspected, ultrasonography is useful for confirming clotting and for locating the clots. Magnetic resonance imaging (MRI) may be done if ultrasonography results are unclear. If results are still unclear, venography may be needed. For this test, special x-rays are taken after contrast dye is injected into a vein. When clotting in arteries is suspected, clotting may be confirmed using blood tests or arteriography. For arteriography, special x-rays are taken after contrast dye is injected into arteries. The cause must be identified. Blood tests can help. The amount and activity of different proteins that control clotting are measured. The platelet count and the time blood takes to clot may be determined. These tests are usually done after a blood clot has been treated. If the cause is another disorder or a drug, the clotting problems may subside when the disorder is treated or the drug is discontinued. If a hereditary disorder is the cause, people who have had one or more clots are often advised to take the anticoagulant warfarin for the rest of their life. Sometimes people who have had only one clot are advised to take warfarin or another anticoagulant, heparin, only when the risk of clots is high and special treatment is required. For example, they should take an anticoagulant when they need bed rest for a long time. Because taking anticoagulants increases the risk of excessive bleeding, people who take them must have blood tests periodically to check whether blood is taking too long to clot. Doctors then adjust the dose of the anticoagulant if needed.

According to Merck, clotting in arteries may be treated with a drug that makes platelets less likely to clump and thus makes blood clots less likely to form. These drugs, called antiplatelet drugs, include aspirin, clopidogrel, and dipyridamole. If a clot is still present or if a person has atrial fibrillation, heparin or warfarin is used. If a clot causes blood pressure to fall dangerously low or blocks blood flow to the brain or other vital organs, emergency treatment is needed. Treatment may involve giving drugs to dissolve clots (thrombolytic drugs) or, rarely, performing surgery to remove a clot from a blood vessel. However, these treatments can have dangerous, even life-threatening side effects, especially in older people. If disseminated intravascular coagulation develops suddenly, it requires emergency treatment for clotting and bleeding. If bleeding is severe, transfusions of red blood cells, platelets, and clotting factors are given to replace those that are used up and to stop the bleeding. If clotting is more of a problem than bleeding, heparin may be given.

Moderate exercise such as walking or swimming is recommended if you have suffered from blood clots and are taking anticoagulants. A return to your normal exercise routine depends on your physical condition before the clot and the severity and location of your clots. Refrain from crossing your legs which interferes with circulation. Do not sit for more than 2 hours at a time. In an automobile, stop every hour or so and walk for several minutes. On a plane, try to sit where you can stretch your legs (aisle seat, exit aisle, bulkhead seats, business class, etc.). Periodically, get up and walk the aisle(s) for several minutes. It is also a good idea to wear compression stockings when traveling. For any dental work, definitely tell the dentist when you make an appointment. Every dentist handles the issue of anticoagulants differently. Much more detail about using anticoagulants can be found at http://www.stoptheclot.org/learn_more/blood_clot_treatment.htm .

Blood clots are serious business. Deciding to take action if you feel that you are suffering from one is the best course to stay safe. Follow up immediately with your doctor or nearest health care provider. Avoiding care with blood clots is not advised. Seek medical attention at your earliest opportunity so you can maintain your health and avoid illness or death.

Until next time. Let me know what you think.

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