Dear Doctor,

When I get a small cut or scratch I tend to bleed profusely for long. I am now 18, but growing up I never had this problem. What could be the cause and how do I overcome it? Charlie

Dear Charlie,

For how long have you had this problem? Is it always there, i.e. after every cut/scratch or is it sometimes only.

Spontaneous prolonged bleeding after a minor cut can be due to deficiency of platelets(elements of blood which aid in clotting of blood). This may be due to no known reason(primary thrombocytopenia). It may be secondary to infections. Bacterial , viral or even protozoal infections, all can cause a fall in platelet count. Cancers of the blood like leukemias, suppression of bone marrow as due to some drugs, tumors or infections, exposure to extreme cold or heat, are some of the causes of low platelet count. Defective coagulation of blood leads to excess bleeding even after a small cut or abrasion.

Excess bleeding can also be due to some diseases like Von wille Brand disease or Christmas disease. These are hereditary conditions, where the body lacks some important factor involved in process of clotting. Hence clotting does not occur adequately after any injury, causing excess bleeding. These conditions are hereditary. In major deficiencies, even a 2 year toddler can suffer from prolonged bleeding, whereas mild defects may manifest in teenage or early adulthood. Deficiency of vitamin C, is known to cause excess bleeding after injury or surgery.. This problem can also be created due to prolonged use of anti clotting drugs like aspirin or clopidrogel. Pain killers of NSAID group can also cause slightly prolonged bleeding as adverse effect. Prolonged bleeding can be due to liver diseases as well like hepatitis and cancer. This happens because clotting factors are manufactured in liver, which become reduced or absent after liver damage.

The underlying cause of prolonged bleeding can be detected by blood counts, that include count of platelets as well. Bone marrow biopsies, blood levels of clotting factors are other tests that help to detect the underlying cause. Treatment depends on underlying cause.