Written by: Vanessa De Aquino, RPN, 3^rd year Nursing BScN student at Trent University 

April: World Hemophilia Day – April 17^th

The month of April marks World Hemophilia Day so why not speak about blood disorders? Shine Through the Rain would like to bring some insight into what our blood is and its components and what happens when the body has a hard time producing blood clots. Let’s get to it! 

What’s in the blood? 

The blood is composed of different things. About 55% of the blood is made up of plasma, which contains water and some solutes, and about 45% is made up of formed elements such as red blood cells, white blood cells and platelets. When someone gets injured and the person starts to bleed, the body reacts by sending some of the white blood cells and platelets to help create a plug to stop the bleeding. But is this enough? Well, the blood also has clotting factors, known as coagulation factors, which are proteins, mostly produced in the liver and found in the plasma of the blood, that help strengthens this super plug. So what happens if someone does not have enough of these cells to create the plug? Or what if they do not have enough of these clotting factors? What if the cells are defective? What if the liver is impaired? This is what happens to patients suffering from blood disorders! These individuals are at risk for persistent and prolonged bleeding even with minor events such as small cuts, brushing teeth, dental extractions, major nose bleed after a small blow to the face, bleeding from ulcers, easy bruising and hematoma post-fall, bleeding in the joints, and so many more. There are two major forms of hemophilia. The classic one is hemophilia A, which is a deficiency in clotting factor VIII and hemophilia B, also known as Christmas disease, which is a deficiency in clotting factor IX. Most bleeding disorders are inherited rather than acquired. 

Did you Know?

• According to the Canadian Hemophilia Society, the gene for an inherited bleeding disorder is present in about 300,000 Canadians. One out of every ten of them will require medical care because of severe symptoms (1).
• Any person with a bleeding disorder can have internal and external bleeds potentially leading to a life-threatening hemorrhage. 
• The incidence of Hemophilia A is 1 in 5000 to 10 000 male births (4).
• The incidence of Hemophilia B is 1 in 25 000 to 30 000 male births (4).
• Men with hemophilia will not pass the genetic defect to their sons but all daughters will be carriers (4). 
• Female carriers will transmit the genetic defect to 50% of their sons and 50% of their daughters will be carriers (4). 

What do Do

Do you have a bleeding disorder or know someone who does? Understanding how to prevent injuries is a great start. If bleeding occurs, apply direct pressure as quickly as possible to prevent blood loss. Patients with hemophilia do not bleed any faster but instead, they bleed for a longer time, so keeping the pressure a little longer is important. It is advised for patients to seek immediate medical attention if they are experiencing severe abdominal pain, swelling and restriction of the joints, suffered a head injury, sustained any wounds that require sutures, or if there is blood in the urine or stool (4). 

Physical Activities

According to the Canadian Hemophilia Society, individuals with bleeding disorders should try to choose the right activity to avoid the risks of bleeding. They recommend exercises that involve cardiovascular activities, muscle strengthening and flexibility exercises. For example, brisk walking, swimming, cycling, use of weights or stretchy bands, yoga or tai chi are all good options.  Sports that involve contact or collision, repetitive motions, speed, height and anything under unpredictable conditions should all be avoided (2). Improve your flexibility and get your heart pumping. Staying physically active can improve your range of motion in addition to maintaining a healthy weight and increasing muscle strength and bone mass. But first, speak with your physician to ensure your safety and ways to decrease the risks of injuries. Stay safe and have fun!

Nutrition

Canadian Hemophilia Society has a list of herbs and spices that should be avoided altogether. They include alcohol, ginger, garlic, ginkgo biloba, chamomile, omega-3 essential fatty acids, papaya, pineapple and Vitamin E. They are associated with having an action by thinning the blood or inhibiting the production of platelets, which is very important in the formation of a clot. Speak with your physician before taking nonsteroidal anti-inflammatory medications such as Aspirin and Ibuprofen as they can also increase the bleeding time (3). 

**The recipe was taken from Canada’s Food Guideline:

Ingredients:

• 500 mL (2 cups) loosely packed spinach or any other leafy green
• 1 ripe banana 
• 500 mL (2 cups) of fresh or frozen fruits (blueberries, strawberries, peaches, plums, mangoes or a combination thereof)
• 375 mL (1 ½ cups) skim milk or unsweetened fortified plant-based beverage
• 250 mL (1 cup) 0% plain Greek yogurt
• 20 mL (1 ½ tbsp) rolled oats or oat bran

Directions:

1. In a blender, place all ingredients and blend until smooth. 
2. Pour into a glass and serve cold!

References

1. Canadian Hemophilia Society (2018). Bleeding Disorders. https://www.hemophilia.ca/bleeding-disorders/
2. Canadian Hemophilia Society (2012). Destination fitness. https://www.hemophilia.ca/files/Destination%20fitness.pdf
3. Canadian Hemophilia Society (2007). All about carriers: a guide for carriers of Hemophilia A and B. https://www.hemophilia.ca/wp-content/uploads/2018/04/AACFinal.pdf
4. Tyerman, J., Cobbett, S. L., Lewis, S. M.(2023) Lewis’s Medical-Surgical Nursing in Canada: assessment and management of clinical problems. (5^th ed.). Elsevier.

The content posted here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It does not provide medical advice, diagnosis, or treatment but education only.