Let it bleed: Seeing red over blood woes

Some people faint at the sight of blood, which I don't quite understand because we all bleed– some more than others (especially drama queens). Remember the Saturday Night Live skit* on Julia Child?

It's amazing any of us are alive. I'm studying for my 10-year re-certification for the internal medicine boards. I reviewed the blood clotting pathways (coagulation), and they're more complicated than setting up a surround-sound stereo system. (I think Tommy Lee should study the coagulation pathways while he's in college so he can flunk out and end his reality TV show pronto.) There are hundreds of ways for the blood clotting system to– well– spring a leak.

Bleeding disorders include such things as iron-deficiency anemia, excessive bleeding following surgery or tooth extractions (e.g. Little Shop of Horrors), heavy menstrual periods, easy bruising, nose bleeds, and mouth bleed. Sounds like the WWF. (By the way, what's the deal with Hulk Hogan? He is so '80s.)

The number-one acquired bleeding disorder is related to platelets. Platelets are not small dishes for cake from your Easy Bake Oven. Platelets form clots in blood vessels to stop bleedingĀ­ like a scab on a cut.

In people who take aspirin, small bruises and petechiae are pretty common. Petechiae are tiny spot-like bruises usually seen on areas that come into contact with pressureĀ­ like the lower legs if you cross your feet, the elbow if you think a lot like The Thinker, and your forehead if you are arrested a lot and handcuffed on the ground face-down.

Aspirin has an effect on platelets for about nine days, while other pain medication like ibuprofen affects them for a couple of days. This is why when you have surgery, you're told to stop your aspirin a week ahead of time so you don't bleed like the Dark Knight from Monty Python ("It's just a flesh wound!").

Boxers cannot afford to have von Willebrand Disease (VWD) because one punch to the mouth will make Tina Turner's lips look like two spaghetti noodles in comparison. VWD patients usually have bad mouth and nose bleeds, so flossing can be like a scene from Friday the 13th. VWD is the #1 inherited bleeding disorder, though we don't hear about it as much as we hear about hemophilia. Up to one percent of the population has deficiency of von Willebrand factor which is needed for platelets to huddle together to form a clot.

Vitamin K– found in dark green leafy vegetables and digested by bacteria in the gut– is necessary for coagulation. If someone is on chronic antibiotics or has a malabsorption problem (sort of like Mary-Kate Olsen), bleeding and bruising can start to occur.

Some medicines and diseases can cause the bone marrow to stop producing platelets or simply wipe them out by destruction. When that happens, on a blood smear, we can't count enough platelets to constitute a Happy Meal.

Folks, there are five billion other reasons for bleeding disorders, and I'm sure you would all like to read more about them. However, my fingers are bleeding from typing, so I must stop and take a nap. Save the chicken liver!


*In the skit, Dan Ackroyd as "Julia" is slicing up a chicken and accidentally cuts her thumb. Blood starts to squirt everywhere like the Bellagio Hotel fountains, and she reaches over to the phone to call 911, only to realize it's a prop phone. Despite applying pressure to her wound, her thumb continues to gush like a fire hydrant and she becomes very tired. So she says, "Good-bye, I'm going to take a nap here– and don't forget to save the chicken liver!" Eat your heart out, Martha Stewart.