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Forum Name: Clots & Anticoagulants

Question: Question about slow clotter getting clogged arteries


 zarqua - Tue Feb 26, 2008 7:05 pm

Please see my profile for medical background. For reference, I am an ex-EMT in California, so reasonably knowledgeable about medical facts. I will give a brief background of my question just so you have some reference.

I was diagnosed as being a "slow blood clotter" back when I was a child (~1969) when I had a tonsillitis operation. After the procedure, the doctors couldn't stop the bleeding, and I was sent to Children's Hospital in Seattle for immediate attention. I ended up getting a transfusion, and later, when I was older, my parents explained that the doctor's had classified me as a slow clotter, but NOT a hemophiliac. They mentioned something about a "missing 13th gene"?? or some such, but I've never been given a good explanation.

Throughout my childhood (and still today), I bruised very easily, was slow to clot when cut or hurt, and bled a long time when having teeth removed (for example). Even today, if I cut myself with a knife, I would bleed for a couple of hours, but it will eventually clot. None of this was ever unmanageable, but I did have two accidents of note. One when I was about 12, where I fell on a pair of scissors, in my neck, and bled for about four hours before I was sutured and treated. Did not lose consciousness. Later, at 18, got in a motorcycle accident and lacerated my ankle such that a fair volume of blood was spurting out before I spotted it. Taken to ER, and they popped the hematoma (size of a baseball), and I almost did pass out briefly. Not sure of the exact volume lost. This one was pretty severe though, and I spent three days in the hospital, continuing to bleed periodically during that entire time. It took almost 24 hours for the bleeding to subside enough that I was out of danger. No other substantial injury since then.

Okay, that brings me to today, and two questions:

Clearly, I am an extremely slow clotter. Does this "help" me in any way as far as forming or not forming clots in arteries? Logic would imply that if my blood tends to clot very slowly, or rarely at all when in motion, then I would find far fewer plaque build ups in my arteries, and thus less susceptible to blockages and common issues related to this. Does this logic hold water, though?

Second, I have an umbillical hernia that showed up in the past 1.5 years. I've seen my doc, plus a specialist, and both said that it would be good to have it fixed, but it's not critical. I discussed my clotting problem with the specialist, but he said he would do a few test (which, likely??) and decide then, but didn't think it would be an issue. The hernia IS annoying and unsightly, and I would prefer to have it fixed rather than leave it alone. However, at 44, and slightly overweight for my frame, I am hesitant to have my first substantial surgery in my life with this risk. What would be your opinion on the likelihood of complications or risks, especially not being able to clot after the procedure? Would it make more sense to leave this alone and live with it as-is? Or is this still -- even being a slow clotter -- still a fairly straightforward and low risk procedure?

THANKS MUCH!!
bruce
 Dr. A. Madia - Tue Mar 25, 2008 1:06 pm

User avatar Hi Bruce,

A very good question and sorry for a late answer.

Let’s get some facts straight. I want to explain to you three different medical terms first.

1. Atherosclerosis: This is defined as deposition of fatty material on the inner lining of blood vessels [endothelium]. This deposition also attracts some calcium and then it becomes a hard plaque. Gradually as the deposition progresses the size of plaque increases to obstruct part of the vessel lumen which is now called 'Stenosis'. Note that nowhere in this process blood components or blood clotting is involved.

2. White Thrombus: Blood contains three types of cells. White, Red and Platelets. These Platelets are elongated cells that have the property to stick to each other on trigger from vessel injury or foreign body exposure and form what is known as a White thrombus or a Platelet plug.

3. Red Thrombus: The blood contains Red Cells [RBCs] as well as clotting factors in the plasma. On injury or foreign body exposure a chain chemical reactions take place and a 'clotting cascade' is triggered and a mesh like structure is formed out of these clotting factors in which the RBCs get entangled and this results in formation of what is called a Red Thrombus.

If you are a slow clotter, this last item of clot formation or Red Thrombus is what is delayed. This gives you absolutely no protection form the first item Atherosclerosis. So you are as much or as less prone to development of Blockages or Stenosis in your arteries any anybody else.

Having developed the stenosis from Atherosclerosis, the formation of white thrombus may be somewhat delayed in some types of slow clotters and the third thing, Red Thrombus is delayed in all slow clotters.

So you might be somewhat protected from acute catastrophic effects of artery clogging like a heart attack. But you have no protection against Atherosclerosis and Stenosis or the arteries.

There is no issue whatsoever for you getting operated for Umbilical hernia. A hematologist has to be in the team of your doctors and she would administer appropriate clotting factors through blood component therapy prior to surgery.


Apurva
 zarqua - Thu Mar 27, 2008 6:07 pm

Awesome!

Thanks, Dr. Madia, for clarifying and giving me the best explanation, and best set of facts I've heard yet on this topic. Clearly, I need to start working on losing weight and improving my diet so that I can address some of my risk factors for atherosclerosis. I completely understand the mechanism now and how it relates to clotting.

The other aspects are good to know -- especially about the surgery -- and have set my mind at ease. I will proceed with that when I've lost some weight and am in a better situation for good recovery.

Thanks again, and thanks for this very valuable forum!

Bruce
 Dr. A. Madia - Sat Mar 29, 2008 2:50 am

User avatar You are most welcome Bruce and I am happy to have been able to help You. Take Care,

Apurva

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