Bleeding

There are multiple conditions which can be associated with bleeding, a symptom which can become increasingly difficult to manage as diseases progress. 

Causes

• Direct tumour invasion of blood vessels
• Platelet disorders
• Coagulation dysfunction e.g. with liver disease
• Worsened by certain drugs
• Infections

Non-drug treatment

• Stop contributory medications (anticoagulants, antiplatelets) - discussion with haematology may be required if reversal of these is required in severe, acute bleeding
• Treat potential infections
• Radiotherapy to bleeding tumours
• Cautery may be appropriate
• Advice on using dark coloured clothing, bedding, and cloths to limit visual distress 

Drug treatment

• Regular blood product transfusion may be beneficial
• Tranexamic acid with full consideration of thrombotic risk, though this is small, likely less than 1:1000
• Etamsylate can be used to enhance platelet function but is unlicensed in the UK
• Topical tranexamic acid, including used as a mouthwash, may be preferable to oral preparation as less risk of VTE
• Topical adrenaline, including nebulised, may reduce bleeding by causing vasoconstriction