Often, it is said that people after recovering from an illness, surgery or a long journey suddenly fall down and die. Dr Peter Ogundeji, an hematologist at the University College Hospital, Ibadan, in this interview with Sade Oguntola, say over 50 per cent of these deaths are related to blood clotting problems not discovered and prevented.
What is thrombosis and why is this something so significant that everybody must know about?
Thrombosis is when you have blood forming a solid mass within the blood vessels. It is otherwise called a blood clot and it leads to blockage of blood vessels. Normally, blood is supposed to be in the liquid form, but more often than not, there could be one reason or the other why liquid blood can form a solid mass.
Thrombosis is good. When people have injury, it is by virtue of the formation of thrombus that the bleeding stops. Thrombus formation occurs at the point of the injury so as to seal the injured blood vessels and stop blood loss through the injured area. But sometimes, blood clots can form abnormally in any part of the body even when there are no injuries, particularly in the deep part of the abdomen and in the legs.
However, a blood clot becomes a serious issue first when it is dislodged from where it is formed and it travels down to block blood flow to organs of the body, including lungs, heart or even the brain.
For example, if a dislodged blood clot is pumped to the lung by the right chamber of the heart, it can block the blood supply to the lungs so much that the blood that is being pumped by the left chamber of the heart would not be oxygenated. This may be fatal, particularly when it is a massive blood clot that was dislodged and that goes into the lungs. Oxygenation of blood takes place in the lungs. An individual just needs about three minutes not to be oxygenated before occurrence of severe brain damage or death occurs. So, that is where the problem with abnormal blood clot lies.
According to a study, one in four people worldwide die from conditions caused by blood clot. How true is this?
That is true. A lot of hospitalised people die from complications of thrombosis, particularly when they have terminal diseases and blood clot formation is not prevented in them. However, this data is from studies in developed countries where access to healthcare is better and people easily visit the hospital when they are sick. In fact, some people say that blood clots accounted for almost half of the deaths in the hospitalised patients who were admitted for several medical conditions. These individuals had come to the hospital with diseases like cancer, heart failure, trauma, pregnancy, etc. On top of that, they have issues with mobility. This, alongside the medical conditions, predisposes them to blood clot formation. So, a lot of people die from complications of blood clot.
What are the signs and symptoms of a blood clot blocking blood flow in any part of the body?
There are 2 main types of thrombosis: Venous thrombosis is when the blood clot blocks a vein. Veins carry blood from the body back into the heart. Arterial thrombosis is when the blood clot blocks an artery. Arteries carry oxygen-rich blood away from the heart to the body. There are three things that contribute to clot formation. One is stasis, when the blood is not flowing as fast as it should be. The second thing is when there is a problem with the blood being clotted easily (hypercoagulable) and the third factor is injuries on the inside of the blood vessels (endothelial injury). These three factors must be present before someone’s blood will clot.
Thrombosis most of the time involves the big veins of the body, particularly in the lower part of the abdomen(tummy) or in the thigh. Most of the time, it involves the left leg. The leg would be swollen. But in two out of ten cases, the two legs may be involved.
For example, a lot of people in the course of their daily schedule they sit down for a long time and this can predispose them to blood clots in the veins that carry blood away from this leg. So, if such a thrombosis involves the legs, then we say that we have deep venous thrombosis. The second type of thrombosis is when the dislodged blood clot has travelled to the lungs, which is called pulmonary embolism.
Signs and symptoms of thrombosis develop slowly over time. The symptoms only become more noticeable the longer the issue exists. In the legs, where a blood clot can form, one of six symptoms can occur individually, or at the same time in different combinations. These could include discomfort in the legs caused by pain, muscle cramp, swelling, and warm skin around the swollen area.
And again, if it has now involved the lung, there will be breathlessness. The person will not be able to breathe well or have difficulty with breathing. You have a feeling of anxiety, sweating, your heart rate would be beating fast. You may have chest pain. There may be cough and if you cough, there may be blood in the sputum.
The dry season is approaching. Is it possible for heat stroke to induce thrombosis in individuals?
One of the things that happen with heat stroke is dehydration; not having enough water in our body system. When the blood is supposed to be flowing at a particular rate and the amount of water in the blood is reduced from dehydration, that means that there will be reduction in blood flow rate and this could be a factor that may lead to formation of thrombosis as a result of stasis that I talked about earlier. So, dehydration from not having enough water in our body is a risk factor for thrombosis.
Moreover, a lot of people when travelling a long distance don’t take a lot of water. Many times, some of these people have come down with blood clot formation.
In fact, I have seen a couple of individuals who after they have travelled from Ibadan to Lagos by road, because of traffic congestion and had spent more than 4 hours, end up having blood clot. This is attributable to the fact that they did not drink enough water and they sat down in the crowded vehicle during the journey; you know the situation in those commercial buses where people are packed together with little or no room for movement.
Are there pre-existing diseases that can predispose one to blood clot?
There are conditions that individuals inherit that may make them prone to blood clot formation. Also, other conditions such as cancer, burns, heart failure and many other terminal illnesses can predispose one to blood clot formation. Fractures, obesity, road traffic accidents, long distance travel, some medicines like oral contraceptive pills, and pregnancy are also factors that increase individuals’ risks of developing thrombosis. A fractured leg is put into a Plaster of Paris (POP) so that the bone can heal and that increases the chances of a blood clot formation. Women that use oral contraceptive pills have been shown to have an increased risk of developing thrombosis more than those who are not using them. Moreover, pregnancy is a risk factor for thrombosis because the body clotting system is set up to prevent excessive blood loss at the delivery. This risk remains until six weeks after delivery. We have had several reports of women who two weeks after childbirth just fell down and died most likely from blood clot complication. Age is also an important factor. Thrombosis is very rare in individuals less than 40 years. In fact, if you are less than 20 years, it is very, very rare. So, it is as age advances that the risk increases.
Is thrombosis really a new disease?
It is not a new disease. It has been from antiquity. Maybe people are beginning to understand it. But it is said that about 50% of people that died in hospital had died because they had a blood clot somewhere that blocked blood flow. Now, we are beginning to be more aware of this condition and a lot of people are getting treated for it. It is now a standard practice to evaluate people’s risk of developing a blood clot when they get admitted in the hospital. They are re-assessed 24 hours after admission and also when there is an intervention or procedure carried out on them to know their risk of thrombosis so that something can be done to prevent it.
For example, we know that about two to three people out of a hundred thousand people develop abnormal thrombus per year globally. Being black is an additional risk factor for thrombus formation and so we believe that the incidence in Nigeria may be more.
Studies say some people develop blood clots after COVID-19 vaccination? Does it mean individuals with a history of blood clot should avoid the vaccine?
Cases of vaccine-associated thrombosis are very rare with only a few cases reported worldwide. Therefore, it’s not something that should prevent anybody from taking the vaccine because the benefit of taking the vaccine outweighs the risk. And I don’t think that we should bother ourselves about the risk of thrombosis in COVID-19 vaccine because it is a very rare occurrence. It is not something that is common.
How do you prevent coming down with thrombosis?
We encourage people to lose weight as much as possible. Then, if traveling long distances either by road or air, we encourage people to walk down the aisle of the plane from time to time and take water to hydrate properly. And if you are at increased risk of thrombosis, if you want to travel long distances, you may need to see your doctor so that they give you drugs to prevent you from throwing an embolus.
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