HEALTH EDUCATION: One In 10 Million Conditions, Curious Case Of Sweating Blood

HEALTH EDUCATION: One In 10 Million Conditions, Curious Case Of Sweating Blood

YAHOO.NEWS.AU: A young woman who has a rare condition that causes her to constantly sweat blood from her hands and face has left medical experts perplexed.

With no visible skin lesions, doctors were at a loss when the 21-year-old Italian patient began suffering repeated spontaneous nosebleeds.

NCBI Resources: Jesus Christ experienced hematohidrosis while praying in the garden of Gethsemane before his crucification as mentioned in the Defenders Bible by Physician Luke as “and being in anguish he prayed more earnestly and his sweatwas like drops of blood falling to the ground.”

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LIVE SCIENCE: The 21-year-old told her doctors that, over the last three years, she periodically experienced bleeding from her face and palms, without any cuts or skin lesions. These bleeding episodes typically lasted about 1 to 5 minutes, and were more intense when she was under emotional stress.

While the woman was at the hospital, her doctors observed “the discharge of blood-stained fluid from her face,” according to the report, which is published today (Oct. 23,2017) in the Canadian Medical Association Journal. She was diagnosed with a rare condition in which blood oozes from intact skin and membranes, according to the National Institutes of Health’s Genetic and Rare Diseases Information Center (GARD).

The condition has been reported for centuries, although some doctors have been skeptical of its existence, according to Dr. Jacalyn Duffin, a medical historian and hematologist at Queen’s University in Kingston, Ontario, who wrote a commentary accompanying the case report. [27 Oddest Medical Cases]

But after conducting a review of recent cases of hematohidrosis — 28 cases in the last 13 years — Duffin concluded that the condition really does exist. “Credible, though scant, observations of sweating blood persist” in the medical literature, she wrote in her commentary. “This collection of well-documented observations commands respect and acceptance,” she said.

However, nobody knows what causes the condition. Some researchers have hypothesized that increased pressure in blood vessels leads to the passage of blood cells through the ducts of the sweat glands, according to GARD. Others speculate the condition may be the result of activation of the body’s “fight or flight” response, which generally occurs when people experience sudden fear or stress. This response triggers the release of certain hormones that make a person more alert. But in rare cases, it may also cause the rupture of small blood vessels, resulting in bleeding, according to Healthline.

In some cases, the condition is tied to bleeding disorders, such as conditions in which the blood doesn’t clot properly, or to high blood pressure, according to GARD.

Descriptions of “blood sweat” go back as far as the writings of Aristotle in the third century B.C., Duffin said. In the late medieval and early modern periods, some references to bloody sweat were in the context of writings about the crucifixion of Christ, Duffin said. But starting in the 1600s, the first “eyewitness accounts” of hematohidrosis appear in the medical literature, in what doctors would consider case reports, she said.

In more recent years, there appears to have been an increase in reports of hematohidrosis — since 2013 alone, there have been 18 reported cases of hematohidrosis, Duffin said. (In total, there have been 42 reported cases of hematohidrosis in the medical literature since 1880.) Most recent cases are in young women, although some cases in men have also been reported, she said.

Image result for sweat blood picAn Italian woman has a rare condition that causes her to sweat blood. On the left, an image of the woman’s face during a bleeding episode. On the right, an image of the woman’s skin under a microscope, which showed normal tissue.Credit: Reprinted with permission from CMAJ Source: LIVE SCIENCE

YAHOO.NEWS.AU: The report said the strange defect had left the young woman socially isolated as a result of her growing embarrassment.

There was no obvious trigger, and the spontaneous bleeding could happen while she slept and during physical activity.

“She reported symptoms consistent with major depressive disorder and panic disorder,” the report stated.

The intensity of the bleeding increases when the patient is under stress, with episodes said to last anywhere between one and five minutes.

Co-director of the Hemophilia Comprehensive Care program Dr Michelle Sholzberg she had “never seen a case like this ever”.

“I can say that I’ve seen some of the worst bleeding disorders, and I’ve never seen them sweat blood,” she told CBC News.

She said she didn’t think the patient had a bleeding disorder, suggesting it could be an abnormality in the sweat ducts.

Doctors eventually diagnosed her with hematohidrosis, a rare disease that causes a patient to excrete or sweat blood through unbroken skin or pores.

While medical experts have not been able to cure her, they have prescribed a medication that helps alleviate the symptoms.

Her case remains a matter of much discussion within the medical community and the search for a cure remains ongoing.

LIVE SCIENCE: The Italian woman said that there did not appear to be a single trigger to her bleeding — it could occur while she was asleep, or while she was exercising or under stress. She said that she had become socially isolated as a result of her condition, and she experienced symptoms of depression and panic disorder, the report said.

Tests showed that it was indeed blood on her face, and not “colored sweat,” which can occur in certain conditions. An analysis of her skin under a microscope showed normal skin tissue, the report said.

The woman was treated with a medication for high blood pressure, which has been used before to treat hematohidrosis. After treatment, she experienced a “marked reduction” in her bleeding, although it did not completely stop, the report said. She was also given antidepressants for her depression symptoms.

Another case of “sweat blood” : 

Girl, 7, ‘sweats’ blood from her eyes, nose, ears and skin every time she gets a headache due to a one in 10 million condition

Daily Mail Australia/ May 3, 2017

  • Phakamad Sangchai , 7, from Thailand, started bleeding almost six months ago
  • Despite treatment and a likely diagnosis, Phakamad’s condition is unconfirmed
  • Her painless bleeding may be the result of ruptured skin vessels when stressed
  • Phakamad’s family are desperately seeking answers to the bizarre disorder
  • Despite the impact it has had on her life,  Phakamad remains happy and smiling

A young girl bleeds from her eyes, nose, ears and skin every time she gets a headache.

Phakamad Sangchai , 7, from Nongkghai, Thailand, started profusely bleeding almost six months ago.

Related image  Phakamad Sangchai, 7-year-old is suffering from a rare disorder that attacks one in 10 million people. Imagedeccanchronicle.com

Despite receiving treatment at a local hospital, Phakamad continues to suffer from the baffling condition, leaving her family desperate for help.

Phakamed said: ‘I don’t want to be famous, but I just want someone to help me with this mystery illness. It is really spoiling my life and I am so concerned that it will get worse.’

VANGUARD NEWS: The little girl from Nongkghai, Thailand, practically bleeds from her eyes, nose, ears and skin every time she gets a headache. Her life is like a horror movie. The strange but painless condition began spontaneously from the skin and mucous membranes six months ago and has defied all treatment efforts. Phakamad continues to suffer from the mysterious condition. “It is really spoiling my life and I am so concerned that it will get worse,” she laments. Doctors are not exactly sure what Phakamad’s diagnosis is, but her mother, Nipaporn Khantain, believes her daughter is living with hematohidrosis. The illness has taken its toll on their family and Nipaporn desperately seeks answers to help obtain treatment.

“I have searched on the internet myself and found that something called Hematohidrosis, which could be the condition, but we are waiting for an answer from the hospital.

“My daughter has always been a very happy child and still continues to smile when she can, she is a very brave girl,” she lamented.

Phakamad is not alone. An unnamed 13-year-old boy is also reported with history of spontaneous bleeding daily, more so during school hours of 9-11 am and this lasted for around one minute. It recurred after five minutes and the patient bled continuously or intermittently followed by spontaneous cessation.

There was no past history or family history of bleeding tendencies, nor of any systemic diseases or evidence of any trauma, scratch marks or any sign suggestive of bleeding.

On examination, there was oozing of blood stained fluid from face, arm and trunk. On mopping, it disappeared immediately leaving behind no signs of trauma, nor any disease only to appear again within few seconds. This fact confirmed it as sweating of blood as opposed to bleeding.

According to medical experts, hematohidrosis may occur when a person is suffering from extreme stress, for example, facing his or her own death.

Very few cases of have been reported in medical literature. The exact etiology is unknown but it is believed to be a systemic disease, associated with “vicarious menstruation”—a condition in which bleeding occurs from a surface other than the mucous membrane of the uterine cavity at a time when normal menstruation should take place.

One school of thought says that there are multiple blood vessels around the sweat glands arranged in a net like form. It is believed that under the pressure of great stress the vessels contract. Subsequently as the anxiety passes the blood vessels dilate to the point of rupture. The blood at this point goes into the sweat glands which push the blood to the surface and manifests as droplets of blood mixed with sweat. However one looks at it, it’s quite an unpleasant condition to encounter or experience.

WHAT IS HEMATOHIDROSIS?

Hematohidrosis is a very rare condition in which an individual sweats blood. It may occur in an individual who is suffering from extreme levels of stress. Various causative factors have been suggested like component of systemic disease, vicarious menstruation, excessive exertion, psychogenic, and unknown causes. Fear and intense mental contemplation are the most frequent causes. It may also occur in bleeding disorders.

A Curious Case of Sweating Blood

Source: Indian Journal of Dermatology/ ncbi.nlm.nih.gov/pmc/

Bloody sweating is called hematohidrosis; true hematohidrosis occur in bleeding disorders. It may occur in individuals suffering from extreme levels of stress. Around the sweat glands, there are multiple blood vessels in a net-like form, which constrict under the pressure of great stress. Then, as the anxiety passes, the blood vessels dilate to the point of rupture and goes into the sweat glands. As the sweat glands produce a lot of sweat, they push the blood to the surface, which comes out as droplets of blood mixed with sweat. Duan et al., reported hematohidrosis associated with primary thrombocytopenic purpura. Migliorini described a case of hematidrosis, which is otorrhea with otoerythrosis. We hereby report a case where bloody sweat discharged from the forehead, face, and body episodically in a healthy young girl who did not have any underlying disorders.

A 12-year-old healthy girl visited us with a history of bleeding from the intact skin over the forehead, scalp, cheek, nose, and trunk [Figures [Figures1 and and 2] for the last 2 years. The bleeding occurred in episodes, once or twice a day, sometimes more frequently, especially on waking up in the morning. No preceding history of stress or anxiety and no preceding episode of tingling sensation were found. Each episode started with mild watery secretion over the forehead or other body parts, followed immediately with bright-red colored secretion. Each episode lasted for about 10-15 min, and the patient remained perfectly alright during the post-episode period until the next episode. There was no history of bleeding from any other site. No history of ingestion of any anticoagulants, dyes, or other drugs was obtained from her. She did not have any history of major medical or surgical illness in the past. No family member had similar complaints. Menstrual cycles were regular and normal.

Figure 1

An external file that holds a picture, illustration, etc.
Object name is IJD-58-478-g001.jpgSweat admixed with blood from the right side of the face (Indian Journal of Dermatology)

Figure 2

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Object name is IJD-58-478-g002.jpgSweat admixed with blood from nose (Indian Journal Of Dermatology)

Her general physical examination and systemic examinations did not reveal any abnormality. The skin over the forehead was normal. There was no local tenderness. Blood or red colored secretion could not be extruded on manipulation. On gross examination, the secretion was bright-red in color, less viscous than blood, and it was not frank blood. On collection of the secretion and examination of its smeared preparation under a microscope, plenty of erythrocytes were observed; the sample was benzidine test positive [Figure 3] and alkaptonuria negative. Her routine hemogram, blood counts, platelet count, bleeding time (2 min), clotting time (3 min 30 sec), active partial thrombin time (25 sec; normal range 24-32 sec), prothrombin time, liver function tests, and renal function tests were within normal limits. Peripheral smear of the secretion showed multiple red blood cells (RBCs) along with numerous gram-positive cocci and bacilli [Figure 4]. Urine and stool examination did not reveal erythrocytes or any abnormalities.

Figure 3

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Object name is IJD-58-478-g003.jpgBenzidine test of the secretion, confirming presence of blood

 

Figure 4

An external file that holds a picture, illustration, etc.
Object name is IJD-58-478-g004.jpgPeripheral smear of the secretion showing RBCs and numerous cocci and bacilli

Psychiatric analysis revealed Intelligent Quotient (I.Q.) between 60 and 70 and a loss of insight. Histopathological examination revealed no abnormalities in blood vessels and intact walls. Hair follicles, sweat glands, and sebaceous glands are normal. Direct immunofluorescence study ruled out vasculitis.

The patient was given atropine transdermal patch over the involved sites and she noticed gradual improvement in both the severity and frequency of the episodes. Gradually, after 1 month, the patient stopped getting similar episodes. We followed the patient for 2 months after stopping the atropine treatment. During this period, she did not have any more episode.

Discussion

Hematohidrosis also known as hematidrosis, hemidrosis, and hematidrosis is a condition in which capillary blood vessels that feed the sweat glands rupture, causing them to exude blood; it occurs under conditions of extreme physical or emotional stress.

Various causative factors have been suggested by Holoubek, like component of systemic disease, vicarious menstruation, excessive exertion, psychogenic, psychogenic purpura, and unknown causes. Acute fear and intense mental contemplation are the most frequent causes, as reported in six cases in a study. In our case, no causative factor was identified.

One hypothesis proposed for etiopathogenesis of hematohidrosis, as suggested by some authors, is that multiple blood vessels present in a net-like form around the sweat gland constrict under pressure of stress. As the anxiety passes out, the blood vessels dilate to the point of rupture. The blood goes into the sweat glands, which push it along with sweat to the surface, presenting as droplets of blood mixed with sweat. Severe mental anxiety activates the sympathetic nervous system to invoke stress-fight reaction to such a degree as to cause hemorrhage of the vessels supplying the sweat glands into the ducts of the sweat glands. Skin histopathological study by Zhang et al., revealed some intradermal bleeding and obstructed capillaries. No abnormality was found in sweat glands, hair follicles, and sebaceous glands. They concluded that pathological basis for hematohidrosis might be distinctive vasculitis, but direct immunofluorescence study did not reveal any abnormality in our case.

Biopsy during symptom free period did not reveal any blood-filled vascular spaces, intradermal bleeding or abnormality in hair follicle, sebaceous, or sweat glands. Benzidine test is an important tool in diagnosis, where hemoglobin in blood reacts with hydrogen peroxide-liberating oxygen, which then reacts with organic reagent producing a green to blue colored compound.Peripheral blood smear confirms that the blood is of human origin in our case.

Treatment of this condition is not so convincing. There is one report of successful use of propranolol. In our case, the patient was treated with atropine transdermal patch, followed by complete remission. We believe that a further insight in the etiopathogenesis may help develop more comprehensive management protocol of this rare and unusual condition.

What is new?

1. In our case, no underlying precipitating factors such as stress, strain, or any bleeding disorder was identified.

2. No evidence of vasculitis.

3. Dramatic response with atropine sulphate transdermal patch.

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