The truth about blood clots: A silent killer
Chest pain or shortness of breath can be symptoms of blood clots in your lungs or heart. Photo/Courtesy
What you need to know:
- A 2021 study, conducted at Mulago Hospital, revealed that six in 10 patients nursing fractures died due to blood clots. The report highlighted blood clots as one of the significant causes of death and illness among patients who have undergone surgery. Blood clots are a deadly and costly public health care problem as Jennifer Kabaale reports.
In March 2024, Chelsea Kaweesa survived death by a whisker. She was at work, having lunch, when she suddenly began experiencing difficulty in breathing, heart palpitations, and then, general body weakness.
She did not pay much attention to these signs because she had just had a verbal altercation with her colleague.
“I worked in a hospital, so I had access to a doctor. When I described the symptoms to him, he asked if I had just climbed a flight of stairs. When I replied in the negative, he told me to relax and take a deep breath. Everything would be well,” she recalls.
Kaweesa returned to her workstation and indeed, everything seemed to have returned to normal. However, two hours later, she began gasping for breath.
“I was anxious, wondering what exactly I was experiencing. I rushed to the emergency room and requested the nurse to perform a thorough check up on me. She found that my blood pressure was low, and the heartbeat was too high,” she says.
The nurse summoned a doctor, and they performed a range of tests on Kaweesa, including malaria and cancer markers, but they were all negative. The doctor then asked Kaweesa if she had had a fall or an accident.
“I had not had either. That is when he said he suspected I might have a blood clot. He wanted to know what risk factor I had. I did not know what it was. He asked about different things. Then, he asked if I was using an implant. I said, ‘Yes, I have an implant,”
Three months after a c-section delivery, Kaweesa’s gynaecologist had inserted the implant in her arm. The doctor recommended that she undergo a CT scan, which showed a blood clot in one of her lungs.
“I got so worried. I began thinking about many things. One of the doctors scared me by saying the clot could lead to my death. I did not know that people can die without knowing what has killed them. The doctor said I was lucky that the clot was not big,” Kaweesa recalls.
Types of clots
Dr Joseph Mutyaba, a physician at Lubaga Hospital in Kampala, explains that blood clotting is essential for stopping bleeding when a blood vessel is punctured. However, he warns that blood clots can be dangerous if they form in the wrong place or fail to dissolve properly.
“There are arterial clots, which come from high lipid (fats) levels in the body. These clots are pumped by the arteries and can go to the brain and cause ischemic strokes. Ine this case, someone will wake up with paralysis on one side of the body,” he says.
Dr Mutyaba adds that arterial clots can also flow downwards and block the arteries in the lower part of the legs.
“This is when you see the feet turning black because clots have formed in the arteries. Some can present with swelling or warmth in the limbs. Others fail to move the affected limb. We see this more in people who have diabetes, hypertension, or too much fat in their bodies,” he notes.
On the other hand, venous clots can move through the bloodstream and lodge in small blood vessels in the lungs.
“That is an embolus. Ninety percent come from below the knee and move upwards towards the lungs. That is why people start developing difficulty in breathing, coughing blood, and getting tired easily,” Dr Mutyaba explains.
Various conditions can cause blood clots in the body, such as a sedentary lifestyle, surgery, being involved in an accident, some hormonal contraceptives, and diseases such as cancer.
The study conducted by Andrew Muleledhu also revealed that “incidence of blood clots range between 16 percent and 36 percent” among general surgery patients. Photo | Shutterstock
Other risk factors
In December 2023, Simon Peter Emwamu, a journalist, fractured his right leg in a motorcycle accident. At Kumi Hospital, his leg was put in a Plaster of Paris (POP) cast and immobilised for three months.
“When the POP was removed, I realised my leg was swollen. When I returned to the hospital for review, the doctor told me he suspected a blood clot was causing the swelling,” he says.
A scan revealed that several clots were logged in the veins of Emwamu’s right leg in three different areas. He was immediately admitted to the hospital.
“I thought I was going to die. I was worried and I felt exhausted. For two weeks, I was given injections twice a day. The injections were administered on the skin. Afterward, I moved to a private hospital where I was treated with various medications for six months,” Emwamu recalls.
He adds that his medication during that period, including eight CT scans, cost him Shs4.5m. Most of the drugs were bought in Kampala City since they were not available in local pharmacies in Kumi and Soroti districts.
Dr Mutyaba says other risk factors are the exogenous hormones being sold yet they can cause changes in the blood.
“Some of these are the Chinese pills on the market that have been implicated in causing blood clots in young girls,” he says.
Lack of movement is also a risk factor. Some people sit at their desks, in front of their computers or television sets, or even on a long flight, for more than three hours without getting up.
“After surgery one needs bed rest for a long time. That is why we give such immobile patients blood thinners to counter the development of clots. That is why when the surgeon tells you to return for review after one week, please do so without fail,” Dr Mutyaba says.
Treatment
After she was diagnosed, Kaweesa began feeling chest pain and heaviness. She was given medication to regulate the condition and with time, the pain disappeared. The implant was also removed.
“The doctors treated me for six months. At first, I was given Apixaban, a medication used to treat and prevent blood clots and stroke. However, after getting severe reactions to it, my medication was changed. I was developing black spots on my body,” she says.
Black spots on the skin can be a sign of internal bleeding. Kaweesa was changed to Rivaroxaban, a medication that thins the blood to keep it from clotting.
Dr Oscar Mugerwa, a physician at Nsambya Hospital in Kampala, says most blood clots do not cause pain and yet, pain or loss of function is what motivates people to come to hospitals.
“Someone can see a swelling on their leg and massage it with some ointment. However, when you massage a clot, it disintegrates and begins moving. A blood clot is a case for the high dependence unit,” he advises.
Frequent wellness checks are the only way to detect clots before they cause fatal consequences. A wellness check is a comprehensive assessment of one’s health depending on their history.
“If you tell me one of your relatives had a clot, or that you have had surgery, or have diabetes, or have been on a long journey in an airplane, it will point to the possibility that you are at risk of developing a blood clot. That is why it is important to have wellness checks every six months,” Dr Mugerwa explains.
The simplest way to prevent blood clots from developing is to keep active. At least, one should walk for 30 minutes a day and drink lots of water.
“If you notice any changes in your body, such as painless swellings, go to the hospital. Do not wait to start feeling pain. The most dangerous diseases are usually silent diseases, such as hypertension, diabetes, cancers, and liver diseases. That is why by the time people come to hospitals, they are in advanced stages of the disease,” Dr Mutyaba says.
Life today
Today, Kaweesa no longer works in a hospital environment because she says her employer doubted her capacity to fully recover from the blood clot.
“The company felt I was not going to give them my best, so I decided to quit. They did not know the trauma I had gone through and the mental state I was in at the time,” she says.
She opened up an event planning company and bridal shop. She has also abandoned the use of all contraceptives.
If detected early, blood clots can be treated and cured depending on their cause. Some, however, are treated indefinitely, especially if the patient is suffering from an incurable cancer.
UNDERSTANDING YOUR RISK FOR BLOOD CLOTS WITH PREGNANCY
Women who are pregnant or have recently had a baby have a higher risk of blood clots. It is important to know the signs and symptoms of a blood clot and talk with your healthcare provider about factors that might increase your risk during pregnancy.
During pregnancy, a woman's blood clots more easily to lessen blood loss during labour and delivery. Pregnant women may also experience less blood flow to the legs later in pregnancy because the blood vessels around the pelvis are pressed upon by the growing baby. Several other factors may also increase a pregnant woman's risk for a blood clot such as a previous blood clot, an inherited blood clotting disorder, delivery by C-section, prolonged immobility (not moving a lot), such as during bed rest or recovery after delivery, pregnancy at age 35 or older, and overweight or obesity. Protect yourself and your baby from blood clots A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT).
Signs and symptoms of a DVT include swelling of the affected limb, pain or tenderness not caused by injury, and skin that is warm to the touch, red, or discloured.
A blood clot in the legs or arms can break off and travel to the lungs. This is called a pulmonary embolism (PE) and can be life-threatening. Signs and symptoms of a PE include difficulty breathing, chest pain that usually worsens with a deep breath or cough, Cough or coughing up blood, faster than normal or irregular heartbeat.
Seek immediate medical attention if you experience any of the signs or symptoms of a possible PE.
Source: US Centres for Disease Control and Prevention (CDC).
NOTE
Blood clots help control bleeding, whether you are bleeding from a paper cut, a serious injury or even after surgery. On the other hand, blood clots can also be life-threatening if they keep blood from flowing through your body. Blood clots happen for many reasons, some of which you may not be able to avoid.
For example, you may have an inherited (genetic) condition that increases your risk of developing blood clots. If that is your situation, you are probably managing your condition with medication and other steps. If you are worried about developing blood clots, talk to a doctor.
Source: my.clevelandclinic.org
Produced by Nation Media Group in partnership with the Bill & Melinda Gates Foundation.
Editorial Team
General Manager Editorial: Daniel Kalinaki
Acting Managing Editor: Allan Chekwech
Editor, Sustainability Hub: Gillian Nantume
Features Editor: Caesar Karuhanga Abangirah
Contributor: Jennifer Kabaale
