One of the most common clinical problems that hematologists deal with is diagnosis and management of patients with prolonged, excessive, or unusual bleeding. As a pediatric hematologist interested in hemorrhagic disorders for three decades, I thought until recently that I had “seen it all.” But I was wrong. This past January, I was asked by the ASH Communications Department staff to consider working with the National Geographic Channel in filming a story about a 13-year-old girl in India who was said to “cry tears of blood.” Somewhat hesitantly, I agreed to become involved. Little did I then imagine what was to follow. My odyssey during the subsequent months started with discussions involving the prospective film’s producer/director and his crew, based in London. They described an unusual patient named Twinkle, whose story had surfaced in press reports and on the Internet. They shared with me some of her medical records. Several years earlier she had begun having unexplained, spontaneous bleeding from her eyes, scalp, hands, and feet on almost a daily basis. Several evaluations at medical centers in Northern India resulted in no specific diagnosis. As a result of the unusual bleeding, the girl was expelled from school and shunned by her friends.
It was felt by the National Geographic Channel that telling Twinkle’s story and attempting to find the cause of her bleeding and identify a “cure” would be of widespread interest. The plan was to have a hematologist from America travel to India to observe her bleeding, assist with making a correct diagnosis, and deliver effective treatment. I wasn’t sure whether ASH was honoring me or punishing me by recommending that I be that hematologist! But in late March, I traveled to India with the film crew, met the patient and her family, and — working collaboratively with a hematologist and other staff at a hospital in Mumbai — reviewed the existing medical records and ordered tests. I also observed Twinkle’s bleeding … well, more specifically, observed Twinkle after she bled.
The bottom line of this adventure is that the National Geographic Channel documentary was successfully filmed and will be internationally televised beginning on Sunday, September 13. Does Twinkle really cry tears of blood? What is her diagnosis? To find out, you’ll have to watch the program! Although it may not fully clarify what is wrong with Twinkle, I am hopeful that it will inform the thousands of viewers about the diagnosis and management of bleeding disorders — and the important role of hematologists in that process — as well as provide a fascinating overview of a girl and her family in rural India whose life has been changed by a perplexing problem.