Haemorrhage

Haemorrhage

Definition – Haemorrhage is the escape of blood from a blood vessel.

HAEMATOMA – Extravasation of blood into the tissue with resultant swelling is known as haematoma.

ECCHYMOSIS – Large extravasations of blood into the skin and mucous membranes are called ecchymosis.

PURPURA – Small areas of haemorrhage (up to 1 cm) into the skin and mucous membrane called purpura.

PETECHIAE – Minute pinhead size haemorrhages on the skin are called petechiae.

FORMS –

1. Epistaxis  (nosebleed)
2. Haemoptysis (coughing up blood)
3. Haematemesis (vomiting blood)
4. Haematuria (blood in urine)
5. Melena (dark stool)
6. Polymenorrhea (short menstrual cycle <21 days)
7. Menorrhagia (heavy periods)
8. Postpartum haemorrhage (excessive bleeding after childbirth)
9. Antepartum haemorrhage (genital bleeding during pregnancy, third trimester to till birth or delivery)

Classification –

1. According to the nature or type … (a) External or visible haemorrhage (b) Internal or concealed haemorrhage.

2. According to the timing …

            a. Primary haemorrhage – When haemorrhage occurs just after injury of vessels.

            b. Reactionary haemorrhage – When bleeding within 24 hours (usually 4-6 hours) causing slipping of ligature, dislodgement of clot.

            c. Secondary haemorrhage – When haemorrhage occurs after 7-14 days causing surgery, sloughing of vessels due to infection.

3. According to the source…

            a. Arterial haemorrhage – When bleeding occurs due to rupture of artery. Blood is bright red in colour and emitted as spurting jet.

            b. Venous haemorrhage – When bleeding occurs due to rupture of veins. Blood is dark red in colour and emitted steady and copious flow.

            c. Capillary haemorrhage – When bleeding occurs due to rupture of capillaries. Blood is bright red in colour and emitted rapid oozing.

4. According to the duration … (a) Acute haemorrhage (b) Chronic haemorrhage

5. According to the type of intervention… (a) Surgical (b) Non-surgical haemorrhage

 Effects of Haemorrhage –

• 33% of total blood, sudden loss may cause death.
• 50% of total blood, loss over the period of 24 hours may not necessary fatal.
• Chronic haemorrhage generally produce iron deficiency anaemia while occur acute haemorrhage may cause hypovolaemic shock.

Etiology –

1. Trauma to the vessel wall, e.g. penetrating wound in the heart or great vessels.
2. Spontaneous haemorrhage, e.g. rupture of an aneurism, septicaemia, bleeding diathesis, acute leukaemias, pernicious anaemia, scurvy.
3. Inflammatory lesions of the vessel wall, e.g. bleeding from chronic peptic ulcer, typhoid ulcers, traversing a tuberculous cavity in the lung, syphilitic involvement of the aorta, polyarteritis nodosa.
4. Neoplastic invasion, e.g. vascular invasion in carcinoma of the tongue.
5. Vascular disease, e.g. atherosclerosis.
6. Elevated pressure within the vessels, e.g. cerebral and retinal haemorrhage in systemic hypertension, severe haemorrhage from varicose veins due to high blood pressure in the veins of legs or oesophagus.

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