Bleeding. Methods Of Hemostasis Lecture Bleeding. Methods Of Hemostasis Reader R. Ya. Kushnir

Bleeding Haemorrhage, or bleeding, is the escape of blood from the blood vessels into the tissues and cavities of human body or outside, as the result of an injury or defect in the permeability of the blood vessel wall.

Hematoma In other cases when the poured out blood causes stratification of tissues, separation of organs and as a result the dimension cavity arised, which is filled with a blood is formed, - we speak about a hematoma

Anatomical classification (according to kind of bleeding vessel) Arterial hemorrhage; Venous hemorrhage; Capillary hemorrhage; Parenchymatous hemorrhage.

Types of bleeding

Classification according to mechanism of beginning Mechanical failure, vessel rupture (haemorrhagia per rhexin); Arrosive hemorrhage (haemorrhagia per diabrosin). This types of bleeding takes place during suppurative melting of wessel wall; Diapedetic hemorrhage (haemorrhagia per diapedesin); The violation of chemical composition of blood. The hemophilia, scarlet fever, sepsis, scurvy and others are causing bleeding sometimes. Toxins or beriberi to produce defect in the permeability of the vascular walls and caused of hemorrhage; Increased of arterial and venous blood pressure. The diseases, such as essential hypertension, atherosclerosis sometimes coursed of an injury of the vascular wall and bleeding (stroke, hemorrhoidal bleeding, etc.); Violation of fibrillation (haemophilia, Werlgof’s disease, cholemic hemorrhage in patients with jaundice)

Classification according to environment the bleeding External bleeding; Internal bleeding.

Symptoms of acute anemia persisting paleness; trembling and small pulse; progressing decrease of blood pressure; dizziness; nausea; vomiting; syncope.

Symptoms of bleeding to the stomach At bleedings in empty space of a gastrointestinal tract the blood in a stomach changes the color. In ample quantity of its accumulation a vomiting, like “ground coffe” (hematemesis), is originated. Further or at a bleeding from underlaying departments of a gastrointestinal tract it is observed weak tarry stool in large quantity (melena).

Some kinds of internal bleeding have specific name Haemobilia – haemorrhage from diliary ducts; Haematuria - haemorrhage from kidneys and urinary system; Haemoperitoneum - haemorrhage in abdominal cavity; Haemothorax - haemorrhage in pleural cavity; Haemopericardium - haemorrhage in pericardial cavity; Haemartrosis – haemorrhage in joint cavity; Metrorrhagia – uterine bleeding; Proctorrhagia – rectal bleeding; Hemorrhagic insult – cerebral hemorrhage.

Classification according to time of beginning primary; secondary (early and late).

Classification according to clinical course acute; chronic.

Classification according to degree of severity (V. I. Struchkov and E Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich ) I level – easy degree – blood loss is even to 10 – 12% of blood circulating volume (500 – 700 ml). Haemorrhage is causing little changes to hemodynamic. The general condition of patient is satisfactory. Pulse is slightly quickened, arterial pressure is normal (standart). Blood hemoglobin is rised above 100 g/l (10 g %). During capillaroscopy: background is rosy, 3 – 4 capillary loops with quick gomogenous bloodstream are determined.

Classification according to degree of severity (V. I. Struchkov and E Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich ) II level – middle degree - blood loss is even to 15 – 20 % of blood circulating volume (1000 – 1400 ml). Apparent bleeding is distinguished. The general condition is medium-scale difficalty. Limpness, dizziness, hyperhidrosis, syncope are observed. Coverlet is pale. Respiration is accelerated. Reflexes are decrease. Single vomiting or melena may be observed. Pulse become noticeably more rapid (90 – 100 per min.). Arterial pressure is decreased to 90 mm Hg. Leucocytosis, deviation of the differential count to the left are determined. Hematocrit is 0,38 – 0,32, hemoglobin is 80 – 100 g/l (8 – 10 g %). Quantity of urination is decreased.

Classification according to degree of severity (V. I. Struchkov and E Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich ) III level – heavy degree – blood loss is 20 – 30 % of blood circulating volume (1500 – 2000 ml). The general condition of patient is bad (grave condition). Paleness of skin, cold sweat is observed. Rapid vomiting and melena are determined. The bleeding is accompanied by syncope. Visible mucous membranes are colourless. The patient yawns, feels thirst. Pulse is rapid and thready. Arterial pressure is decreased to 60 mm Hg. Hematocrit is 0,30 – 0,32, hemoglobin is 50 – 80 g/l (5 – 8 g %). Oliguria is observed.

Classification according to degree of severity (V. I. Struchkov and E Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich ) IV level – massive blood loss – loss of blood is more then 30 % of blood circulating volume (more than 2000 ml). Plentiful bleeding with prolonged loss of consciousness may be observed. The general condition of patient is very grave, preagony. Pulse and arterial pressure are not fixed. Hematocrit is 0,23 and lower, hemoglobin is 50 g/l and lower. Anuria is observed.

The compensatory-adaptive mechanisms during acute blood loss Spasm of veins; Interstitial fluid inflow; Tachycardia; Oliguria; Hyperventilation; Peripheral arteriolespasm; Sympaticoadrenal system’ activation; Activation of fibrillation system and haemopoiesis stimulation.

Temporary control of bleeding

Temporary control of bleeding

Final hemostasis

Final hemostasis