Hemorrhage and Hemostasis by Dr. Nimer Khraim DVMS, MVSc

Hemorrhage Hemorrhage : is lose of blood from vascular system Hemorrhage : is lose of blood from vascular system Bleeding : is h. combined by shock, lose of RBCs and reduce of Oxygen carrying capacity of the blood Bleeding : is h. combined by shock, lose of RBCs and reduce of Oxygen carrying capacity of the blood

Hemorrhage Cause of h. Penetrating wound Penetrating wound Failure of blood clot within normal time may due to liver dis., irradiation, chemical poising, such as heparin, phosphorus, Failure of blood clot within normal time may due to liver dis., irradiation, chemical poising, such as heparin, phosphorus,

Hemorrhage Blood disorder such as hemophilia, thrombocytopenic purpura Blood disorder such as hemophilia, thrombocytopenic purpura Localized dis. Of B.V, high blood p. anuerysim and infections Localized dis. Of B.V, high blood p. anuerysim and infections

Type of Hemorrhage

According to the source Arterial h. The blood is bright, flow in spurts under p. The blood is bright, flow in spurts under p.

Type of Hemorrhage Venous h. The blood is dark red (bluish red) flow freely The blood is dark red (bluish red) flow freely Cappilary h. Blood oozing under very low p. Blood oozing under very low p.

Type of Hemorrhage According to the time Primary h. Occur at the time of injury Occur at the time of injury

Type of Hemorrhage Intermediate h. Occur with 24h after injury, this mostly occur due to failure of b.v ligature Occur with 24h after injury, this mostly occur due to failure of b.v ligature Secondary h. Occur more than 24h after injury, it’s the serous one of h. Occur more than 24h after injury, it’s the serous one of h. Its result from necrosis, suppuration or ulceration of b.v after ligation Its result from necrosis, suppuration or ulceration of b.v after ligation

Type of Hemorrhage According to extent Petechial h. Characterized by small h. area within he skin, serosa and mucosa Characterized by small h. area within he skin, serosa and mucosa

Type of Hemorrhage Bruising h. Characterized by a large area of h. in S\C T. or sub-mucosal T. Characterized by a large area of h. in S\C T. or sub-mucosal T. Deep h. Characterized by suffusion of the deep T. with large amount of blood Characterized by suffusion of the deep T. with large amount of blood

Hemostasis

Hemostasis Hemostasis In accidental wound the h. must be controlled while with surgical wound h. should be prevented In accidental wound the h. must be controlled while with surgical wound h. should be prevented

The important of hemostasis

Bleeding obscure the surgical field so it will reduce accuracy and efficiency Bleeding obscure the surgical field so it will reduce accuracy and efficiency Blood In the field, instrument and the drapes which will provide an ideal media for growth of bacteria and increase the chance of surgical wound infection Blood In the field, instrument and the drapes which will provide an ideal media for growth of bacteria and increase the chance of surgical wound infection

The important of hemostasis Post-operative h. prevent proper coaptation of wound edge, delay healing and increase the chance of infection Post-operative h. prevent proper coaptation of wound edge, delay healing and increase the chance of infection Sever continuous h. may lead to shock Sever continuous h. may lead to shock

Arresting of h.

Crushing The ends of bleeding vessels may be crushed with hemostatic forceps in which the forceps will provide a sufficient p. and help to produce clot formation The ends of bleeding vessels may be crushed with hemostatic forceps in which the forceps will provide a sufficient p. and help to produce clot formation

Arresting of h. Torsion Torsion the end of bleeding v. has been attached with hemostatic forceps with twisting of the end of b.v for several time before releasing the forceps

Arresting of h. Note: torsion and crushing may satisfactory for small b.v. Note: torsion and crushing may satisfactory for small b.v.

Arresting of h. Ligation This method include tying of the end of bleeding b.v This method include tying of the end of bleeding b.v The material using for ligation are catgut, cotton and silk The material using for ligation are catgut, cotton and silk

Arresting of h. Suturing Although suturing is used for primary to close the wound edge but it also help in arresting of h. Although suturing is used for primary to close the wound edge but it also help in arresting of h.

Arresting of h. Pressure By pressing a gauze against bleeding points By pressing a gauze against bleeding points Sufficient time must be allowed for clotting to occur Sufficient time must be allowed for clotting to occur

Arresting of h. Tourniquet This method applying compression with bandage This method applying compression with bandage It should be used only for short time and never use when other method of hemostasis is available, to avoid gangrene, trauma, nerve injury It should be used only for short time and never use when other method of hemostasis is available, to avoid gangrene, trauma, nerve injury Tourniquet should released every 20 min to perimite the re-oxygenation of T. Tourniquet should released every 20 min to perimite the re-oxygenation of T.

Arresting of h. Electrocoagulation( Thermocautery) using intense heat to burn the T. and coagulate T. act as hemostatic plug using intense heat to burn the T. and coagulate T. act as hemostatic plug

Arresting of h. Hemostate with topical applied sub. By applying sub. Which act as stringent agent on tissue and blood v. By applying sub. Which act as stringent agent on tissue and blood v. Ferric chloride, glacial acetic acid. Silver nitrate, alum, adrenaline Ferric chloride, glacial acetic acid. Silver nitrate, alum, adrenaline

Arresting of h. Specific coagulant Using gel foam sub. Which provide a large surface on which the blood will clot Using gel foam sub. Which provide a large surface on which the blood will clot

Arresting of h. Systemic hemostatic agent Sub. Administrated systemically usually are beneficial only when there are deficiency like Vit. K which is necessary for formation of prothrombin Sub. Administrated systemically usually are beneficial only when there are deficiency like Vit. K which is necessary for formation of prothrombin

Arresting of h. Whole blood transformation Whole blood transformation

Factor responsible for the spontious arrest of the h.

Extravascular factor This factor depend on the location of blood b.v This factor depend on the location of blood b.v The elastic nature of the tissue will resist the escape of blood from severed blood v. The elastic nature of the tissue will resist the escape of blood from severed blood v.

Factor responsible for the spontious arrest of the h. Vascular factor When a b.v. is severed, the intema will roll inward and the v. end retract in which the inverted end of b.v provide an suitable surface for accumulation of platelet and clot formation When a b.v. is severed, the intema will roll inward and the v. end retract in which the inverted end of b.v provide an suitable surface for accumulation of platelet and clot formation

Factor responsible for the spontious arrest of the h. Intravascular factor A series of blood clotting become active when blood platelet undergo morphological change in the presence of damage endothelial T. A series of blood clotting become active when blood platelet undergo morphological change in the presence of damage endothelial T.

Factor responsible for the spontious arrest of the h. The initial damage reaction is activated by tissue factor released from the surrounding T. following trauma The initial damage reaction is activated by tissue factor released from the surrounding T. following trauma These factor with calcium change prothrombin to fibrinogen which make the network of clotting formation These factor with calcium change prothrombin to fibrinogen which make the network of clotting formation