DIAGNOSIS AND MANAGEMENT OF
HEMORRHAGE
• Introduction
• Types of hemorrhage
• Mechanism of hemostasis
• Causes of hemorrhage
• Evaluation of patient with hemorrhage
• Blood tests
• Management of hemorrhage
INTRODUCTION TO HEMORRHAGE
• Means escape of blood from a blood vessel.
• Bleeding which is prolonged & uncontrolled
• Blood loss can be less or more in quantity.
• Abnormal internal or external loss of blood.
TYPES OF HEMORRHAGE
1. DEPENDING ON THE TYPE OF BLOOD VESSEL INVOLVED
- Arterial : Bright red and sudden jets of blood.
- Venous : Dark red and continuous flow of blood.
- Capillary : Bright red and slow oozing of blood.
TYPES OF HEMORRHAGE
2. DEPENDING ON THE TIME PERIOD AFTER SURGERY
- Primary hemorrhage :
At the time of injury / surgery
or continuously afterwards.
- Reactionary hemorrhage : Restarts after period of 3
hours post-operatively.
- Secondary hemorrhage :
Restarts few days later after
surgery.
MECHANISM OF HEMOSTASIS
• Hemostasis means “STOPPAGE OF BLEEDING”.
STEPS IN HEMOSTASIS (Normal Mechanism)
1. Vasoconstriction.
2. Formation of platelet plug.
3. Coagulation.
1. Vasoconstriction: When the blood vessel is
damaged, vasoconstriction occurs to reduce bleeding,
as a normal mechanism.
2. Activation and aggregation of platelets causing
formation of platelet plug at the damaged surface of
blood vessel.
3. Activation of clotting mechanism, conversion of
fibrinogen to fibrin. Platelets bind with fibrin and
form a blood clot.
MAJOR REASONS EFFECTING NORMAL HEMOSTASIS
VESSEL WALL
• Severe damage to the wall of blood vessel like in
Major Trauma.
• Laceration of any Major Blood Vessel.
PLATELETS
• Less number of platelets than normal “PLATELET COUNT”
which has normal value 150,000 - 400,000 Platelets Per
Microliter (mcL).
• Lower than normal platelet count is called
thrombocytopenia can be caused by certain specific drugs
like anticancer drugs, radiotherapy, autoimmune diseases.
• Proper functioning of platelets.
• A higher-than-normal number of platelets
thrombocytosis.
DEFECTIVE CLOTTING MECHANISM
• Inadequate levels of clotting factors.
NORMAL CLOTTING MECHANISM
CAUSES OF HEMORRHAGE
In normal patients
- Local infection.
- Tear of blood vessel.
- Punctured wound.
- Disturbance of blood clot.
- Post-operative trauma to the operated site.
In patients with systemic diseases
• Haemophilia.
• Hypertension.
• Anticoagulant therapy.
• Vitamin K deficiency.
• Thrombocytopenia.
• Liver disorders.
EVALUATION OF PATIENT WITH
HEMORRHAGE
• History.
• Physical examination.
• Patients on medications like anticoagulants etc.
• Screening for any relevant systemic diseases.
• Investigations
BLOOD TESTS
• Bleeding time.
• Clotting time.
• Prothrombin time.
• Partial thromboplastin time.
• Platelet count
MANAGEMENT OF HEMORRHAGE
Depends on patients hematological status.
1. Patient with normal hematological status.
2. Patient with deficiency in any of the factors
promoting coagulation and healing.
MANAGEMENT OF HEMORRHAGE
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Normal patients
Digital pressure pack.
Hemostatic agents like Monsel’s solution,
Tannic acid, Gelfoam, Oxycel, Surgicel,
Thrombin, Bone wax.
Electrocautery.
Ligation.
Suturing the wound.
Patients with systemic diseases
• Preoperative treatment for the underlying cause
like hypertension etc.
• Preoperative care for underlying deficiency of
platelets or clotting factors etc, and their proper
replacement.
BLOOD TESTS NORMAL VALUES
• Bleeding time = 1 - 9 Minutes in adults,
1 - 13 Minutes in children,
Longer in female than in male
• Clotting time (or)
Prothombin time
= 10.5 - 13.5 / 14 Seconds
• Partial thromboplastin time = 25 – 35 Seconds