•

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

• • • • •

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) = 10.5 - 13.5 / 14 Seconds Prothombin time • Partial thromboplastin time = 25 – 35 Seconds