Corpus: Bleeding

Haemorrhage or haemorrhage is the leakage of blood from the vascular system. In a haemorrhage, the blood leaves the closed circulatory system and there is a deficit of circulating blood, i.e. a loss of blood.

Colloquially, "haemorrhage" often also refers to a woman's physiological menstruation (menorrhoea).

...according to the affected vessel[Bearbeiten]

• arterial haemorrhage
• venous haemorrhage
• capillary haemorrhage
• variceal haemorrhage
• haemorrhoidal bleeding

...according to time course[Bearbeiten]

• acute haemorrhage
• chronic haemorrhage
• secondary haemorrhage

...according to amount of blood[Bearbeiten]

• slight haemorrhage
• heavy bleeding
• mass haemorrhage

...by aspect[Bearbeiten]

• oozing haemorrhage
• spurt haemorrhage
• occult haemorrhage

...by reference to body surface[Bearbeiten]

• internal haemorrhage
• external haemorrhage

...by affected organ or tissue[Bearbeiten]

• Abnormal uterine haemorrhage (AUB)
• Gastric haemorrhage
• Intestinal haemorrhage
• Brain haemorrhage
• Skin haemorrhage
• Joint haemorrhage (haemarthrosis)
• Tumour bleeding

...according to localisation[Bearbeiten]

• intracerebral haemorrhage
• subdural haemorrhage
• epidural haemorrhage
• gastrointestinal haemorrhage
• vaginal haemorrhage

...according to accompanying circumstances[Bearbeiten]

• Arrosion haemorrhage
• rhexis haemorrhage
• intraoperative haemorrhage
• postoperative haemorrhage
• surgical haemorrhage
• peripartum haemorrhage
• agonal haemorrhage
• bleeding complication
• spontaneous haemorrhage
• Drawing haemorrhage
• menstrual haemorrhage
• Nidation haemorrhage

Major haemorrhages lead to a decrease in the circulating blood volume. If the circulating blood volume falls below a critical value during a haemorrhage, haemorrhagic shock occurs. If this shock leads to death, it is referred to as haemorrhage.

However, the medical significance of a haemorrhage depends not only on the extent of the blood loss, but also on the localisation of the haemorrhage. In functionally important parts of the body (e.g. the brain), even a small haemorrhage can be life-threatening. The general danger to a patient from haemorrhage is described by the term bleeding risk.

Internal bleeding into the surrounding tissue or a body cavity ("haemorrhage") leads to bruising, which is medically referred to as a haematoma.

A distinction is made in pathology between special forms of haemorrhage:

• Petechiae: small punctiform haemorrhage
• Ecchymosis: small, patchy haemorrhage
• Sugillation: extensive skin or mucous membrane haemorrhage, larger than ecchymosis
• Suffusion: haematoma, diffuse extensive bleeding of the skin or mucous membrane
• Purpura: multiple, closely spaced haemorrhages

In healthy people, bleeding from minor injuries stops within a few minutes due to vasoconstriction and the body's own haemostasis mechanisms. The functionality of this system can be determined by measuring the bleeding time.

In the case of coagulation disorders, even minor injuries can lead to significant blood loss. Major haemorrhages always require surgical treatment of the vessel, for example by coagulation or ligation.

In the case of highly acute blood loss, the haemoglobin concentration (Hb), the haematocrit (Hct) and the erythrocyte count are initially normal, as the relative ratios in the remaining blood remain the same.

The serum lactate is considered an indirect marker for the body's oxygen supply. In the event of haemorrhagic shock and major blood loss, the oxygen supply to the tissue drops and more lactate is produced via anaerobic glycolysis. The blood loss suffered by a patient can therefore be roughly estimated on the basis of the serum lactate.

Blood loss can also be roughly estimated on the basis of the symptoms. With a blood loss of up to 10% of the blood volume (approx. 500 ml of blood), patients usually show no clinical abnormalities. If the patient has lost more than 10% of their blood volume, they may become tachycardic and their blood pressure drops. Pallor, cyanosis and cold sweats are further signs of major blood loss.

Apathy, somnolence or unconsciousness usually occur from a blood loss of around 35 to 50% of the blood volume (approx. 1,800 to 2,500 ml of blood).

In the case of postpartum haemorrhage, blood loss is usually estimated by visual assessment or weighing the materials soaked in blood. A bandage full of blood should correspond to approximately 100 ml of blood loss, a soaked Moltex pad represents approximately 250 ml of blood loss and a 1 metre pool of blood on the floor approximately 1,500 ml of blood loss.