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For other uses, see Bleeding (disambiguation).
"Hemorrhage" redirects here. For the song by Fuel, see Hemorrhage (In My Hands). Fuel is a rock band formed by guitarist/songwriter Carl Bell and bassist Jeff Abercrombie in 1989 " Hemorrhage (In My Hands " is a song by the rock band Fuel, released as the first single from their album Something Like Human.
"Haemorrhage" redirects here. For the band, see Haemorrhage (band). Haemorrhage is a five-piece Goregrind band from Madrid, Spain.
For the deliberate extraction of blood, see Bloodletting. Bloodletting (or blood-letting, in modern medicine referred to as phlebotomy) was a tremendously popular medical practice from antiquity up to the late
Blood from a finger
Blood from a finger

Bleeding, technically known as hemorrhage (American English), haemorrhage (British English), or hæmorrhage, is the loss of blood from the circulatory system. Phonology North American English regional phonology In many ways compared to English English, North American English is conservative in its Phonology. British English or UK English ( BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen—and transports Waste products [1] Bleeding can occur internally, where blood leaks from blood vessels inside the body or externally, either through a natural opening such as the vagina, mouth or anus, or through a break in the skin. The blood vessels are part of the Circulatory system and function to transport Blood throughout the body The vagina (from Latin, literally " Sheath " or " Scabbard " is a fibromuscular tubular tract leading from the Uterus The mouth, buccal cavity, or oral cavity is the first portion of the Alimentary canal that receives food and begins digestion by mechanically breaking up The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. The skin is the outer covering of living tissue of an animal (or plant The complete loss of blood is referred to as exsanguination,[2] and desanguination is a massive blood loss. Exsanguination (also known colloquially as bleeding out) is the fatal process of total Hypovolemia (blood loss In Physiology and Medicine, hypovolemia (also hypovolaemia is a state of decreased Blood volume more specifically decrease in volume of Blood plasma Loss of 10-15% of total blood volume can be endured without clinical sequelae in a healthy person, and blood donation typically takes 8-10% of the donor's blood volume. A sequela, (sɨˈkwiːlə plural sequelæ) is a Pathological condition resulting from a Disease, Injury, or other trauma. [3]

Contents

Causes, prevalence, and risk factors

Hemorrhage generally becomes dangerous, or even fatal, when it causes hypovolemia (low blood volume) or hypotension (low blood pressure). In Physiology and Medicine, hypovolemia (also hypovolaemia is a state of decreased Blood volume more specifically decrease in volume of Blood plasma In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. In these scenarios various mechanisms come into play to maintain the body's homeostasis. Homeostasis (from Greek: ὅμος hómos, "equal" and ιστημι istēmi, "to stand" lit These include the "retro-stress-relaxation" mechanism of cardiac muscle, the baroreceptor reflex and renal and endocrine responses such as the renin - angiotensin - aldosterone system (RAAS). The cardiac muscle is a type of involuntary striated Muscle found in the walls of the Heart. Baroreceptors (or baroceptors) in the Human body detect the pressure of blood flowing through them and can send messages to the Central nervous system Renin (pronounced "Ree-nin" or "Rē-nin" (ˈriːnɨn also known as Angiotensinogenase, is a circulating Enzyme that participates in the body's Angiotensin causes blood vessels to constrict and drives blood pressure up Aldosterone is a hormone that causes the tubules of the kidneys to retain sodium and water The renin-angiotensin system (RAS or the renin-angiotensin-aldosterone system (RAAS is a hormone system that regulates Blood pressure and water ( fluid

Certain diseases or medical conditions, such as haemophilia and low platelet count (thrombocytopenia), may increase the risk of bleeding or may allow otherwise minor bleeds to become health or life threatening. Haemophilia (also spelled as hemophilia Platelets, or Thrombocytes, are small cytoplasmic bodies derived from cells They circulate in the Blood of Mammals and are involved Thrombocytopenia (or -paenia, or thrombopenia in short is the presence of relatively few Platelets in Blood. Anticoagulant medications such as warfarin can mimic the effects of haemophilia, preventing clotting and allowing free blood flow. An anticoagulant is a substance that prevents coagulation; that is it stops Blood from clotting Warfarin (also known under the brand names Coumadin, Jantoven, Marevan, and Waran) is an Anticoagulant.

Death from hemorrhage can generally occur surprisingly quickly. This is because of 'positive feedback'. Positive feedback, sometimes referred to as "cumulative causation" is a Feedback loop system in which the system responds to perturbation in the same direction An example of this is 'cardiac repression', when poor heart contraction depletes blood flow to the heart, causing even poorer heart contraction. This kind of effect causes death to occur more quickly than expected.

Types of bleeding

A subconjunctival hemorrhage is a common and relatively minor post-LASIK complication.
A subconjunctival hemorrhage is a common and relatively minor post-LASIK complication. A subconjunctival hemorrhage (or subconjunctival haemorrhage) is bleeding underneath the Conjunctiva. LASIK or Lasik ( Laser -assisted In situ Keratomileusis) is a type

Hemorrhage is broken down into 4 classes by the American College of Surgeons' Advanced Trauma Life Support (ATLS). Advanced Trauma Life Support (ATLS is a training program for doctors in the management of acute trauma cases developed by the American College of Surgeons. [4]

Individuals in excellent physical and cardiovascular shape may have more effective compensatory mechanisms before experiencing cardiovascular collapse. These patients may look deceptively stable, with minimal derangements in vital sounds, while having poor peripheral perfusion (shock). Elderly patients or those with chronic medical conditions may have less tolerance to blood loss, less ability to compensate, and may take medications such as betablockers that can potentially blunt the cardiovascular response. Care must be taken in the assessment of these patients.

See also: WHO bleeding scale

Causes

Minor traumatic bleeding from the head
Minor traumatic bleeding from the head

Traumatic

Traumatic bleeding is caused by some type of injury. The World Health Organization, or WHO made a standardized grading scale to measure the severity of Bleeding. There are different types of wounds which may cause traumatic bleeding. In Medicine, a wound is a type of Injury in which the Skin is torn cut or punctured (an open wound or where blunt force trauma These include:

The pattern of injury, evaluation and treatment will vary with the mechanism of the injury. The term ballistic trauma (generally referred to by the type of weapon such as gunshot wound, etc Blunt trauma causes injury via a shock effect; delivering energy over an area. Wounds are often not straight and unbroken skin may hide significant injury. Penetrating trauma follows the course of the injurious device. As the energy is applied in a more focused fashion, it requires less energy to cause significant injury. Any body organ, including bone and brain, can be injured and bleed. Bleeding may not be readily apparent; internal organs such as the liver, kidney and spleen may bleed into the abdominal cavity. The only apparent signs may come with blood loss. Bleeding from a bodily orifice, such as the rectum, nose, ears may signal internal bleeding, but cannot be relied upon. Bleeding from a medical procedure also falls into this category. A medical procedure is a course of action intended to achieve a result in the care of patients used by medical or paramedical personnel

Due to underlying medical conditions

Medical bleeding is that associated with an increased risk of bleeding due to an underlying medical condition. It will increase the risk of bleeding related to underlying anatomic deformities, such as weaknesses in blood vessels (aneurysm or dissection), arteriovenous malformation, ulcerations. An aneurysm (or aneurism) is a localized blood-filled dilation (balloon-like bulge of a blood vessel caused by disease or weakening of the vessel wall Dissection (also called anatomization) is usually the process of disassembling and observing something to determine its internal structure and as an aid to discerning the function Cerebral arteriovenous malformation Arteriovenous malformation or AVM in the majority of cases is a Congenital disorder consisting of a connection between Similarly, other conditions that disrupt the integrity of the body such as tissue death, cancer, or infection may lead to bleeding.

The underlying scientific basis for blood clotting and hemostasis is discussed in detail in the articles, Coagulation, haemostasis and related articles. Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby Hemostasis (or Haemostasis refers to a process whereby bleeding is halted in most animals with a closed Circulatory system. The discussion here is limited to the common practical aspects of blood clot formation which manifest as bleeding.

Certain medical conditions can also make patients susceptible to bleeding. These are conditions that affect the normal "hemostatic" functions of the body. Hemostasis involves several components. Hemostasis (or Haemostasis refers to a process whereby bleeding is halted in most animals with a closed Circulatory system. The main components of the hemostatic system include platelets and the coagulation system. Platelets, or Thrombocytes, are small cytoplasmic bodies derived from cells They circulate in the Blood of Mammals and are involved Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby

Platelets are small blood components that form a plug in the blood vessel wall that stops bleeding. Platelets, or Thrombocytes, are small cytoplasmic bodies derived from cells They circulate in the Blood of Mammals and are involved Platelets also produce a variety of substances that stimulate the production of a blood clot. One of the most common causes of increased bleeding risk is exposure to non-steroidal anti-inflammatory drugs (or "NSAIDs"). Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher The prototype for these drugs is aspirin, which inhibits the production of thromboxane. NSAIDs inhibit the activation of platelets, and thereby increase the risk of bleeding. Platelets, or Thrombocytes, are small cytoplasmic bodies derived from cells They circulate in the Blood of Mammals and are involved The effect of aspirin is irreversible; therefore, the inhibitory effect of aspirin is present until the platelets have been replaced (about ten days). Other NSAIDs, such as "ibuprofen" (Motrin) and related drugs, are reversible and therefore, the effect on platelets is not as long-lived.

There are several named coagulation factors that interact in a complex way to form blood clots, as discussed in the article on coagulation. Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby Deficiencies of coagulation factors are associated with clinical bleeding. For instance, deficiency of Factor VIII causes classic Hemophilia A while deficiencies of Factor IX cause "Christmas disease"(hemophilia B). Haemophilia A (also spelled Hemophilia A or Hæmophilia A) is a Blood clotting disorder caused by a mutation of the Factor VIII gene Haemophilia B (also spelled Hemophilia B or Hæmophilia B) is a blood clotting disorder caused by a Mutation of the Factor IX Antibodies to Factor VIII can also inactivate the Factor VII and precipitate bleeding that is very difficult to control. This is a rare condition that is most likely to occur in older patients and in those with autoimmune diseases. Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues von Willebrand disease is another common bleeding disorder. Von Willebrand disease (vWD is the most common hereditary Coagulation abnormality described in humans although it can also be acquired as a result of other medical conditions It is caused by a deficiency of or abnormal function of the "von Willebrand" factor, which is involved in platelet activation. Deficiencies in other factors, such as factor XIII or factor VII are occasionally seen, but may not be associated with severe bleeding and are not as commonly diagnosed.

In addition to NSAID-related bleeding, another common cause of bleeding is that related to the medication, warfarin ("Coumadin" and others). Warfarin (also known under the brand names Coumadin, Jantoven, Marevan, and Waran) is an Anticoagulant. This medication needs to be closely monitored as the bleeding risk can be markedly increased by interactions with other medications. Warfarin acts by inhibiting the production of Vitamin K in the gut. Vitamin K (K from "Koagulations-Vitamin" in German Danish Swedish and Norwegian denotes a group of Lipophilic, Hydrophobic Vitamins that Vitamin K is required for the production of the clotting factors, II, VII, IX, and X in the liver. One of the most common causes of warfarin-related bleeding is taking antibiotics. The gut bacteria make vitamin K and are killed by antibiotics. This decreases vitamin K levels and therefore the production of these clotting factors.

Deficiencies of platelet function may require platelet transfusion while deficiciencies of clotting factors may require transfusion of either fresh frozen plasma of specific clotting factors, such as Factor VIII for patients with hemophilia. Fresh Frozen Plasma ( FFP) is defined as the fluid portion of one unit of Human blood that has been centrifuged separated and frozen solid at -18° C (or colder Factor VIII (FVIII is an essential Clotting factor A deficiency of FVIII causes Hemophilia A, a bleeding disorder

First aid

All people who have been injured should receive a thorough assessment. It should be divided into a primary and secondary survey and performed in a stepwise fashion, following the "ABCs". ABC (and extensions of this Initialism) is a Mnemonic for memorizing essential steps in dealing with an unconscious or unresponsive patient Notification of EMS or other rescue agencies should be performed in a timely manner and as the situation requires. Emergency medical services (abbreviated to the initialism "EMS" in many countries are a branch of Emergency services dedicated to providing out-of-hospital

The primary survey examines and verifies that the patient's Airway is intact, that s/he is Breathing and that Circulation is working. A similar scheme and mnemonic is used as in CPR. However, during the pulse check of C, attempts should also be made to control bleeding and to assess perfusion, usually by checking capillary refill. Capillary refill is the rate at which Blood refills empty Capillaries. Additionally a persons mental status should be assessed (Disability) or either an AVPU scale or via a formal Glasgow Coma Scale. The AVPU scale is a system by which a First aider, Ambulance crew or other suitably trained person can measure and record a person's Level of consciousness The Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological scale which aims to give a reliable objective In all but the most minor cases, the patient should be Exposed by removal of clothing and a secondary survey performed, examining the patient from head to toe for other injuries. The survey should not delay treatment and transport, especially if a non-correctable problem is identified.

Minor bleeding

Minor bleeding is bleeding that falls under a Class I hemorrhage and the bleeding is easily stopped with pressure.

The largest danger in a minor wound is infection. An infection is the detrimental Colonization of a host Organism by a foreign Species. Bleeding can be stopped with direct pressure and elevation, and the wound should be washed well with soap and water. A dressing, typically made of gauze, should be applied. A dressing is an adjunct used by a person for application to a Wound in order to promote healing and/or prevent further harm Peroxide or iodine solutions (such as Betadine) can injure the cells that promote healing and may actually impair proper wound healing and delay closure. Hydrogen peroxide (H2O2 is a very pale blue liquid which appears colorless in a dilute solution slightly more Viscous than water Iodine (ˈaɪədaɪn ˈaɪədɪn or /ˈaɪədiːn/ from ιώδης iodes "violet" is a Chemical element that has the symbol I and Atomic Betadine is the name of Purdue Pharma 's brand of consumer-available Povidone-iodine (PVPI Topical Antiseptics Betadine like most PVPI [5]

Emergency Bleeding Control

Main article: Emergency bleeding control

Severe bleeding poses a very real risk of death to the casualty if not treated quickly. Emergency bleeding control is the steps or actions taken to control Bleeding from a Patient who has suffered a Traumatic injury or who has a medical condition Therefore, preventing major bleeding should take priority over other conditions, save failure of the heart or lungs. Most protocols advise the use of direct pressure, rest and elevation of the wound above the heart to control bleeding.

The use of a tourniquet is not advised in most cases, as it can lead to unnecessary necrosis or even loss of a limb. A tourniquet is a constricting or compressing device used to control venous and arterial circulation to an extremity for a period of time Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. Tourniquets should rarely be used as it is usually possible to stop bleeding by the application of manual pressure.

Bleeding from body cavities

The only minor situation is a spontaneous nosebleed, or a nosebleed caused by a slight trauma (such as a child putting his finger in his nose). Epistaxis (or a nosebleed in Plain English) is the relatively common occurrence of Hemorrhage from the Nose, usually noticed when the blood drains

Simultaneous externalised bleeding from the ear may indicate brain trauma if there has been a serious head injury. Loss of consciousness, amnesia, or fall from a height increases the likelihood that there has been a severe injury. This type of injury can also be found in motor vehicle accidents associated with death or severe injury to other passengers.

Hemoptysis, or coughing up blood, may be a sign that the person is at risk for serious bleeding. Hemoptysis or haemoptysis (see American and British spelling differences) is the expectoration ( Coughing up of Blood or of blood-stained This is especially the case for patients with cancer. Hematemesis is vomiting up blood from the stomach. Hematemesis or haematemesis (see American and British spelling differences) is the Vomiting of Blood. Often, the source of bleeding is difficult to distinguish and usually requires detailed assessment by an emergency physician.

Internal bleeding

Main article: Internal bleeding

Internal bleeding occurs entirely within the confines of the body and can be caused by a medical condition (such as aortic aneurysm) or by trauma. Internal bleeding is Bleeding occurring inside the Body. It can be a serious Medical emergency depending on where it occurs (e Symptoms of internal bleeding include pale, clammy skin, an increased heart rate and a stupor or confused state.

The most recognisable form of internal bleeding is the contusion or bruise.

Risk of blood contamination

Because skin is watertight, there is no immediate risk of infection to the aide from contact with blood, provided the exposed area has not been previously wounded or diseased. Before any further activity (especially eating, drinking, touching the eyes, the mouth or the nose), the skin should be thoroughly cleaned in order to avoid cross contamination.

To avoid any risk, the hands can be prevented from contact with a glove (mostly latex or nitrile rubber), or an improvised method such as a plastic bag or a cloth. LaTeX (ˈleɪtɛ Nitrile rubber or Buna-N, is a Synthetic rubber Copolymer of Acrylonitrile (ACN and Butadiene. This is taught as important part of protecting the rescuer in most first aid protocols.

Following contact with blood, some rescuers may choose to go to the emergency department, where post-exposure prophylaxis can be started to prevent blood-borne infection. Post-exposure prophylaxis ( PEP) is any prophylactic treatment started immediately after exposure to a pathogen (such as a disease-causing Virus) in order

As a medical treatment

Before the advent of modern medicine the technique of bloodletting, or phlebotomy, was used for a number of conditions: causing bleeding intentionally to remove a controlled amount of excess or "bad" blood. Bloodletting (or blood-letting, in modern medicine referred to as phlebotomy) was a tremendously popular medical practice from antiquity up to the late Phlebotomy is still used as an extremely effective treatment for Haemochromatosis. Haemochromatosis, also spelled hemochromatosis (see spelling differences) also called siderophilia

Footnotes

  1. ^ Bleeding Health Article. Healthline. Retrieved on 2007-06-18. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 618 - Coronation of the Chinese governor Li Yuan as Emperor Gaozu of Tang, the new Emperor of China, initiating three centuries
  2. ^ Dictionary Definitions of Exsanguination. Reference. com. Retrieved on 2007-06-18. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 618 - Coronation of the Chinese governor Li Yuan as Emperor Gaozu of Tang, the new Emperor of China, initiating three centuries
  3. ^ Blood Donation Information. UK National Blood Service. Retrieved on 2007-06-18. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 618 - Coronation of the Chinese governor Li Yuan as Emperor Gaozu of Tang, the new Emperor of China, initiating three centuries
  4. ^ Manning, JE "Fluid and Blood Resuscitation" in Emergency Medicine: A Comprehensive Study Guide. JE Tintinalli Ed. McGraw-Hill: New York 2004. p227
  5. ^ Waston, JR et al. Adv Skin Wound Care. 2005 Sep;18(7):373-8. PMID: 16160464

See also

}} Upper gastrointestinal (GI bleeding refers to Hemorrhage in the Upper gastrointestinal tract. Vaginal bleeding refers to bleeding in females that is either a physiologic response during the non-conceptional Menstrual cycle or caused by hormonal or organic problems of

Dictionary

bleeding

-adjective

  1. (British English, slang) extreme, outright.

-noun

  1. The flow or loss of blood from a damaged blood vessel.

-verb

  1. Present participle of bleed.
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