BLEEDING is technically known as hemorrhaging or haemorrhaging, is blood escaping from the circulatory system .

 

BLEEDING

*Bleeding  ,technically  known as  hemorrhaging or haemorrhaging, is blood escaping  from the circulatory system .

*  Bleeding  can  occur internally  , where blood leaks from blood  vessels inside  the body or externally , either through a natural  opening such as the mouth, nose, ear ,urethra , vagina or anus .

* Or through  a break  in the skin hypovolemia is a  massive decrease in blood volume and death bye excessive loss of blood is referred to as exsanguination .

* Typically a healthy person can endure a loss of 10-15 %  of total blood volume without serious medical difficulties by comparison , blood donation typically take 8- 10% of the donor’s blood volume ) .The stopping or controlling of bleeding is called hemostasis and is an important part of first aid and surgery.

Classification :-

 

* The endoscopic image of units plastic , a type of stomach cancer leading to a leather bottle – like appearance with blood coming out of it .

*  Micrograph showing abundant hemosiderin – laden alveolar macrophages (dark brown ) ,as seen in a pulmonary hemorrhage . H and E stain .

Blood  loss :-

Hemorrhaging  is broken down into four classes by American college of surgeon’s advanced  trauma life support (ATLS)

*Class   I   hemorrhage :-

Involves up   to 15% of    Blood  volume .There is typically no change   in usually necessary .

*Class hemorrhage :- involves 15 -30% of total blood volume .A patient is often  tachy cardia (rapid heart beat ) with a narrowing of the difference between the systolic and diastolic blood pressure .The blood attempts  to compensate with peripheral vasoconstriction .Skin may start  to look pale and be cool to the touch . The  patient may exhibit slight changes in behavior . volume resuscitation with crystalloids (saline solution or lactated  Ringer solution ) is all that is typically required . blood transfusion is not typically required .

Class – 3 Hemorrhages :- involves loss of 30-40% of circulating blood volume .The patient’s blood pressure drops, the heart rate increases , peripheral hypo perfusion (shock)  , such capillary retail worsens . Fluid resuscitation with crystalloid and blood transfusion are usually necessary .

Class iv hemorrhage :- It involves loss of >10 % of circulating blood volume . the limit of the body’s compensation is required and aggressive resuscitation is required to prevent death .

This system  is basically the same as used in the  staging of hypovolemic shock . Individual in excellent physical and cardiovascular shape man have more effective compensatory mechanisms before experiencing cardiovascular collapse . these patients may look deceptively  stable with minimal derangements in vital signs , while having poor peripheral prefusion . Elderly patients or those with chronic medical conditions may have less tolerance to blood loss, less ability to compensate , and may take medication such as  beta bluckers  that can potentially blunt the cardiovascular  response . care must be taken in the assessment of these patient .

World  health organization  severity of bleeding

Grade -0                              no  bleeding

Grade -1                               petechial  bleeding

Grade - 2                             Mild blood loss (clinically significant )

Grade – 3                                 Gross blood loss , requires transfusion (severe)

Grade – 4                                  Debilitating blood loss , retinal or cerebral associated with fatality.                                                                                                                                                                                                                                       

Origin:-

*mouth 

* Hematemesis – vomiting  fresh blood

* Anus * Haematuria – blood in the urine from urinary bleeding .

* upper head

* cerebral hemorrhage – a type of intra cranial hemorrhage , bleeding within the brain tissue itself .

* Hemoptysis :- coughing up blood from the  lungs .

* Hematochezia :- rectal blood .* urinary tract

* Intracranial  hemorrhage – bleeding  in the skull.

* Intracerebral hemorrhage –bleeding in the brain caused by the  rupture of a  blood vessel  with in the head . see also hemorrhagic stroke .

* Subarachnoid hemorrhage (SAH)  implies the presence  of blood within the subarachnoid space  from some pathologic process . The common medical use of the term  SAH refers to the nontraumatic types of hemorrhages , usually from rupture of a berry  aneurysm or Arteriovenous malformation (ANM).The scope of this article  is limited  to these nontraumatic  hemorrhages .

* Lungs