hemorrhage (bleeding)
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Introduction
Bleeding from the rupture of a blood vessel.
Etiology
- frequency, severity & type of bleeding are clues to etiology.
- hemostatic plug disorder
- cutaneous bleeding
- mucous membrane bleeding
- epistaxis
- oropharyngeal bleeding
- menorrhagia
- coagulation disorder
- deep hematomas
- hemarthrosis
- delayed bleeding after surgery or trauma
Epidemiology
- of persons mean age 54 years, 3976 had major bleeding during 1,281,896 person years follow-up
- 73% of major bleeding events were GI
- 274 fatal bleeding events
- 153 due to intracerebral hemorrhage
- case fatalities from GI bleed 3.4-4.6%[4]
Pathology
- breakdown in the control of bleeding through interplay of vasoconstriction, platelet aggregation, & coagulation
Laboratory
- complete blood count (CBC)
- prothrombin time (PT) & aPTT
- additional testing as indicated
- bleeding time
- von Willebrand factor (vWF)
- specific assays for coagulation factor VIII or factor IX
- dilute whole blood clot lysis
- euglobulin clot lysis time
- dilute thrombin time
- serum fibrinogen
- qualitative factor XIII assay
Complications
- extracranial hemorrhage is associated with
- 15% increase in ADL disability
- 15% increase in iADL disability
- 8% increase in nursing home stays
- 4% increase in mortality[6]
Management
- pressure over bleeding vessels
- monitor: blood pressure, heart rate
- correct underlying bleeding diathesis
- 4-factor prothrombin complex concentrates for life-threatening bleeding due to warfarin[1]
- correct hypovolemia
- normal saline or lactated Ringers
- blood transfusion if indicated
- UrgentQR applied directory to wound may be of value
- tranexamic acid may be of benefit for severe hemorrhage[2]
- effectiveness of tranexamic acid decreases 10% for every 15-minute delay & is negligible at 3 hours[3]
Notes
- model predicts risks for major hemorrhage[5]
More general terms
More specific terms
- bleeding gums; gingival bleeding
- ecchymosis
- exsanguination
- hematuria
- hemoptysis
- immune or idiopathic thrombocytopenic purpura (ITP)
- internal hemorrhage
- mucosal bleeding
- ocular hemorrhage (hemophthalmos)
- otorrhagia
- penile fracture
- purpura; retiform purpura
Additional terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 19. American College of Physicians, Philadelphia 1998, 2022
- ↑ 2.0 2.1 The NNT: Tranexamic Acid for Severe Trauma. http://www.thennt.com/nnt/tranexamic-acid-for-severe-trauma/
CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. Lancet 2010 Jun 15; [e-pub ahead of print]. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20554319 <Internet> http://dx.doi.org/10.1016/S0140-6736(10)60835-5
Levy JH. Antifibrinolytic therapy: New data and new concepts. Lancet 2010 Jun 15; [e-pub ahead of print]. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20554318 <Internet> http://dx.doi.org/10.1016/S0140-6736(10)60939-7 - ↑ 3.0 3.1 Gayet-Ageron A, Prieto-Merino D et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: A meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet 2017 Nov 7; [e-pub]. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29126600 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32455-8/fulltext
Dries DJ. Tranexamic acid: Is it about time? Lancet 2017 Nov 7 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29126598 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32806-4/fulltext - ↑ 4.0 4.1 Selak V, Kerr A, Poppe K et al Annual Risk of Major Bleeding Among Persons Without Cardiovascular Disease Not Receiving Antiplatelet Therapy. JAMA. 2018;319(24):2507-2520. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29946729 https://jamanetwork.com/journals/jama/fullarticle/2685989
- ↑ 5.0 5.1 Selak V, Jackson R, Poppe K et al. Predicting bleeding risk to guide aspirin use for the primary prevention of cardiovascular disease: A cohort study. Ann Intern Med 2019 Feb 26; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30802900 https://annals.org/aim/article-abstract/2726667/predicting-bleeding-risk-guide-aspirin-use-primary-prevention-cardiovascular-disease
- ↑ 6.0 6.1 Parks AL et al. Long-term functional outcomes and mortality after hospitalization for extracranial hemorrhage. J Hosp Med 2022 Apr; 17:235. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35535921 https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.12799