HAEMORRHAGE

Definition of Haemorrhage

• Haemorrhage is the excessive or uncontrolled loss of blood from the vascular system.

Types of Haemorrhage (Location-based)

1. External Haemorrhage

• Blood loss from an external wound or cut.
• Occurs due to a break in skin and blood vessel.

2. Internal Haemorrhage

• Blood loss inside body cavities (peritoneum, thorax, joints).
• Caused by rupture of internal vessels.

3. Cerebral Haemorrhage

• Bleeding inside the cranial cavity.
• Due to trauma, hypertension, or aneurysm rupture.

4. Pulmonary Haemorrhage

• Bleeding into lung tissues or airways.
• Due to trauma, infections, hypertension, coagulopathy.

Types of Haemorrhage (Time and Pattern-based)

1. Primary Haemorrhage

• Occurs immediately at the time of injury.

2. Secondary Haemorrhage

• Occurs after a latent period (usually 24 hrs to 7 days).
• Often due to infection, sloughing of vessels.

3. Tertiary Haemorrhage

• Occurs later during healing due to failure of tissue repair.

4. Quaternary Haemorrhage

• Occurs months or years after injury due to weak scar tissue.

5. Massive Haemorrhage

• Loss of more than 40% blood volume rapidly.

6. Overt Bleeding

• Visible external bleeding.

7. Concealed Bleeding

• Internal bleeding, not visible externally.

8. Bledging

• Slow oozing of blood from small vessels.

Types of Haemorrhage (Vessel-based)

1. Arterial Haemorrhage

• Bright red, spurting blood.
• Rapid and dangerous.

2. Venous Haemorrhage

• Dark red, steady flow.

3. Capillary Haemorrhage

• Slow oozing from multiple points.

4. Haemorrhage due to Coagulopathy

• Caused by clotting disorders like haemophilia.

5. Traumatic Haemorrhage

• Caused by injury to tissues or vessels.

Causes of Haemorrhage

• Trauma or accidents
• Medical procedures / surgeries
• Ruptured aneurysm or varices
• Coagulopathies (haemophilia, DIC)
• Hypertension
• Tumors or cancers
• Infections
• Iatrogenic causes (medications, procedures)

Clinical Features of Haemorrhage

• Pallor (pale skin)
• Weakness and fatigue
• Pain at injury site
• Pulselessness (weak or rapid pulse)
• Paresthesia (numbness)
• Poikilothermia (cold extremities)
• Signs of shock: low BP, rapid pulse, sweating
• Decreased urine output
• Abdominal pain (if internal)
• Haematemesis (vomiting blood)
• Haematochezia (blood in stool)

Investigations for Haemorrhage

• History and physical examination
• Complete blood count
• Coagulation profile (PT, INR, aPTT)
• Blood grouping and cross-match
• Imaging: X-ray, ultrasound, CT scan, MRI
• Angiography to locate bleeding vessel
• Endoscopy or laparoscopy if needed

Complications of Haemorrhage

• Hypovolemic shock
• Organ failure due to poor perfusion
• Cardiac arrest
• respiratory failure
• Coagulopathy
• Severe anaemia
• Infection (if wound contaminated)

Management of Haemorrhage

1. Stabilize the Patient

• Ensure airway, breathing, circulation

2. Control Bleeding

• Direct pressure
• Elevation of limb
• Pressure bandage
• Tourniquet (only in severe limb bleeding)
• Hemostatic agents
• Surgical ligation or cauterization

3. Fluid Resuscitation

• IV crystalloids to restore blood volume

4. Blood Transfusion

• Replace lost blood components

5. Monitoring

• Continuous vital signs
• Urine output
• Repeated lab investigations

Haemostasis (Physiology)

Mechanism of Haemostasis

Step 1 → Vasoconstriction

• Immediate narrowing of vessel to reduce blood flow.

Step 2 → Platelet Plug Formation

• Platelets adhere, activate, and aggregate.

Step 3 → Coagulation Cascade

• Fibrin clot formation stabilizes platelet plug.

Blood Transfusion and Blood Products

Types of Blood Products

• Whole blood: all components
• Packed RBC: for anaemia, blood loss
• Fresh frozen plasma: clotting factors
• Platelets: thrombocytopenia
• Cryoprecipitate: fibrinogen, factor VIII

Indications for Blood Transfusion

• Severe blood loss
• Severe anaemia
• Surgery and trauma
• Coagulopathy

Complications of Transfusion

• Transfusion-related acute lung injury (TRALI)
• Transfusion-associated circulatory overload (TACO)
• Allergic reactions
• Haemolytic reaction due to mismatch

Examination of Haemorrhagic Patient

Steps

• Assess airway, breathing, circulation
• Check vital signs
• Examine bleeding site
• Perform necessary labs and imaging

Blood Transfusion Procedure

Preparation

• Confirm indication
• Select appropriate blood product
• Cross-match and prepare

Transfusion

• Connect transfusion set
• Administer blood slowly
• Monitor patient continuously

Post-Transfusion

• Check vitals
• Monitor site of bleeding
• Document procedure

Homoeopathic Therapeutic Approach

General Homoeopathic Remedies for Haemorrhage

• Arnica montana: trauma-related bleeding
• Calendula: healing of wounds and bleeding
• Hamamelis: venous bleeding, bruising
• Aconitum: shock after haemorrhage
• Hypericum: bleeding with nerve injury
• Symphytum: bone and tissue repair

Homoeopathy in Coagulopathy-related Haemorrhage

• Calcarea carbonica: bleeding tendency
• Phosphorus: bright red bleeding
• Carbo veg: collapse, cold skin, shock