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Lecture. Bleeding. Methods Of Hemostasis L.Yu.Ivashchuk. Bleeding. Haemorrhage, or bleeding, is the escape of blood from the blood vessels into the tissues and cavities of human body or outside, as the result of an injury or defect in the permeability of the blood vessel wall. Hematoma.
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Lecture Bleeding. Methods Of HemostasisL.Yu.Ivashchuk
Bleeding • Haemorrhage, or bleeding, is the escape of blood from the blood vessels into the tissues and cavities of human body or outside, as the result of an injury or defect in the permeability of the blood vessel wall.
Hematoma • In other cases when the poured out blood causes stratification of tissues, separation of organs and as a result the dimension cavity arised, which is filled with a blood is formed, - we speak about a hematoma
Anatomical classification (according to kind of bleeding vessel) • Arterial hemorrhage; • Venous hemorrhage; • Capillary hemorrhage; • Parenchymatous hemorrhage.
Classification according to mechanism of beginning • Mechanical failure, vessel rupture (haemorrhagia per rhexin); • Arrosive hemorrhage (haemorrhagia per diabrosin). This types of bleeding takes place during suppurative melting of wessel wall; • Diapedetic hemorrhage (haemorrhagia per diapedesin); • The violation of chemical composition of blood. The hemophilia, scarlet fever, sepsis, scurvy and others are causing bleeding sometimes. Toxins or beriberi to produce defect in the permeability of the vascular walls and caused of hemorrhage; • Increased of arterial and venous blood pressure. The diseases, such as essential hypertension, atherosclerosis sometimes coursed of an injury of the vascular wall and bleeding (stroke, hemorrhoidal bleeding, etc.); • Violation of fibrillation (haemophilia, Werlgof’s disease, cholemic hemorrhage in patients with jaundice)
Classification according to environment the bleeding • External bleeding; • Internal bleeding.
Symptoms of acute anemia • persisting paleness; • trembling and small pulse; • progressing decrease of blood pressure; • dizziness; • nausea; • vomiting; • syncope.
Symptoms of bleeding to the stomach • At bleedings in empty space of a gastrointestinal tract the blood in a stomach changes the color. In ample quantityof its accumulation a vomiting, like “ground coffe” (hematemesis), is originated.Further or at a bleeding from underlaying departments of a gastrointestinal tract it is observed weak tarry stool in large quantity(melena).
Some kinds of internal bleeding have specific name • Haemobilia – haemorrhage from diliary ducts; • Haematuria - haemorrhage from kidneys and urinary system; • Haemoperitoneum - haemorrhage in abdominal cavity; • Haemothorax - haemorrhage in pleural cavity; • Haemopericardium - haemorrhage in pericardial cavity; • Haemartrosis – haemorrhage in joint cavity; • Metrorrhagia – uterine bleeding; • Proctorrhagia – rectal bleeding; • Hemorrhagic insult – cerebral hemorrhage.
Classification according to time of beginning • primary; • secondary (early and late).
Classification according to clinical course • acute; • chronic.
Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich ) • IV level – massive blood loss – loss of blood is more then 30 % of blood circulating volume (more than 2000 ml). Plentiful bleeding with prolonged loss of consciousness may be observed. The general condition of patient is very grave, preagony. Pulse and arterial pressure are not fixed. Hematocrit is 0,23 and lower, hemoglobin is 50 g/l and lower. Anuria is observed.
The compensatory-adaptive mechanisms during acute blood loss • Spasm of veins; • Interstitial fluid inflow; • Tachycardia; • Oliguria; • Hyperventilation; • Peripheral arteriolespasm; • Sympaticoadrenal system’ activation; • Activation of fibrillation system and haemopoiesis stimulation.
On statistical Europe data • 42-44% people have a second blood type; • 38-39% - first; • 12-14% - third; • 4-6% - fourth.
Otenberg’s rules were held under hemotransfusion. These rules stated that during blood transfusion agglutinating introduced erythrocytes (agglutinogens) because the incorporated plasma (agglutinins) are diluting in general volume of liquid and their titre becomes to be insufficient for agglutination of patient's erythrocytes. Truth, clinicists forewarned that in events an edge of anemia, attempt of quick indemnity of bleeding by the donor’s blood of first group was observe agglutination of patient’s erythrocytes because was saved high concentration introduced agglutinins -named else "inverse agglutination".
Pseudoagglutination At the account of reactions possible to find agglutination where it practically is absent and reason to this phenomena are tobe: • low temperatureindoors, this below 15° C; • account to reactions later 5 minutes; • eating of erythrocytes (momental columns), their easy find of staggering of plate; • concentrate (is sub narrow) standard whey; • at presence infesting blood the immune antibody, if patient suffers a sepsis, system disease of blood.
Sometimes agglutination is impossible to notice, this can be at number of conditions: • Determination of blood types is lead at temperature over 25-30C; • If it is take reaction less than 5 minutes into account; • If low titre of agglutinins (below 1:32), in other words, you define blood type by one series of serum; • Unless it is keep correlation a whey-blood and last much.
