Haemorrhage

Haemorrhage is the loss of blood from the circulatory system due to rupture of vessels or failure of hemostasis. It can be external, visible on skin or mucosa, or internal, occurring within body cavities or tissues. It may be acute or ongoing and vary in severity from minor to life-threatening.

External haemorrhage involves bleeding to the outside of the body, while internal haemorrhage occurs away from the body and may present with pain, swelling, or signs of organ dysfunction. The source is commonly arterial or venous: arterial bleeding is usually bright red and spurting, rapid; venous bleeding is darker and steadier.

Causes include trauma, surgical procedures, peptic ulcers or ruptured aneurysms, obstetric bleeding, and medical conditions that impair coagulation or increase bleeding risk such as anticoagulant therapy, thrombocytopenia, liver disease, or clotting factor deficiencies.

Pathophysiology: loss of circulating blood reduces oxygen delivery and circulating volume, potentially causing hypovolaemic shock. The body mounts compensatory mechanisms but continued bleeding necessitates intervention. Coagulopathy can worsen bleeding; massive haemorrhage may require advanced therapies.

Diagnosis: assessment relies on history and examination, followed by investigations such as complete blood count, coagulation tests, and imaging (ultrasound or CT) to locate internal bleeding. Ongoing vital signs monitoring guides resuscitation.

Management: initial care focuses on stopping the bleed, securing airway, and supporting circulation. This includes direct pressure for external bleeding, intravenous access, fluid resuscitation, and blood products as needed. Reversal of anticoagulation, tranexamic acid in select settings, and definitive control of the bleeding source (surgery or radiology) are part of therapy.

Prognosis and prevention: prognosis depends on volume lost, duration, and cause. Early recognition and rapid haemorrhage control improve outcomes. Preventive measures include safety protocols, prompt treatment of coagulopathies, and careful use of anticoagulants.