hemorrhage

Hemorrhage refers to the escape of blood from the vessels due to rupture or failure of the normal hemostatic processes. It can be accidental or spontaneous, external or internal, and may occur acutely or chronically. Classification commonly uses the rate of bleeding (minor, moderate, severe; potentially life-threatening), the location (external bleeding, internal bleeding, intracavitary bleeding), and the source (arterial versus venous).

Common causes include trauma, surgical procedures, obstetric complications, ruptured aneurysms, ulcers, tumors, anticoagulant or antiplatelet therapy, liver disease, thrombocytopenia, and hypertension. The pathophysiology involves primary hemostasis (platelet plug formation) and secondary hemostasis (the coagulation cascade); failure of these processes leads to ongoing blood loss.

Clinical features depend on the volume and location of bleeding. External bleeding is visible, while internal hemorrhage may present with pain, swelling, abdominal distension, or signs of hypovolemia such as tachycardia, hypotension, and cool, clammy skin. Diagnosis relies on history and examination, supported by imaging (ultrasound or CT) to locate bleeding, and laboratory tests (hemoglobin/hematocrit, complete blood count, coagulation studies).

Management emphasizes rapid stabilization and source control. This includes airway and breathing support, direct pressure or a tourniquet for external bleeding, hemodynamic resuscitation with fluids and blood products as needed, reversal of anticoagulation if present, and tranexamic acid in certain trauma or surgical contexts. Definitive control of the bleeding source may require surgery or interventional radiology.

Prognosis varies with severity and speed of control. Complications can include hypovolemic shock, organ ischemia, anemia, and coagulopathy. Prevention focuses on safety measures, appropriate anticoagulant use, and prompt treatment of bleeding disorders.