- Bleeding to Death
Hemorrhage causes death by interrupting blood flow to the brain or heart—resulting in oxygen deprivation that damages the ability of surrounding nerve cells to function, which eventually causes cell death.
Blood is critical for maintaining circulation, pH levels, adequate tissue oxygenation, and waste removal in the body. Hemorrhagic shock can cause death despite medical treatment due to heavy blood loss in a very short period of time—more than 30% of total blood volume—due to a combination of factors:
- Coagulopathy (impaired blood clotting leading to excessive and prolonged blood loss)
- Hypothermia (dangerous drop in body temperature)
- Acidosis (high acid levels in the body)
Additionally, severe hemorrhage can trigger catastrophic multiorgan dysfunction by mechanisms that include:
- Hypovolemic shock affecting tissue perfusion
- Redistribution of blood from organs such as the intestines, liver, and kidneys to the brain, heart, and lungs, which causes dysfunctional changes
- Proinflammatory state due to release of tumor necrosis factor alpha and C-reactive protein, which speeds up coagulopathy
What are different types of hemorrhage?
Hemorrhage is defined as loss of blood from a damaged blood vessel. Hemorrhages can be:
- Internal (invisible blood loss): Due to injury to an internal organ
- External (visible blood loss): Due to a cut, wound, or bruise
Different types of hemorrhage include:
- Intracranial hemorrhage: Bleeding inside the brain
- Intracerebral hemorrhage: Bleeding within the brain tissues
- Subarachnoid hemorrhage: Injury to blood vessels of the brain caused by head trauma
- Subconjunctival hemorrhage: Damage to the blood vessels of the eye
- Subdural hematoma: Blood leak into the dura mater (a membrane between the brain and skull)
- Postpartum hemorrhage: Heavy bleeding after childbirth
- Epistaxis: Bleeding from the nostril, nasal cavity or nasopharynx
- Hematoma: Collection of blood outside the blood vessel (bruise)
- Hemothorax: Collection of blood between the chest wall and the lungs
- Petechiae: Tiny, pinpoint red or purple spots on the skin
What are the symptoms of hemorrhage?
Symptoms vary depending on the location and severity of hemorrhage.
In cases of a minor bruise or trauma, there may be light bleeding along with mild pain and discomfort. However, heavy blood loss can lead to:
- Cold and clammy skin
- Shortness of breath
- Nausea and vomiting
- Chest pain
- Numbness or tingling
- Severe headache
- Slurred speech
- Tachycardia (fast heart rate)
- Tachypnea (rapid breathing)
- Multiorgan failure
- Vision changes
What causes hemorrhage?
Normally with an injury, the body initiates a clotting process to stop the bleeding. Clotting requires proteins in the blood and platelets which combine to form a plug and seal the inside of the wound, thus preventing excessive bleeding. However, significant injuries often cannot be stopped by a clot. Certain medical conditions can also interfere with the clotting process.
Potential causes of hemorrhage include:
- Clotting disorders
- Bleeding disorders such as sickle cell anemia
- Inherited diseases such as hemophilia and hereditary hemorrhagic telangiectasia (malformations of blood vessels)
- Severe trauma, falls, or crush injuries
- Liver diseases
- Gastrointestinal diseases such as inflammatory bowel disease, celiac disease, and gastroenteritis
- Brain tumors
- Atherosclerosis (hardening of the arteries)
- Aneurysm (weakening of the blood vessel walls)
- Cerebral amyloid angiopathy (accumulation of amyloid in the arterial walls of the brain)
- Vehicular accidents
- Bone fractures
- Traumatic brain injury
- Ectopic pregnancy (when the fetus develops outside the uterus)
- Physical abuse
- Viral infections such as viral hemorrhagic fever (Ebola and dengue)
- Anticoagulant therapies (blood thinners)
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How is hemorrhage diagnosed?
Diagnosis is made based on:
- Physical examination in which symptoms are evaluated based on the accident or trauma, existing medical conditions, and current medications taken
- Electroencephalogram (EEG) to record the electrical activity of the brain
- Computed tomography scan and magnetic resonance imaging scan to determine the cause, location, and extent of internal hemorrhage
- Urine test
- Blood test
- X-ray chest
How is hemorrhage treated?
Treatment of hemorrhage depends on:
- Location of the hemorrhage
- Severity of the hemorrhage
- Amount of blood loss
- General condition of the patient
External bleeding can be treated with first aid such as:
- Applying pressure on the wound by using hands, a clean cloth, or bandage
- Wrapping a clean, dry cloth on the wound
- Tying a cloth or band (tourniquet) proximal to the wound, toward the heart, to stop the bleeding
Seek immediate medical help if the bleeding doesn't stop or the person has the following signs:
- Cold to the touch
- Dizziness or fainting
- Difficulty breathing
- Spitting or coughing blood
- Severe chest pain
- Unbearable headache
Treatment may consist of:
- Intravenous administration of blood or blood products (fresh frozen plasma or platelets)
- Intravenous electrolytes
- Surgery to repair the damaged blood vessel or to remove the clotted blood
- Medications to promote clotting
What are complications of hemorrhage?
Complications of hemorrhage include:
Can hemorrhage be prevented?
Lifestyle modifications can prevent the recurrence of hemorrhage:
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Hemorrhage. Cleveland Clinic: https://my.clevelandclinic.org/health/symptoms/21654-hemorrhage
Christopher Melinosky. Brain Hemorrhage. WebMD: https://www.webmd.com/brain/brain-hemorrhage-bleeding-causes-symptoms-treatments
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