Bleeding. Bleeding. Methods Of Methods Of HemostasisHemostasis

L.Yu.IvashchukL.Yu.Ivashchuk

LectureLecture

BleedingBleeding

Haemorrhage, or bleeding, is the Haemorrhage, or bleeding, is the escape of blood from the blood escape of blood from the blood vessels into the tissues and vessels into the tissues and cavities of human body or cavities of human body or outside, as the result of an injury outside, as the result of an injury or defect in the permeability of or defect in the permeability of the blood vessel wall.the blood vessel wall.

HematomaHematoma

In other cases when the In other cases when the poured out blood causes poured out blood causes stratification of tissues, stratification of tissues, separation of organs and separation of organs and as a result the dimension as a result the dimension cavity arised, which is cavity arised, which is filled with a blood is filled with a blood is formed, - we speak about a formed, - we speak about a hematomahematoma

Anatomical classification Anatomical classification (according to kind of (according to kind of

bleeding vessel) bleeding vessel) Arterial hemorrhage;Arterial hemorrhage; Venous hemorrhage;Venous hemorrhage; Capillary hemorrhage;Capillary hemorrhage; Parenchymatous hemorrhage.Parenchymatous hemorrhage.

Types of bleedingTypes of bleeding

Classification according to Classification according to mechanism of beginning mechanism of beginning

Mechanical failure, vessel rupture (haemorrhagia per Mechanical failure, vessel rupture (haemorrhagia per rhexin);rhexin);

Arrosive hemorrhage (haemorrhagia per diabrosin). This Arrosive hemorrhage (haemorrhagia per diabrosin). This types of bleeding takes place during suppurative melting of types of bleeding takes place during suppurative melting of wessel wall;wessel wall;

Diapedetic hemorrhage (haemorrhagia per diapedesin);Diapedetic hemorrhage (haemorrhagia per diapedesin); The violation of chemical composition of blood. The The violation of chemical composition of blood. The

hemophilia, scarlet fever, sepsis, scurvy and others are hemophilia, scarlet fever, sepsis, scurvy and others are causing bleeding sometimes. Toxins or beriberi to produce causing bleeding sometimes. Toxins or beriberi to produce defect in the permeability of the vascular walls and caused of defect in the permeability of the vascular walls and caused of hemorrhage;hemorrhage;

Increased of arterial and venous blood pressure. The Increased of arterial and venous blood pressure. The diseases, such as essential hypertension, atherosclerosis diseases, such as essential hypertension, atherosclerosis sometimes coursed of an injury of the vascular wall and sometimes coursed of an injury of the vascular wall and bleeding (stroke, hemorrhoidal bleeding, etc.);bleeding (stroke, hemorrhoidal bleeding, etc.);

Violation of fibrillation (haemophilia, Werlgof’s disease, Violation of fibrillation (haemophilia, Werlgof’s disease, cholemic hemorrhage in patients with jaundice) cholemic hemorrhage in patients with jaundice)

Classification according to Classification according to environment the bleeding environment the bleeding

External bleeding;External bleeding; Internal bleeding.Internal bleeding.

Symptoms of acute Symptoms of acute anemia anemia

persisting paleness;persisting paleness; trembling and small pulse;trembling and small pulse; progressing decrease of blood progressing decrease of blood

pressure;pressure; dizziness;dizziness; nausea;nausea; vomiting;vomiting; syncope. syncope.

Symptoms of bleeding to the Symptoms of bleeding to the stomachstomach

At bleedings in empty space of a At bleedings in empty space of a gastrointestinal tract the blood in a gastrointestinal tract the blood in a stomach changes the color. In ample stomach changes the color. In ample quantityquantity of its accumulation a vomiting, of its accumulation a vomiting, like “ground coffe” (like “ground coffe” (hematemesishematemesis), is ), is originated.originated. Further or at a bleeding Further or at a bleeding from underlaying departments of a from underlaying departments of a gastrointestinal tract it is observed gastrointestinal tract it is observed weak tarry stool in large quantityweak tarry stool in large quantity ((melenamelena).).

Some kinds of internal Some kinds of internal bleeding have specific name bleeding have specific name

Haemobilia – haemorrhage from diliary ducts;Haemobilia – haemorrhage from diliary ducts; Haematuria - haemorrhage from kidneys and Haematuria - haemorrhage from kidneys and

urinary system;urinary system; Haemoperitoneum - haemorrhage in abdominal Haemoperitoneum - haemorrhage in abdominal

cavity;cavity; Haemothorax - haemorrhage in pleural cavity;Haemothorax - haemorrhage in pleural cavity; Haemopericardium - haemorrhage in pericardial Haemopericardium - haemorrhage in pericardial

cavity;cavity; Haemartrosis – haemorrhage in joint cavity;Haemartrosis – haemorrhage in joint cavity; Metrorrhagia – uterine bleeding;Metrorrhagia – uterine bleeding; Proctorrhagia – rectal bleeding;Proctorrhagia – rectal bleeding; Hemorrhagic insult – cerebral hemorrhage.Hemorrhagic insult – cerebral hemorrhage.

Classification according to Classification according to time of beginningtime of beginning

primary;primary; secondary (early and late).secondary (early and late).

Classification according to Classification according to clinical course clinical course

acute;acute; chronic.chronic.

Classification according to degree Classification according to degree of severity (of severity (V.I.Struchkov and V.I.Struchkov and

E.W.Lutzevich E.W.Lutzevich )) IV level IV level – massive blood loss – loss of – massive blood loss – loss of

blood is more then 30 % of blood blood is more then 30 % of blood circulating volume (more than 2000 circulating volume (more than 2000 ml). Plentiful bleeding with prolonged ml). Plentiful bleeding with prolonged loss of consciousness may be observed. loss of consciousness may be observed. The general condition of patient is very The general condition of patient is very grave, preagony. Pulse and arterial grave, preagony. Pulse and arterial pressure are not fixed. Hematocrit is pressure are not fixed. Hematocrit is 0,23 and lower, hemoglobin is 50 g/l 0,23 and lower, hemoglobin is 50 g/l and lower. Anuria is observed.and lower. Anuria is observed.

The compensatory-adaptive The compensatory-adaptive mechanisms during acute mechanisms during acute

blood loss blood loss Spasm of veins;Spasm of veins; Interstitial fluid inflow;Interstitial fluid inflow; Tachycardia;Tachycardia; Oliguria;Oliguria; Hyperventilation;Hyperventilation; Peripheral arteriolespasm;Peripheral arteriolespasm; Sympaticoadrenal system’ activation;Sympaticoadrenal system’ activation; Activation of fibrillation system and Activation of fibrillation system and

haemopoiesis stimulation.haemopoiesis stimulation.

Temporary control of Temporary control of bleedingbleeding

Temporary control of Temporary control of bleedingbleeding

Final hemostasisFinal hemostasis

Final hemostasisFinal hemostasis

42-44% people have a second blood 42-44% people have a second blood type;type;

38-39% - first;38-39% - first; 12-14% - third;12-14% - third; 4-6% - fourth. 4-6% - fourth.

On statistical Europe On statistical Europe datadata

Serological characteristics of Serological characteristics of Blood GroupsBlood Groups

Determination of Blood Determination of Blood Groups In System ABOGroups In System ABO

Determination of Blood Determination of Blood Groups In System ABOGroups In System ABO

Determination of Blood Determination of Blood Groups In System ABOGroups In System ABO

Blood TransfusionBlood Transfusion

Determination Of Blood Determination Of Blood Compatibility Of Donor And Compatibility Of Donor And

RecipientRecipient

Determination Of Blood Determination Of Blood Compatibility Of Donor And Compatibility Of Donor And

RecipientRecipient

Individual Biological TestIndividual Biological Test

Otenberg’s rules were held under Otenberg’s rules were held under hemotransfusion. These rules stated that during hemotransfusion. These rules stated that during blood transfusion agglutinating introduced blood transfusion agglutinating introduced erythrocytes (agglutinogens) because the erythrocytes (agglutinogens) because the incorporated plasma (agglutinins) are diluting in incorporated plasma (agglutinins) are diluting in general volume of liquid and their titre becomes general volume of liquid and their titre becomes to be insufficient for agglutination of patient's to be insufficient for agglutination of patient's erythrocytes. Truth, clinicists forewarned that in erythrocytes. Truth, clinicists forewarned that in events an edge of anemia, attempt of quick events an edge of anemia, attempt of quick indemnity of bleeding by the donor’s blood of indemnity of bleeding by the donor’s blood of first group was observe agglutination of first group was observe agglutination of patient’s erythrocytes because was saved high patient’s erythrocytes because was saved high concentration introduced agglutinins -named concentration introduced agglutinins -named else "inverse agglutination". else "inverse agglutination".

Pseudoagglutination Pseudoagglutination

At the account of reactions possible to find At the account of reactions possible to find agglutination where it practically is absent agglutination where it practically is absent and reason to this phenomena are toand reason to this phenomena are to bebe::

low temperaturelow temperature indoorsindoors,, this below 15° C; this below 15° C; account to reactions later 5 minutes;account to reactions later 5 minutes; eating of erythrocytes (momental columns), eating of erythrocytes (momental columns),

their easy find of staggering of plate;their easy find of staggering of plate; concentrate (is sub narrow) standard whey;concentrate (is sub narrow) standard whey; at presence infesting blood the immune at presence infesting blood the immune

antibody, if patient suffers a sepsis, system antibody, if patient suffers a sepsis, system disease of blood.disease of blood.

Sometimes agglutination is impossible Sometimes agglutination is impossible to notice, this can be at number of to notice, this can be at number of conditions:conditions:

Determination of blood types is lead Determination of blood types is lead at temperature over 25-30at temperature over 25-30C;C;

If it is take reaction less than 5 If it is take reaction less than 5 minutes into account;minutes into account;

If low titre of agglutinins (below If low titre of agglutinins (below 1:32), in other words, you define 1:32), in other words, you define blood type by one series of serum;blood type by one series of serum;

Unless it is keep correlation a whey-Unless it is keep correlation a whey-blood and last much.blood and last much.