2. INTRODUCTION
• The word hemorrhage is synonymous with bleeding.
• Any damage to the vasculature leads to outflow of blood. Blood
carries oxygen and nutrients to the tissues and is vital for body
functions.
• Loss of blood due to any reason beyond a certain point is
potentially life threatening and may lead to exsanguination
3. DEFINATION
• Hemorrhage (Hemo + rrhage) denotes the escape of blood from a
blood vessel to the surface of the body or into the body tissues or
cavities.
4. CLASSIFICATION
I. Based on the source of blood loss
• Arterial haemorrhage
• Venous haemorrhage
• Capillary haemorrhage
II. Based on the time of occurrence
• Primary haemorrhage
• Secondary haemorrhage
• Reactionary haemorrhage
5. III. Based on visualization
• External haemorrhage
• Internal haemorrhage
IV. Based on clinical signs
• Petechial haemorrhage
• Ecchymosis
• Haematoma
6. CAUSES
• Trauma
• Infections
• Local irritants
• Congenital malformations
• Surgical (intraoperative/postoperative)
• Haemorrhage due to abnormalities in clotting factors
1. Clotting factor deficiencies
i. Hereditary—haemophilia A, haemophilia B thrombocytopaenia.
ii. Anticoagulant, antiplatelet or fibrinolytic therapy—warfarin, coumarin,
heparin, enoxaparin, aspirin, clopidogrel, argatroban, alteplase, tirofiban,
dipyridamole, eptifibatide, fondaparinux
7. iii. Liver disease (Factor II, VII, IX, X deficiencies).
2. Dysfunction of clotting—multiple myeloma
• Haemorrhage due to abnormalities in platelets
a. Deficiencies
▪ Idiopathic thrombocytopaenia purpura
▪ Secondary thrombocytopaenia purpura
▪ Leukaemia
b. Thrombocytosis
c. Dysfunction—thrombocytopaenia
• Haemorrhage due to systemic disease
a. Viral infection
b. b. Scurvy
c. c. Allergy
8. INVESTIGATION
coagulation profile.
Patients with liver disease, a previous history of haemorrhage,
under an anticoagulant therapy, a familial history of blood
dyscrasias may advised to be subjected to an investigation prior to
any oral surgical procedure.
The coagulation profile includes:
• Clotting time (CT)
• Bleeding time (BT)
• Prothrombin time (PT) and international normalised ratio (INR)
• Activated partial thromboplastin time (APTT)
• Factors assay
9.
10. HEMOSTASIS
cessation of extravasation of blood
1. Vasoconstriction
2. Primary haemostasis by platelet plug formation
3. Secondary haemostasis by initiation of coagulation cascade
4. Tertiary haemostasis by consolidation of the fibrin clot.( clot retraction)
