Pathology of hemorrhage it's causes,risk factor, symptoms, prevention and management How the hemorrhage effect person health and completely understand that you turn the operation theater technology and what is the causes and risk factor of hemorrhage

3. Ch Muhammad Abrar Saeed
BSc Hons.M.L.T.
U.H.S.
MPhill Histopathology *
Lecturer Allied college of Health Sciences
Pathology Lecture (M.L.T ) # 24
14/07/2020

4.  Abnormal internal or external loss of blood
 Escape of blood from blood vessel
 Disorders associated with abnormal bleeding
inevitably stem from primary or secondary
defects in vessel walls, platelets, or
coagulation factors, all of which must function
properly to ensure hemostasis

6.  It can be as ruptures of large vessels such as the aorta or of
the heart.
 Diseases associated with sudden, massive hemorrhage
include
 aortic dissection in the setting of Marfan syndrome ,
 aortic abdominal aneurysm
 ,myocardial infarction
 rupture of aorta or the heart.

7. At the other end of the spectrum are subtle defects in clotting
that only become evident under conditions of hemostatic
stress, such as
 surgery
 childbirth
 dental procedures,
 menstruation, or trauma.
 Inherited defects in von Willebrand factor
 aspirin consumption,
 uremia (renal failure)

8.  Defects of primary hemostasis
 Defects of secondary hemostasis
 Generalized defects

9. Defects of primary hemostasis (platelet defects or
von Willebrand disease) often present with small
bleeds in skin or mucosal membranes.
These bleeds typically take the form of
1) Petechiae, minute 1 to 2mm hemorrhages
2) Purpura, which are slightly larger (≥3 mm) than
petechiae.
3) Hematoma extravasion of blood into the tissue
with swelling
4) Ecchymomoses larger extravasion of blood into
skin and mucous membrane 1-2cm

10. Mucosal bleeding associated with defects in
primary hemostasis may also take the form of
 epistaxis (nosebleeds),
 gastrointestinal bleeding,
 excessive menstruation
A feared complication of very low platelet counts
(thrombocytopenia) is intracerebral hemorrhage,
which may be fatal

11.  Defects of secondary hemostasis (coagulation
factor defects) often present with bleeds into soft
tissues
 e.g., muscle , joints,hemophilia
 It is unknown why severe defects in secondary
hemostasis present with this peculiar pattern of
bleeding
 as with severe platelet defects, intracranial
hemorrhage, sometimes fatal, may also occur.

12.  Generalized defects involving small vessels often present with
“palpable purpura” and ecchymoses.
 Ecchymoses (sometimes simply called bruises) are
hemorrhages of 1 to 2 cm in size.
 In both purpura and ecchymoses, the volume of extravasated
blood is sufficient to create a palpable mass of blood known
as a hematoma.
 Purpura and ecchymoses are particularly characteristic of
systemic disorders that disrupt small blood vessels
 e.g., vasculitis,
 blood vessel fragility e.g., amyloidosis, curvy

14. Results from soft tissue injury.
• The seriousness of the injury is dependent on:
– Anatomical source of the hemorrhage (arterial,
venous, capillary)
– Degree of vascular disruption
– Amount of blood loss that can be tolerated by the
patient

15. • Can result from:
– Blunt or penetrating trauma
– Acute or chronic medical illnesse
Internal bleeding that can cause hemodynamic instability
usually occurs in one of four body cavities
– Chest
– Abdomen
– Pelvis
– Retroperitoneum

16. Signs and symptoms :
– Bright red blood from mouth, rectum, or other
orifice
– Coffee-ground appearance of vomitus
– Melena (black, tarry stools)
– Dizziness or syncope on sitting or standing
– Orthostatic hypotension

17. • The body’s initial response to hemorrhage is
to stop bleeding by chemical means
(hemostasis).
– This vascular reaction involves:
• Local vasoconstriction
• Formation of a platelet plug
• Coagulation
• Growth of tissue into the blood clot that
permanently closes and seals the injured
vessel

18.  The clinical significance of hemorrhage depends on
the volume of the bleed, the rate at which it occurs,
its location.
 Rapid loss of up to 20% of the blood volume may
have little impact in healthy adults.
 Greater losses, can cause hemorrhagic
(hypovolemic) shock.
 Bleeding that is trivial in the subcutaneous tissues
can cause death if located in the brain.

19.  Chronic or recurrent external blood loss (e.g.,
peptic ulcer or menstrual bleeding) causes
iron loss and can lead to an iron deficiency
anemia