What is a hemorrhage?

Causes and Symptoms

The term “hemorrhage” generally implies a massive loss of blood from the body, but
many types involve only a small amount of blood loss. Hemorrhage can connote a
slowly evolving process or a rapid, sudden loss of blood. Its causes include
trauma, spontaneous blood vessel rupture, bleeding disorder, and medications.

In traumatic hemorrhage, the body experiences some external force that causes a
blood vessel or organ to break open. The bleeding may be internal, as in splenic
rupture or brain bleed (hematoma), or it may be external, as in
an open laceration. Blood vessels may rupture spontaneously if they are malformed
or have suffered previous injury as in certain types of strokes caused by
arteriovenous malformations and aneurysms.

Other causes of hemorrhage are due to disorders causing easy bleeding such as
hemophilia or platelet dysfunction. Hemorrhage can also be
incited by the use of blood-thinning medications such as nonsteroidal
anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen or heavier
anticoagulants like heparin and warfarin.

The symptoms of hemorrhage depend on how rapidly the bleeding
evolves and how much blood is lost. This blood loss is separated into four
classes: Class I includes hemorrhage of up to 15 percent of the total blood volume
and is asymptomatic. Class II is 15 to 30 percent hemorrhage and can result in
rapid heartbeat and pallor. Class III is 30 to 40 percent hemorrhage, and its
symptoms are rapid heartbeat, low blood pressure, altered mental status, and
shock. Class IV is more than 40 percent hemorrhage and can result in death.

Treatment and Therapy

Treatment for hemorrhage depends on its cause and the class of blood loss under
which it falls. In traumatic hemorrhage, the bleeding may be stopped with external
pressure but also may require sutures or surgery. In
spontaneous blood vessel rupture, treatment involves medication or surgery.
Bleeding disorders are often treated with medication, and patients are advised to
avoid anything that can precipitate trauma, leading to a bleed. If the cause is
medication, then a physician may instruct the patient to stop the medication or
take precautions, as with bleeding disorders.

Class I blood loss is generally not treated. Class II is treated with fluids such
as saline solution or Ringer’s lactate. Class III is treated with a combination of
fluids and blood
transfusion. Class IV is an emergency and requires rapid
replacement of blood volume with both blood transfusions and other solutions.

Bibliography

Carhuapoma, J. Ricardo, Stephan A. Mayer,
and Daniel F. Hanley, eds. Intracerebral Hemorrhage.
Cambridge: Cambridge UP, 2010. Print.

Emergency Nurses Assoc. Sheehy's
Manual of Emergency Care. 7th ed. St. Louis: Mosby, 2013.
Print.

Fulde, Gordian, and
Sascha Fulde. Emergency Medicine: The Principles of
Practice. 6th ed. Chatswood: Elsevier, 2004. Print.

Gray, Linda R., ed. Subarachnoid
Hemorrhage: Epidemiology, Management and Long-Term Health
Effects. New York: Nova Biomedical, 2015. Print.

Hankey, Graeme, ed.
Stroke: Your Questions Answered. 2nd ed. Philadelphia:
Elsevier Health Sciences, 2007. Print.

Rosdahl, Caroline
Bunker. “Emergency Care and First Aid.” Textbook of Basic
Nursing. Ed. Elizabeth Nieginski. Philadelphia: Lippincott,
2007. Print.