Acute blood loss syndrome
Internal hemorrhage occurs without compromising the integrity of the skin. With slow blood leakage, symptoms develop gradually, but with massive bleeding (e.g., rupture of the splenic capsule), acute anemia symptom complex rapidly develops.
- Patient complaints: darkening of the vision, dizziness, severe thirst, drowsiness, possible fainting.
- Physical examination: pronounced pallor of the skin and visible mucous membranes.
- Hemodynamics: drop in blood pressure (hypotension) and tachycardia (pulse rate increasing to 120–140 bpm).
Hemorrhage into the lumen of hollow organs
Blood pours into the lumen of the gastrointestinal tract, respiratory, or urinary system and eventually exits through natural orifices. The source is determined by the visual characteristics of the discharge:
| Source of hemorrhage | Clinical sign |
|---|---|
| Lungs | Expectoration of frothy bright red blood |
| Stomach and duodenum | «Coffee-ground» emesis |
| Upper GI tract | Melena (black tarry stool) |
| Rectum or sigmoid colon | Passage of unaltered bright red blood |
| Kidneys and urinary tract | Hematuria (presence of blood in the urine) |
For precise localization diagnosis, endoscopic methods are used: bronchoscopy, esophagogastroduodenoscopy (EGD), colonoscopy, and cystoscopy. For occult and atypical bleeding, intravenous administration of a radionuclide (colloidal gold solution) followed by radiometry is used.
Accumulation of blood in closed cavities
The clinical picture consists of general symptoms of blood loss and signs of fluid accumulation in a specific anatomical region.
- Hemoperitoneum (haemoperitoneum): Accumulation of blood in the abdominal cavity. It occurs in trauma, damage to parenchymal organs (liver, spleen), mesenteric vessels, or in gynecological pathology (ectopic pregnancy, ovarian apoplexy). The abdomen is soft, tender, with mild muscular defense. Symptoms of peritoneal irritation are poorly pronounced. With a concomitant bowel rupture, the hemorrhage is masked by peritonitis. Treatment consists of emergency laparotomy.
- Hemothorax (haemothorax): Blood in the pleural cavity. A frequent source is the intercostal or internal thoracic arteries. An important detail: due to the anticoagulant properties of lung tissue, the escaped blood usually does not clot. By volume, hemothorax is classified as small (confined to sinuses), moderate (up to the angle of the scapula), and large (total). It is complicated by aseptic hemopleurisy or purulent empyema.
- Hemopericardium (haemopericardium): Blood in the pericardial cavity. Leads to muffled heart sounds, displacement of the apex beat, and tamponade.
- Hemarthrosis (haemarthrosis): Blood in a joint. Causes smoothing of contours and fluctuation. A specific marker for the knee joint is the patellar tap (ballottement) sign.
Interstitial hemorrhage and hematomas
Infiltration of tissues with blood is called imbibition (or hemorrhage). It can occur in muscles, adipose tissue, the brain, or internal organs. When blood pours into tissues, a cavity forms — a hematoma (e.g., in a femoral fracture, more than 500 ml of blood can escape into the tissues).
Damage to major vessels is the most dangerous. If a hematoma maintains communication with the arterial lumen, it becomes pulsating (with a blowing systolic murmur on auscultation), and over time a capsule forms around it — thus forming a false aneurysm. Against this background, critical limb ischemia develops: the limb becomes pale, cold, sensitivity and distal pulses disappear. Emergency surgery to restore blood supply is required.
Briefly: answers to topical questions
What are the severity degrees of acute blood loss classified by the volume of lost blood?
- Grade I (mild) — loss of 500–700 ml, 10–15% decrease in circulating blood volume (CBV).
- Grade II (moderate) — loss of 1000–1500 ml, 15–20% decrease in CBV.
- Grade III (severe) — loss of 1500–2000 ml, 20–30% decrease in CBV.
- Grade IV (massive) — loss of more than 2000 ml, >30% decrease in CBV.
What methods exist for the temporary cessation of external arterial hemorrhage?
- Tourniquet application — the most reliable method for temporary hemorrhage arrest, used primarily on the extremities.
- Digital arterial pressure — pressing the arterial trunk against underlying bony prominences proximal to the wound site prior to applying a tourniquet or bandage.
- Wound packing and pressure dressing — an effective method for temporarily stopping bleeding from small arteries by tightly inserting a gauze pack into the wound followed by fixation.
To easily remember the manifestations of gastrointestinal bleeding, use the «color rule»: the higher the bleeding source is in the GI tract, the darker the blood appears upon evacuation from below (down to black melena), and the closer it is to the outlet, the brighter red it is.
Class and exam questions
How does gastric bleeding differ from pulmonary hemorrhage?
In pulmonary hemorrhage, foamy bright red blood is expelled from the mouth. In gastric bleeding, blood reacts with gastric juice, causing vomitus to acquire a characteristic dark brown color—the "coffee ground" sign.
Why does blood in hemothorax usually not clot?
Lung tissue contains a large amount of anticoagulant substances that prevent clot formation. Clotting occurs only during massive and very rapid hemorrhage.
What is a pulsating hematoma?
This is an interstitial blood collection whose cavity communicates directly with the lumen of the injured artery. Pulsation synchronous with the cardiac rhythm is visualized and palpated over it.
What else to study on this topic
- Radioisotope diagnostic methods for occult hemorrhages (features of colloidal gold application).
- Differential diagnosis of hemoperitoneum and developing peritonitis in combined abdominal trauma.
- Complications of hemothorax: pathogenesis of hemopleurisy and purulent pleural empyema development.
- Surgical management tactics for patients with a pulsating hematoma and critical limb ischemia.
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