Hemorrhage and Haemostasis : Recent techniques to stop hemorrhages.ppt

Hemorrhage remains a significant cause of morbidity and mortality in various clinical conditions necessitating the development of innovative techniques for rapid and effective management.This power point presentation highlights the multifaceted nature of contemporary hemorrhage control techniques, emphasizing the need for an integrated approach to improve patient outcomes and reduce the burden of hemorrhagic events.

1. Dr Saurav Kshirsagar
Haemorrhage and Haemostasis
: Recent techniques to stop Haemorrhages :
VSR - 503 - Principles of Surgey ( 2+1 ))

2. HAEMORRHAGE
Definition: Extravasation of blood and blood cells from the vessels
• It means escape of blood from an artery, vein or capillary to extravascular space.
• The complete loss of blood is referred to as
Hemorrhage occurs by :-
1) Rhexis- break in wall of blood vessel
2) Diapedesis - in which blood escapes through intact wall of blood
vessel when the permeability of wall is increased
ExsanguinationExsanguination

3. HAEMORRHAGE DEFINITION
The term haemorrhage
refers to a large amount of bleeding in a short time. (Thygerson, Gulli &
Krohmer 2006)
An escape of blood from a ruptured blood vessel. ( Weller & Wells 1990)
Haemorrhage is the loss of blood from a vessel. (Malcolm R. Colmer
1986)

4. CLASSIFICATION OF HEMORRHAGE
1.
 
DEPENDING ON THE SOURCE OF BLEEDING:
i) External Hemorrhage: When bleeding is revealed and
seen outside, e.g. epistaxis.
ii) Internal Hemorrhage: Bleeding is concealed and not
seen outside, e.g. intracranial hematoma.

5. 2) DEPENDING ON THE NATURE OF BLEEDING VESSEL :
(1) Arterial:
• The blood is bright red in color.
• The blood comes in pulsatile jets.
• The bleeding more from the proximal than the distal end.
(2) Venous:
• The blood is dark red in color.
• The blood comes as a steady flow.
• It is more from the distal than the proxi
­mal end.
(3) Capillary:
• Bleeding occurs as diffuse ooze of bright red blood.

6. 3. DEPENDING ON THE TIME OF
HEMORRHAGE:  :
i) Primary Hemorrhage : Occurs at the time of trauma or surgery.
ii) Reactionary Hemorrhage : Occurs within 24 hours of trauma or
operation. As the blood pressure rises due to correction of hypovolemia, an
insecure ligature is going to slip or a clot is going to dislodge.
iii) Secondary Hemorrhage: Occurs after 7 – 14 days of trauma or operation.
infection eroding the arte
­rial wall, e.g. Secondary postpartum hemorrhage
(SPPH) is defined as
 any significant vaginal bleeding that occurs after 1-2 weeks

7. 4. DEPENDING ON VOLUME OF BLOOD LOSS :   
i) Mild Hemorrhage: Blood loss ≤ 500 mL.
ii) Moderate Hemorrhage: Blood loss 500 – 1000 mL.
iii) Severe Hemorrhage: Blood loss ≥ 1 L.
5 .DEPENDING ON SPEED OF BLOOD LOSS:
 
i) Acute Hemorrhage: Massive bleeding in short span of time.
ii) Chronic Hemorrhage: Slow bleeding small in quantity for
long time.

8. •6. Depending upon PERCENTAGE OF BLOOD LOSS:
• i) Class I: Up to 15%.
•ii) Class II: Between 15 – 30%.
• iii) Class III: Between 30 – 40%.
• iv) Class IV: More than 40%.

9. ETIOLOGY
A) CONDITIONS AFFECTING THE BLOOD VESSELS
1) Trauma – mechanical injuries like lacerations, incisions, contusions & rupture
2) Necrosis of the vessel wall – Arteriosclerotic changes weakened vessel wall & rupture
occurs
3)Diseases of vessel wall –
-Aneurysm – is local dilatation of an artery or vein in which vessel walls become weakened,
bulge & ruptures. Eg. Strongylus vulgaris infection in equines in anterior mesenteric artery.
-Atheroma of aorta & larger arteries - where degeneration, necrosis & weakening of vessels
occurs

10. 4)Neoplasm:- vessel wall may be destroyed by extending erosive tumors
5)Toxic injury to capillary endothelium :Capillary endothelium is easily damaged by various toxins
produced by
Bacteria - Salmonella, clostridium, streptococcus, pasteurella, Enterotoxaemia in sheep caused by
Clostridium perfringens Type –D.
Virus – Swine fever virus invades endothelial cells
Toxic chemicals- arsenic, phosphorus, chloroform, cyanide
Plants poisoning – Crotalaria poisoning injures endothelial cells
Asphyxia- Lack of oxygen injures the endothelium
6) Increased blood pressure - during exercise & excitement, as in race horses, there may bleeding due to
rupture of blood vessels in which blood pressure is increased.
ETIOLOGY

11. B) CONDITIONS AFFECTING THE BLOOD CONSTITUENTS
i) Reduced platelet number/Thrombocytopenia – e.g. Thrombocytopenic purpura or purpura
hemorrhagica in horses. Thrombocytopenia may also results due to injury to bone marrow by a)
irradiations, b) Chemicals- benzol, c) replacement by leukemic cells etc.
ii) Abnormalities in clotting factors – Eg. Hemophilia –A in humans, dog, cats & horses due to
deficiency of factor VIII
iii)Plant poisons – Brakern fern & sweet clover prevents formation of prothrombin.
iv) Nutrition
a)Deficiency of Vitamin K – is required for formation of prothrombin which helps in clotting
mechanism
b) Deficiency of Vitamin C – is required for ground substance of the wall of capillaries. In
deficiency, vascular fragility increases & haemorrhages occurs.
ETIOLOGY

13. •Purpura
– are haemorrhages upto 3 - 5 mm in size
Eg. purpura hemorrhagica in horses
•Linear hemorrhage
-Hemorrhage that appears as lines on crests
of folds in mucous membrane

Morphology

14. HAEMOSTASIS
•Definition: Mechanism by which the body attempts to stop
bleed
­ing after injury .
•Four important steps:
1) Injured blood vessel undergoes constriction due to spasm.
2) Activation of platelets and formation of platelet plug. This leads to
primary hemostasis.
3) Activation of clotting mechanism and formation of clot leading to
completion of secondary hemostasis.
4) Fibrous organization of clot or retraction of clot.
 

16. Mechansim of hemostasis

17. Methods of controlling hemorrhage

19. FOR INTERNAL BLEEDING :
A.Hemostatic Drugs
1)Inj Hemocoagulase (Botropase,Reptilase,Troylase)

Hemcoagulase is an enzyme fraction, which is isolated, purified and
standardised from the venom of
 
Bothrops atrox / Bothrops jararaca,
which are predominantly found in South American region.
It acts on fibrinogen to produce a fibrin monomer which can be
converted by thrombin into clot
It has Thrombin like action

21. Eg. = Inj. Botropase: 1Coagulation Unit
•1 CU = One Coagulation Unit/ Klobusitzky unit
•It expresses the power of coagulation (potency of Botropase).
•An ampoule of Botropase is said to have haemocoagulase
solution of 1 CU/ml strength if it can coagulate freshly prepared
fibrinogen solution (0.4% w/v) in about 30 seconds.

22. 2) Epinephrine :

24. 4) Protamine :

25. 5)Desmopressin :

26. 6) Lysine analogue :

27. 6) Aderenaline:
Applied topicaly induces vasoconstriction and thus helps in acheiving
hemostasis.
• Extensive application or undiluted preparation can cause systemic
effects therefore ,care should be exercised while using adrenaline.
•It can also be injected along with local anesthetic in a concentration of
1:80,000 to 1:2,00,000 Adrenaline
 

28. 6) Herbal Styptics (Styplon Bolus,Tablet):
 Indian Gooseberry (Indian Gooseberry has anti-inflammatory and antioxidant properties, which control
inflammation and oxidative tissue damage respectively.), Indian Sarsaparilla, Lodh Tree, Red Coral(Red
Coral (Pravala pishti) is a styptic commonly used in bleeding disorders.)

29.  Hemostatic mechanism is due to activation of thromboplastin formation on damaged vessel
walls and decrease prostacyclin 2 synthesis and facilitates platelet aggregation.
Ethamsylate reduces capillary bleeding in the presence of normal number of platelets.
•It acts by correcting abnormal platelet adhesion.
•It exerts antihyaluronidase action,improves capillary wall.stability. (not stabilize fibrin ,not an
antifibrinolytic).
 Indications: used in prevention and treatment of capillary bleeding in *epistaxis *hematuria
*Efficacy is unsubstantiated adverse effects like rash are common and blood pressure falls
only after IV injection.
7) Ethamsylate: