Blood loss

Loss of blood can occur in many situations including injury, surgery, menstruation or sometimes spontaneously due to a bleeding disorder. Depending on the amount of blood lost, the symptoms can vary from no symptoms to hypovolemic shock which is medical emergency

Other names

Shock - hypovolemic

Causes

Bleeding from cuts Bleeding from other injuries Internal bleeding, such as in the gastrointestinal tract Rarely, heavy menstruation, or surgery

Bleeding wound on thumb

Bleeding wound on thumb

Symptoms

Anxiety or agitation Cool, clammy skin Confusion Decreased or no urine output Generalized weakness Pale skin color called pallor Rapid breathing Sweating, moist skin Loss of consciousness The greater and more rapid the blood loss, the more severe the symptoms of shock.

Bleeding

Bleeding

Signs and symptoms

A physical exam will show signs of shock, including:

• Low blood pressure
• Low body temperature
• Rapid pulse, often weak and thready

Depiction of a woman with bleeding gums or gingival bleeding or bleeding on probing

Depiction of a woman with bleeding gums or gingival bleeding or bleeding on probing

Tests

Blood chemistry, including kidney function tests and those tests looking for evidence of heart muscle damage

• Complete blood count (CBC)
• CT scan, ultrasound, or x-ray of suspected areas
• Echocardiogram
• Electrocardiogram
• Endoscopy if gastrointestinal bleeding is suspected
• Right heart (Swan-Ganz) catheterization
• Urinary catheterization
• In some cases, other tests such as MRI, genetic studies when genetic causes of bleeding is suspected, etc may be done as well.

Intracranial bleed with significant midline shift

Intracranial bleed with significant midline shift

Treatment

Get medical help right away. In the meantime, follow these steps:

Keep the person comfortable and warm (to avoid hypothermia). Have the person lie flat with the feet lifted about 12 inches (30 centimeters) to increase circulation. However, if the person has a head, neck, back, or leg injury, do not change the person's position unless they are in immediate danger. Do not give fluids by mouth. If person is having an allergic reaction, treat the allergic reaction, if you know how. If the person must be carried, try to keep them flat, with the head down and feet lifted. Stabilize the head and neck before moving a person with a suspected spinal injury. The goal of hospital treatment is to replace blood and fluids. An intravenous (IV) line will be put into the person's arm to allow blood or blood products to be given.

Medications such as dopamine, dobutamine, epinephrine, and norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart (cardiac output).

Epistaxis or nose bleed

Epistaxis or nose bleed

Complications

• Kidney damage
• Brain damage
• Gangrene of arms or legs, sometimes leading to amputation
• Heart attack
• Other organ damage
• Death

Treatment

Treatment of blood loss starts with understanding the cause of the blood loss and measures to stop further bleeding and at the same time, treat any hemodynamic effects such as shock. Treatment measures, on top of stopping the bleeding, include:

• Red blood cell transfusion.
• Intravenous fluids.
• Blood plasma transfusion.
• Platelet transfusion.

Prevention

Preventing shock is better than trying to treat it once it happens. Quickly treating the cause will reduce the risk of developing severe shock. Early first aid can help control shock.

ICD

Hypovolemic shock ICD 10:R57.1 Bleeding ICD10:R58

Bleeding ICD9:459.0