107. Hemorrhage - classification, etiology, pathogenesis, clinical manifestations.

Classification

1. 1 By site of bleeding

1. 2 By type of tissue collection

1. 3 By location (examples)

• Hemothorax —pleural cavity.
• Hemopericardium —pericardial sac.
• Hemoperitoneum —abdominal cavity.
• Hemarthrosis —joints.

Etiology

Vessel wall rupture

• Trauma.
• Aneurysm rupture.
• Ulcer erosion (e.g., gastric ulcer).

Coagulation disorders

• Platelet disorders (thrombocytopenia, qualitative defects).
• Coagulation factor deficiencies ( hemophilia, vitamin K deficiency).
• Disseminated intravascular coagulation (DIC).

Vascular disorders

• Vasculitis (immune- mediated vessel wall damage).
• Amyloid angiopathy

Increased vascular fragility

• Scurvy (vitamin C deficiency → defective collagen).
• Senile purpura.

Pathogenesis

1. Primary hemostatic failure (platelet or vessel problem) → immediate bleeding, often mucocutaneous.
2. Secondary hemostatic failure (coagulation factor deficiency) → delayed deep bleeding (joints, muscles).
3. Blood loss → hypovolemia → decreased perfusion → shock (if severe).

Clinical manifestations

General signs

• Pallor.
• Weakness, fatigue.
• Cold, clammy skin (hypovolemia).

Acute severe hemorrhage

• Hypotension.
• Tachycardia.
• Oliguria or anuria.
• Hypovolemic shock → organ failure.

Chronic blood loss

• Iron deficiency anemia signs:
• Fatigue.
• Pallor.
• Koilonychia, glossitis.

Characteristic bleeding patterns