Haemorrhage

Management of haemorrhage includes rapid control of the source of bleeding and restoration of circulating blood volume to correct hypoperfusion to end organs.  Uncontrolled blood loss also contributes to the development of haemostasis failure which further exacerbates bleeding.

Restoration of circulating volume is initially achieved by rapid infusion of crystalloid or colloid.   Clinical trials in humans have not demonstrated that albumin solutions or other colloids are superior to crystalloid in resuscitation, but larger quantities of crystalloid are required.(1)

Red cells are necessary for their oxygen carrying capacity and also contribute to improving haemostasis.  The need for red cell transfusion depends on:
•    the estimated loss of circulating blood volume, and
•    the patient’s ability to compensate for the quantity of blood lost.

Blood volume can be estimated as approximately 70 mL/kg for adults, 80 mL/kg in children and 100 mL/kg in neonates.

Red cell transfusion is usually required when 30–40% of blood volume is lost (1500 mL in a 70 kg male) and more than 40% blood volume loss (1500 to 2000 mL) is life threatening and requires immediate transfusion.(2)

With ongoing bleeding, platelets, FFP or cryoprecipiate may also be required.  Also see Massive Transfusion

Reference

  1. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Databases for Systematic Reviews 2013; 28(2)
  2. British Committe for Standards in Haematology. A practical guideline for the haematological management of major haemorrhage. British Journal of Haematology 2015;170(6):788-803.