Exsanguination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Desagnuination; bleeding out; hemorrhagic shock; bleeding to death; massive blood loss; fatal bleed; fatal bleeding; fatal blood loss; severe hemorrhage; massive bleeding; massive bleed; massive hemorrhage
Overview
Exsanguination is the fatal process of total hypovolemia (blood loss). It is most commonly known as "bleeding to death."
Historical Perspective
The term was widely used by Hippocrates in traditional medicine practiced in the Greco-Roman civilization and in Europe during the Middle Age. The word was possibly used to describe the lack of personality (by death or by weakness) that often occurred once a person suffered hemorrhage or massive blood loss.
The exact ideology of the term, as it is commonly used, is not clearly understood. Medical literature suggests that a person who suffered massive blood loss as being alive, but some authors may be convinced the person is not living. This ambiguity is likely the cause of its infrequent use in the medical profession today.
The word itself originated from Latin: 'ex' (out of) and 'sanguis' (blood). Therefore the word literally means 'out of blood'.
Epidemiology and Demographics
Exsanguination is a relatively uncommon cause of death in humans.
Causes
It might be more precise to say that exsanguination is a mode of death rather than a cause, since exsanguination itself will have an underlying cause which is listed here:
Common causes
- Hematemesis - vomiting fresh blood.
- Hemoptysis - coughing up blood from the lungs.
- Hematochezia - rectal blood.
- Hematuria - blood in the urine from urinary bleeding.
- Intracranial hemorrhage - bleeding in the skull.
- Cerebral hemorrhage - a type of intracranial hemorrhage, bleeding within the brain tissue itself.
- Intracerebral hemorrhage - bleeding in the brain caused by the rupture of a blood vessel within the head. See also hemorrhagic stroke.
- Subarachnoid hemorrhage (SAH) implies the presence of blood within the subarachnoid space from some pathologic process. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from rupture of a berry aneurysm or arteriovenous malformation(AVM). The scope of this article is limited to these nontraumatic hemorrhages.
- Pulmonary hemorrhage
- Vaginal bleeding
- Postpartum hemorrhage
- Breakthrough bleeding
- Ovarian bleeding. This is a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome undergoing transvaginal oocyte retrieval.[1]
- Upper gastrointestinal bleed
- Suicide: Exsanguination is a suicide method caused by cutting of arteries, notably: carotid, radial, ulnar, and femoral arteries.
- Trauma: Injury or trauma can cause exsanguination if bleeding is not stymied. It is the most common cause of deaths on the battlefield (though the most common cause of death from battle is infection). Non-battlefield causes can include partial or complete amputation from use of circular saws (e.g., hand-held circular saw, radial arm saw, table saw).
- Internal hemorrhage: Patients can develop catastrophic internal hemorrhages, such as from a bleeding peptic ulcer or splenic hemorrhage, which can cause exsanguination even without any external bleeding. It is a relatively common cause of unexpected, sudden death in patients who seemed previously well.
- Alcoholism: Alcoholics can also suffer from exsanguination. Thin-walled dilated veins just below the lower esophageal mucosa, called esophageal varices, may ulcerate or be torn ("Mallory-Weiss syndrome") during the violent retching of the alcoholic leading to massive bleeding and sometimes exsanguination.
- Retroperitoneal hematoma
- Ruptured aortic aneurysm
- Ruptured abdominal aortic aneurysm
Causes by Organ System
| Cardiovascular | Ruptured aortic aneurysm, Aorticoduodenal fistula |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Breakthrough bleeding |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | Dieulafoy's lesion, Esophageal variceal bleeding, Hematemesis, Hematochezia, Liver rupture, Mallory-Weiss syndrome, Oropharyngeal tumour erosion in mouth, Upper gastrointestinal bleed |
| Genetic | No underlying causes |
| Hematologic | Disseminated intravascular coagulation |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | Cerebral hemorrhage, Intracranial hemorrhage, Subarachnoid hemorrhage |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | Breakthrough bleeding, Ovarian bleeding, Postpartum hemorrhage, Vaginal bleeding |
| Oncologic | Carotid artery erosion from neck metastases, Tumour lymph node erosion into adjacent vessels, Oropharyngeal tumour erosion in mouth |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | Suicide |
| Pulmonary | Hemoptysis, Pulmonary artery rupture, Pulmonary hemorrhage, Pulmonary vein rupture |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | Trauma, Liver rupture, Pulmonary artery rupture, Pulmonary vein rupture |
| Urologic | Hematuria |
| Dental | No underlying causes |
| Miscellaneous | Aorticoduodenal fistula, Internal hemorrhage, Retroperitoneal hematoma |
Causes in Alphabetical Order
Treatment
Medical Therapy
- Compression at the bleeding site.
- Resuscitation with fluid.
- Transfusion of red blood cells.
- Reversal of anticoagulation or antiplatelet agents with fresh frozen plasma (FFP) or platelet transfusion.
Surgery
- Surgical repair of a lacerated artery or vein.
Related Chapters
References
- ↑ Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ (2008). "Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome". Fertil. Steril. 93 (3): 874–879. doi:10.1016/j.fertnstert.2008.10.028. PMID 19064264. Unknown parameter
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