12. Major Haemorrhage
1
Dealing with a major haemorrhage is a very stressful fast paced dynamic environment for all
involved therefore there is a window of opportunity for a transfusion reaction to occur
therefore as BMSs you want to do everything you can to minimise that risk.
.
.
A major haemorrhage can arise due to variety of reasons such as a road traffic accident, GI
bleeding, aortic aneurism or surgery for example.
Major haemorrhage and blood loss is the number one preventable cause of death following
trauma.
If we take the example of an individual who had 80mls of blood per kg, if they were to lose
40mls of that within less than 3 hours we would class that as a major haemorrhage.
Hypovolaemic shock arises due to a major haemorrhage and due to the sheer blood loss – it
is the blood pressure of less than 90mm of mercury and its in relation to a heart rate of
greater than 110 beats per minute. In a major haemorrhage we get the loss of blood volume
so a loss of blood pressure therefore we get reduced oxygen carrying capacity to tissues so
tissues will become damaged and undergo necrosis.
Differences in adults in children – not just related to the total blood volume that a healthy
child compared to a healthy adult has but it refers to the differences in tolerance of how
much blood they can actually afford to lose. This also refers to things like therapeutic goals,
children and adults have a different haemoglobin concentration that we want to reach so its
important to be aware of all of that when we are dealing with a major haemorrhage.
.
The symptoms of a major haemorrhage are the symptoms associated with loss of blood
volume – if you stand up quickly you have a drop in blood pressure and will go a bit dizzy,
these symptoms are worse than that in a major haemorrhage.
We expect to see confusion because we get loss within oxygenation and blood flow to the
brain and drowsiness and lethargy for the same sort of reasons.
Cold and clammy skin because the blood is redirected form the extremities of the body to
the central part of the body therefore the skin will become both cold and clammy in relation
to the other limbs.
Tachycardia – increased heart rate as an attempt of the body to deal with the huge loss of
blood volume therefore to try and maintain oxygen perfusion to tissues.
Decreased urine output – we will see reabsorption of water in response to the drop in blood
pressure.
.
When initiating the major haemorrhage protocol, it is important that the lines of
communication are clear – this is not only between the scientists within the laboratory,
generally one BMS will be dedicated to one particular major haemorrhage case or patient
but also to ensure that the lines of communications are clear between individuals contacting
the laboratory.
It is the responsibility of the individuals calling the laboratory to assign a runner – if this is in
a theatre for example it may well be that a member of that theatre staff will be assigned as
the runner, and they will come to and from the laboratory to collect the units and to take
them back to the patient.
If it is a known patient which fit the 3 criteria, we can initiate the electronic issue which is a
very quick way which we can issue blood to the patient – this takes 5 minutes unlike a full
1
Dealing with a major haemorrhage is a very stressful fast paced dynamic environment for all
involved therefore there is a window of opportunity for a transfusion reaction to occur
therefore as BMSs you want to do everything you can to minimise that risk.
.
.
A major haemorrhage can arise due to variety of reasons such as a road traffic accident, GI
bleeding, aortic aneurism or surgery for example.
Major haemorrhage and blood loss is the number one preventable cause of death following
trauma.
If we take the example of an individual who had 80mls of blood per kg, if they were to lose
40mls of that within less than 3 hours we would class that as a major haemorrhage.
Hypovolaemic shock arises due to a major haemorrhage and due to the sheer blood loss – it
is the blood pressure of less than 90mm of mercury and its in relation to a heart rate of
greater than 110 beats per minute. In a major haemorrhage we get the loss of blood volume
so a loss of blood pressure therefore we get reduced oxygen carrying capacity to tissues so
tissues will become damaged and undergo necrosis.
Differences in adults in children – not just related to the total blood volume that a healthy
child compared to a healthy adult has but it refers to the differences in tolerance of how
much blood they can actually afford to lose. This also refers to things like therapeutic goals,
children and adults have a different haemoglobin concentration that we want to reach so its
important to be aware of all of that when we are dealing with a major haemorrhage.
.
The symptoms of a major haemorrhage are the symptoms associated with loss of blood
volume – if you stand up quickly you have a drop in blood pressure and will go a bit dizzy,
these symptoms are worse than that in a major haemorrhage.
We expect to see confusion because we get loss within oxygenation and blood flow to the
brain and drowsiness and lethargy for the same sort of reasons.
Cold and clammy skin because the blood is redirected form the extremities of the body to
the central part of the body therefore the skin will become both cold and clammy in relation
to the other limbs.
Tachycardia – increased heart rate as an attempt of the body to deal with the huge loss of
blood volume therefore to try and maintain oxygen perfusion to tissues.
Decreased urine output – we will see reabsorption of water in response to the drop in blood
pressure.
.
When initiating the major haemorrhage protocol, it is important that the lines of
communication are clear – this is not only between the scientists within the laboratory,
generally one BMS will be dedicated to one particular major haemorrhage case or patient
but also to ensure that the lines of communications are clear between individuals contacting
the laboratory.
It is the responsibility of the individuals calling the laboratory to assign a runner – if this is in
a theatre for example it may well be that a member of that theatre staff will be assigned as
the runner, and they will come to and from the laboratory to collect the units and to take
them back to the patient.
If it is a known patient which fit the 3 criteria, we can initiate the electronic issue which is a
very quick way which we can issue blood to the patient – this takes 5 minutes unlike a full
