Trauma, the rupture of a peptic ulcer of an ectopic pregnancy, and bleeding in connection with hemophilia or purpura hemorrhagica are examples of the widely varied possible causes of acute blood loss. They indicate that the blood loss may be external and recognizable at one, or internal and, consequently, sometimes not readily discovered.
The rapid loss of blood leads to reduction in blood volume, and the clinical manifestations are mainly circulatory. If the blood loss is great, “acute posthemorrhagic shock” develops. If the hemorrhage is visible to the patient, whether the amount of blood loss is great or small, symptoms are
likely to appear sooner and are more pronounced in relation to the amount of blood lost when the bleeding is external than when it is not recognizable by the patient. The symptoms of the underlying disorder may be present as well.When acute hemorrhage is not evident, such signs as pallor, faintness, restlessness, sweating, and palpitation should lead to a search for hemorrhage. If the subject is recumbent, much blood may be lost before these signs appear. They can be brought out by tilting the
patient to the erect position. Late signs of acute blood loss are air hunger, thirst, and a falling blood pressure.Stopping of the hemorrhage and restoration of the blood volume to normal, preferably by transfusions of whole blood, otherwise by administration of plasma or other fluids, are the essentials. Speed in restoration of blood volume is more important than whether plasma or whole blood is used. If the blood loss has been great and the blood volume is profoundly reduced, multiple portals should be used for administration of blood, and even intraarterial administration may be advisable.
Fluids by mouth (unless the bleeding is from the upper portion of the alimentary tract) and by hypodermoclysis are valuable, adjuncts, as are rest and quiet, induced by morphine if necessary. Following the acute phase, a good diet containing meat, fruit, and vegetables affords the proteins and vitamins needed for erythropoiesis. Iron can be given in the form of ferrous sulfate but is not needed in previously normal individuals unless blood loss has been granted.