Haemorrhage/bleeding

The prevention of excessive blood loss through breaches of the vascular barrier is important to maintain oxygen delivery and blood volume. A fall in blood volume would cause a drop in blood pressure and the metabolism of all of the major organs would be badly affected. Failures of the haemostatic mechanisms can lead to haemorrhage (bleeding disorders) or thrombosis (hypercoagulation disorders). 

Tumor, infarction (stroke/ischemia), haemorrhage (bleeding/ ischemia) and infection (abscess) are the example of brain lesions that are affected in the brain cerebrum. In 2006, it was reported that tumor and brain diseases such as brain infarction and haemorrhage were the third and fourth leading cause of death in Malaysia [1]. The incidence of brain tumor in 2006 was 3.9 among males and 3.2 among females per 100,000 populations with a total of 664 cases reported by the Minister of Health Malaysia. In the United States, the combined incidence of primary brain tumor was 6.6 per 100,000 persons per year with a total of 22,070 new cases in 2009 [2], while brain infarction affects approximately 750,000 new cases per year [3]. 

Haemorrhage (Bleeding/ Ischemia) Deoxyhemoglo -bin Hyperintense Oxyhemoglo- bin Hypointense Paralysis unconsciousness visual disturbances speech problems Presence of blood products outside of the cerebral vascular... 

Due to bleeding risk, individuals on anticoagulant therapy or individuals who are vitamin K-deficient should not take vitamin E supplementation without close medical supervision. Absent of that, vitamin E is a well-tolerated relatively non-toxic nutrient. A tolerable upper intake level of 1,000 mg daily of a-tocopherol of any form (equivalent to 1,500 IU of RRR a-tocopherol or 1,100 IU of all-rac-a-tocopherol) would be, according to the Food and Nutrition Board of the Institute of Medicine, the highest dose unlikely to result in haemorrhage in almost all adults. 

Animals fed spoiled sweet clover were prone to fatal haemorrhages. The canse was traced to the presence of dicoumarol. This compound interferes with the effects of vitamin K in blood coagulation, the blood loses its ability to clot, and minor injnries can lead to severe internal bleeding. Synthetic dicoumarol has been nsed as an oral blood anticoagnlant in the treatment of thrombosis, where the risk of blood clots becomes life threatening. It has since been snperseded by warfarin, a synthetic development based on the natnral prodnct. 

The only major side-effect of these oral anticoagulants is prolonged bleeding, thus the dosage levels are chosen with care. Dicoumarol was first isolated from spoiled sweet clover hay, as the agent which promoted haemorrhage disease in cattle. Both dicoumarol and warfarin have also been utilized (at high doses) as rat poisons. 

Prescribing perspective requires that an arbitrary level such as 20 x 10 /1 not necessarily be retained but rather that this intervention be reserved for those who have significant bleeding that includes extending purpura and particularly retinal haemorrhages. Often surprisingly low counts are tolerated if adults are given between 500 and 1000 mg of cyclocapron orally every 8 hours. 

IS-methyl-PGF is used to control postpartum haemorrhage when oxytocin and ergot alkaloids fail to control the bleeding. 

It is used for prophylaxis and control of bleeding in gynaecological and obstetric surgery, haemorrhage associated with lUCD insertion, conisation of the cervix, intra- and... 

Deficiency symptoms In vitamin C deficiency scurvy develops. It is characterized by ecchymosis, petechiae, swollen and bleeding gums, subperiosteal haemorrhage, bones are painful to touch, impaired wound healing, anaemia, loosening of teeth and gingivitis. 

Connolly AJ, Ishihara H, Kahn ML et al. (1996) Role of the thrombin receptor in development and evidence for a second receptor. Nature 381 516-519 Cui J, O Shea KS, Purkayastha A et al. (1996) Fatal haemorrhage and incomplete block to embryogenesis in mice lacking coagulation factor V. Nature 384 66-68 Denis C, Methia N, Frenette PS et al. (1998) A mouse model of severe von Willebrand disease defects in hemostasis and thrombosis. Proc Nad Acad Sci USA 95 9524-9529 Dewerchin M, Liang Z, Moons L et al. (2000) Blood coagulation factor X deficiency causes partial embryonic lethality and fatal neonatal bleeding in mice. Thromb Haemost 83 185-190... 

Q9 A patient who has recently received a head injury, or had surgery, or who has haemorrhaged recently may bleed excessively in this situation, thrombolytics are contraindicated. These drugs are also unsuitable for patients who have previously experienced an adverse reaction to one of the drugs, such as an allergic reaction to streptokinase. 

GLYCOPROTEIN lib/ Ilia INHIBITORS THROMBOLYTICS 1. t risk of major haemorrhage when co-administered with alteplase 2. Possible t risk of bleeding complications when streptokinase is co-administered with eptifibatide 1. Uncertain other thrombolytics do not seem to interact 2. Additive effect 1. Avoid co-administration 2. Watch for bleeding complications. Risk-benefit analysis is needed before co-administering this will involve the availability of alternative therapies such as primary angioplasty... 

These are used in treatment of migraine and in obstetrics (to control late uterine bleeding - postpartum haemorrhage). Their predominant action involves vasoconstriction (partial agonist effects at alpha-adrenergic receptors and 5-HT receptor-mediated effects). They are metabolized mainly via CYP3A4. 

May cause easy bruising and excessive bleeding from minor injuries. Reports of haemorrhage with concomitant use of warfarin and dan shen. INR may not always be altered. Case report with ginseng of normal coagulation studies during postoperative bleeding... 

The clinical features are those of haemorrhage— blood in the urine, blood in the vomit, and bleeding from the nose. 

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