Exsanguination: Life Threatening Severe Blood Loss

When it is about a life, every drop of blood really counts. Very often in our daily lives while doing our routine works, we meet with many wounds, get many injuries and loose our blood that might be negligible. However there are also some tragic periods, some fatal incidents where there is so much of blood loss that one can be dragged down to fight for survival and prevent death. This process of loss of blood where the degree of blood loss is sufficient enough to cause threat of death is termed as “Exsanguination.”

This present article will revolve around some of the facts of the process of Exsanguination. We will be discussing some of the causes leading to exsanguination, severe blood loss resulting in physiological condition of exsanguinations and how to prevent the fatal effects of severe loss of blood leading to human death.

Definition and Some Facts About Exsanguination:

Exsanguination is defined as, “The extreme blood loss cause by traumatic injuries or rupture of aneurysm of major blood vessels, which often results in death if blood loss is not replaced within few minutes.” Exsanguination is the term used for diagnosis by physician to indicate severe life threatening blood loss and this term is also use by slaughtermen (while animal slaughter) suggesting animal death is caused by severe blood loss. Unless there is a restricted pathway to stop the excessive blood loss in exsanguinations, the person or the animal is going to die.

  • Exsanguinations as a diagnosis suggests a patient has loss over 40% of the entire blood volume outside the circulatory system. The blood may be visible or not visible. Victim, observer or medical care taker can see the blood loss when the accidental injury results in rupture or tear of major blood vessels and open wound. The profuse bleeding from head, face, arm, chest, abdomen and legs is seen immediately following injury. Patient in such situation may loose over 40% blood volume unless the blood loss is stopped by any means so as to prevent death or serious brain or heart damage.
  • Exsanguination is most commonly known as “bleeding to death” or “bleeding out”. Tolerance to blood loss depends upon the age, heart disease, vascular diseases and general fitness level. Healthy and fit individual can tolerate up to 50-75% of the blood loss. However any blood loss more than 40% is dangerous to life in general. Bleeding leading to loss of less than 40% of blood volume is often identified and diagnosed as hemorrhage.

Causes of Exsanguination

Causes of Exsanguination

External Blood Loss-

  • Trauma– One of the most serious causes for exsanguinations is an accident. This may be the car accidents, sports injury, domestic fall, accidents due to falling from great height or work accident. Injury caused by car accident and work accident often results in severe blood loss, which if ignored results in exsanguination. Upper extremity injury may cause laceration or tear of subclavian or brachial artery, which can bleed profusely and open wound outside does not prevent continuous blood loss. Patients often do not realize the blood loss because of severe pain associated with fracture of one of the extremities or dislocation of a major joint.
  • Suicidal Attempts– Many individuals try suicidal attempt by cutting radial artery at wrist and brachial artery at elbow. Continuous blood loss over 25 to 30% causes loss of consciousness and drowsiness. Radial artery bleeding may slow down because of collapsing of arterial wall but brachial arterial bleeding results in exsanguination.
  • Gun Shot Injury– The gunshot injury may cause internal or external bleeding. In few cases internal bleeding may bleed outside abdomen or chest through penetrating wound and become external bleeding. Thoracic or abdominal gun shot would often causes laceration or tear of major blood vessels like aorta, subclavian artery in chest, mesentery artery in abdomen and common iliac artery in pelvis. The loss of blood is often difficult to measure because some blood gets lodged in internal organ and most blood loss is through wound outside.

Internal Blood Loss

  • Ruptured Aneurysm– Internal bleeding is often caused by rupture of aneurysm in elderly patient. The arterial wall becomes weak with aging and very often wall of the major artery starts swelling, which is diagnosed as aneurysm. The weak arterial wall expands and becomes thin by pressure exerted by flow of blood due to pressure from inside the blood vessels. The thin weak swollen arterial wall eventually ruptures and causes internal bleeding.
  • Surgical Complication– Patient often bleed following surgery because of surgical trauma of the major artery resulting in laceration or tear. The profuse internal bleeding resulting in exsanguination is occasionally seen following vascular surgery. Vascular surgery involves surgery of one of the major arteries.
  • Infection and Sepsis– Infection of viscera or internal organs often causes sepsis and suppuration of surrounding tissue. Migration of infection to vasculature or blood vessels causes ulceration of external wall of the blood vessels. As the infections spreads the external wall become thin and weak, which eventually ruptures resulting in life threatening internal exsanguination.
  • Cancer– Patient suffering with cancer of lungs in chest and viscera in abdomen often suffer with profuse bleeding in late or terminal stage of cancer. Malignant Cancer spreads and encroaches surrounding soft tissue and grows internally. The expansion of cancer over major blood vessels causes penetration of cancer cells through the wall of the blood vessels. Bleeding is internal and profused, bleeding become exsanguination if not controlled before loss of 40% or more of blood volume.

Symptoms and Signs of Exsanguination:

The symptoms and signs caused by Exsanguination are as follows-

  • Hypothermia: Exsanguination can be diagnosed physically by checking the body temperature after the excessive blood loss. One of the most common symptom in Exsanguination is hypothermia, that means the victim suffers from an extremely low body temperature that is highly dangerous.
  • Coagulopathy: This is the term to explain the condition in a human body where the blood meets with trouble in clotting normally. This is one of the noted symptoms of exsanguinations.
  • Acidosis: In case of exsanguinations, all the tissues of the body turn more of acidic than being normal. This is the condition known as acidosis.

Exsanguination: Can The Blood Loss Cause Human Death?

Bleeding following accidental injuries resulting in exsanguinations is preventable if victim is able to keep pressure over bleeding blood vessels until help arrives. However, there are many circumstances when certain blessings are over-ruled by the evil acts and odd times. Lack of knowledge how to stop bleeding, pain when wound is touched and associated other injuries causing severe pain deter victim to take right steps to stop bleeding. In several occasions lack of immediate help and equipments to stop bleeding results in life threatening bleeding. There are obvious chances of death due to the severe trauma caused by any evil incident.

It is true that human death due to excessive blood loss is not very common case. However in cases like the military combat, where there are less chances of stopping the blood loss on an immediate basis can cause the death to human life. It is perhaps the most common cause of death in military combat.

Now coming down to the non combat cases where there are chances of exsanguinations or human death due to blood loss; we can note down that serious accidents causing the traumatic injuries including motor cycle accident, car accidents, gunshots, stabbing wounds etc which can cause either external or internal blood loss, the direct rupture of veins or arteries, especially in the wrists in case of suicide, total or partial limbs amputation while operating machinery etc can cause sufficient blood loss which can lead to immediate death in human before hospitalization.

There are also cases of internal injuries or patients with visceral organ diseases like liver diseases, which can cause human death due to exsanguinations. Alcoholics do have a greater chance to meet with exsanguinations due to internal hemorrhage in liver leading to death if not treated. Catastrophic internal hemorrhages that can lead to exsanguinations resulting in death in patients who may internally bleed are peptic ulcers and postpartum bleeding.

There is also a condition seen in humans where the thin walled dilated veins located below the lower oesophageal mucosa may get enlarged and start up with excessive bleeding that may be fatal and cause death in the process of exsanguinations.

Final Note on Exsanguination and Its Treatment:

Well! When we look at the treatment procedure it can be explained in short by explaining the primary aim in the treating procedure of exsanguinations. The treatment aims at stopping any further blood loss and in transfusing the required blood to the suffered body. Thus the basic treatment procedure comprises of two primary steps, i.e. the hemostasis (allowing the blood to stop leaking out further) and blood transfusion(involves infusion of outside match bank blood into the human body so as to compensate the amount of blood loss).

It is true that this rare yet dramatic condition of excessive blood loss can cause human death it is also possible that if the bleeding can be stopped remarkably on a quick time one can save a life from being at its end due to loss of total blood content.

“Blood relates to love and makes up a life. Let every ounce of blood be protected.”

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:July 5, 2021

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