Haemorrhage, Shock & Blood Products
Recognise concealed bleeding and understand why resuscitation must accompany prompt haemorrhage control.
Quick revision ↓ Medical Dictionary
01Recognise impaired perfusion
Tachycardia, cool peripheries, altered mentation, reduced urine output and rising lactate can indicate shock before marked hypotension. Beta-blockers, age and other factors can modify expected signs. Consider haemorrhagic, distributive, cardiogenic and obstructive mechanisms, including combinations. The response to initial treatment is important evidence, but a transient improvement does not establish that bleeding has stopped or that transfer is safe.
02Look for the source
In trauma, blood may be concealed in the chest, abdomen, retroperitoneum, pelvis or injured limbs. After surgery, consider the operative site, drains, gastrointestinal loss and internal collections. Quantified visible loss can underestimate total haemorrhage. Check anticoagulants and procedure details while arranging source-control assessment. A normal early haemoglobin concentration does not reliably exclude significant acute blood loss.
03Activate coordinated care
Major haemorrhage requires a team response, access, warming, rapid testing and an appropriate blood-product pathway. Balanced resuscitation follows local protocols and changes with laboratory or point-of-care results. Avoid repeated large crystalloid volumes as the sole response to uncontrolled bleeding. Definitive haemostasis may require surgery, endoscopy or interventional radiology; resuscitation buys time but does not repair the source.
04Monitor treatment hazards
Hypothermia, acidosis and coagulopathy can amplify bleeding. Monitor calcium and electrolytes during substantial transfusion and reassess clotting and platelets. If a transfusion reaction is suspected, stop the transfusion and follow the emergency investigation and support pathway. Do not assume every deterioration during transfusion is caused by the original illness. Patient identification and product checks remain essential under time pressure.
05Reassess after apparent control
Track perfusion, urine output, mental state, haemoglobin trends and continuing losses. Rebleeding and organ injury remain possible after a reassuring first response. Explain the plan to the patient or family when feasible and document blood products and treatment decisions. After recovery, review anaemia, transfusion indications and the cause of bleeding so discharge addresses more than the final haemoglobin number.
High-Yield Revision
- Shock may precede obvious hypotension.
- Source control and resuscitation proceed together.
- Warm the patient and monitor coagulation and calcium during major transfusion.
Common Pitfalls
- Do not exclude acute haemorrhage from one normal haemoglobin.
- Do not mistake a transient response for definitive bleeding control.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.