Blood is concentrated

Introduction Due to the severe dehydration of the body, some non-formed components of the blood penetrate into the tissue, causing the formation of concentrated components in the blood. It is common in bleeding caused by trauma, bleeding from peptic ulcer, rupture of esophageal varices, and bleeding caused by obstetrics and gynecology. Whether or not shock occurs after blood loss depends not only on the amount of blood loss, but also on the rate of blood loss. Shock is often caused by rapid, large (more than 30 to 35% of total blood) blood loss without timely replenishment.

Cause

The cause of the blood is concentrated

It is common in bleeding caused by trauma, bleeding from peptic ulcer, rupture of esophageal varices, and bleeding caused by obstetrics and gynecology. Whether or not shock occurs after blood loss depends not only on the amount of blood loss, but also on the rate of blood loss. Shock is often caused by rapid, large (more than 30 to 35% of total blood) blood loss without timely replenishment.

an examination

Related inspection

Blood routine

Blood concentration test

In many cases, it is not too difficult to diagnose bleeding. Both medical history and physical signs can reflect the lack of vascular content and the compensatory response of adrenal energy. However, experimental testing is not entirely true. Because in the short time after acute blood loss, body fluid movement is not very obvious, it is difficult to reflect through blood test indicators. If the process of blood loss is slightly longer and the body fluid movement is gradually increased, the blood will be concentrated, which is manifested by increased hemoglobin, increased hematocrit, and increased ratio of urea nitrogen to creatinine. If the process of blood loss is long, the amount of blood loss is large, especially the loss of free water is gradually increased, and serum sodium is also increased. In short, the amount of blood loss in shock should be fully estimated, and it is often estimated that the clinical is insufficient.

When the blood loss is large, causing severe low-volume shock, and it is difficult to grasp the actual and regular changes in the clinical, especially if the rehydration therapy is difficult to show positive effects, it should be considered that the central venous catheter or pulmonary artery can be placed. Catheter for invasive hemodynamic monitoring. Central venous pressure (CVP) and pulmonary wedge pressure (PCWP) were reduced by central manometry, cardiac output was reduced, venous oxygen saturation (SVO2) was reduced, and systemic vascular resistance was increased.

Differential diagnosis

Symptom identification of blood confounding

Increased blood viscosity: Blood viscosity is an important indicator of blood flow properties. Normal blood viscosity is an important condition to ensure blood circulation, especially the normal operation of microcirculation. Once the blood viscosity increases, the blood flow slows down, and a large amount of lipids, shed endothelial cells, etc. are easily deposited on the intima of the blood vessel, narrowing the blood vessels, slowing the blood flow, and relatively reducing the oxygen and nutrients obtained by the body. When the viscosity of the blood increases to a certain extent, blood coagulation occurs, that is, blood coagulation occurs, causing blood vessel embolism, thereby causing ischemic cardiovascular and cerebrovascular diseases.

Hemolysis: A phenomenon in which red blood cells rupture and hemoglobin escapes from the cells. In vitro, hypotonic solution, mechanical strong oscillation, sudden low temperature freezing (-20 ° C ~ -25 ° C) or sudden freezing, peracid or over-alkali, and alcohol, ether, soap, choline salt, etc. can cause hemolysis . Hemolysis in the body, mainly due to the intrinsic defects of red blood cells (such as sickle cell anemia), or due to certain factors in the plasma (such as hemolytic bacteria or some snake venom invasion, antigen-antibody reaction, various mechanical damage, some The role of some drugs, etc., causes red blood cells to be excessively destroyed.

Increased red blood cell volume: The red blood cell volume distribution width is a parameter reflecting the heterogeneity of red blood cell volume size, often with the coefficient of variation of the measured red blood cell volume. This is a parameter measured by a blood analyzer that reflects the heterogeneity of peripheral red blood cell volume. In short, it is an objective indicator that reflects the size of red blood cells. Morphological classification of anemia is generally performed by two parameters, RDW and MCV.

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