3 Types of Haemorrhage in Surgery

1. Primary Haemorrhage

• Bleeding that occurs immediately at the time of injury or surgery.
• It happens during the operation itself.
• Cause: direct vessel damage from the surgical procedure or trauma.

2. Reactionary Haemorrhage

• Bleeding that is delayed, occurring within 24 hours postoperatively (some sources say 24-48 hours).
• Causes:
  • Dislodgement of a clot due to resuscitation, normalisation of blood pressure, or vasodilatation
  • Slippage of a ligature (suture tie coming loose)
  • A missed vessel injury where bleeding was temporarily stopped by vasoconstriction and hypotension - once blood pressure recovers postoperatively, bleeding resumes
• Management: return to theatre to identify and control the bleeding vessel.

3. Secondary Haemorrhage

• Bleeding that occurs 7-14 days after injury or surgery (days to weeks postoperatively).
• Cause: sloughing (erosion) of a vessel wall, most commonly due to:
  • Infection (most common) - infective organisms erode the vessel wall
  • Pressure necrosis (e.g. from a poorly positioned drain)
  • Malignancy eroding into a blood vessel
• It is the most dangerous type because it is unexpected and can be torrential.

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