LECTURE NO 11

Hemorrhages and Infarction

HAEMORRHAGE
HAEMORRHAGE
• Definition:
❖Hemorrhage (bleeding) is an escape of
blood from the blood vessels (artery,
vein, capillary or heart), as a result of
trauma, inflammation, neoplasia or
abnormal haemostasis.
❖Extravasation of blood or erythrocytes
present outside blood vessels.
Causes of Haemorrhages
• Physical trauma
❖Stabbing
❖Stick injury
❖Gunshot
❖Motor vehicle accident
• Inadequacies in blood clotting which can be due to:
• A. Too few or poorly functioning platelets (i.e. qualitative & quantitative
defect of platelets)
• B. Missing or low amount of clotting factors
• E.g. Low levels of prothrombin, fibrinogen & other precursors.
• Inadequate vitamin K leads to clotting factor deficiency because this vitamin
is important in the synthesis of the clotting factors by the liver.
Haemorrhage can occur in two ways
• Haemorrhage is the escape of blood
from a vessel. It can be due to Rhexis
• (1) Haemorrhage by rhexis: when
there is rupture or break of a blood vessel.
• (2) Haemorrhage by diapedesis:
when blood leaves through an apparently
intact vascular wall. It is a microscopic
Haemorrhage, but just how the erythrocytes
escape is still not completely understood. Diapedesis
Types of Hemorrhages

• Hematoma: Enclosed accumulation

of blood in a tissue (bulging, rounded
area of hemorrhage)
• Hematoma is a grossly visible
extravasated blood in the tissue. Firstly it
is red, then as the blood is deoxygenated,
it becomes bluish red, as the RBCs are
lysed.
Types of Hemorrhages

•Petechiae: 1-2 mm hemorrhage

in the skin, mucous membranes, or
serosal surface of an organ
• Associated with locally increased
intravascular pressure,
thrombocytopenia, defective
platelet function, of clotting factor
deficits.
Types of Hemorrhages

•Petechial
Hemorrhage:
bleeding Under the Skin of
Dog. Tick-borne disease,
blood-sucking insect.
Types of Hemorrhages

Newcastle Disease Coccidiosis

Types of Hemorrhages

• Purpura: 1mm to 1cm hemorrhage

in the skin, mucous membrane, or
serosal surfaces of organs
• Associated with same as
petechiation
• Alsotrauma, local vasculitis,
increased vascular fragility
Types of Hemorrhages
• Ecchymoses: Larger than 1cm
called ecchymoses
• Associated with locally
increased intravascular
pressure, thrombocytopenia,
defective platelet function, of
clotting factor deficits or Ecchymotic hemorrhages (ecchymoses),
trauma subcutis, rabbit. Ecchymoses result from
moderate injury to endothelial cells in the
capillary beds.
Types of Hemorrhages
• Suffusive
(Paintbrush):
Hemorrhage along a natural
plane.

Suffusive hemorrhage, serosa, stomach,

dog. Suffusive hemorrhage results from
severe injury to endothelial cells in the
capillary beds.
.
Nomenclature of Hemorrhages
• Hemothorax: blood in thorax.
• Hemopericardium: pericardial sac.
• Hemoperitoneum: peritoneal cavity.
• Hemarthrosis: joint or synovial cavity.
• Hematuria: Hematuria is appearance of blood in urine.
• Hematemesis: Hematemesis is vomiting of blood.
• Hemoptysis: bloody stained sputum and associated with cough
INFARCTION
 Infarction
• Ischemic necrosis of tissue caused
by occlusion of either the arterial
supply or the venous drainage in a
particular tissue.
• The2 most important causes are
thrombosis and thromboembolism.
Factors affecting infarction
❖Development & the size of an infarct are determined by the nature of the vascular
supply dual or single. Some organs have single blood supply while others have a
dual supply.
✓Organ with dual blood supply: Lung: Pulmonary artery and bronchial artery.
Liver: Hepatic artery and portal vein. Hand & Forearm: Radial arteries and ulnar
arteries.
❖The rate of development of occlusion slow or rapid.
❖Susceptibility ofthe tissue to` hypoxia: Neurons undergo irreversible damage
when deprived of their blood supply for only 3 to 4 minutes, myocardial cells die
after 20-30 minutes of ischemia
❖Oxygen content of the blood. Partial obstruction of the blood flow in an anaemic
or cyanotic patient may lead to severe tissue infarction.
❖The severity & duration of ischemia.
Types of Infarcts
Infarcts are classified depending on the basis of their colour
(reflecting the amount of Haemorrhage) into:
❖Anaemic (white) infarcts: Anaemic (white) infarcts are quite
common. They occur due to arterial occlusion and are most
commonly found in solid organs (spleen, kidney, heart)
❖Haemorrhagic (red) infarcts: Red (haemorrhagic) infarcts occur
due to venous occlusion or obstruction in organ with dual blood
supply. In tissues with dual circulations permitting flow of blood
from the unobstructed vessel into the necrotic zone (obviously
such perfusion is not sufficient to rescue the ischemic tissues)
 Morphology of Infarcts

• Gross Morphology: All infarcts are wedge-shaped with the occluded

vessel at the apex and the periphery of the organ forming the base of the
wedge, the infarction will induce inflammation in the tissue surrounding
the area of infarction. Following inflammation, some of the infarcts may
show recovery, however, most are ultimately replaced by scars except in
the brain.
• Microscopic Morphology: The dominant histologic feature of infarction
is ischemic coagulative necrosis; the brain is an exception to this
generalization, where liquefactive necrosis is common.
Consequences of infarction

All infarcts heal by scarring

because all tissue is dead &
there is nothing left to heal.
White Infarct
A picture of an anaemic
infarct of the kidney.
Note the wedge shape of
the infarct. This shape
correlates with the arterial
blood supply of the
kidney. Necrosed area
lined by hyperemic line.
White Infarct
Splenic infarct
Red Infarct
A picture of an intestinal
infarct. It is red in colour
because the small intestine
has a dual blood supply.
Red Infarct
Kidney infarct
Character White infarct Red infarct
Color Pale, anemic Red hemorrhagic
Affected vessels Arterial Venous occlusion
occlusion
Consistency of Solid organ Loose organ
the organ
Blood supply of Single artery Dual arterial blood
the organ supply
Examples of Kidney, heart, Lung, intestine,
organs spleen (solid liver (dual blood)
organs) ovary, testis
Myocardial infarcts
Microscopic image
• The normal cells are located in the
upper right corner of the image
• Note the nucleus (a) and myofibrils
(long pink filaments running
lengthwise along the cells)
• The necrotic cells are in the middle-
bottom half of the picture.
• Note absent nucleus (c), loss of
myofibrils (d), increased eosinophilia
(pinkness! – necrotic fibers take up the
pink (eosin) stain more readily than
normal fibers)
Common Types of Infarction on the basis of
sites of infarction
Cerebral infarcts
Myocardial infarcts
Intestinal infarcts
Renal & splenic infarct