Hematoma

Key points

The hematoma is a collection of blood located outside the blood vessels, a typical consequence of trauma or bruising. Blood flows out of the circulation, concentrates in a tissue or in a cavity of the organism, and gives rise to a hematoma.

Hematoma: causes

In addition to traumas and bruises, the hematoma can also be caused by other factors: alteration of coagulation (thrombocytopenia, hemophilia), surgical wounds, leukemia, anticoagulant therapy (heparin, dicumarol, etc.).

Hematoma: symptoms

The characteristic symptoms of hematoma differ according to the severity of the trauma suffered. Pain varies from mild (superficial hematomas) to acute / intense (severe / deep trauma). A mild to medium-sized hematoma blends its color scheme from red to blue, and from purple to yellow. Superficial hematomas are self-resolving in a short time.

Hematoma: classification

SUBCUTANEOUS HEMATOMAS are classified as: petechiae, purpura and ecchymoses

The most frequent BRAIN HEMATOMAS are: cephalohematoma, epidural hematoma, subdural hematoma, subarachnoid hematoma, subgaleal hematoma.

Among the OTHER TYPES of hematoma, we mention: otoematoma, perianal hematoma, surgical wound hematoma, sub unguemous hematoma.

Hematoma: care

The treatment of the hematoma depends on the severity of the damage suffered. Superficial hematomas tend to self-purify over a few days: it is advisable to apply ice to speed healing. Deep hematomas must be evacuated by surgery. The sub-nail hematoma should be treated with the perforation of the nail: the blood flows from the hole and the hematoma is reabsorbed.

Definition of hematoma

The hematoma is a collection of blood, more or less abundant, located outside the blood vessels. The blood, which has escaped from the circulatory system after traumas or bruises, is concentrated in a tissue or in a cavity of the body, thus giving rise to a hematoma.

The term hematoma derives from the Greek: the root " hemat -" refers to "blood", while the suffix - oma (from soma) means "body".

Hematomas can develop in any area of ​​the body: inside a muscle, under the surface of the skin, in the head or in the brain, in the ear, in the anal region or under the nail.

The hematoma proper must be distinguished from ecchymosis and hemangioma:

• ecchymosis (or bruise): it is a sort of mild hematoma, characterized by the diffusion of blood under the skin (the blood flow is limited)
• hemangioma: is an abnormal accumulation of blood vessels in the skin or internal organs. It is precisely a tumoral form in which blood vessels proliferate in the endothelium.

But why does a hematoma form? What are the main symptoms? What types of hematoma exist? What are the treatments? In the course of the discussion, we will give an answer to these questions.

Causes

In the hematoma, the blood is totally or partially coagulated, based on the time elapsed since the bleeding. The blood from the injured subcutaneous capillaries pours into the underlying tissue, where it remains imprisoned; not finding outlets, the blood creates a typical red spot on the skin, or a hematoma.

The causes that trigger the hematoma are many:

• Coagulation alteration: some defects in blood coagulation capacity - such as thrombocytopenia or haemophilia - may favor the formation of hematomas. In similar circumstances, small pseudo-haematomas (better to say ecchymoses) may occur even after minor trauma. The same symptom is found in patients taking antithrombotic drugs, such as coumadin.
• Surgery: the hematoma is one of the most common complications that occur after some surgical procedures. A hypertensive patient, subjected to surgery, is more exposed to the risk of hematoma.
• Lesion of blood vessels already altered by pathological conditions, such as aneurysms, infections and neoplasms
• Leukemia
• Anticoagulant therapy: administration of heparin or dicumarol
• Traumas, bruises, barrel: after the rupture of a blood vessel, blood collects in the damaged tissue or organ, becomes denser and gives rise to the hematoma.

The hematoma can involve every body structure; the severity of the injury is dependent on the type of trauma, the size of the hematoma and, above all, the anatomical site in which it occurs.

Often, it is sufficient to bump against an object to break the capillaries and originate a small hematoma: it is easy to understand that, in similar situations, the hematoma is certainly not a medical emergency. In other circumstances, a severe contusion can cause profound and extensive damage, so the bleeding created takes on a completely different meaning from the previous situation.

The elderly develop hematomas more easily than the young: in fact, as the age progresses, the blood vessels become more fragile and thin, therefore more exposed to the risk of rupture.

Symptoms

The characteristic symptoms of hematoma vary according to the severity of the trauma suffered. For example, a small hematoma created under the skin causes relatively light symptoms, such as PAIN / TENSION in the affected area and HEAT SENSATION. Mild hematomas of this type are self-resolving in a short time, without the need for intervention.

The variation of the color scheme is typical of "superficial" hematomas. Initially, the bruise appears reddish; after a couple of days, the hematoma takes on a bluish / purple, sometimes black color. After about a week, the hematoma is dressed in greenish-yellow and, after a couple of weeks, disappears completely.

The variation of the chromaticity of the hematoma is due to the transformation of EME (prosthetic group of hemoglobima) into bilirubin, the yellow-orange bile pigment derived from the catabolism of red blood cells

Some hematomas can even go unnoticed: it is the case of the classic "home accidents", in which the collision with an object can cause a micro-hematoma (therefore a rupture of the small blood vessels), which may not be felt.

Different and more delicate discourse for severe traumas: for example, a cerebral hematoma, which involves complex and imposing symptoms, requires urgent and immediate intervention.

To understand the severity of a hematoma, we distinguish two cases:

1. The hematoma is self-resolving spontaneously: typical condition of small hematomas, involving capillaries or small-caliber vessels. The blood that has accumulated in the coagulated tissue and is slowly reabsorbed.
2. The hematoma increases in volume: when the hematoma involves large-caliber blood vessels (eg arteries) the bleeding tends to persist, and the lesion is not able to self-resolve. The arterial vessels are in fact little predisposed to spontaneous haemostasis, therefore the hematoma increases in volume. In these cases, medical intervention is necessary to avoid possible and catastrophic consequences.

In the next article, we will analyze the main types of hematoma »