ABSTRACT
This chapter focuses on the causes and management of hemorrhage in patients with terminal illness. It briefly summarize the pathophysiology of hemorrhage in these patients and then turn to specific bleeding problems. The chapter provides more in-depth discussions of disseminated intravascular coagulation and thrombocytopenia and conclude with recommendations for the clinical approach to hemorrhage. However, some evidence suggests that tumors greater than 10 cm in diameter, whether primary or metastasized, carry a significant risk of hemorrhage, and it has been suggested that patients with such lesions should receive prophylactic treatment for hemoptysis. Uterine arterial embolization has been used relatively frequently in cases of postpartum hemorrhage and sometimes also in the management of cancer-related vaginal bleeding. There is concurrent consumption of platelets and clotting factors, which may cause profuse hemorrhage. Although the staff providing palliative care can initiate many simple treatments, a definitive approach to hemorrhage management requires an interdisciplinary approach and sometimes the expertise of various specialists.
