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The management of bleeding in palliative care 

The management of bleeding in palliative care
Chapter:
The management of bleeding in palliative care
Author(s):

Jose Pereira

and Jennifer Brodeur

DOI:
10.1093/med/9780199656097.003.0087
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date: 07 May 2021

Bleeding is one of the more distressing symptoms experienced by patients with advanced life-threatening illnesses. The prevalence and incidence of bleeding in these patients vary depending on the disease and the illness trajectory. The causes of bleeding in patients with advanced disease are varied and sometimes several aetiologies or aggravating factors occur simultaneously in any given patient. The clinical presentation may be visible, as in haemoptysis or hematemesis, or invisible, as in cerebral haemorrhaging, and volumes may vary, from low-grade oozing to massive and catastrophic haemorrhaging. Catastrophic, terminal haemorrhaging warrants special attention because of its dramatic clinical presentation and the profound distress it causes to patients, families, and caregivers. A number of treatment modalities are available and these can be divided into (a) general measures, (b) local measures, and (c) systemic measures. Unfortunately studies in the palliative care setting comparing various modalities and approaches are generally lacking and guidelines are largely based on case reports and expert opinion.

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