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The history and examination are essential in the assessment and replacement of blood loss e.g. is the patient shocked with sweating, pallor etc.
The most significant measurements are the pulse rate and the blood pressure - a pulse rate above 100 and a blood pressure which has a systolic pressure below 100 mmHg is suggestive of a significant blood loss. A postural drop in blood pressure occurs in significant bleeds.
The pulse and blood pressure are readily available objective indicators of intravascular volume. However they are not ideal e.g. in a hypertensive patient, a systolic pressure of above 100 may still be a strong indication for transfusion. The central venous pressure is a more important measure for management of a patient who has had a severe haemorrhage.
The value of the haemoglobin on admission will give and estimate of blood loss. However a severe blood loss may lead to haemoconcentration and therefore the haemoglobin will be increased from its normal value.
If the patient is having haematemesis and melaena then the quantification of these volumes provides measures that help identify significant blood loss.
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