Hemorrhage
Bleeding from a blood vessel, ranging from minor to life-threatening
Quick Facts
- Type: Vascular emergency or injury
- Forms: External and internal bleeding
- Danger sign: Rapid, heavy, or uncontrolled bleeding
- Seek urgent care: Severe bleeding, fainting, or shock
Overview
Hemorrhage is the medical term for bleeding, meaning blood escaping from a damaged blood vessel. It can be external, where blood leaves the body through a wound or opening, or internal, where blood collects inside the body in tissues, organs, or body cavities. Internal bleeding can be harder to recognize because it is not visible.
Hemorrhage ranges from trivial, such as a small cut that stops on its own, to a life-threatening emergency when a large amount of blood is lost quickly. Severe or ongoing blood loss can lead to shock, in which the body cannot deliver enough oxygen to its organs. Recognizing serious bleeding and getting rapid help can be lifesaving.
Symptoms
External hemorrhage is obvious, but internal bleeding may only show up through its effects on the body. Warning signs of significant blood loss include:
- Visible heavy or spurting bleeding that does not slow with pressure
- Lightheadedness, dizziness, or fainting
- Rapid heartbeat and rapid breathing
- Pale, cool, clammy skin
- Weakness, confusion, or anxiety
- Vomiting blood, coughing up blood, black or bloody stools, or blood in urine
- Pain, swelling, or tightness in an area of suspected internal bleeding
These can indicate dangerous blood loss and require emergency care.
Causes
Hemorrhage occurs whenever a blood vessel is damaged or fails to seal properly. Common causes include:
- Trauma: Cuts, falls, crush injuries, fractures, or accidents.
- Surgery or medical procedures: Bleeding during or after an operation.
- Ruptured vessels: A burst aneurysm or torn blood vessel, including bleeding in the brain.
- Disease of an organ: Ulcers, tumors, or inflamed tissue that bleeds, such as in the digestive tract.
- Childbirth: Heavy bleeding after delivery (postpartum hemorrhage).
- Bleeding disorders or blood thinners: Conditions or medicines that impair clotting.
Risk Factors
- Taking blood-thinning medicines or aspirin
- Inherited bleeding disorders such as hemophilia
- Liver disease, which reduces clotting factors
- High blood pressure, which raises the risk of vessel rupture
- Recent surgery, trauma, or childbirth
- Low platelet counts
Diagnosis
For external bleeding, the source is usually clear. Internal hemorrhage is diagnosed using a combination of assessment and tests:
- Vital signs: A fast heart rate and falling blood pressure suggest significant blood loss.
- Blood tests: To measure red blood cell levels and clotting ability.
- Imaging: Ultrasound, CT scans, or other imaging to locate internal bleeding.
- Endoscopy: A camera to find and treat bleeding inside the digestive tract.
Treatment
Treatment depends on the severity and source. The priorities are to stop the bleeding and replace lost blood.
- Direct pressure: Firm, continuous pressure on an external wound is the most important first-aid step.
- Wound care: Stitches, staples, or dressings for cuts; a tourniquet may be needed for severe limb bleeding.
- Procedures and surgery: To repair a damaged vessel or organ or to seal a bleeding site.
- Blood and fluids: Transfusions and intravenous fluids to restore volume in heavy bleeding.
- Reversing blood thinners: Medicines to counteract anticoagulants when bleeding is serious.
Major hemorrhage is an emergency that requires immediate professional care.
Prevention
- Use seat belts and protective equipment to reduce injury risk
- Follow instructions carefully when taking blood-thinning medicines and attend monitoring appointments
- Control high blood pressure
- Treat conditions such as ulcers that can bleed
- Tell your healthcare team about any bleeding disorder before procedures
When to See a Doctor
Call emergency services right away for severe, heavy, or uncontrolled bleeding, or for signs of internal bleeding or shock. While waiting for help, apply firm, direct pressure to any external wound. Seek emergency care for:
- Bleeding that will not stop with steady pressure
- Vomiting or coughing up blood, or black or bloody stools
- Fainting, severe dizziness, confusion, or pale, clammy skin
- A sudden severe headache with collapse, which can signal bleeding in the brain
Rapid treatment of major hemorrhage can be lifesaving.
Frequently Asked Questions
What is the difference between internal and external hemorrhage?
External hemorrhage is bleeding you can see, such as from a cut. Internal hemorrhage is bleeding inside the body into tissues or cavities, which is not visible and may only show up as dizziness, a fast heart rate, pale skin, or pain. Internal bleeding can be especially dangerous because it is harder to detect.
How do I stop bleeding from a wound?
Apply firm, steady, direct pressure to the wound with a clean cloth and keep pressing without lifting to check. Raise the injured area if possible. If bleeding is severe and will not stop, call emergency services right away while continuing to apply pressure.
What is hemorrhagic shock?
Hemorrhagic shock occurs when so much blood is lost that the body cannot supply enough oxygen to its organs. Signs include a rapid heartbeat, pale and clammy skin, confusion, and fainting. It is a life-threatening emergency that needs immediate treatment.
Can medicines cause hemorrhage?
Yes. Blood thinners, aspirin, and some other medicines reduce the blood's ability to clot and can make bleeding more likely or harder to control. Always follow dosing instructions and tell your healthcare team about these medicines before any procedure.
When is bleeding an emergency?
Bleeding is an emergency when it is heavy or will not stop with pressure, when there are signs of internal bleeding such as vomiting blood or black stools, or when there are signs of shock like fainting, confusion, or pale clammy skin. Call emergency services in these situations.
References
- MedlinePlus, U.S. National Library of Medicine. Bleeding.
- American Red Cross. First Aid for Severe Bleeding.
- Mayo Clinic. Severe bleeding: First aid.
- Centers for Disease Control and Prevention (CDC). Stop the Bleed.