Bleeding: What to Do and What It Can Mean

How to stop bleeding from a wound

1. Protect yourself with gloves or a plastic bag if helping someone else.
2. Press firmly and directly on the wound with a clean cloth, gauze or your hand. Keep pressing for at least 10 minutes without peeking.
3. Add more layers if blood soaks through. Do not remove the first dressing.
4. Raise the injured part above the heart if it is a limb and nothing is broken.
5. For life-threatening bleeding from an arm or leg that pressure does not control, apply a tourniquet 5 to 7 cm (2 to 3 inches) above the wound, tighten until bleeding stops, and note the time. Call 911.
6. Do not remove embedded objects. Pack around them and press on either side.
7. Once bleeding stops, clean small wounds with running water and cover them.

For a nosebleed, sit up, lean forward, and pinch the soft part of the nose firmly for 10 to 15 minutes. Do not tip your head back.

Types of bleeding

Signs of internal bleeding

Internal bleeding can follow an injury, such as a car crash or fall, or happen without injury from an ulcer, a ruptured ectopic pregnancy or an aneurysm. Clues include:

• dizziness, fainting, weakness and thirst
• a fast pulse and fast breathing
• pale, cold, clammy skin
• a swollen, tense or painful abdomen
• large bruises, especially around the belly button or flanks
• black stools, vomiting blood, or blood in the urine
• confusion or drowsiness

Heavy blood loss leads to hemorrhagic shock, when the body cannot supply enough blood to the organs. See internal bleeding.

Bleeding from specific places

• Nose: usually dry air, picking or colds. See nosebleed.
• Gums: gingivitis, brushing too hard, or rarely low platelets or leukemia. See bleeding gums.
• Bowel: hemorrhoids, fissures, polyps, colitis or cancer. See rectal bleeding.
• Stomach: ulcers, gastritis from NSAIDs or alcohol, and enlarged veins in liver disease, causing vomited blood or black stools.
• Urine: infections, kidney stones, enlarged prostate, or bladder and kidney cancer.
• Vagina: periods, pregnancy complications, fibroids, polyps, hormonal contraception, or bleeding after menopause, which always needs checking.
• Lungs: coughing up blood from infection, bronchiectasis, pulmonary embolism or lung cancer.

Unusual bleeding: when the cause is in the blood

Blood clots through platelets (tiny cells that plug holes) and clotting factors (proteins that form a mesh). Problems with either cause bleeding that is easier, heavier or longer than normal.

Signs of a bleeding problem

• bruising easily, or large bruises from minor knocks
• tiny pinpoint red or purple spots (petechiae), often on the legs
• nosebleeds that last longer than 10 minutes or happen often
• heavy periods since your first period
• prolonged bleeding after cuts, dental extraction, childbirth or surgery
• bleeding into joints or muscles

Common causes

• Blood thinners and other medicines: warfarin, direct oral anticoagulants, aspirin, clopidogrel, NSAIDs, some antidepressants, and supplements such as fish oil and ginkgo.
• Von Willebrand disease: the most common inherited bleeding disorder, often causing heavy periods and nosebleeds. Many people are undiagnosed.
• Hemophilia: an inherited lack of clotting factor VIII or IX, mostly in males, causing bleeding into joints and muscles.
• Thrombocytopenia: low platelets, from immune thrombocytopenia, infections, medicines, leukemia or chemotherapy.
• Liver disease: the liver makes most clotting factors.
• Vitamin K deficiency: in newborns not given vitamin K, or adults with malabsorption.
• Leukemia and bone marrow disorders.

How doctors investigate bleeding

A doctor will ask about where and how often you bleed, medicines and supplements, family history, and previous surgery or dental work. Tests usually include a complete blood count (for anemia and platelet count), clotting tests (PT/INR and aPTT), fibrinogen, iron studies, and kidney and liver function. Von Willebrand factor tests and specific factor levels are done if an inherited disorder is suspected. Endoscopy, colonoscopy or imaging look for the source of internal bleeding.

Treatment

Treatment depends on the cause: stitching or gluing wounds, treating ulcers or hemorrhoids, adjusting blood thinner doses, iron for anemia, and specific treatments for bleeding disorders such as desmopressin, tranexamic acid or clotting factor replacement. Heavy bleeding may need transfusion and surgery or endoscopic procedures.

Do not stop a prescribed blood thinner on your own. Speak to your doctor first, because stopping suddenly can cause clots.

Frequently asked questions

How long should a cut bleed before I seek help?

Most small cuts stop bleeding within 10 minutes of firm, continuous pressure. If bleeding continues after 10 to 15 minutes of pressure, spurts, or the wound gapes, get medical care. Call 911 for heavy bleeding that soaks through dressings.

What causes unusual bleeding?

Unusual bleeding is often caused by blood-thinning medicines, aspirin or NSAIDs. Other causes include von Willebrand disease, hemophilia, low platelets, liver disease, vitamin K deficiency and leukemia. A blood count and clotting tests help find the cause.

What are the signs of internal bleeding?

Signs include dizziness, fainting, a racing pulse, pale and clammy skin, a swollen or painful abdomen, large unexplained bruises, black stools, vomiting blood and confusion. Internal bleeding is an emergency: call 911.

Why do I bruise and bleed so easily?

Easy bruising and bleeding can come from aging skin, blood thinners, aspirin, steroids, supplements, low platelets or an inherited bleeding disorder such as von Willebrand disease. If it is new, unexplained or with heavy periods or nosebleeds, ask for blood tests.

Should I use a tourniquet?

Use a tourniquet only for life-threatening bleeding from an arm or leg that firm direct pressure cannot control. Place it a few inches above the wound, tighten until bleeding stops, note the time and call 911.