Hemorrhage

What is a hemorrhage?

A hemorrhage is a loss of blood from a damaged blood vessel. The bleeding can be “trapped” inside your body (internal hemorrhage). Or it can flow outside of your body (external hemorrhage) from a wound or body opening (orifice). The blood loss can be minor or major.

Most hemorrhages are medical emergencies.

Types of hemorrhages

You have blood vessels throughout your entire body, so there are many different types of hemorrhages. Some examples include:

• Hemothorax: This is when blood collects in the space between your lungs and rib cage (pleural space). It can compress your lung(s) and cause difficulty breathing or chest pain.
• Intracranial hemorrhage (brain bleed): This is uncontrolled bleeding inside your brain or within the layers between your brain and skull. It’s called a hemorrhagic stroke when the bleeding is in your brain. This kind of stroke is especially severe and can get worse quickly. It’s different from an ischemic stroke, which means there’s a blockage of blood flow in your brain.
• Postpartum hemorrhage (PPH): This is severe vaginal bleeding after childbirth. It’s a serious condition that can lead to death. It can occur right after delivery or up to 12 weeks after delivery.
• Subarachnoid hemorrhage (SAH): This is bleeding in the area between your brain and the thin tissues that cover and protect it. SAH is a medical emergency.
• Subconjunctival hemorrhage: This is bleeding in the whites of your eye. The blood is trapped in your conjunctiva. It’s one of the few types of hemorrhages that usually aren’t serious.

Bruises (bleeding under your skin) are also examples of hemorrhages (usually minor). Another related word is a hematoma — a pooling of blood in the tissues.

What are the symptoms of hemorrhaging?

The way hemorrhaging makes you feel varies a lot depending on where it is and how severe it is.

Healthcare providers consider up to 15% of blood volume loss as a Class I hemorrhage. People with this amount of blood loss generally don’t have symptoms.

A Class II hemorrhage is a loss of 15% to 30% of your total blood volume. The first signs of this level of blood loss may include:

• Dizziness or lightheadedness (due to low blood pressure).
• Fatigue and weakness.
• Nausea and vomiting.
• Shortness of breath (dyspnea) and increased breathing rate.
• Increased heart rate (tachycardia).

Call 911 or go to the emergency room if you or someone near you has these symptoms.

Losing more than 30% of your total blood volume can lead to severe symptoms and complications, like:

• Confusion.
• Seizures.
• Loss of consciousness.
• Hypovolemic shock.

Specific symptoms of internal hemorrhage

Specific symptoms of internal hemorrhage in certain areas of your body include:

• Head: Sudden onset severe headache, vision changes, confusion and weakness on one side of your body.
• Chest: Difficulty breathing, chest pain and coughing up blood.
• Abdomen: Swelling or a feeling of fullness, abdominal bruising and bloody vomit, pee or poop.
• Bones, joints and muscles: Bruising, swelling and pain. Increased pressure in tissues due to bleeding in a closed space is a medical emergency. It can compress nerves and blood vessels, leading to permanent loss of function.

Call 911 or go to the emergency room if you or someone near you has these symptoms.

How do you know if you’re hemorrhaging?

Sometimes, it can be hard to know how much blood loss is too much. For example, nosebleeds are common and often harmless. But if the bleeding is from a major blood vessel or artery, it can be severe and difficult to stop. The same goes for postpartum vaginal bleeding. This is an expected part of childbirth. But excessive bleeding is a sign of postpartum hemorrhage, which can be life-threatening.

The best things you can do are to be aware of your body and symptoms and to always seek medical help if you’re unsure if you’re bleeding too much. Familiarize yourself with the symptoms of excessive blood loss, like dizziness, fatigue and breathing issues. Don’t hesitate to get medical help if you’re concerned about blood loss.

What causes hemorrhages?

Damage to one or more blood vessels can lead to a hemorrhage. The severity of a hemorrhage often depends on where it is in your body and how big the blood vessel is.

Many conditions and situations can cause a hemorrhage or significantly increase your risk for one, including:

• Alcohol use disorder. This is a significant risk factor for subarachnoid hemorrhage.
• Blood clotting disorders, like antiphospholipid syndrome.
• Blood disorders, like inherited hemophilia and Von Willebrand disease.
• Cancer.
• Certain medications, like warfarin (Coumadin®), aspirin (including baby aspirin), Clopidogrel (Plavix®) and apixaban (Eliquis®).
• Certain vascular (blood vessel) diseases, like hereditary hemorrhagic telangiectasia and aneurysms.
• Complications from medical procedures, like surgery.
• Damage to an internal organ, like an ulcer in your stomach from painkillers like ibuprofen (Advil®).
• Injuries, like cuts, long bone fractures or traumatic brain injury.
• Trauma, like gunshot or knife wounds.
• Viral hemorrhagic fevers. These are a group of illnesses caused by viruses that damage your blood vessels and can cause severe bleeding. Examples include Ebola, dengue fever, Marburg and yellow fever.

How is a hemorrhage diagnosed?

Healthcare providers diagnose a hemorrhage based on symptoms (like dizziness) and signs (high heart rate and low blood pressure). The next steps involve finding its location and what’s causing it. While external bleeding is often obvious, internal bleeding can be more difficult to find.

A provider will do a physical exam and assess your symptoms and medical history. They may need to do imaging and laboratory tests.

What is the treatment for a hemorrhage?

Treatment for a hemorrhage depends on:

• Where it is and if it’s internal or external.
• Its severity.
• The underlying cause.
• If you have other conditions or injuries.

If there’s an unknown cause and/or the bleeding is severe, you’ll need treatment in a hospital. Your healthcare team will find the cause and treat it appropriately. You may need:

• Surgery.
• Vitamin K injections (to help stop bleeding if it’s caused by medication like warfarin).
• IV fluids.
• Blood transfusions.

First aid for external hemorrhage

You may be able to provide first aid for someone — or yourself — in cases of severe external bleeding. Follow these steps:

• Call 911 or your local emergency services.
• Lay the person down. If their limb is injured, raise it above the level of their heart, if possible.
• If you have access to medical supplies, cover the wound with sterile gauze or a clean cloth.
• Have the person apply direct pressure to the wound with their hand(s). If they can’t, do it yourself. If an object is embedded in the wound, don’t remove it. Apply pressure around it.
• Use a tourniquet (if you know how) as a last resort for severe bleeding only.

What is the prognosis for someone with hemorrhaging?

If you have a hemorrhage, your prognosis (outlook) depends on several factors, like:

• The kind of hemorrhage.
• Its severity.
• How quickly you got treatment.
• Your age and overall health.

Quick medical treatment is key to a better outlook. Once you receive treatment, your healthcare team will give you a better idea of what to expect going forward.

Possible complications of hemorrhages

Complications of hemorrhages happen due to decreased blood flow to your organs. This can ultimately lead to tissue and cell death, causing complications like:

• Organ failure.
• Seizures.
• Coma.
• Death.

Hemorrhage is a leading cause of potentially preventable death, especially in people who have trauma injuries.

Specific types of hemorrhages can have certain complications. For example, a brain hemorrhage can lead to permanent brain damage and neurological issues. Postpartum hemorrhage can cause Sheehan syndrome, which is damage to your pituitary gland from excessive blood loss.

Other general complications of hemorrhages include rebleeding and complications related to hospitalization, like deep venous thrombosis and infection.