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Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is
blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the Cell (biology), cells and transports metabolic waste products away from those same cells. In vertebrates, it is composed ...

blood
escaping from the
circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system An organ system is a biological system A biological system is a complex biological network, network which connects several biologically ...
from damaged
blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system that permits blood to circulate and transport nutrients (such as amino ...
s. Bleeding can occur internally, or externally either through a natural opening such as the
mouth In animal anatomy Anatomy (Greek ''anatomē'', 'dissection') is the branch of biology concerned with the study of the structure of organism In biology, an organism (from Ancient Greek, Greek: ὀργανισμός, ''organismos'') is ...
,
nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for Respiration (physiology), respiration alongside the mouth. Behind the nose are the olfactory mucosa and the Paranasal sinus, sinuses. Be ...
,
ear The ear is the organ of hearing and, in mammals, balance. In mammals, the ear is usually described as having three parts—the outer ear The outer ear, external ear, or auris externa is the external part of the ear, which consists ...

ear
,
urethra The urethra (from Greek language, Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, ...

urethra
,
vagina In mammal Mammals (from Latin language, Latin , 'breast') are a group of vertebrate animals constituting the class (biology), class Mammalia (), and characterized by the presence of mammary glands which in Female#Mammalian female, femal ...

vagina
or
anus The anus (from Latin ''wikt:en:anus#Latin, anus'' meaning "ring", "circle") is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that ...

anus
, or through a wound in the
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular eukaryotic organisms that form the Kingdom (biolo ...

skin
.
Hypovolemia Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss ...
is a massive decrease in blood volume, and death by excessive loss of blood is referred to as
exsanguination Exsanguination is death Death is the permanent, irreversible cessation of all biological functions that sustain a living Living or The Living may refer to: Common meanings *Life, a condition that distinguishes organisms from inorgani ...
. Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious medical difficulties (by comparison,
blood donation A blood donation occurs when a person voluntarily has blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A nutrient is a substance used by an organism to survive, grow, and reprod ...
typically takes 8–10% of the donor's blood volume). The stopping or controlling of bleeding is called
hemostasis Hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vess ...
and is an important part of both
first aid First aid is the first and immediate assistance given to any person suffering from either a minor or serious illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of a ...

first aid
and
surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical or dental specialty that uses operative manual and instrumental techniques on a person to investigate or tr ...
. The use of
cyanoacrylate glue
cyanoacrylate glue
to prevent bleeding and seal battle wounds was designed and first used in the
Vietnam War {{Infobox military conflict , conflict = Vietnam War , partof = the Indochina Wars and the Cold War , image = VNWarMontage.png , image_size = 300px , caption = Clockwise, from top left: U.S. ...
. Today many medical treatments use a medical version of "super glue" instead of using traditional stitches used for small wounds that need to be closed at the skin level.


Classification


Blood loss

Hemorrhaging is broken down into four classes by the American College of Surgeons'
advanced trauma life support Advanced trauma life support (ATLS) is a training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons. Similar programs exist for immediate care providers such as paramedics. The pro ...
(ATLS). *Class I Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and
fluid resuscitation Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced with oral rehydration therapy (drinking), intravenous ...
is not usually necessary. *Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a reduction in the difference between the
systolic to supply all body systems; 2) oxygen-depleted blood (blue arrow) in the right ventricle begins pulsing through the pulmonic (pulmonary) valve en route to the lungs for reoxygenation. depolarization is the start-point of the atrial stage of syst ...
and
diastolic Image:Heart diastole.png, upright=1.5, Heart performance during ventricular diastole: early diastole is a suction mechanism that draws blood 'down' from the left atrium (pink) and right atrium (blue) into each of the two ventricles. Then, in late ve ...
blood pressures. The body attempts to compensate with
peripheral vasoconstriction
peripheral vasoconstriction
. Skin may start to look pale and be cool to the touch. The patient may exhibit slight changes in behavior. Volume resuscitation with crystalloids (
Saline solution Saline (also known as saline solution) is a mixture of sodium chloride in water and has a number of uses in medicine. Applied to the affected area it is used to clean wounds, help remove contact lenses, and help with dry eyes. By intravenous infu ...
or
Lactated Ringer's solution Ringer's lactate solution (RL), also known as sodium lactate solution and Hartmann's solution, is a mixture of sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. It is used for replacing fluids and electrolytes in ...
) is all that is typically required.
Blood transfusion Blood transfusion is the process of transferring blood product A blood product is any therapeutic substance prepared from human blood. This includes whole blood; blood components; and plasma derivatives. Whole blood is not commonly used in t ...

Blood transfusion
is not usually required. *Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

blood pressure
drops, the
heart rate Heart rate is the speed of the heartbeat Heartbeat or heartbeats may refer to: Physiology *Cardiac cycle, of the heart *Contraction of the cardiac muscle, muscles of the heart, or a perceived effect of it, such as: **Heart sounds, the noises gene ...

heart rate
increases, peripheral hypoperfusion ( shock) with diminished
capillary refillCapillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. It can be measured by holding a hand higher than heart-level and pressing the soft pad of a fin ...
occurs, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary. *Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death. This system is basically the same as used in the staging of
hypovolemic shock Hypovolemic shock is a medical emergency and an advanced form of hypovolemia due to insufficient amounts of blood and/or fluid In physics, a fluid is a substance that continually Deformation (mechanics), deforms (flows) under an applied shea ...
. Individuals in excellent physical and
cardiovascular The circulatory system, also called the cardiovascular system or the vascular system, is an organ system An organ system is a group of organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many o ...
shape may have more effective compensatory mechanisms before experiencing cardiovascular collapse. These patients may look deceptively stable, with minimal derangements in vital signs, while having poor peripheral perfusion. Elderly patients or those with chronic medical conditions may have less tolerance to blood loss, less ability to compensate, and may take medications such as betablockers that can potentially blunt the cardiovascular response. Care must be taken in the assessment.


Massive hemorrhage

Although there is no universally accepted definition of massive hemorrhage, the following can be used to identify the condition: "(i) blood loss exceeding circulating blood volume within a 24-hour period, (ii) blood loss of 50% of circulating blood volume within a 3-hour period, (iii) blood loss exceeding 150 ml/min, or (iv) blood loss that necessitates plasma and platelet transfusion."


World Health Organization

The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unit ...
made a standardized grading scale to measure the severity of bleeding.


Types

* Upper head **
Intracranial hemorrhage Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull The skull is a bone A bone is a Stiffness, rigid tissue (anatomy), tissue that constitutes part of the vertebrate skeleton in animals. Bones p ...
– bleeding in the skull. **
Cerebral hemorrhage Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and hemorrhagic stroke, or haemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. It is one kind of bleedi ...
– a type of intracranial hemorrhage, bleeding within the brain tissue itself. **
Intracerebral hemorrhage Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and hemorrhagic stroke, or haemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. It is one kind of bleed ...

Intracerebral hemorrhage
– bleeding in the brain caused by the rupture of a blood vessel within the head. See also
hemorrhagic stroke A stroke is a medical condition in which poor blood flow to the brain A brain is an organ (anatomy), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually c ...

hemorrhagic stroke
. **
Subarachnoid hemorrhage Subarachnoid hemorrhage (SAH) is bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressi ...
(SAH) implies the presence of blood within the
subarachnoid space In anatomy, the meninges (, ''singular:'' meninx ( or ), from grc, μῆνιγξ, mēninx, membrane, ''adjectival:'' meningeal ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the a ...
from some pathologic process. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from rupture of a berry aneurysm or
arteriovenous malformation Arteriovenous malformation is an abnormal connection between arteries and veins, bypassing the capillary system. This vascular anomaly is widely known because of its occurrence in the central nervous system (usually cerebral AVM), but can app ...
(AVM). The scope of this article is limited to these nontraumatic hemorrhages. * Eyes **
Subconjunctival hemorrhage
Subconjunctival hemorrhage
– bloody eye arising from a broken blood vessel in the
sclera The sclera, also known as the white of the eye or, in older literature, as the tunica albuginea oculi, is the opaque, fibrous, protective, outer layer of the human eye containing mainly collagen and some crucial elastic fiber. In humans, and some ...
(whites of the eyes). Often the result of strain, including sneezing, coughing, vomiting or other kind of strain *Nose ** **
Epistaxis A nosebleed, also known as epistaxis, is bleeding from the nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for Respiration (physiology), respiration alongside the mouth. Behind th ...
– nosebleed * Mouth **
Tooth eruption Tooth eruption is a process in tooth development Tooth development or odontogenesis is the complex process by which tooth, teeth form from embryonic cells, cell growth, grow, and erupt into the human mouth, mouth. For human tooth, human teeth to ...
– losing a tooth **
Hematemesis Hematemesis is the vomiting Vomiting (also known as puking, throwing up, barfing, emesis, among other names) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can ...
– vomiting fresh blood **
Hemoptysis Hemoptysis is the coughing up of blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally continuum mechanics, incompressible flow ( ...

Hemoptysis
– coughing up blood from the lungs * Lungs **
Pulmonary hemorrhage Pulmonary hemorrhage (or pulmonary haemorrhage) is an acute Acute may refer to: Science and technology * Acute angle ** Acute triangle ** Acute, a leaf shape in the glossary of leaf morphology#acute, glossary of leaf morphology * Acute (medicine), ...
* Gastrointestinal **
Upper gastrointestinal bleed Upper gastrointestinal bleeding is gastrointestinal bleeding Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the Human gastrointestinal tract, gastrointestinal tract, from the mouth ...
** Lower gastrointestinal bleed ** Occult gastrointestinal bleed * Urinary tract **
Hematuria Hematuria or haematuria is defined as the presence of blood or red blood cells Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid ce ...

Hematuria
– blood in the urine from urinary bleeding * Gynecologic **
Vaginal bleeding Vaginal bleeding is any expulsion of blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the Cell (biology), cells and transports metabolic waste products away from those ...
***
Postpartum hemorrhage Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth. Some have added the requirement that there also be signs or symptom ...
***
Breakthrough bleeding Intermenstrual bleeding, previously known as metrorrhagia, is uterine bleeding at irregular intervals, particularly between the expected menstrual periods. It is a cause of vaginal bleeding. In some women, menstrual spotting between periods occur ...
** Ovarian bleeding – This is a potentially catastrophic and not so rare complication among lean patients with
polycystic ovary syndrome Polycystic ovary syndrome, or PCOS, is the most common endocrine The endocrine system is a messenger system comprising feedback loops of the hormone A hormone (from the Greek Greek may refer to: Greece Anything of, from, or related to G ...
undergoing
transvaginal oocyte retrievalTransvaginal oocyte retrieval (TVOR), also referred to as oocyte retrieval (OCR), is a technique used in in vitro fertilization In vitro fertilisation (IVF) is a process of fertilisation Fertilisation or fertilization (see spelling dif ...
. * Anus **
Melena Melena or melaena refers to the dark black, tarry feces Feces ( or faeces) is the solid or semi-solid remains of food that was not digested in the small intestine The small intestine or small bowel is an organ (anatomy), organ in the human ...
– upper gastrointestinal bleeding **
Hematochezia Haematochezia is the passage of fresh blood through the anus path, usually in or with stools (contrast with melena). The term is from Greek αἷμα ("blood") and χέζειν ("to defaecate"). Hematochezia is commonly associated with lower gastroi ...

Hematochezia
– lower gastrointestinal bleeding, or brisk upper gastrointestinal bleeding * Vascular ** Ruptured
Aneurysm An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the ca ...
** Aortic transection ** Iatrogenic injury


Causes

Bleeding arises due to either traumatic injury, underlying medical condition, or a combination.


Traumatic injury

Traumatic bleeding is caused by some type of injury. There are different types of
wound A wound is a type of which happens relatively quickly in which is torn, cut, or punctured (an ''open'' wound), or where blunt force causes a (a ''closed'' wound). In , it specifically refers to a sharp injury which damages the of the skin. ...

wound
s which may cause traumatic bleeding. These include: * Abrasion – Also called a graze, this is caused by transverse action of a foreign object against the skin, and usually does not penetrate below the
epidermis The epidermis is the outermost of the three layers that comprise the skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate Vertebrates () comprise all species of animal Animals (also calle ...
. * Excoriation – In common with Abrasion, this is caused by mechanical destruction of the skin, although it usually has an underlying medical cause. *
Hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid ...

Hematoma
– Caused by damage to a blood vessel that in turn causes blood to collect under the skin. *
Laceration A wound is a type of injury Injury, also known as physical trauma, is damage Damage is any change in a thing, often a physical object, that degrades it away from its initial state. It can broadly be defined as "changes introduced into a sys ...

Laceration
– Irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing such as in childbirth. In some instances, this can also be used to describe an incision. * Incision – A cut into a body tissue or organ, such as by a
scalpel A scalpel, or lancet, or bistoury, is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various handicraft, arts and crafts (called a hobby knife). Scalpels may be disposable product, single-use ...

scalpel
, made during surgery. *
Puncture Wound Penetrating trauma is an injury Injury, also known as physical trauma, is damage Damage is any change in a thing, often a physical object, that degrades it away from its initial state. It can broadly be defined as "changes introduced into ...
– Caused by an object that penetrated the skin and underlying layers, such as a nail, needle or knife. *
Contusion A bruise, also known as a contusion, is a type of hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a bod ...

Contusion
– Also known as a bruise, this is a blunt trauma damaging tissue under the surface of the skin. * Crushing Injuries – Caused by a great or extreme amount of force applied over a period of time. The extent of a crushing injury may not immediately present itself. *
Ballistic Trauma A gunshot wound (GSW) is physical trauma Injury, also known as physical trauma, is damage Damage is any change in a thing, often a physical object, that degrades it away from its initial state. It can broadly be defined as "changes introd ...

Ballistic Trauma
– Caused by a projectile weapon such as a firearm. This may include two external wounds (entry and exit) and a contiguous wound between the two. The pattern of injury, evaluation and treatment will vary with the mechanism of the injury. Blunt trauma causes injury via a shock effect; delivering energy over an area. Wounds are often not straight and unbroken skin may hide significant injury. Penetrating trauma follows the course of the injurious device. As the energy is applied in a more focused fashion, it requires less energy to cause significant injury. Any body organ, including bone and brain, can be injured and bleed. Bleeding may not be readily apparent; internal organs such as the liver, kidney and spleen may bleed into the abdominal cavity. The only apparent signs may come with blood loss. Bleeding from a bodily orifice, such as the rectum, nose, or ears may signal internal bleeding, but cannot be relied upon. Bleeding from a
medical procedure A medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, measuring, or diagnosing a patient condition or parameter is also called a medical test ...
also falls into this category.


Medical condition

"Medical bleeding" denotes hemorrhage as a result of an underlying medical condition (i.e. causes of bleeding that are not directly due to trauma). Blood can escape from
blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system that permits blood to circulate and transport nutrients (such as amino ...
s as a result of 3 basic patterns of injury: *
Intravascular changes
Intravascular changes
– changes of the blood within vessels (e.g. ↑
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

blood pressure
, ↓
clotting factors Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a thrombus, blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The me ...
) * Intramural changes – changes arising within the walls of blood vessels (e.g.
aneurysms An aneurysm is an outward :wikt:bulge, bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be ...
, dissections, AVMs,
vasculitides Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both artery, arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily c ...
) * Extravascular changes – changes arising outside blood vessels (e.g.
''H pylori''
''H pylori''
infection,
brain abscess A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tiss ...
,
brain tumor A brain tumor occurs when abnormal cells form within the brain A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on ...
) The underlying scientific basis for blood clotting and hemostasis is discussed in detail in the articles,
coagulation Coagulation, also known as clotting, is the process by which blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A nutrient is a substance used by an organism to survive, grow, and r ...
,
hemostasis Hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vess ...
and related articles. The discussion here is limited to the common practical aspects of blood clot formation which manifest as bleeding. Some medical conditions can also make patients susceptible to bleeding. These are conditions that affect the normal hemostatic (bleeding-control) functions of the body. Such conditions either are, or cause, bleeding diatheses.
Hemostasis Hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vess ...
involves several components. The main components of the hemostatic system include
platelets Platelets, also called thrombocytes (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. ...

platelets
and the
coagulation Coagulation, also known as clotting, is the process by which blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A nutrient is a substance used by an organism to survive, grow, and r ...
system.
Platelets Platelets, also called thrombocytes (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. ...

Platelets
are small blood components that form a plug in the blood vessel wall that stops bleeding. Platelets also produce a variety of substances that stimulate the production of a blood clot. One of the most common causes of increased bleeding risk is exposure to
nonsteroidal anti-inflammatory drugsA nonsteroidal compound is a drug that is not a steroid nor a steroid derivative. Nonsteroidal anti-inflammatory drugs (NSAIDs) are distinguished from corticosteroids as a class of anti-inflammatory agents. List of nonsteroidal steroid receptor modu ...
(NSAIDs). The prototype for these drugs is aspirin, which inhibits the production of thromboxane. NSAIDs inhibit the activation of
platelets Platelets, also called thrombocytes (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. ...

platelets
, and thereby increase the risk of bleeding. The effect of aspirin is irreversible; therefore, the inhibitory effect of aspirin is present until the platelets have been replaced (about ten days). Other NSAIDs, such as "ibuprofen" (Motrin) and related drugs, are reversible and therefore, the effect on platelets is not as long-lived. There are several named coagulation factors that interact in a complex way to form blood clots, as discussed in the article on
coagulation Coagulation, also known as clotting, is the process by which blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A nutrient is a substance used by an organism to survive, grow, and r ...
. Deficiencies of coagulation factors are associated with clinical bleeding. For instance, deficiency of Factor VIII causes classic
hemophilia A Haemophilia A (or hemophilia A) is a genetic deficiency in clotting factor VIII, which causes increased bleeding and usually affects males. In the majority of cases it is inherited as an X-linked recessive trait, though there are cases which aris ...
while deficiencies of Factor IX cause "Christmas disease"( hemophilia B). Antibodies to Factor VIII can also inactivate the Factor VII and precipitate bleeding that is very difficult to control. This is a rare condition that is most likely to occur in older patients and in those with
autoimmune Autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other body normal constituents. Any disease that results from such an aberrant immune response is termed an "autoimmune disease An autoimmun ...
diseases. Another common bleeding disorder is
Von Willebrand disease Von Willebrand disease (VWD) is the most common hereditary Heredity, also called inheritance or biological inheritance, is the passing on of Phenotypic trait, traits from parents to their offspring; either through asexual reproduction or sex ...
. It is caused by a deficiency or abnormal function of the "Von Willebrand" factor, which is involved in platelet activation. Deficiencies in other factors, such as factor XIII or factor VII are occasionally seen, but may not be associated with severe bleeding and are not as commonly diagnosed. In addition to NSAID-related bleeding, another common cause of bleeding is that related to the medication,
warfarin Warfarin, sold under the brand name Coumadin among others, is a medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, thera ...

warfarin
("Coumadin" and others). This medication needs to be closely monitored as the bleeding risk can be markedly increased by interactions with other medications. Warfarin acts by inhibiting the production of
Vitamin K Vitamin K refers to structurally similar, fat-soluble vitamers found in foods and marketed as dietary supplements. The human body requires vitamin K for post-translational modification, post-synthesis modification of certain proteins that are r ...
in the gut. Vitamin K is required for the production of the clotting factors, II, VII, IX, and X in the liver. One of the most common causes of warfarin-related bleeding is taking antibiotics. The gut bacteria make vitamin K and are killed by antibiotics. This decreases vitamin K levels and therefore the production of these clotting factors. Deficiencies of platelet function may require platelet transfusion while deficiencies of clotting factors may require transfusion of either
fresh frozen plasma Fresh frozen plasma (FFP) is a blood product A blood product is any therapeutic substance prepared from human blood. This includes whole blood; blood components; and plasma derivatives. Whole blood is not commonly used in transfusion medicine. ...
or specific clotting factors, such as
Factor VIII Factor VIII (FVIII) is an essential blood-clotting protein Proteins are large s and s that comprise one or more long chains of . Proteins perform a vast array of functions within organisms, including , , , providing and , and from one l ...
for patients with hemophilia.


Infection

Infectious diseases such as
Ebola Ebola, also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF), is a viral hemorrhagic fever Viral hemorrhagic fevers (VHFs) are a diverse group of animal and human illness A disease is a particular abnormal c ...

Ebola
,
Marburg virus disease Marburg ( or ) is a university town in the German federal state (''Bundesland'') of Hesse Hesse (, , ) or Hessia (, ; german: Hessen ), officially the State of Hessen (german: links=no, Land Hessen), is a state of the Germany, Federal Republ ...
and
yellow fever Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever Fever, also referred to as pyrexia, is defined as having a above the due to an increase in the body's temperature . There is not a singl ...
can cause bleeding.


Diagnosis/Imaging

Dioxaborolane chemistry enables radioactive
fluoride Fluoride (). According to this source, is a possible pronunciation in British English. is an inorganic In chemistry Chemistry is the scientific discipline involved with Chemical element, elements and chemical compound, compounds compose ...
(
18F
<sup>18</sup>F
) labeling of
red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek language, Greek ''erythros'' for "red" and ''k ...

red blood cell
s, which allows for
positron emission tomography Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in Metabolism, metabolic processes, and in other physiological activities including blo ...
(PET) imaging of intracerebral hemorrhages.


Management

Acute bleeding from an injury to the skin is often treated by the application of direct pressure. For severely injured patients,
tourniquet A tourniquet is a device that is used to apply pressure to a limb or extremity in order to limit – but not stop – the flow of blood. It may be used in emergencies, in surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ...

tourniquet
s are helpful in preventing complications of shock.
Anticoagulant Anticoagulants, commonly known as blood thinners, are chemical substance A chemical substance is a form of matter In classical physics and general chemistry, matter is any substance that has mass and takes up space by having volume. All ...
medications may need to be discontinued and possibly reversed in patients with clinically significant bleeding. Patients that have lost excessive amounts of blood may require a
blood transfusion Blood transfusion is the process of transferring blood product A blood product is any therapeutic substance prepared from human blood. This includes whole blood; blood components; and plasma derivatives. Whole blood is not commonly used in t ...

blood transfusion
.


Etymology

The word "Haemorrhage" (or ''hæmorrhage''; using the æ ligature) comes from Latin haemorrhagia, from Ancient Greek αἱμορραγία (''haimorrhagía'', "a violent bleeding"), from αἱμορραγής (''haimorrhagḗs'', "bleeding violently"), from αἷμα (''haîma'', "blood") + -ραγία (''-ragía''), from ῥηγνύναι (''rhēgnúnai'', "to break, burst").


See also

* Anaesthesia Trauma and Critical Care *
Aneurysm An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the ca ...
* Autohemorrhaging *
Anemia Anemia (American and British English spelling differences#ae and oe, also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. When anemia c ...

Anemia
*
Coagulation Coagulation, also known as clotting, is the process by which blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A nutrient is a substance used by an organism to survive, grow, and r ...
*
Contusion A bruise, also known as a contusion, is a type of hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a bod ...
*
Exsanguination Exsanguination is death Death is the permanent, irreversible cessation of all biological functions that sustain a living Living or The Living may refer to: Common meanings *Life, a condition that distinguishes organisms from inorgani ...
* Hemophage *
Hemophilia Haemophilia (also spelled hemophilia) is a mostly inherited genetic disorder A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene In biology, a ge ...
*
Hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid ...

Hematoma
*
Istihadha In Islam Islam (;There are ten pronunciations of ''Islam'' in English, differing in whether the first or second syllable has the stress, whether the ''s'' is or , and whether the ''a'' is pronounced , or (when the stress is on the first ...


References


External links

{{Authority control Transfusion medicine