Bleeding, also known as hemorrhaging or haemorrhaging, is blood
escaping from the circulatory system.
Bleeding can occur
internally, where blood leaks from blood vessels inside the body, or
externally, either through a natural opening such as the mouth, nose,
ear, urethra, vagina or anus, or through a break in the skin.
Hypovolemia is a massive decrease in blood volume, and death by
excessive loss of blood is referred to as exsanguination.
Typically, a healthy person can endure a loss of 10–15% of the total
blood volume without serious medical difficulties (by comparison,
blood donation typically takes 8–10% of the donor's blood
volume). The stopping or controlling of bleeding is called
hemostasis and is an important part of both first aid and surgery. The
use of cyanoacrylate glue to prevent bleeding and seal battle wounds
was designed and first used in the Vietnam War. 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.
1.2 Massive hemorrhage
1.3 World Health Organization
3.1 Traumatic Injury
3.2 Medical condition
6 See also
8 External links
A subconjunctival hemorrhage is a common and relatively minor
The endoscopic image of a type of stomach cancer known as linitis
plastica. The leather bottle-like appearance can also cause bleeding
as can be seen in this image.
Micrograph showing abundant hemosiderin-laden alveolar macrophages
(dark brown), as seen in a pulmonary hemorrhage. H&E stain.
Hemorrhaging is broken down into four classes by the American College
of Surgeons' advanced trauma life support (ATLS).
Class I Hemorrhage involves up to 15% of blood volume. There is
typically no change in vital signs and fluid resuscitation is not
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 and diastolic blood pressures. The
body attempts to compensate with 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 or Lactated Ringer's solution) is all that is
Blood transfusion is not usually required.
Class III Hemorrhage involves loss of 30-40% of circulating blood
volume. The patient's blood pressure drops, the heart rate increases,
peripheral hypoperfusion (shock) with diminished capillary refill
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
Individuals in excellent physical and cardiovascular 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.
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
World Health Organization
World Health Organization made a standardized grading scale to
measure the severity of bleeding.
mild blood loss (clinically significant);
gross blood loss, requires transfusion (severe);
debilitating blood loss, retinal or cerebral associated with fatality
Intracranial hemorrhage – bleeding in the skull.
Cerebral hemorrhage – a type of intracranial hemorrhage, bleeding
within the brain tissue itself.
Intracerebral hemorrhage – bleeding in the brain caused by the
rupture of a blood vessel within the head. See also hemorrhagic
Subarachnoid hemorrhage (SAH) implies the presence of blood within the
subarachnoid space 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(AVM). The scope of this article is limited to these
Subconjunctival hemorrhage - bloody eye arising from a broken blood
vessel in the sclera (whites of the eyes). Often the result of strain,
including sneezing, coughing, vomiting or other kind of strain
Epistaxis - nosebleed
Tooth eruption – losing a tooth
Hematemesis – vomiting fresh blood
Hemoptysis – coughing up blood from the lungs
Upper gastrointestinal bleed
Lower gastrointestinal bleed
Occult gastrointestinal bleed
Hematuria – blood in the urine from urinary bleeding
Ovarian bleeding - this is a potentially catastrophic and not so rare
complication among lean patients with polycystic ovary syndrome
undergoing transvaginal oocyte retrieval.
Melena - upper gastrointestinal bleeding
Hematochezia – lower gastrointestinal bleeding, or brisk upper
Bleeding arises due to either traumatic injury, underlying medical
condition, or a combination.
Traumatic bleeding is caused by some type of injury. There are
different types of wounds which may cause traumatic bleeding. These
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.
Excoriation - In common with Abrasion, this is caused by mechanical
destruction of the skin, although it usually has an underlying medical
Hematoma - Caused by damage to a blood vessel that in turn causes
blood to collect under the skin.
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,
made during surgery.
Wound - Caused by an object that penetrated the skin and
underlying layers, such as a nail, needle or knife.
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 - 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 also falls into this category.
"Medical bleeding" denotes hemorrhage as a result of an underlying
medical condition (i.e. causes of bleeding that are not directly due
Blood can escape from blood vessels as a result of 3 basic
patterns of injury:
Intravascular changes - changes of the blood within vessels (e.g. ↑
blood pressure, ↓ clotting factors)
Intramural changes - changes arising within the walls of blood vessels
(e.g. aneurysms, dissections, AVMs, vasculitides)
Extravascular changes - changes arising outside blood vessels (e.g. H
pylori infection, brain abscess, brain tumor)
The underlying scientific basis for blood clotting and hemostasis is
discussed in detail in the articles, coagulation, hemostasis 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 involves several components.
The main components of the hemostatic system include platelets and the
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 drugs (NSAIDs). The prototype for these
drugs is aspirin, which inhibits the production of thromboxane. NSAIDs
inhibit the activation of 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.
Deficiencies of coagulation factors are associated with clinical
bleeding. For instance, deficiency of
Factor VIII causes classic
hemophilia A 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 diseases. Another common
bleeding disorder is Von Willebrand disease. 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 ("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 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 or specific clotting factors, such as
Factor VIII for patients with hemophilia.
Dioxaborolane chemistry enables radioactive fluoride (18F) labeling of
red blood cells, which allows for positron emission tomography (PET)
imaging of intracerebral hemorrhages.
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”).
Anaesthesia Trauma and Critical Care
Bleeding Health Article". Healthline. Retrieved 2007-06-18.
^ "Dictionary Definitions of Exsanguination". Reference.com. Retrieved
Blood Donation Information". UK National
Blood Service. Archived
from the original on 2007-09-28. Retrieved 2007-06-18.
^ Manning, JE "Fluid and
Blood Resuscitation" in Emergency Medicine: A
Comprehensive Study Guide. JE Tintinalli Ed. McGraw-Hill: New York,
2004, p. 227.
^ Irita, K. (2011). Risk and crisis management in intraoperative
hemorrhage: Human factors in hemorrhagic critical events. Korean
journal of anesthesiology, 60(3), 151-160.
^ Webert KE, Cook RJ, Sigouin CS, et al. The risk of bleeding in
thrombocytopenic patients with acute myeloid leukemia. haematologica
^ Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ
(December 2008). "Ovarian hemorrhage after transvaginal
ultrasonographically guided oocyte aspiration: a potentially
catastrophic and not so rare complication among lean patients with
polycystic ovary syndrome". Fertil. Steril. 93 (3): 874–879.
doi:10.1016/j.fertnstert.2008.10.028. PMID 19064264.
^ Wang, Ye; An, Fei-Fei; Chan, Mark; Friedman, Beth; Rodriguez, Erik
A; Tsien, Roger Y; Aras, Omer; Ting, Richard (2017-01-05).
"18F-positron-emitting/fluorescent labeled erythrocytes allow imaging
of internal hemorrhage in a murine intracranial hemorrhage model".
Journal of Cerebral
Blood Flow & Metabolism.
^ "Hemorrhage Origin". dictionary.com. Retrieved 16 July 2015.
V · T · D
Emergency bleeding control
Automated external defibrillator
Bag valve mask
First aid kit
Certified first responder
Emergency medical technician
Wilderness Emergency Medical Technician
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Disorders of blood flow
Renal vein thrombosis
Ischaemic heart disease
large intestine: Ischemic colitis
small intestine: Mesenteric ischemia