Hemorrhage: Types, Causes, Symptoms, Treatment and More

Overview

When you start bleeding, it is known as hemorrhaging. In simple terms, it means blood loss. There are two types of Hemorrhage: internal and external. In internal Hemorrhage, there is blood loss inside the body through a damaged blood vessel or an organ, whereas, in external Hemorrhage, the blood loss occurs outside the body through a break in the skin. Thus, bleeding can occur in most parts of our body. However, it becomes noticeable when the blood exits from a natural body opening, such as:

• Vagina
• Mouth 
• Rectum
• Nose 

What are the different types of Hemorrhage?  

The following are the different types of Hemorrhage:

Upper Head

• Intracranial Hemorrhage: A bleeding that occurs in the skull
• Cerebral Hemorrhage: This is one of the types of intracranial Hemorrhage where the brain tissue bleeds within itself
• Intracerebral Hemorrhage: When the brain bleeds due to the rupture in the blood vessel within the head.
• Subarachnoid Hemorrhage (SAH): when there is blood present within the subarachnoid space due to a pathologic process. It is a nontraumatic type of hemarrhage, typically caused due to a berry aneurysm or arteriovenous malformation.

Eyes

• Subconjunctival Hemorrhage: A broken blood vessel in the sclera – the white of the eyes – results in the blood eye. It often occurs due to strain, including sneezing, coughing, vomiting, or other kinds of strain.

Nose

• Epistaxis: It is commonly known as a nosebleed.

Mouth

• Tooth eruption: When you lose a tooth, it is known as a tooth eruption.
• Hematemesis: You start vomiting fresh blood. 
• Hemoptysis: When you start coughing blood from the lungs is called hemoptysis.

Lungs

• Pulmonary Hemorrhage

Gastrointestinal

• Upper gastrointestinal bleed
• Lower gastrointestinal bleed
• Occult gastrointestinal bleed

Urinary Tract

• Hematuria – When you urinate, there is blood. It is known as hematuria.

Gynacologic

• Vaginal bleeding
• Postpartum Hemorrhage
• Breakthrough bleeding
• Ovarian bleeding: Patients with polycystic ovary syndrome undergoing trans vaginal occyte retrieval are more likely to experience ovarian bleeding. It is fatal and is a common complication of the procedure.

Anus

• Melena – occurs when there is an upper gastrointestinal bleeding
• Hematochezia – occurs when there is lower gastrointestinal bleeding or brisk upper gastrointestinal bleeding

Vascular

• Ruptured aneurysm
• Aortic transection
• Iatrogenic injury

What are the symptoms of Hemorrhage?  

Hemorrhage can occur in different parts of the body, but there are a few signs and symptoms that are common for all types of Hemorrhage. These include the following:

• Unstoppable bleeding, even after applying pressure
• Swelling and the secretion of yellow or brown pus
• A state of shock or experiencing high fever

If a patient suffers from these symptoms, they should be administered emergency medical help and taken to a hospital as fast as possible, as excessive blood loss can lead to fatalities.

When should you call the doctor?

You need to immediately visit the nearest clinic or a hospital or call your doctor if you or someone you know is bleeding externally or suspect internal bleeding. If you also notice the following signs:

• Breathing difficulties
• Coughs or spits up blood
• Faints
• Unstoppable bleeding
• Experiences severe chest or abdomen pain
• Develops clammy or cold skin
• Experiences dizziness, light-headed, and confusion

What causes a hemorrhage?

There are a variety of conditions that causes bleeding, including the following: 

Traumatic bleeding  

Any external or internal injury can cause traumatic bleeding depending on its severity. Some common types of traumatic injuries are:  

• Scrapes or abrasions that penetrate deep into the skin  
• Cuts or lacerations  
• Wounds from needles, nails or knives  
• A gunshot wound  
• Crushing injury  

Medical conditions  

Certain medical conditions can also cause bleeding or Haemorrhage but are less common when compared with traumatic bleeding. The conditions that cause this type of bleeding include: 

• Leukemia  
• Haemophilia  and other blood clotting disorders 
• Liver disease  
• Vitamin K deficiency  
• Brain trauma  
• Thrombocytopenia or low blood platelet count  
• Menorrhagia – prolonged menstrual bleeding  
• Acute bronchitis  
• Cancers 
• Complications from medical procedures, such as childbirth or surgery
• Damage to an internal organ
• Viruses that attack the blood vessels like viral hemorrhagic fever or dengue hemorrhagic fever 

Medications  

The chances of bleeding or Hemorrhage may increase due to the intake of certain medicines and treatments. The doctor will warn the patients regarding this during the therapy prescription and advise on how to handle the situation when bleeding occurs. Medications that can lead to bleeding includes: 

• Blood thinners  
• Certain antibiotics  
• Radiation therapy  
• Aspirin and other NSAIDs  

Depending on the location or cause, a haemorrhage may be called:

• Hematoma (a predominantly bad bruise) or bruise.  Both include bleeding just under the skin
• Hemothorax, blood collecting between chest wall and the lungs
• Nosebleed 
• Intracranial Hemorrhage, bleeding in the brain
• Postpartum Hemorrhage, more bleeding than normal after childbirth
• Petechiae tiny spots on skin that may be red, brown or purple 
• Subarachnoid Hemorrhage (a kind of stroke caused by head trauma)
• Subdural hematoma : blood leaking into the dura mater (membrane between brain and skull) 
• Subconjunctival Hemorrhage, broken blood vessels in the eye.

The Way A Hemorrhage Makes You Feel

The location and severity of the Hemorrhage contribute to how a hemorrhage makes you feel. Suppose you are bruised; you may experience mild discomfort compared to a head injury. Hemorrhage in the brain may cause headaches, whereas Hemorrhage in the chest may cause troubled breathing. 

If you experience severe blood loss, you may feel:

• Cold to touch
• Dizziness
• Tired
• Nauseous 
• Shortness of breath
• Weakness

If severe Hemorrhage is left untreated, it may result in:

• Chest pain
• Confusion
• Increase breathing or heart rate
• Organ failure
• Seizures
• Shock
• Coma or even death

Is a hemorrhage sign of an emergency?

Internal or external bleeding, bleeding disorders or blood thinners leading to bleeding are all emergencies that require immediate attention. 

The following are a few situations that should be taken care of on an immediate basis: 

• The patient has severe fever along with bleeding or has gone into shock  
• Uncontrolled bleeding despite applying pressure  
• Wound requiring a tourniquet  
• Bleeding caused by serious injury  
• The wound requires stitches to stop bleeding  
• Foreign objects  are stuck in the wound  
• The wound is infected – with swelling or leaking of pus  
• Injury due to a bite from an animal or human 

What are the treatment options for Hemorrhage? 

Before emergency services arrive, passers-by must try to save the life of the person experiencing excessive bleeding. Below are some of the methods or treatment options that can be used to control bleeding:  

First AID for Traumatic Bleeding  

Call the hospital if the person is exhibiting any emergency indicators described above or requires urgent assistance to stop the bleeding. To keep the heart rate and blood pressure under control, the individual who is bleeding should remain calm as the bleeding will be accelerated if the heart rate or blood pressure is excessively high.   

To lessen the danger of fainting, lay the individual down as soon as possible and elevate the bleeding location. Clear the wound of any loose debris or foreign objects. Removing objects such as knives, arrows and weapons can end up causing more damage and will lead to increased bleeding. In this circumstance, use bandages and pads to retain the object in place and absorb the bleeding till the hospital is reached.  

To put pressure on the wound, one can use the following to maintain medium pressure till the bleeding slows down and stops:  

• Clean cloth  
• Bandages  
• Clean hands 

Things Not To Do in Haemorrhage

• When the bleeding stops, do not remove the cloth from its place or use adhesive tape to hold it in place.  
• Do not open the wound regularly to see if the bleeding has stopped, as this will cause disturbance to the wound and may lead to continued bleeding. 
• Do not apply pressure when the person has an injury in the eye.  

How To Diagnosis Hemorrhage?

Hemorrhages are classified as follows:

Blood Loss

The American College of Surgeons’ advanced trauma life support classified it into four categories:

• Class 1 Hemorrhage: It involves close to 15% of blood volume. Generally, there are no changes in vital signs. However, fluid resuscitation is not required.
• Class 2 Hemorrhage: The Hemorrhage involves close to 15-30% of blood volume. Often, a patient may experience a rapid heartbeat with a reduced difference between systolic and diastolic blood pressure. Thus, the body may try to compensate with peripheral vasoconstrictions. Slowly, the skin starts looking pale and cold to the touch. Additionally, one may see behaviour changes in the patient. Saline solution or lactated ringer’s solutions helps in volume resuscitation. In this category, the patient may not require a blood transfusion. 
• Class 3 Hemorrhage: Here, the patient may lose close to 30%-40% of the circulating blood volume. As the blood pressure drops, there is an increase in heart rate. The patient may also experience shock with diminished capillary refile, and the mental status slowly declines or worsens. Saline solution or lactated ringer’s solutions is required for volume resuscitation.
• Class 4 Hemorrhage: The patient may lose more than 40% of the circulating blood volume – which means the body has reached the compensation limit. In such cases, aggressive resuscitation is vital to preventing death.

The above parameter is the same in the staging of hypovolemic shock. 

It is vital to remember that individuals with excellent physical and cardiovascular health may develop better coping mechanisms before a severe cardiovascular collapse. In such cases, the patient may seem stable with minimal derangements in vital signs; however, they may experience poor peripheral perfusion. Other patients, such as elderly individuals or those with chronic conditions with less tolerance to blood loss, may have medications such as beta-blockers that may minimize the cardiovascular response. It is vital to be careful during an assessment. 

Massive Hemorrhage

There is no definition for a massive Hemorrhage; however the following must be considered when identifying the condition. If a patient loses blood,

• That is more than circulating blood volume within a 24-hour
• More than 50% within 3-hours
• Exceeding 150 ml/min
• That needs plasma and platelet transfusion

How to use a tourniquet for bleeding?

Tourniquets should only be used as a last resort by an experienced person. These steps can be followed to apply a tourniquet:  

• Identify the best location for the tourniquet. It should be applied to a limb between the heart and the bleeding.  
• If possible, make the tourniquet with bandages by tying a half knot around the limb. Make sure there’s enough room on the loose ends to tie another knot.  
• Place a stick between the knots.  
• Tighten the bandage by twisting the stick  
• Secure the tourniquet place with the help of a tape or cloth  
• At least every 10 minutes, check the tourniquet. Release the tourniquet and apply direct pressure if the bleeding has slowed down enough. 

Frequently Asked Questions (FAQs)

How serious is a Hemorrhage?

Minor cases do not need medical attention. When small blood vessels near the skin are damaged, internal bleeding may result in immediate medical attention. Remember that even a small Hemorrhage can become fatal, and in severe cases, internal bleeding may result in death within 6-hours of hospitalization. 

Can a hemorrhage cause death?

Yes, Hemorrhage can cause death. Sometimes, a small Hemorrhage can lead to death within 6-hours of hospitalization.

What is used to treat Hemorrhage?

An inexpensive antifibrinolytic drug called Tranexamic acid is used to treat Hemorrhage. It increases blood clotting and decreases of fatality in patients with uncontrolled Hemorrhage.

What are the first signs of internal bleeding?

Internal bleeding in different parts of the body has different signs, which are as follows:

Signs of internal bleed in the head

• Weakness and numbness, on one side of the body
• Hands and feet tingle
• Headaches that are severe and sudden
• Difficulty in understanding, speaking, and writing
• Problems in alertness and increased sleepiness, lethargy, and stupor
• Loss of consciousness

Internal Hemorrhage in the chest or abdomen

• Pain in the abdomen and chest
• Breathing difficulties
• Dizziness when standing
• Bruises on the navel and the side of the abdomen
• Nausea and vomiting
• Bloody urine
• Stool that is tarry and black
• Bleeding from ears, nose, mouth, and anus

Internal bleeding in your muscles and joints

• Joint pain and swelling
• Limited range of motion

Symptoms of shock include the following:

• Increased heart rate
• Decreased blood pressure
• Weakness and decreased alertness
• Sweaty skin

If a patient develops an underlying condition, the doctors can easily identify if the patient is losing blood elsewhere. 

What are the two ways to tell if bleeding is life-threatening?

The two ways to tell if bleeding is life-threatening are when the vein or artery is hurt and bruising in the skin, indicating internal bleeding.