bleeding, blood loss, haemorrhage
Bleeding is any loss of blood from the body. Bleeding can occur either internally or externally. It can occur through a natural opening such as the vagina. Most bleeding occurs through a break in the skin.
What are the signs and symptoms of the condition?
Symptoms of a large amount of blood loss are:
Examples of external bleeding through a natural opening include:
- clammy skin
- bluish lips and fingernails
- decreased alertness
- rapid heart rate
- low blood pressure
Internal bleeding can be minimal or serious. It can cause bruising or a haematoma, which is an area of swelling filled with blood. Internal swelling or bruising cannot be seen.
- blood in the stool. Blood in the stool can appear to be either black, bright red or maroon. Pepto Bismol or iron supplements can change the colour of the stool making it appear to have blood in it.
- blood in the urine.
- vaginal bleeding. This is normal in women having their monthly period or menses. Bleeding that is very heavy or occurs for a prolonged period of time may be abnormal. Bleeding is also abnormal if it occurs in women who are postmenopausal, which is the time in a woman's life when normal menstrual cycles have stopped permanently.
- blood in the vomit. This usually looks bright red. It can also appear to be brown or black, like coffee grounds.
Signs of internal bleeding include:
What are the causes and risks of the condition?
- abdominal pain, caused by irritation to the coverings of the abdominal structures
- swelling of the abdomen
- dizziness or light-headedness after the injury
- coughing up blood, which can be due to lung damage from injury, pneumonia, or tumours
- passing out or a change in consciousness, which can occur with massive bleeding or bleeding inside the head
Bleeding is caused by injury to blood vessels, the structures that hold the blood. The injury can be minimal or life threatening. The most common causes of injuries to blood vessels are cuts and puncture wounds. Automobile accidents, gunshot wounds, household tools, machinery and construction equipment often cause injuries. There are a significant number of visits to emergency rooms for bleeding injuries.
What can be done to prevent the condition?
Common sense is the most important way to prevent most bleeding. Knives should be kept away from children. Dangerous areas should be avoided. Guards should be kept on saws. People should follow proper procedure and safety instructions when using electrical, mechanical or construction equipment. If people are under the influence of alcohol or drugs or have extreme fatigue, they should not work with materials and objects that can cause injury.
How is the condition diagnosed?
Many cases of bleeding are obvious and noticed by the affected individual. For people with internal bleeding, the history and physical examination often make the doctor suspect internal bleeding. Special x-ray tests, such as CAT scans, can be used to confirm internal bleeding.
What are the treatments for the condition?
First aid is the most common treatment given when a cut or injury occurs at home or in the workplace. First aid is appropriate for external bleeding. If bleeding is severe or if shock or internal bleeding is suspected, immediate emergency medical help should be obtained.
People are advised to seek emergency medical assistance if:
The following sequence of events should be followed when giving first aid to someone with bleeding:
- the bleeding cannot be controlled.
- the bleeding is associated with a serious injury.
- the wound needs stitches or there is a large amount of embedded foreign materials, such as gravel or dirt, that cannot be removed easily with gentle cleaning.
- internal bleeding is suspected.
- there are signs of infection. Signs of infection include swelling, redness, discharge, swollen glands, fever, red streaks spreading from the site of the injury, or pain. Often, the pain from the injury is more intense than the severity of the injury.
- The person should be calmed and reassured. Many people become frightened and panic when they see blood. This panic may cause more blood loss.
- The person should be laid down on his or her back. This will reduce the chances of the person fainting or falling.
- The person giving assistance should wear latex gloves to prevent exposure to blood. Any obvious loose debris and dirt in a wound should be removed. It is important not to remove any objects that are stuck inside the person, such as a knife.
- External bleeding should be controlled using direct pressure. A clean cloth, sterile bandage, or, if nothing else is available, a gloved hand should be used to apply the pressure. Pressure should be applied until the bleeding stops. Direct pressure should not be applied to an eye injury, a head injury with a fractured skull, or a wound with an imbedded object in it.
- The wound should be washed with soap and warm water if the near the surface, and then dried. After bleeding has stopped, even if there is still some oozing, a clean dressing should be firmly applied over the wound. The dressing should be large enough to fully cover the wound and extend beyond the wound by at least 4cm. The wound should not be dressed so tightly that circulation is reduced.
- An additional dressing can be placed directly over the first one if the bleeding continues and seeps through the first dressing.
- Care from a doctor is required if bleeding does not stop after 15 minutes of direct pressure. Pressure can also be applied to the closest artery while waiting for medical care.
- Immediate medical attention should be sought if the bleeding is severe. The injured part should be kept still or immobilised. A person with severe bleeding should be laid flat on his or her back and covered with a warm blanket.
If a person has severe bleeding, treatment in a hospital setting may include different treatments based on the location and reason for the bleeding. Stitches, blood transfusions, and surgery to control bleeding may be required.
What are the side effects of the treatments?
With any injury, bleeding can continue. Infection can occur with any injury to an organ or the skin. Applying a tourniquet to control bleeding can cause loss of an entire limb and is not recommended. This manoeuvre often causes more harm than good.
Blood transfusions carry a risk of infection and allergic reactions. Surgery carries a risk of further bleeding, infection, and even death if severe injuries are present or serious reactions to anaesthetics occur.
What happens after treatment for the condition?
After treatment, people should watch for signs of infection such increased pain, redness, swelling, discharge, or pus. If these occur, a doctor should be contacted. If stitches are required, removal may be necessary after healing.
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 21/09/2004
Potential conflict of interest information for reviewers available on request