What Is a Hemorrhage?

Hemorrhage is another word for bleeding. It most often refers to severe bleeding, though not all hemorrhages are serious. A hemorrhage can be internal, such as in the brain or abdomen, or external, from a cut or other wound to the skin.

This article will discuss what is important to know about what the types of hemorrhage are, when first aid is appropriate, when emergency medical treatment is required, and what the risks of serious or fatal hemorrhage are.

Causes

Hemorrhages occur when blood escapes through damaged blood vessels. They can happen almost anywhere in the body because the circulatory system delivers blood to every part of it.

Hemorrhages range from slight bleeding from a shaving nick, a bruise due to bleeding beneath the skin (bruises appear bluish because the skin affects the way the blood looks), to hemorrhages caused by events like trauma, stroke, or aneurysm (a bulge in an artery). Commonly, the term applies to sudden and severe blood loss.

In Americans below the age of 40, hemorrhage that occurs due to trauma, such as car accidents or gunshot wounds, is the leading cause of death.

Types of Hemorrhage

Hemorrhages can be internal or external, and are typically divided into three types:

• Arterial hemorrhage: This is usually severe and a medical emergency. Blood can spurt out in a pulsing rhythm as the heart beats to pump out blood. Arteries deliver oxygenated blood from the heart to the body. The oxygen attached to iron-containing hemoglobin in red blood cells gives arterial blood a bright red color.
• Venous hemorrhage: This can also be severe and life-threatening. Bleeding is steady rather than pumping. Veins carry blood back toward the heart. The blood is a darker red because it has less oxygen attached to its hemoglobin.
• Capillary hemorrhage: This is often less serious. Capillaries are small, thin blood vessels that deliver nutrients through the body, like tributaries from a river. Blood trickles out of capillaries until the body's clotting agents close over the wound or cut.

Hemorrhagic Shock

The most serious level of hemorrhage is hemorrhagic shock, which is a medical emergency that can quickly be fatal. Hemorrhagic shock is when the body loses so much blood that the heart cannot keep up, and vital systems begin failing.

There are four classes of hemorrhage, categorized by the percentage of blood volume loss. Blood volume is measured as a percentage of weight, but a typical 180-pound adult has about 1.5 gallons of blood.

Hemorrhagic shock can begin when you lose about 20% of blood volume. Classes of hemorrhagic according to blood volume loss are:

• Class 1: Up to 15% blood loss, heart rate may increase slightly
• Class 2: 15–30% blood loss, causing rapid heartbeat and breathing
• Class 3: 30–40% blood loss, causing an increased heart rate, decreased blood pressure, changes in mental state, difficulty returning blood to the capillaries, and decreased urine output
• Class 4: More than 40% blood loss, with a severe drop in blood pressure, further mental changes, a racing heart, and a possible coma
  

Symptoms

External hemorrhage is usually very easy to spot, and you can identify the source of the bleeding quite quickly. Internal hemorrhage can be difficult to diagnose, even for medical professionals.

If an internal injury or illness is causing hemorrhaging, the symptoms depend on where the hemorrhage is. Some of the symptoms, which can also be symptoms of shock, are:

• Dizziness and nausea
• Vomiting blood
• Changes in mental state, sensory capability, and motor skills
• Seizures
• Swelling
• Pale, gray, clammy, or sweaty skin
• Shortness of breath
• Extreme thirst
• Thunderclap headache: Extremely severe headache that peaks within the first minute, usually due to bleeding next to the brain or spinal cord

Risks of Hemorrhage

Other than trauma, there are health conditions that increase the risk of serious hemorrhage. Death from hemorrhage can happen quickly if the blood loss is rapid. They include:

• Cancer
• High blood pressure
• Diabetes
• Peptic ulcers (erosions in the lining of the stomach or first part of the intestine)
• Kidney damage
• Anemia (a low number of healthy red blood cells)
• Alcohol use disorder
• History of stroke (a blockage of blood flow or bleeding in the brain)
• Anticoagulant and antiplatelet medications (“blood thinners”) such as Coumadin (warfarin) or aspirin
• Liver disease
• Bleeding disorders such as hemophilia

Postpartum hemorrhage is severe bleeding after the vaginal delivery of a child. It can be a serious complication and is the leading cause of mortality in childbirth.

Treatment

Treatment of a hemorrhage varies according to its severity and location.

First aid for minor external bleeding includes:

• Cleaning the affected area with soap and water if possible, or the cleanest cloth available that will not stick to the wound.
• Keeping direct pressure on the wound using a clean dressing. In most cases, the pressure will help minor bleeding stop.

In cases of severe external bleeding:

• Apply direct pressure to the site.
• If necessary, use a tourniquet, which can be life-saving.
• Call 911 and arrange to transport the person to a hospital as quickly as possible.

A tourniquet should be tied 2 inches above the injury but never over a joint. Use whatever material is available and tie a simple knot. Insert a stick or rod into the knot so you can twist and tighten it and maintain pressure.

Internal bleeding cannot be helped by first aid. In hospital and emergency settings, healthcare professionals will assess the nature and severity of the hemorrhage. Their goal will be to supply the body with sufficient oxygen while working to control the bleeding and limit damage to tissues.

A person with severe hemorrhaging may need intravenous (IV) fluids or a blood transfusion. They may need surgery to stop the hemorrhage. In less severe cases of external hemorrhage, stitches or surgical glue may be used to close a wound.

The “lethal triad” of hemorrhage from trauma, which can quickly result in death, is acidosis (too much lactic acid in the blood), hypothermia (low body temperature), and coagulopathy (blood clotting impairment).

Summary

Hemorrhage is a term for any type of bleeding, but it's most commonly associated with severe bleeding. External hemorrhages from a cut or wound can be minor or serious. Minor wounds may respond to pressure and stop bleeding, but steady, significant bleeding requires urgent medical attention.

Internal hemorrhages cannot be treated by first aid and are medical emergencies. Significant loss of blood can lead to irreversible damage and death, but not all hemorrhages are severe.

A Word From Verywell

If you or someone near you is bleeding profusely, it's better to play it safe and seek medical care. Internal hemorrhages can be hidden, but death from hemorrhage can happen quickly, so don't take any chances. Get the person to an emergency room if they are hemorrhaging severely. You could save a life.