Hemorrhage (Bleeding)


Hemorrhage is the medical term for bleeding marked by loss of blood from the circulatory system. Hemorrhage can be of two types external or internal. External bleeding is the passing of blood out into the environment and occurs through the natural opening of the body like the mouth, nose, anus, genitalia or a break of the skin. Internal bleeding is when the blood loss occurs within the body and not out into the environment.

Symptoms of a hemorrhage include visible blood loss, fall in blood pressure and rapid heart rate. Untreated hemorrhages may lead to features of shock and eventually death of the person. Treatment of a hemorrhage is aimed at stoppage of bleeding and replacement of lost blood (infusion of fluid or blood transfusion).


Symptoms depend upon the type of bleeding (external or internal) and severity of bleeding. Minor bleeding may not cause any obvious symptoms apart from pain at the site of blood loss. Long term minor bleeding can lead to anemia. Major bleeding tends to present with more pronounced symptoms like rapid heart beat, low blood pressure and even fainting. Death is a possibility

The severity of bleeding depends upon the degree of blood loss and hemorrhage has been classified in four categories.

  • Class I: less than 15% loss of total blood volume. no change in vital signs (blood pressure, heart rate).
  • Class II: 15 -30% loss of total blood. Symptoms are rapid heartbeat but no change in blood pressure.
  • Class III (30-40%)and class IV (>40%): Symptoms are fall in blood pressure along with rapid heartbeat and features of shock like cold, clammy limbs, confusion, disorientation

External bleeding

Visible blood loss (fresh or clot) or body fluids and stool tinged with blood may not always be visible with the naked eye. Body fluids like sputum, cough, urine may be tinged with blood. External blood loss occurs either through natural openings of the body namely mouth, nose, ear, urethra, vagina and rectum, or due to a breach in the continuity of the skin.

Internal bleeding

Blood loss is usually not visible from the outside. Symptoms depend upon the site involved.

  • bleeding in the brain will lead to headache, weakness of limbs, due to pressure on the concerned nerve, slurring of speech even bleeding from nose or ear can also occur
  • bleeding in upper gastrointestinal tract like stomach will cause blood vomiting (hematemesis)


Hemorrhage can occur mainly due to two causes namely, trauma and certain underlying diseases.

  • Trauma: different types of trauma can lead to blood loss namely abrasion or grazing injury, excoriation, hematoma due to rupture of a superficial blood vessel and resultant blood collection under the skin, fire arm injury, cut, puncture injury with a sharp object.
  • Underlying diseases: hemorrhage occurring due to this cause will be categorized into three classes.
    – Defect in circulating blood (intravascular): raised blood pressure or deficiency of clotting factors, which help in blood clot formation (hemophilia).
    – Defect in the wall of the blood vessel (intramural): aneurysm due to ballooning of specific part of the blood vessel, atherosclerosis due to fatty deposits on the vessel walls.
    – Defect outside the blood vessel: brain tumor, abcess pressing the adjacent blood vessel can cause its rupture.

Risk factors

  • Trauma
  • Bleeding disorder (hemophilia)
  • High blood pressure
  • Atherosclerosis
  • Brain tumor


Treatment aims at :

  • Stoppage of bleeding: by compression bandage, repair of the bleeding vessel.
  • Replacement of lost blood: by fluid infusion or blood transfusion.
  • Management of underlying disease.

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