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{{short description|Loss of blood escaping from the circulatory system}}{{redirect2|Hemorrhage|Haemorrhage|the song by
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{{Infobox medical condition (new)
| image = Bleeding finger.jpg
| caption = A bleeding wound in the finger
| synonyms = Hemorrhaging, haemorrhaging, blood loss
| field = [[Emergency medicine]], [[hematology]]
| symptoms =
| complications = [[Exsanguination]], [[hypovolemic shock]], [[coma]], [[shock (circulatory)|shock]]
| onset =
| duration =
| types =
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
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| prognosis =
| frequency =
| deaths =
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'''Bleeding''',
}}</ref> Bleeding can occur [[Internal bleeding|internally]], or externally either through a natural opening such as the [[Mouth (human)|mouth]], [[human nose|nose]], [[ear]], [[urethra]], [[vagina]] or [[anus]], or through a puncture in the [[human skin|skin]].
[[Hypovolemia]] is a massive decrease in blood volume, and death by excessive loss of blood is referred to as [[exsanguination]].<ref>{{cite web|url=http://dictionary.reference.com/browse/exsanguination|title=Dictionary Definitions of Exsanguination|publisher=Reference.com|access-date=2007-06-18|archive-url=https://web.archive.org/web/20070711062056/http://dictionary.reference.com/browse/exsanguination|archive-date=2007-07-11|url-status=live}}</ref> Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious [[sequela|medical difficulties]] (by comparison, [[blood donation]] typically takes 8–10% of the donor's blood volume).<ref>{{cite web|url=http://www.blood.co.uk/pages/b36faint.html|title=Blood Donation Information|publisher=UK National Blood Service|access-date=2007-06-18 |archive-url = https://web.archive.org/web/20070928035216/http://www.blood.co.uk/pages/b36faint.html <!-- Bot retrieved archive --> |archive-date = 2007-09-28}}</ref> The stopping or controlling of bleeding is called [[hemostasis]] and is an important part of both [[first aid]] and [[surgery]].
==Types==
* Upper head
** [[Intracranial hemorrhage]] – bleeding in the skull.
** [[Intracerebral hemorrhage|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 stroke]].
** [[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).<ref name="Roth 2011 pp. 2423–2423">{{cite book | last=Roth | first=Elliot J. | title=Encyclopedia of Clinical Neuropsychology | chapter=Subarachnoid Hemorrhage (Aneurysmal subarachnoid hemorrhage) | publisher=Springer New York | publication-place=New York, NY | year=2011 | doi=10.1007/978-0-387-79948-3_2201 | pages=2423|quote=A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space that exists between the arachnoid and pia membranes that surround the brain.}}</ref> The scope of this article is limited to these nontraumatic hemorrhages.
* Eyes
** [[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
* Nose
**
** [[Nosebleed|Epistaxis]] – nosebleed
* Mouth
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*** [[Postpartum hemorrhage]]
*** [[Breakthrough bleeding]]
** Ovarian bleeding – This is a potentially catastrophic and not so rare complication among lean patients with [[polycystic ovary syndrome]] undergoing [[transvaginal oocyte retrieval]].<ref name="Liberty">{{cite journal |vauthors=Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ |title=Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome |journal=Fertil. Steril. |volume= 93|issue= 3|pages= 874–879|date=December 2008 |pmid=19064264 |doi=10.1016/j.fertnstert.2008.10.028 |doi-access=free }}</ref>
* Anus
** [[Melena]] – upper gastrointestinal bleeding
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=== Traumatic injury ===
Traumatic bleeding is caused by some type of injury. There are different types of [[wound]]s which may cause traumatic bleeding. These include:{{cn|date=June 2022}}
* [[Abrasion (medical)|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 (skin)|epidermis]].
* [[Excoriation]] – In common with Abrasion, this is caused by mechanical destruction of the skin, although it usually has an underlying medical cause.
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* [[Ballistic trauma|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.{{cn|date=June 2022}}
=== Medical condition ===
"Medical bleeding" denotes hemorrhage as a result of an underlying medical condition (i.e. causes of bleeding that are not directly due to trauma). Blood can escape from [[blood vessel]]s as a result of 3 basic patterns of injury:{{cn|date=June 2022}}
* [[blood|Intravascular changes]] – changes of the blood within vessels (e.g. ↑ [[blood pressure]], ↓ [[clotting factors]])
* [[blood vessel|Intramural changes]] – changes arising within the walls of blood vessels (e.g. [[aneurysms]], [[aortic dissection|dissections]], [[arteriovenous malformation|AVMs]], [[vasculitides]])
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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 diathesis|bleeding diatheses]]. [[Hemostasis]] involves several components. The main components of the hemostatic system include [[platelets]] and the [[blood coagulation|coagulation]] system.
[[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 (for example Ibuprofen) 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.{{cn|date=June 2022}}
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.
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=== Infection ===
Infectious diseases such as [[Ebola]], [[Marburg virus disease]] and [[yellow fever]] can cause bleeding.{{cn|date=June 2022}}
== Diagnosis/Imaging ==
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===Classification===
[[File:Eye hemorrhage.jpg|thumbnail|A [[subconjunctival hemorrhage]] is a common and relatively minor post-[[LASIK]] complication.]]
[[Image:Pulmonary haemorrhage - high mag.jpg|thumb|right|[[Micrograph]] showing abundant [[hemosiderin]]-laden [[alveolar macrophage]]s (dark brown), as seen in a [[pulmonary hemorrhage]]. [[H&E stain]].]]
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==Management==
{{Main|Emergency_bleeding_control#Wound_management}}
{{
Acute bleeding from an injury to the skin is often treated by the application of direct pressure.<ref>{{cite web |title=Severe bleeding: First aid |url=https://www.mayoclinic.org/first-aid/first-aid-severe-bleeding/basics/art-20056661 |website=Mayo Clinic |access-date=15 June 2020 |language=en}}</ref> For severely injured patients, [[tourniquet]]s are helpful in preventing complications of [[shock (circulatory)|shock]].<ref>{{cite journal |last1=Scerbo |first1=MH |last2=Holcomb |first2=JB |last3=Taub |first3=E |last4=Gates |first4=K |last5=Love |first5=JD |last6=Wade |first6=CE |last7=Cotton |first7=BA |title=The Trauma Center Is Too Late: Major Limb Trauma Without a Pre-hospital Tourniquet Has Increased Death From Hemorrhagic Shock |journal=J Trauma Acute Care Surg |date=December 2017 |volume=83 |issue=6 |pages=1165–1172 |doi=10.1097/TA.0000000000001666 |pmid=29190257|s2cid=19121937 }}</ref> [[Anticoagulant]] medications may need to be discontinued and possibly reversed in patients with clinically significant bleeding.<ref>{{cite web |last1=Hanigan |first1=Sarah |last2=Barnes |first2=Geoffrey D |title=Managing Anticoagulant-related Bleeding in Patients with Venous Thromboembolism |url=https://www.acc.org/latest-in-cardiology/articles/2019/10/07/14/29/managing-anticoagulant-related-bleeding-in-patients-with-venous-thromboembolism |website=American College of Cardiology |access-date=15 June 2020}}</ref> Patients that have lost excessive amounts of blood may require a [[blood transfusion]].<ref>{{cite journal |last1=Nunez |first1=TC |last2=Cotton |first2=BA |title=Transfusion Therapy in Hemorrhagic Shock |journal=Curr Opin Crit Care |date=December 2009 |volume=15 |issue=6 |pages=536–41 |doi=10.1097/MCC.0b013e328331575b |pmid=19730099 |pmc=3139329}}</ref>
The use of [[Cyanoacrylate|cyanoacrylate glue]] to prevent bleeding and seal battle wounds was designed and first used in the [[Vietnam War]].<ref>{{cite news |last1=Harris |first1=Elizabeth A. |date=28 March 2011 |title=Harry Coover, Super Glue's Inventor, Dies at 94 |language=en |newspaper=The New York Times |url=https://www.nytimes.com/2011/03/28/business/28coover.html |access-date=2018-06-30}}</ref> Skin glue, a medical version of "super glue", is sometimes used instead of using traditional stitches used for small wounds that need to be closed at the skin level.<ref>{{Cite web |date=2018-06-26 |title=How do I care for a wound treated with skin glue? |url=https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/how-do-i-care-for-a-wound-treated-with-skin-glue/ |access-date=2022-12-10 |website=nhs.uk |language=en}}</ref>
==Etymology==
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== See also ==
* [[Aneurysm]]
* [[
* [[Anemia]]
* [[Coagulation]]
* [[Contusion]]
* [[Exsanguination]]
* [[Hematophagy
* [[Hemophilia]]
* [[Hematoma]]
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== External links ==
{{Medical resources
| DiseasesDB =
| ICD10 = {{ICD10|R|58||r|50}}
| ICD9 = {{ICD9|459.0}}
| |||