What is a hemorrhage?
At its most basic, excessive blood loss is medically termed a hemorrhage. A hemorrhage occurs when blood escapes from a damaged blood vessel. This can be either an external hemorrhage, where blood exits the body through a wound or natural opening, or an internal hemorrhage, where blood pools inside the body. A seemingly minor scrape that bleeds for an extended period is a minor external hemorrhage, while a ruptured aneurysm causing bleeding in the brain is a major internal one. The severity of the hemorrhage depends on the amount of blood lost and how quickly it happens. Minor bleeding can often be controlled by the body's natural clotting process, a procedure called hemostasis. However, with excessive bleeding, the body's compensatory mechanisms can be overwhelmed, leading to more serious medical consequences.
The progression to hemorrhagic shock
When excessive blood loss becomes severe enough to prevent the heart from pumping enough blood to the vital organs, it can cause a state of shock. Hemorrhagic shock is a specific type of hypovolemic shock caused by severe bleeding, as opposed to other fluid losses from burns or severe dehydration. A person's prognosis depends heavily on the amount and rate of blood loss and how quickly they receive medical attention. Doctors classify the severity of hemorrhagic shock into four stages, based on the percentage of blood volume lost:
- Class I: Loss of up to 15% of total blood volume. There are usually no major changes in vital signs, and symptoms may be minimal.
- Class II: Loss of 15% to 30% of blood volume. The heart rate increases, and the difference between systolic and diastolic blood pressure narrows. Signs of peripheral vasoconstriction (pale, cool skin) may appear.
- Class III: Loss of 30% to 40% of circulating blood volume. The patient's blood pressure drops significantly, and mental status worsens due to poor perfusion. Fluid and blood transfusions are typically required.
- Class IV: Loss of over 40% of blood volume. This represents a life-threatening emergency where the body's compensatory mechanisms have failed. Immediate, aggressive resuscitation is needed to prevent death.
Causes of excessive bleeding
Excessive blood loss can stem from a variety of causes, from traumatic injuries to underlying medical conditions. Some of the most common reasons for severe bleeding include:
- Traumatic injury: Car accidents, falls, gunshot wounds, deep lacerations, and other severe injuries are frequent causes of hemorrhage.
- Surgical complications: Blood loss can occur during or after surgical procedures.
- Gastrointestinal bleeding: Conditions like peptic ulcers, gastritis, or cancer can cause internal bleeding in the digestive tract, which may manifest as bloody or black, tarry stools, or bloody vomit.
- Postpartum hemorrhage (PPH): This is a severe complication of childbirth, involving heavy vaginal bleeding after delivery.
- Ectopic pregnancy: A life-threatening condition where a fertilized egg implants outside the uterus, which can rupture and cause massive internal bleeding.
- Aneurysms: A ruptured aneurysm, especially in the brain (intracranial hemorrhage) or aorta, can be fatal.
- Blood clotting disorders: Inherited conditions like hemophilia or von Willebrand disease, as well as liver disease and some cancers, can impair the body's ability to form blood clots effectively.
- Medications: Certain drugs, particularly anticoagulants (blood thinners) and some nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, can increase bleeding risk.
Recognizing the symptoms of a hemorrhage
Recognizing the signs of excessive blood loss is critical for seeking timely medical help. The symptoms vary depending on the location and severity of the bleeding. For external bleeding, the wound itself is the most obvious sign. For internal bleeding, symptoms can be more subtle but often include:
- Signs of Shock: Cool, clammy, or pale skin; rapid, weak pulse; rapid breathing; confusion or altered mental status; anxiety or agitation.
- Dizziness and weakness: A feeling of lightheadedness or overall weakness can occur from reduced blood volume.
- Internal Bleeding-specific signs: Abdominal pain and swelling, chest pain, blood in urine or stool, bloody vomit, or heavy vaginal bleeding.
Emergency first aid and medical treatment
If you suspect excessive blood loss, it is a medical emergency. For severe external bleeding, immediately call emergency services and then apply direct, firm pressure to the wound with a clean cloth or sterile gauze. Elevate the injured limb above the heart if possible. Do not remove any embedded objects; apply pressure around them instead. In cases of life-threatening bleeding from a limb where direct pressure fails, a tourniquet may be used, but only if you are properly trained.
Hospital treatment
Once in a hospital, treatment will focus on stabilizing the patient, stopping the bleeding, and replacing lost fluids and blood. A healthcare team will determine the source of the bleeding using diagnostic tools like imaging tests (CT scans, ultrasounds). Treatment options may include:
- IV fluids and blood transfusions: To restore lost blood volume and oxygen-carrying capacity.
- Medications: Depending on the cause, medications may be given to help with clotting, increase blood pressure, or reverse the effects of certain drugs.
- Surgery: To repair damaged blood vessels or organs and stop the bleeding at its source.
Hemorrhage vs. Hematoma: A crucial distinction
| Feature | Hemorrhage | Hematoma |
|---|---|---|
| Definition | General term for excessive blood loss from a damaged blood vessel. | Localized collection or pooling of blood outside the blood vessels, often clotted. |
| Appearance | Can be external (visible) or internal (hidden within tissues or body cavities). | Typically appears as a bruise under the skin, or a mass of clotted blood within a tissue or organ. |
| Severity | Can range from minor to life-threatening, depending on the volume and rate of blood loss. | Often minor and resolves on its own, but can be serious if it puts pressure on vital organs, such as in the brain. |
| Examples | Severe bleeding from a deep cut, internal bleeding from an organ rupture, postpartum bleeding. | A large bruise, a swollen mass under the scalp after a head injury. |
Conclusion
Understanding what is excessive blood loss called is the first step toward recognizing a potentially life-threatening medical emergency. While the term “hemorrhage” is the broad medical term, the specific implications, such as progressing to hemorrhagic shock, highlight the urgency of the situation. Rapid recognition of symptoms and immediate, appropriate first aid can be critical for improving the chances of a positive outcome. For any suspected severe bleeding, always prioritize calling emergency medical services immediately.
For more detailed information on emergency response to bleeding, consider reviewing resources like the American Red Cross's guidelines on first aid for life-threatening external bleeding: American Red Cross: Bleeding (Life-Threatening External).
