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"Hemorrhage" and "Haemorrhage" redirect here. For the song by Fuel, see Hemorrhage (In My Hands). For the band, see Haemorrhage (band).
For the deliberate extraction of blood, see Bloodletting. For other uses, see Bleeding (disambiguation).
Classification and external resources
Bleeding finger.jpg
A bleeding human finger
ICD-10 R58
MedlinePlus 000045
MeSH D006470

Bleeding, technically known as hemorrhaging or hæmorrhaging (see American and British spelling differences), is blood escaping from the circulatory system.[1] Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally, either through a natural opening such as the mouth, nose, ear, urethra, vagina or anus, or through a break in the skin. Hypovolemia is a massive decrease in blood volume, and the complete loss of blood, causing death, is referred to as exsanguination.[2] Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious medical difficulties (by comparison, blood donation typically takes 8–10% of the donor's blood volume).[3] The stopping or controlling of bleeding is called hemostasis and is an important part of both first aid and surgery.


The word "Haemorrhage" comes from Latin haemorrhagia, from Ancient Greek αἱμορραγία (haimorrhagía, “a violent bleeding”), from αἱμορραγής (haimorrhagḗs, “bleeding violently”), from αἷμα (haîma, “blood”) + -ραγία (-ragía), from ῥηγνύναι (rhēgnúnai, “to break, burst”).


Micrograph showing abundant hemosiderin-laden alveolar macrophages (dark brown), as seen in a pulmonary hemorrhage. H&E stain.

Blood loss[edit]

Hemorrhaging is broken down into four classes by the American College of Surgeons' advanced trauma life support (ATLS).[4]

  • Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient may exhibit slight changes in behavior. Volume resuscitation with crystalloids (Saline solution or Lactated Ringer's solution) is all that is typically required. Blood transfusion is not typically required.
  • Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's blood pressure drops, the heart rate increases, peripheral hypoperfusion (shock), such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary.



World Health Organization[edit]

The World Health Organization made a standardized grading scale to measure the severity of bleeding.[5]

Grade 0 no bleeding
Grade 1 petechial bleeding;
Grade 2 mild blood loss (clinically significant);
Grade 3 gross blood loss, requires transfusion (severe);
Grade 4 debilitating blood loss, retinal or cerebral associated with fatality



Bleeding arises due to either traumatic injury, underlying medical condition, or a combination.

Traumatic Injury[edit]


  • Hematoma - Caused by damage to a blood vessel that in turn causes blood to collect under the skin.
  • 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


Medical condition[edit]

'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 vessels as a result of 3 basic patterns of injury:

The underlying scientific basis for blood clotting and hemostasis is discussed in detail in the articles, Coagulation, hemostasis and related articles. The discussion here is limited to the common practical aspects of blood clot formation which manifest as bleeding.





Deficiencies of platelet function may require platelet transfusion while deficiencies of clotting factors may require transfusion of either fresh frozen plasma or specific clotting factors, such as Factor VIII for patients with hemophilia.

Condition Prothrombin time Partial thromboplastin time Bleeding time Platelet count
Vitamin K deficiency or warfarin Prolonged Normal or mildly prolonged Unaffected Unaffected
Disseminated intravascular coagulation Prolonged Prolonged Prolonged Decreased
Von Willebrand disease Unaffected Prolonged or unaffected Prolonged Unaffected
Hemophilia Unaffected Prolonged Unaffected Unaffected
Aspirin Unaffected Unaffected Prolonged Unaffected
Thrombocytopenia Unaffected Unaffected Prolonged Decreased
Liver failure, early Prolonged Unaffected Unaffected Unaffected
Liver failure, end-stage Prolonged Prolonged Prolonged Decreased
Uremia Unaffected Unaffected Prolonged Unaffected
Congenital afibrinogenemia Prolonged Prolonged Prolonged Unaffected
Factor V deficiency Prolonged Prolonged Unaffected Unaffected
Factor X deficiency as seen in amyloid purpura Prolonged Prolonged Unaffected Unaffected
Glanzmann's thrombasthenia Unaffected Unaffected Prolonged Unaffected
Bernard-Soulier syndrome Unaffected Unaffected Prolonged Decreased or unaffected
Factor XII deficiency Unaffected Prolonged Unaffected Unaffected
C1INH deficiency Unaffected Shortened Unaffected Unaffected

See also[edit]


  1. ^ "Bleeding Health Article". Healthline. Retrieved 2007-06-18. 
  2. ^ "Dictionary Definitions of Exsanguination". Retrieved 2007-06-18. 
  3. ^ "Blood Donation Information". UK National Blood Service. Archived from the original on 2007-09-28. Retrieved 2007-06-18. 
  5. ^ Webert KE, Cook RJ, Sigouin CS, et al. The risk of bleeding in thrombocytopenic patients with acute myeloid leukemia. haematologica 2006;91:1530-1537
  6. ^ Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ (December 2008). "Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome". Fertil. Steril. 93 (3): 874–879. doi:10.1016/j.fertnstert.2008.10.028. PMID 19064264.