Bleeding is known as hemorrhage in medical terms. It actually means blood loss from the body either due to external or internal causes. Bleeding can be life threatening if there is massive blood loss and person can go in coma due to reduced blood supply to brain or can die due the heart failure. Death from the loss of blood volume is generally known as exsanguination.

Following are some possible sites of bleeding.

  • Bleeding can be inside the body from damaged vessel or organs.

  • Bleeding can be outside the body from a break in the continuity of skin

  • Bleeding can take place from natural orifices such as mouth, nose, ears, anus and vagina.


Bleeding can be the result of some trauma, injuries or can be due to some underlying diseases.

Traumatic conditions: In case of road traffic accidents, a fall from height, gun shot injuries, crushing injuries, puncture wounds by needles or knife, damage to some vessel or abrasions etc.


■  Medical conditions: There are also a number of diseases which can cause bleeding either internally or from natural orifices. These include :

  • Liver diseases

  • Hemophilia (a condition in which there is lack of clotting factors in blood)

  • Vitamin K deficiency

  • Brain trauma

  • Thrombocytopenia (low number of platelets in the body)

  • Obstruction in anywhere in the gastrointestinal tract.


Bleeding is classified as follow according to the World Health Organization (WHO)

  • Grade 0 : It is refers to as zero or no bleeding.
  • Grade 1 : It refers to Petechial Bleeding. It is a type of bleeding occurring underneath the skin. Examples are bruising etc.
  • Grade 2 : Bleeding of Grade 2 is clinically significant. It refers to mild blood loss.
  • Grade 3 : When blood loss is severe it is called Grade 3 bleeding. It requires Blood Transfusion and is defined and gross blood loss.
  • Grade 4 : It is the debilitating form of Bleeding. It occurs in Retina (causing blindness) or Brain (causing Brain Haemorrhage) which is Fatal.




Human body has got an excellent mechanism to limit the loss of blood. This system contains a combination of platelets and coagulation factors. These components start to function as soon as the bleeding starts. However, insufficient functioning of these factors can lead to excessive bleeding, which can lead to a number of complications. Some of these complications include:

  • Inadequate supply of blood to several organs leading to the death of these organs.

  • Development of pressure in closed cavities. For example hemorrhage in cranial cavity can lead to excessive compression of brain and spinal cord.

  • Chronic bleeding can lead to excessive loss of essential nutrients from body like iron leading to the development of anemia.

  • Massive loss of blood over short period of time, as happens in accidents, can lead to the development of a condition called “cardiogenic shock”.

  • Since blood is essential for supplying all body tissues with valuable oxygen and nutrients, loss of blood will hamper this process. Excessive loss of blood, if left untreated, can lead to death.




Management of bleeding depends on a number of factors including site of injury, extent of blood loss etc. Depending on the site of blood loss, internal or external, management options of bleeding include:


  • For external bleeding:

Following the options for the management of external bleeding:

  • Apply pressure on the damaged area.

  • If vessels or arteries are exposed, apply direct pressure on the damaged arteries and veins.

  • Elevate the damaged limb so that blood loss from site can be minimized.

  • Use ice packing and rub the affected area with these packings. It will help constrict the blood vessels and limit the loss of blood.


  • For internal bleeding:

Following steps should be taken to manage internal bleeding:

  • Ask the patient to lie down.

  • Use intravenous morphine.

  • If the bleeding is excessive, refer the patient to hospital so that he/she can be infused with blood or plasma to make up for the loss of blood.