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Save whom you love, learn more about cases of bleeding! A scientific outlook

The day I started thinking seriously about joining pharmacy school was the day I started getting many medical queries from my family and relatives. “I broke my leg. What should I do?”, “I cannot see suddenly? Help me!”, “I sometimes faint, what should I eat?” they asked.

These were the queries I received while I was still “thinking” about studying this major. I thought then about the amount of queries I will get when I get my white coat and start matriculating at pharmacy school.

In my freshman year, I was visiting some relatives. And it was in the stars that their son had a bloody nose only minutes before It was time for me to leave their home. The whole family turned to me for help as if they are thinking “No worries. We got a doctor on board”. I felt I was in a tough situation that I needed to get out of immediately.

All I did was turning the child’s head backwards and putting an ice cube on his neck!

Thinking about what I did then, was this the right thing to do? Or did I endanger the life of this little boy?

This article will look into the best thing to do when somebody in your home, workplace or school is in the same situation. You will learn how to do the right thing if you were in my shoes!


Note that this article contains some scientific terms

Hemorrhage means loss of blood from an external wound or from mucous membrane, or internal hemorrhage.

Special terms of haemorrhage:

  • Epistaxis: bleeding from the nose.
  • Haematemesis: bleeding from the stomach.
  • Haemoptysis: bleeding from the respiratory tract (coughing of blood).
  • Melaena:bleeding per rectum.
  • Haematuria: blood passing by, with the urine.
  • Internal bleeding:as haemo-peritoneum, haemo-thorax and haemo-artharosis.

Classification of haemorrhage: According to the cause of haemorrhage :

  1. Traumatic hemorrhage:
    The trauma affects on the blood vessels, either direct trauma or indirect, causing tearing of blood vessels and subsequently, bleed automatically.
  2. Pathological hemorrhage:
    Due to disease implicating the vessel wall for example: vascularitis or infiltration by malignant tumor.
  3. Spontaneous hemorrhage: (Due to blood disease)
  • Thrombocytopenic purpura:
    Where the bleeding time is prolonged. while the clotting time is normal. It is characterized by quantitative deficiency of platelets. It is two types:
  1. Idiopathic thrombocytopenic purpura (unknown cause )
  2. Secondary thrombocyopenic purpura occurs in leukemia, hypersplenism, pancytopenia, multiple neoplastic deposits in the bone, toxaemic, fever and severe infections where the defect lies in the capillary wall.
  • Haemophilia:
    Where the bleeding time is normal, while the clotting time is prolonged. It is due to factor VIII (8). deficiency (AHF OrAHG ). It is a hereditary congenital disease affect usually males and very very rare affect females.
  • Scurvy:
    Where the capillary wall is unhealthy, it is due to vitamin c deficiency .Bleeding usually occurs from the mucous membrane of the buccal cavity and from upper respiratory tract
  • Sever anemia:
    Due to deficient clotting factors.
  • Jaundice:
    Hemorrhage, is either to deficient absorption of vitamin K from the bowel or due to, inability of the liver to produce prothrombin
  1. other classification of hemorrhage:
  • According to the bleeding vessel:
  • Arterial bleeding: it is synchronous with the heart beats, bright red in color, much more profuse from the proximal than from the distal end of the injured vessels.
  • venous bleeding: occurs in steady stream, it is dark red in color, and from the distal end of the injured vein.
  • capillary:consists of an oozing mixed blood from the surface.
  • According to the onset of hemorrhage:
  • primary hemorrhage: occurs immediately after trauma.
  • Reactionary hemorrhage: occur within 24 hours after the trauma or operation, it is due to restoration of the lowered blood pressure to the normal level.
  • Secondary hemorrhage: occurs, after many days of the trauma, or surgical operation, it is due to sepsis.

Effects of hemorrhage:

  1. Loss of fluid part, results in dehydration, disturbed metabolism, later hypotension and shock.
  2. Loss of corpuscular part
  3. Loss of red blood cells leads to lowering of oxygen leads to anoxia.
  4. Loss of white blood cells leads to lowering the resistance of the body.
  5. Loss of platelets count, leads to lowering of coagulation of the blood.
  6. The extent of primary effect of hemorrhage, depends on:
    a) the amount of blood loss.
    b) the rate of loss is very important.
    c) The age of the patient. Infants and old people tolerate bleeding badly.
    d) Associated diseases as anemia, sepsis, and blood diseases.

General manifestations: pallor, rapid weak respiration, rapid weak pulse, tinnitus, dimness of vession, restlessness, coldness and sweating (shocked),nausea and vomiting, mask face.

Treatment of hemorrhage:

  1. General measures:
    First aid treatment: Rest ,elevation of the bleeding part up, lowering of the head, warmth, oxygen inhalation, assurance, sedatives and coagulant as vitamin k intramuscular injection.
  2. Local measures:
    First aid treatment using digital pressure and tight bandage.
    Treatment of secondary hemorrhage:
  • Pressure on the vessel above, is tried first.
  • The wound is packed.
  • If the wound is still bleeds, refer to the hospital.

Treatment of internal hemorrhage:
Usually occurs, after trauma, whatever it is. Such internal bleeding, requires exploration, to stop the hemorrhage by the above mentioned ways. Sometimes when the main vessel of an organ is injured, that organ may be removed as spleen or kidney. 

Special cases of hemorrhage:

  1. Bleeding from the teeth:

It may occur, after extraction of the tooth or after trauma or accident or haemorrhagic blood diseases. 

How to deal with such case?

  • sit the patient on a chair.
  • Turn his head to the affected site.
  • Put a piece of compact gauze, on the site of bleeding and to be above the level.
  • Ask the patient to compress, firmly on the gauze for about 10-20 minutes.It is more easier to put the elbow joint of the patient on table and support the affected jaw with the palm of the hand of the patient.
  • If the bleeding doesn't stop, refer the patient to the dentist.
  1. Bleeding from the nose (epistaxis):
    It is usually unilateral, but may occur bilateral.
    Causes of bleeding:
  2. local causes:
  • idiopathic bleeding from (little's area):is the commonest cause in adolescence.
  • congenital anomalies:in the septum.
  • trauma: as direct blow to the nose, operative trauma or sharp foreign body
  • Inflammatory: atrophic rhinitis when the crusts separated.
  • Tumor: benign, as papilloma or angioma in the nose. Malignant tumor as naso-pharyngioma.
  • Deviated septum: Bleeding, may arise from convex or concave side.
  • causes in the nasopharynx: as adenoids.
  • The nose may be an outlet of bleeding from the inside of the skull ( fracture base of the skull).
  1. General causes:
  • Arteriosclerosis, hypertension, puberty and violent exercise.
  • High venous pressure, as occurs in mitral stenosis.
  • Fevers, any rise of temperature specially in the children may lead to epistaxis
  • Drugs, specially anticoagulants as heparin and salicylates
  • Blood disease, as hemophilia, leukemia, purpura and jaundice (vitamin k deficiency) or scurvy (vitamin c deficiency).

How to manage a case:

  1. Rest with the head forward (semi -sitting position).
  2. Cold compresses on the forehead.
  3. Removal of any tight or heavy clothes.
  4. Pinching the alae of the nose, between two fingers to compress on the little area, after spitting any clot or oozing discharge.
  5. Adrenaline on a piece of cotton or Vaseline gauze to be put it inside the nostril of the nose (anterior nasal pack) and give vitamin k ampule intramuscular.
  6. If the bleeding is still present, refer to the hospital.
  7. Bleeding from the ear:
    It may be occurs as a result of wound in the ear or entrance of sharp foreign body inside the ear or from hemorrhagic blood diseases or fracture base.
    Treatment of bleeding from the ear:
  • Help the patient to be calm and turn his head to the side of the affected ear .cover the ear completely with sterile dressing, fix it and tie well.
  • Don't put anything inside the ear .Refer the patent to the hospital, for more evaluation.


To know how to treat some common cases of bleeding such as nose bleeding and bleeding ear and teeth, click on the following link:

Colgate oral care center WEBMD Health Grades
Dina Sabbah
Pharmacist, Al Azhar University of Gaza graduate. Interested in health awareness .