Hemorrhage

Bleeding injuries that happen within the body can be much more dangerous than bleeding on the outside. Bleeding on the outside is noticeable and visible and can be quickly treated. Bleeding on the inside may go unnoticed for hours and symptoms may not develop for some time, leading to internal injury and damage. 

Internal hemorrhage can cause different types of injuries and damage depending on where the bleed occurs and what organs are affected. Some of the most serious types of internal hemorrhage involve bleeding in the brain, skull, or spinal cord. Brain hemorrhage and spinal hemorrhage can cause permanent injury or death.

Hemorrhage can be caused by a traumatic event, like a car accident, or have a non-traumatic cause, including disease, medical malpractice, or blood disorders. If a hemorrhage is not diagnosed in time or is not properly treated, it can lead to serious injury

What is a Hemorrhage?

Hemorrhage is a term for bleeding. A person can hemorrhage blood on the outside of the body or the inside. The information on this page focuses on internal bleeding. An internal hemorrhage involves blood leaking out of damaged blood vessels, veins, arteries, capillaries, or the heart. 

The impact of a hemorrhage depends on a number of factors, including the location of the bleed, amount of blood, rate of blood loss, health of the patient, and treatment of the injury. A minor hemorrhage can resolve on its own. Major hemorrhaging may require medication, blood transfusions, or surgery. In some cases, a hemorrhage can cause permanent injury, including brain damage or paralysis.  

Hemorrhage is sometimes confused with hematoma. These terms are related but different. A hematoma generally refers to bleeding which has clotted and a hemorrhage involves active and ongoing bleeding. 

Injuries Caused by Hemorrhage

The injuries caused by a hemorrhage can depend on the type of hemorrhage and where the bleeding occurred. The most serious injuries caused by hemorrhage include shock, brain damage from a brain bleed, and spinal cord damage from a spinal bleed. 

Shock is the body's reaction to an interruption in the normal blood flow in the body. When organs do not get enough oxygenated blood to properly function, the body compensates by shutting down blood flow to some areas of the body to focus blood flow to the brain, heart, and other vital organs. If the system is not restored, the body can begin to break down, leading to cell damage, organ failure, and death.

Shock from bleeding can include hemorrhagic and hypovolemic shock. Hemorrhagic shock is caused by the loss of blood. Hypovolemic shock occurs when there is a decrease in the volume of blood in the body that can compromise the body's ability to pump blood and oxygen throughout the body.

The first signs of hemorrhagic or hypovolemic shock may include tachycardia, or a rapid heart rate. The body may try and speed up the heart rate to get blood and oxygen supplied to the rest of the body. Peripheral vasoconstriction can also restrict flow to the outer vessels and capillaries, giving the individual cold fingers and toes. Other signs and symptoms of shock include: 

  • Low blood pressure
  • Delayed capillary refill
  • Confusion 
  • Rapid breathing
  • Anxiety
  • Loss of consciousness

Where a Hemorrhage Can Occur

Hemorrhage can occur anywhere there is blood supplied throughout the body. Tissues and organs in the body require a steady supply of oxygenated blood to function. As part of the circulatory system, blood vessels extend to just about every part of the body. A hemorrhage can occur anywhere a blood vessel is damaged and leaks blood. 

Brain Hemorrhage

Brain hemorrhage involves bleeding inside the skull. There are many protective layers between the brain and the skull and intracranial hemorrhage can be categorized based on where the bleed occurs, including: 

  • Epidural hemorrhage
  • Subdural hemorrhage
  • Subarachnoid hemorrhage
  • Intracerebral hemorrhage 
  • Intraventricular hemorrhage

Bleeding inside the skull can cause swelling, known as cerebral edema. Cerebral edema can increase the pressure inside the skull, which damages the sensitive brain tissue and kills brain cells. Damage to the brain can also be caused by a lack of oxygen when the brain is not getting a regular supply of oxygenated blood. The brain bleed and edema can both restrict the amount of oxygen that gets to the brain, triggering brain cell death, and eventual death.

Injuries caused by a brain bleed generally depend on the extent of the bleeding, amount of time the brain has been deprived of oxygen, or the amount of time the brain has been under intracranial pressure. Injuries can include permanent brain damage, stroke, coma, vegetative state, seizures, and permanent changes in behavior. 

The signs and symptoms of a brain hemorrhage may depend on the extent of the bleeding, age of the patient, and patient's overall health. In some cases, a minor brain bleed can resolve itself on its own. Some of the signs of a possible brain bleed may include:  

  • Loss of consciousness
  • Sudden and severe headache
  • Weakness on one side of the body
  • Blurred vision or changes in vision 
  • Vertigo 
  • Difficulty speaking or understanding
  • Difficulty concentrating
  • Numbness and tingling
  • Nausea and vomiting
  • Sensitivity to light or noise
  • Irritability 
  • Seizure

Spinal Cord Hemorrhage

Spinal cord hemorrhage is less common than brain hemorrhage but can be just as devastating.  Bleeding in and around the spinal cord can be caused by trauma, medical errors, or other health conditions. 

Like the brain, the spinal cord is surrounded by layers of meninges, or tissue around the central canal. Bleeding within these layers can increase pressure in the spinal cord and block the cerebrospinal fluid (CSF). This can prevent neural transmissions between the brain and the rest of the body, causing pain, weakness, and paralysis.  

Spinal bleeds are more often caused by traumatic events, including falls, car accidents, and gunshot wounds. However, there may be non-traumatic causes of a spinal cord hemorrhage, including: 

  • Vascular malformations
  • Tumors
  • Bleeding disorders 
  • Syphilis
  • Syrinx
  • Myelitis

The signs and symptoms of a spinal hemorrhage generally include acute onset of severe pain in the neck or back. Spinal hemorrhage can result in permanent spinal cord damage. The extent of the damage can depend on the location on the spinal cord where the bleeding occurred, and can cause permanent injury, including: 

  • Paralysis, 
  • Bladder dysfunction, 
  • Bowel dysfunction,
  • Walking impairment, 
  • Weakness, 
  • Pain, and
  • Sexual dysfunction.

Pulmonary Hemorrhage in the Lungs

Pulmonary hemorrhage is bleeding in the lungs, upper respiratory tract, trachea, or alveoli. Bleeding in the lungs can cause swelling, or pulmonary edema. Bleeding in the lungs is a rare but serious event for infants, and can be related to prematurity. The signs of possible pulmonary hemorrhage in birth may be characterized by bloody fluid from the nose and mouth with worsening of respiratory status, cyanosis, and shock. 

Gastrointestinal Bleeds

Gastrointestinal (GI) bleeding may be a sign of a disorder or condition in the digestive tract. A GI bleed can occur anywhere in the tract, including esophagus, stomach, small intestine, colon, rectum, or anus. Signs of a GI bleed can vary, depending on where the bleeding occurs, and can include:

  • Red vomit
  • Vomit that looks like coffee grounds
  • Black or tarry stool
  • Dark blood in the stool
  • Bright red blood in the stool. 

Endoscopy or a colonoscopy can be used to look for damage or the cause of a GI bleed. There may be many causes of a GI bleed, including:

  • Traumatic injury
  • Hemorrhoids
  • Ulcers
  • Diverticulitis
  • Ulcerative colitis
  • Crohn's disease
  • Polyps
  • Colon cancer
  • Stomach cancer
  • Esophagitis

If a GI bleed is serious or not treated, it can lead to shock caused by the loss of blood. 

Causes of Hemorrhage

Hemorrhage can be caused by a number of factors. This includes forces outside the body like a traumatic accident as well as illness, disease, and genetic abnormalities. Some hemorrhage can be caused by medical treatment, such as a surgery that goes wrong, leaving the patient with internal bleeding injuries. In treating a hemorrhage, identifying the cause can focus the treatment on stopping the uncontrolled bleeding. 

Accidents and Hemorrhage

The most common causes of bleeding are accidental injury and violence. Some of the most common causes of serious bleeding include: 

When an accident causes external bleeding, the injury victim may focus on what they can see and feel. Major external bleeding can require emergency medical treatment. Minor external bleeding, including lacerations or abrasions, may just need to be cleansed and dressed. Internal bleeding close to the skin often occurs after an accident as a type of hematoma, contusion, or bruise, where blood pools under the skin.  

The injury victim may not notice internal bleeding and it may require a medical evaluation to identify bleeding inside the skull, abdomen, organs, or where a hematoma is at risk of causing more serious injuries. 

The signs and symptoms of a hematoma may occur within minutes after an accident or could take hours or days to develop. It is always a good idea to get a medical evaluation after an accident to make sure there are not more serious problems that are not immediately evident. This can be even more important when an injury involves a blow to the head, loss of consciousness, or injury to the neck or back. 

Diagnosing a hemorrhage may depend on where it occurs in the body. In many cases, a doctor or medical professional will need to use imaging devices to identify bleeding within the body. Imaging devices that can help identify possible edema (swelling), suspicious masses, or abnormal bleeding include: 

  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT)

Non-Traumatic Causes of Bleeding

Bleeding and hemorrhage can involve a number of non-traumatic causes, including medical conditions, diseases, infection, blood disorders, genetic disorders, or medications. Some people live with an increased risk of hemorrhage for their whole life but many are related to a later onset of health conditions or medical treatment. 

Medical Conditions and Blood Disorders

Medical conditions and blood disorders may make it more likely for someone to bleed or have a blood vessel tear. Other genetic or acquired conditions can make it difficult to clot and stop the bleeding. Some of the conditions that increase the risk of bleeding include: 

  • Hemophilia
  • Von Willebrand disease
  • Wiskott–Aldrich syndrome
  • Sickle cell anemia
  • Brain tumor
  • Amyloid angiopathy
  • Leukemia
  • Liver disease
  • Menorrhagia
  • High blood pressure
  • Thrombocytopenia
  • Vitamin K deficiency
  • Colon diverticulosis
  • Cancer
  • Acute bronchitis
  • Blood vessel abnormalities

Medication and Increased Risk of Bleeding

Many medications can increase the risk of bleeding or inhibit the ability to clot. For some medications, the bleeding risk is a side effect but some medications are used specifically for their anticoagulant properties. Blood thinners are used to treat a number of conditions, including people who have had a previous blood clot or are at risk of having blood clots. Blood thinners and anticoagulants include: 

  • Coumadin or warfarin
  • Heparin
  • Xarelto
  • Eliquis
  • Pradaxa

Hemorrhages in Pregnancy and Childbirth

Pregnancy and childbirth are stressful on the body of the mother and baby. When something goes wrong, it can become a medical emergency to save the mother and the life of the unborn child. Subchorionic bleeding is not uncommon during the first and second trimester of pregnancy. This involves a collection of blood between the womb and the gestational membranes and may cause vaginal bleeding.

Hemorrhage in the mother may be most dangerous after giving birth. Postpartum hemorrhage (PPH) is heavy bleeding after birth. The timing of PPH can occur directly after the child is born or it can be delayed for months. Some blood loss is normal in childbirth but serious blood loss that is not properly treated can lead to shock and death. Signs of postpartum hemorrhage can include:

  • Heavy bleeding that does not stop
  • Drop in blood pressure
  • Chills 
  • Tachycardia
  • Confusion or dizziness
  • Sleepiness
  • Nausea
  • Pale, cold, and clammy skin
  • Swelling around the vagina or perineum
  • Loss of consciousness

Birth Injuries and Hemorrhages

Hemorrhage can be very traumatic in infants and young children. Some of the common birth injuries involving hemorrhage include brain bleeds and bleeding in the eyes. 

Intracranial Hemorrhage

A child's brain is still developing and can be more sensitive to injury. Bleeding in the skull for a young child can cause permanent brain damage. Bleeding that leads to a birth injury can be caused by negligent medical care during delivery. Delayed diagnosis of an internal injury can also increase the risk of harm and permanent damage. 

Intracranial hemorrhages can occur during childbirth. This is often associated with difficult births that involve head trauma during the delivery process. Pulling or twisting of the baby's head can cause bleeding into the brain. Use of forceps or suction devices can also increase the risk of a brain bleed, which can lead to serious and permanent injury, including: 

  • Mental disabilities
  • Physical disabilities
  • Epilepsy

Subarachnoid hemorrhage is among the most common intracranial bleeds in newborns. Trauma-induced brain bleeds can be more likely in cases involving: 

  • Macrosomia: Large babies, weighing more than 8 pounds, 13 ounces that may be more difficult to deliver through the birth canal and pelvis.
  • Cephalopelvic Disproportion (CPD). Large fetus, small pelvis, a fetus that is poorly oriented in the womb, or a combination of these factors can make delivery more difficult.
  • Improper delivery techniques.

Subconjunctival Hemorrhage in the Eyes

Subconjunctival hemorrhage is bleeding under the conjunctiva, which is the thin, moist, transparent membrane that covers the white part of the eye. This is the outermost protective coating of the eyeball and contains nerves and small blood vessels. The benefit of an eye hemorrhage (compared to other hemorrhages) is that it is visible and relatively simple to diagnose.  

Subconjunctival hemorrhages are not uncommon and generally go away after a period of time. As it heals, the patch will reduce in size and may change color. However, it may be a signal that there may be other, more serious, damage to the eye or head. It may also be a sign of a traumatic delivery. Parents should monitor the hemorrhage and seek medical advice with any questions or concerns. 

Medical Malpractice and Hemorrhage

Negligent medical treatments can cause a patient to suffer a hemorrhage, including procedures like back surgery, childbirth, or an epidural. Negligent treatment may also increase the harm of a hemorrhage by failing to diagnose or properly treat the bleed or delayed diagnosis that reduces the chance of recovery. 

If you or a loved one suffered a bleeding injury after a medical mistake, talk to an experienced medical malpractice attorney about getting compensation for your injuries, medical bills, and pain and suffering. Do not hesitate to contact Gilman & Bedigian today for a free consultation.

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