Bleeding and Home Remedies

Bleeding, hemorrhage, or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vagina, or anus or through a wound in the skin. The stopping or controlling of bleeding is called hemostasis and is an important part of both first aid and surgery. The use of cyanoacrylate glue to prevent bleeding and seal battle wounds was designed and first used in the Vietnam War. Today many medical treatments use a medical version of “super glue” instead of using traditional stitches used for small wounds that need to be closed at the skin level.

Bleeding Definition

Bleeding is the loss of blood. It can be external, or outside the body, like when you get a cut or wound. It can also be internal, or inside the body, like when you have an injury to an internal organ.

Bleeding Types

Upper head

• Intracranial hemorrhage – bleeding in the skull.
• Cerebral hemorrhage – a type of intracranial hemorrhage, bleeding within the brain tissue itself.
• Intracerebral hemorrhage – bleeding in the brain caused by the rupture of a blood vessel within the head.
• Subarachnoid hemorrhage (SAH) implies the presence of blood within the subarachnoid space from some pathologic process. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from the rupture of a berry aneurysm or arteriovenous malformation (AVM).

Eyes

• Subconjunctival hemorrhage – bloody eye arising from a broken blood vessel in the sclera (whites of the eyes). Often the result of strain, including sneezing, coughing, vomiting, or another kind of strain

Nose

• Epistaxis – nosebleed

Mouth

• Tooth eruption – losing a tooth
• Hematemesis – vomiting fresh blood
• Hemoptysis – coughing up blood from the lungs

Lungs

• Pulmonary hemorrhage

Gastrointestinal

• Upper gastrointestinal bleed
• Lower gastrointestinal bleed
• Occult gastrointestinal bleed

Urinary tract

• Hematuria – blood in the urine from urinary bleeding

Gynecologic

• Vaginal bleeding

Postpartum hemorrhage

Breakthrough

• Ovarian bleeding – This is a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome undergoing transvaginal oocyte retrieval.

Anus

• Melena – upper gastrointestinal bleeding
• Hematochezia – lower gastrointestinal bleeding, or brisk upper gastrointestinal bleeding

Vascular

• Ruptured aneurysm
• Aortic transection
• Iatrogenic injury

Bleeding Causes

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

Traumatic injury

Traumatic bleeding is caused by some type of injury. There are different types of wounds that may cause traumatic bleeding. These include:

• Abrasion – Also called a graze, this is caused by transverse action of a foreign object against the skin, and usually does not penetrate below the epidermis.
• Excoriation – In common with Abrasions, this is caused by mechanical destruction of the skin, although it usually has an underlying medical cause.
• Hematoma – Caused by damage to a blood vessel that in turn causes blood to collect in an enclosed area.
• Laceration – Irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing such as in childbirth. In some instances, this can also be used to describe an incision.
• Incision – A cut into a body tissue or organ, such as by a scalpel, made during surgery.
• Puncture Wound – Caused by an object that penetrated the skin and underlying layers, such as a nail, needle, or knife.
• Contusion – Also known as a bruise, this is a blunt trauma damaging tissue under the surface of the skin.
• Crushing Injuries – Caused by a great or extreme amount of force applied over a period of time. The extent of a crushing injury may not immediately present itself.
• 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.

Pattern of injury

The pattern of injury, evaluation, and treatment will vary with the mechanism of the injury. Blunt trauma causes injury via a shock effect; delivering energy over an area. Wounds are often not straight and unbroken skin may hide the significant injury. Penetrating trauma follows the course of the injurious device. As the energy is applied in a more focused fashion, it requires less energy to cause significant injury.

Any body organ, including bone and brain, can be injured and bleed. Bleeding may not be readily apparent; internal organs such as the liver, kidney, and spleen may bleed into the abdominal cavity. The only apparent signs may come with blood loss. Bleeding from a bodily orifice, such as the rectum, nose, or ears may signal internal bleeding, but cannot be relied upon. Bleeding from a medical procedure also falls into this category.

Medical condition

“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:

• Intravascular changes – changes in the blood within vessels (e.g. blood pressure, blood clotting factors)
• Intramural changes – changes arising within the walls of blood vessels (e.g. aneurysms, dissections, AVMs, vasculitides)
• Extravascular changes – changes arising outside blood vessels (e.g. H pylori infection, brain abscess, brain tumor)

Some medical conditions can also make patients susceptible to bleeding. These are conditions that affect the body’s normal hemostatic (bleeding-control) functions. Such conditions either are or cause, bleeding diatheses. Hemostasis involves several components. The main components of the hemostatic system include platelets and the coagulation system.

Platelets

These are small blood components that form a plug in the blood vessel wall that stops bleeding. Platelets also produce a variety of substances that stimulate the production of a blood clot. One of the most common causes of increased bleeding risk is exposure to nonsteroidal anti-inflammatory drugs (NSAIDs).

Coagulation factors

There are several named coagulation factors that interact in a complex way to form blood clots, as discussed in the article on coagulation. Deficiencies of coagulation factors are associated with clinical bleeding. For instance, deficiency of Factor VIII causes classic hemophilia A while deficiencies of Factor IX cause “Christmas disease”(hemophilia B).

Antibodies to Factor VIII can also inactivate Factor VII and precipitate bleeding that is very difficult to control. This is a rare condition that is most likely to occur in older patients and in those with autoimmune diseases.

Medication-related bleeding

In addition to NSAID-related bleeding, another common cause of bleeding is that related to the medication, warfarin (“Coumadin” and others). This medication needs to be closely monitored as the bleeding risk can be markedly increased by interactions with other medications.

Warfarin acts by inhibiting the production of Vitamin K in the gut. Vitamin K is required for the production of the clotting factors, II, VII, IX, and X in the liver. One of the most common causes of warfarin-related bleeding is taking antibiotics. The gut bacteria make vitamin K and are killed by antibiotics. This decreases vitamin K levels and therefore the production of these clotting factors.

Platelet deficiencies

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.

Infection

Infectious diseases such as Ebola, Marburg virus disease, and yellow fever can cause bleeding.

Bleeding Diagnosis/Imaging

Dioxaborolane chemistry enables radioactive fluoride (¹⁸F) labeling of red blood cells, which allows for positron emission tomography (PET) imaging of intracerebral hemorrhages.

Bleeding Classification

Blood loss

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

• Class I Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.
• Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heartbeat) with a reduction in the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction.
• Class III Hemorrhage involves losing 30-40% of circulating blood volume. The patient’s blood pressure drops, the heart rate increases, peripheral hypoperfusion (shock) with diminished capillary refill occurs, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion is usually necessary.
• Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body’s compensation is reached and aggressive resuscitation is required to prevent death.

This system is basically the same as used in the staging of hypovolemic shock.

Cardiovascular collapse

Individuals in excellent physical and cardiovascular shape may have more effective compensatory mechanisms before experiencing cardiovascular collapse. These patients may look deceptively stable, with minimal derangements in vital signs, while having poor peripheral perfusion.

Elderly patients or those with chronic medical conditions may have less tolerance to blood loss and are less able to compensate. They may take medications such as beta-blockers that can potentially blunt the cardiovascular response. Care must be taken in the assessment.

Massive hemorrhage

Although there is no universally accepted definition of massive hemorrhage, the following can be used to identify the condition:

(i) blood loss exceeding circulating blood volume within a 24-hour period,

(ii) blood loss of 50% of circulating blood volume within a 3-hour period,

(iii) blood loss exceeding 150 ml/min, or

(iv) blood loss that necessitates plasma and platelet transfusion.

Grading of Bleeding: WHO

The World Health Organization made a standardized grading scale to measure the severity of bleeding:

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 Management

Acute bleeding from an injury to the skin is often treated by the application of direct pressure. For severely injured patients, tourniquets are helpful in preventing complications of shock. Anticoagulant medications may need to be discontinued and possibly reversed in patients with clinically significant bleeding. Patients that have lost excessive amounts of blood may require a blood transfusion.

Home remedies for bleeding

Often injuries can be treated at home, but it is important that a person knows how to do this safely. Whoever is treating the wound should wash their hands and wear latex gloves if possible. In this article, we look at eight home remedies that stop minor bleeding:

1. Apply pressure

Applying pressure to the wound is the best way to stop it from bleeding.

Place a clean and dry piece of material such as a bandage, towel, or cloth on the wound and apply pressure with both hands. Maintain firm and continuous pressure until the bleeding has stopped. Checking too soon to see if the bleeding has stopped may interfere with the healing process.

2. Raise the affected area

Reducing the flow of blood will also help stop the bleeding, so raise the affected area if possible. If the injury is to the hand or arm, simply raise it above the head. If the injury is to a lower limb, lie down and raise the affected area above the level of the heart.

3. Ice

Applying ice to a wound will constrict the blood vessels, allowing a clot to form more quickly and stop the bleeding. The best way to do this is to wrap ice in a clean, dry cloth and place it on the wound.

4. Tea

Tea is a popular remedy to treat bleeding after dental work. Place a steeped black teabag that has been allowed to cool in the fridge on the wound.

Using teabags works because tea contains tannins, which are hemostatic, meaning they cause the blood to clot. Tannins contain astringent, which causes blood vessels to constrict. It is also a kind of antiseptic that kills bacteria and helps the site stay free of infection.

5. Petroleum jelly

Many cosmetics, including lip balms and Vaseline products, contain petroleum jelly. It contains a blend of oils and waxes that can be used to protect the skin.

Fans of boxing and martial arts may have seen fighters’ cuts treated with petroleum jelly. It can also work as a homemade remedy to stop bleeding. Wipe the skin dry beforehand and clean the wound to remove any remaining jelly after the bleeding has stopped.

6. Witch hazel

Witch hazel is a North American shrub that is readily available in pharmacies, some grocery stores, and online, usually in liquid form.

It is known to stop bleeding externally by applying it to the wound. It is important to use distilled witch hazel and to buy it from a reputable source, as the U.S. Food and Drug Association does not regulate complementary medicines.

7. Antiperspirant

As well as shrinking sweat glands, the aluminum chloride in antiperspirants may also constrict blood vessels to help a wound clot.

8. Mouthwash

The alcohol in mouthwash acts as an astringent and applying it to a wound helps the blood clot more quickly. Also, aminocaproic acid (Amicar) can help treat bleeding in the mouth caused by dental work. However, try not to swish the liquid around in the mouth, as this can dislodge a clot.

Preventing infection

Even if the bleeding has stopped, it is important to keep the wound clean to prevent an infection.

Rinse the wound itself with cool water and use soap to wash the surrounding area. Avoid getting soap in the wound. If possible, remove any dirt or debris inside the wound with tweezers. It is important to clean the tweezers with rubbing alcohol before using them.