hematoma

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. Some bleeding, such as gastrointestinal bleeding, coughing up blood, or vaginal bleeding, can be a symptom of a disease.

Normally, when you are injured and start bleeding, a blood clot forms to stop the bleeding quickly. Afterwards, the clot dissolves naturally. To be able to make a clot, your blood needs blood proteins called clotting factors and a type of blood cell called platelets. Some people have a problem with clotting, due to another medical condition or an inherited disease. There are two types of problems:

• Your blood may not form clots normally, known as a bleeding disorder. This happens when your body does not make enough platelets or clotting factors, or they don't work the way they should.
• Your blood may make too many clots, or the clots may not dissolve properly

Sometimes bleeding can cause other problems. A bruise is bleeding under the skin. Some strokes are caused by bleeding in the brain. Severe bleeding may require first aid or a trip to the emergency room.

Your digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from any of these areas. The amount of bleeding can be so small that only a lab test can find it.

Signs of bleeding in the digestive tract depend on where it is and how much bleeding there is.

Signs of bleeding in the upper digestive tract include:

• Bright red blood in vomit
• Vomit that looks like coffee grounds
• Black or tarry stool
• Dark blood mixed with stool

Signs of bleeding in the lower digestive tract include:

• Black or tarry stool
• Dark blood mixed with stool
• Stool mixed or coated with bright red blood

GI bleeding is not a disease, but a symptom of a disease. There are many possible causes of GI bleeding, including hemorrhoids, peptic ulcers, tears or inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn's disease, colonic polyps, or cancer in the colon, stomach or esophagus.

The test used most often to look for the cause of GI bleeding is called endoscopy. It uses a flexible instrument inserted through the mouth or rectum to view the inside of the GI tract. A type of endoscopy called colonoscopy looks at the large intestine.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Menstruation, or period, is a woman's monthly bleeding. Abnormal vaginal bleeding is different from normal menstrual periods. It could be bleeding that is between periods, is very heavy, or lasts much longer than usual. It also includes bleeding that happens before puberty or after menopause. Causes can include:

• Uterine fibroids or polyps
• Hormone problems
• Hormone pills, such as birth control pills and hormone replacement therapy (menopausal hormone therapy)
• Cancer of the cervix, ovaries, uterus or vagina
• Thyroid problems

Bleeding during pregnancy can have several different causes. It is not always serious, but to be safe you should contact your health care provider right away.

Pelvic exams, blood tests, imaging tests, and other procedures can help your health care provider diagnose the problem. Treatment depends on the cause. Treatments may include medicines, hormones, and surgery.

Normally, if you get hurt, your body forms a blood clot to stop the bleeding. For blood to clot, your body needs cells called platelets and proteins known as clotting factors. If you have a bleeding disorder, you either do not have enough platelets or clotting factors or they don't work the way they should.

Bleeding disorders can be the result of other diseases, such as severe liver disease or a lack of vitamin K. They can also be inherited. Hemophilia is an inherited bleeding disorder. Bleeding disorders can also be a side effect of medicines such as blood thinners.

Various blood tests can check for a bleeding disorder. You will also have a physical exam and history. Treatments depend on the cause. They may include medicines and transfusions of blood, platelets, or clotting factor.

Hemophilia is a rare bleeding disorder in which the blood does not clot properly. This can lead to problems with bleeding too much after an injury or surgery. You can also have sudden bleeding inside your body, such as in your joints, muscles, and organs.

Your blood contains many proteins called clotting factors that can help form clots to stop bleeding. People with hemophilia have low levels of one of these factors, usually either factor VIII (8) or factor IX (9). How severe the hemophilia is depends on the amount of factor in the blood. The lower the amount of the factor, the more likely it is that bleeding could happen and might lead to serious health problems.

There are several different types of hemophilia. The most common are:

• Hemophilia A (classic hemophilia), which is caused by a lack or decrease of clotting factor VIII (8)
• Hemophilia B (Christmas disease), which is caused by a lack or decrease of clotting factor IX (9)

Most types of hemophilia are inherited. They are caused by change in one of the genes (also called a mutation) that provides instructions for making the clotting factor proteins. The change may mean that the clotting proteins don't work properly or that they are missing altogether.

These genes are on the X chromosome. You may have one or two X chromosomes:

• People who are born male have one X chromosome (from the mother) and one Y chromosome (from the father). They can get hemophilia if their one X chromosome has the gene change.
• People who are born female have two X chromosomes, one from the father and one from the mother. They usually only get hemophilia if:
  • Both X chromosomes have the gene change OR
  • One X chromosome has the gene change and the other X chromosome is missing or inactive.

  People who are born female who have the gene change on one X chromosome are a "carrier" of hemophilia. Sometimes they may have some symptoms of hemophilia. They can pass the gene change on to their children.

Hemophilia that is not inherited is called acquired hemophilia. It is rare. It happens when your body makes specialized proteins called autoantibodies that attack and disable a clotting factor. This can happen because of pregnancy, immune system disorders, cancer, or allergic reactions to certain medicines. Sometimes the cause is unknown.

Hemophilia is much more common in people who were born male since they can get it with a change to the gene on one X chromosome. People who have a family history of hemophilia are also at higher risk.

The signs and symptoms of hemophilia are:

• Bleeding into the joints. This can cause swelling and pain or tightness in the joints. It often affects the knees, elbows, and ankles.
• Bleeding into the skin (which is bruising).
• Bleeding into the muscle and soft tissue, which can cause a build-up of blood in the area (called a hematoma).
• Bleeding of the mouth and gums, including bleeding that is hard to stop after you lose a tooth.
• Bleeding after circumcision.
• Bleeding after having shots, such as vaccinations.
• Bleeding in the head of an infant after a difficult delivery.
• Blood in the urine or stool.
• Frequent and hard-to-stop nosebleeds.

In some cases, severe hemophilia may cause bleeding in the brain. This may cause brain damage and can be life-threatening.

To find out if you have hemophilia, your health care provider will:

• Ask about your medical history, including your symptoms and other health conditions you may have.
• Ask about your family history, to find out if you have relatives who have or had hemophilia.
• Do a physical exam to look for signs of hemophilia, such as bruising.
• Do certain blood tests to show if your blood is clotting properly. If it does not, then you will have clotting factor tests to diagnose the cause of the bleeding disorder. These blood tests would show the type of hemophilia and the severity.

There is genetic testing for the factor VIII (8) and factor IX (9) genes. This testing may be used in people who have a family history of hemophilia to:

• Identify people who are carriers before they make decisions about pregnancy
• Test a fetus for hemophilia during pregnancy
• Test a newborn for hemophilia

The best way to treat hemophilia is to replace the missing clotting factor so that your blood can clot properly. This is usually done by injecting replacement clotting factor into a vein. The replacement clotting factor may be made from donated human blood. Or it may be made in a lab; this kind is called a recombinant clotting factor.

Replacement clotting factor can help treat a bleeding episode. In more severe cases of hemophilia, you might get the factor on a regular basis to prevent bleeding. You can learn how to inject the factor so that you can do it yourself at home.

There are other medicines to treat hemophilia. They may work by releasing factor VIII (8) from where it is stored in the body tissues, replacing the function of factor VIII (8), or preventing clots from breaking down.

If bleeding has damaged your joints, physical therapy may help them function better.

Good quality medical care from healthcare professionals who know a lot about the disorder can help prevent some serious problems. Often the best choice for care is to visit a hemophilia treatment center (HTC).

Centers for Disease Control and Prevention

Blood thinners are medicines that prevent blood clots from forming. They do not break up clots that you already have. But they can stop those clots from getting bigger. It's important to treat blood clots, because clots in your blood vessels and heart can cause heart attacks, strokes, and blockages.

You may need a blood thinner if you have:

• Certain heart or blood vessel diseases
• An abnormal heart rhythm called atrial fibrillation
• A heart valve replacement
• A risk of blood clots after surgery
• Congenital heart defects

There are different types of blood thinners:

• Anticoagulants, such as heparin or warfarin (also called Coumadin), slow down your body's process of making clots.
• Antiplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets from clumping together to form a clot. Antiplatelets are mainly taken by people who have had a heart attack or stroke.

When you take a blood thinner, follow the directions carefully. Blood thinners may interact with certain foods, medicines, vitamins, and alcohol. Make sure that your health care provider knows all of the medicines and supplements you are using.

You may need regular blood tests to check how well your blood is clotting. It is important to make sure that you're taking enough medicine to prevent clots, but not so much that it causes bleeding.

Bleeding is the most common side effect of blood thinners. They can also cause an upset stomach, nausea, and diarrhea.

Other possible side effects can depend on which type of blood thinner that you are taking.

Call your provider if you have any sign of serious bleeding, such as:

• Menstrual bleeding that is much heavier than normal
• Red or brown urine
• Bowel movements that are red or black
• Bleeding from the gums or nose that does not stop quickly
• Vomit that is brown or bright red
• Coughing up something red
• Severe pain, such as a headache or stomachache
• Unusual bruising
• A cut that does not stop bleeding
• A serious fall or bump on the head
• Dizziness or weakness

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:

• External hemorrhoids, which form under the skin around your anus
• Internal hemorrhoids, which form in the lining of your anus and lower rectum

Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.
• Frequently lifting heavy objects.

The symptoms of hemorrhoids depend on which type you have:

With external hemorrhoids, you may have:

• Anal itching
• One or more hard, tender lumps near your anus
• Anal pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

With internal hemorrhoids, you may have:

• Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement
• Prolapse, which is a hemorrhoid that has fallen through your anal opening

Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort.

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement.
• Drinking enough fluids every day.
• Not straining during bowel movements.
• Not sitting on the toilet for long periods of time.
• Taking over-the-counter pain relievers.
• Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.
• Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.

You should see your health care provider if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding.

To find out if you have hemorrhoids, your health care provider:

• Will ask about your medical history.
• Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.
• Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.
• May do procedures such as an anoscopy to check for internal hemorrhoids.

If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery.

You can help prevent hemorrhoids by:

• Eating foods that are high in fiber
• Taking a stool softener or a fiber supplement
• Drinking enough fluids every day
• Not straining during bowel movements
• Not sitting on the toilet for long periods of time

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Platelets, also known as thrombocytes, are blood cells. They form in your bone marrow, a sponge-like tissue in your bones. Platelets play a major role in blood clotting. Normally, when one of your blood vessels is injured, you start to bleed. Your platelets will clot (clump together) to plug the hole in the blood vessel and stop the bleeding. You can have different problems with your platelets:

• If your blood has a low number of platelets, it is called thrombocytopenia. This can put you at risk for mild to serious bleeding. The bleeding could be external or internal. There can be various causes. If the problem is mild, you may not need treatment. For more serious cases, you may need medicines or blood or platelet transfusions.
• If your blood has too many platelets, you may have a higher risk of blood clots.
• When the cause is unknown, this is called thrombocythemia. It is rare. You may not need treatment if there are no signs or symptoms. In other cases, people who have it may need treatment with medicines or procedures.
• If another disease or condition is causing the high platelet count, it is thrombocytosis. The treatment and outlook for thrombocytosis depends on what is causing it.
• Another possible problem is that your platelets do not work as they should. For example, in von Willebrand Disease, your platelets cannot stick together or cannot attach to blood vessel walls. This can cause excessive bleeding. There are different types of in von Willebrand Disease; treatment depends on which type you have.

NIH: National Heart, Lung, and Blood Institute

Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman's monthly cycle. Every month, your body prepares for pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina.

Periods usually start between age 11 and 14 and continue until menopause at about age 51. They usually last from three to five days. Besides bleeding from the vagina, you may have:

• Abdominal or pelvic cramping pain
• Lower back pain
• Bloating and sore breasts
• Food cravings
• Mood swings and irritability
• Headache and fatigue

Premenstrual syndrome, or PMS, is a group of symptoms that start before the period. It can include emotional and physical symptoms.

Consult your health care provider if you have big changes in your cycle. They may be signs of other problems that should be treated.

NIH: National Institute of Child Health and Human Development

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. This is a closed head injury. A TBI can also happen when an object penetrates the skull. This is a penetrating injury.

Symptoms of a TBI can be mild, moderate, or severe. Concussions are a type of mild TBI. The effects of a concussion can sometimes be serious, but most people completely recover in time. More severe TBI can lead to serious physical and psychological symptoms, coma, and even death.

The main causes of TBI depend on the type of head injury:

• Some of the common causes of a closed head injury include
  • Falls. This is the most common cause in adults age 65 and older.
  • Motor vehicle crashes. This is the most common cause in young adults.
  • Sports injuries
  • Being struck by an object
  • Child abuse. This is the most common cause in children under age 4.
  • Blast injuries due to explosions
• Some of the common causes of a penetrating injury include
  • Being hit by a bullet or shrapnel
  • Being hit by a weapon such as a hammer, knife, or baseball bat
  • A head injury that causes a bone fragment to penetrate the skull

Some accidents such as explosions, natural disasters, or other extreme events can cause both closed and penetrating TBI in the same person.

Certain groups are at higher risk of TBI:

• Men are more likely to get a TBI than women. They are also more likely to have serious TBI.
• Adults aged 65 and older are at the greatest risk for being hospitalized and dying from a TBI

The symptoms of TBI depend on the type of injury and how serious the brain damage is.

The symptoms of mild TBI can include:

• A brief loss of consciousness in some cases. However, many people with mild TBI remain conscious after the injury.
• Headache
• Confusion
• Lightheadedness
• Dizziness
• Blurred vision or tired eyes
• Ringing in the ears
• Bad taste in the mouth
• Fatigue or lethargy
• A change in sleep patterns
• Behavioral or mood changes
• Trouble with memory, concentration, attention, or thinking

If you have a moderate or severe TBI, you may have those same symptoms. You may also have other symptoms such as:

• A headache that gets worse or does not go away
• Repeated vomiting or nausea
• Convulsions or seizures
• Not being able to wake up from sleep
• Larger than normal pupil (dark center) of one or both eyes. This is called dilation of the pupil.
• Slurred speech
• Weakness or numbness in the arms and legs
• Loss of coordination
• Increased confusion, restlessness, or agitation

If you have a head injury or other trauma that may have caused a TBI, you need to get medical care as soon as possible. To make a diagnosis, your health care provider:

• Will ask about your symptoms and the details of your injury
• Will do a neurologic exam
• May do imaging tests, such as a CT scan or MRI
• May use a tool such as the Glasgow coma scale to determine how severe the TBI is. This scale measures your ability to open your eyes, speak, and move.
• May do neuropsychological tests to check how your brain is functioning

The treatments for TBI depend on many factors, including the size, severity, and location of the brain injury.

For mild TBI, the main treatment is rest. If you have a headache, you can try taking over-the-counter pain relievers. It is important to follow your health care provider's instructions for complete rest and a gradual return to your normal activities. If you start doing too much too soon, it may take longer to recover. Contact your provider if your symptoms are not getting better or if you have new symptoms.

For moderate to severe TBI, the first thing health care providers will do is stabilize you to prevent further injury. They will manage your blood pressure, check the pressure inside your skull, and make sure that there is enough blood and oxygen getting to your brain.

Once you are stable, the treatments may include:

• Surgery to reduce additional damage to your brain, for example to
  • Remove hematomas (clotted blood)
  • Get rid of damaged or dead brain tissue
  • Repair skull fractures
  • Relieve pressure in the skull
• Medicines to treat the symptoms of TBI and to lower some of the risks associated with it, such as
  • Anti-anxiety medication to lessen feelings of nervousness and fear
  • Anticoagulants to prevent blood clots
  • Anticonvulsants to prevent seizures
  • Antidepressants to treat symptoms of depression and mood instability
  • Muscle relaxants to reduce muscle spasms
  • Stimulants to increase alertness and attention
• Rehabilitation therapies, which can include therapies for physical, emotional, and cognitive difficulties:
  • Physical therapy, to build physical strength, coordination, and flexibility
  • Occupational therapy, to help you learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing
  • Speech therapy, to help you to with speech and other communication skills and treat swallowing disorders
  • Psychological counseling, to help you learn coping skills, work on relationships, and improve your emotional well-being
  • Vocational counseling, which focuses on your ability to return to work and deal with workplace challenges
  • Cognitive therapy, to improve your memory, attention, perception, learning, planning, and judgment

Some people with TBI may have permanent disabilities. A TBI can also put you at risk for other health problems such as anxiety, depression, and post-traumatic stress disorder. Treating these problems can improve your quality of life.

There are steps you can take to prevent head injuries and TBIs:

• Always wear your seatbelt and use car seats and booster seats for children
• Never drive under the influence of drugs or alcohol
• Wear a properly fitting helmet when riding a bicycle, skateboarding, and playing sports like hockey and football
• Prevent falls by
  • Making your house safer. For example, you can install railings on the stairs and grab bars in the tub, get rid of tripping hazards, and use window guards and stair safety gates for young children.
  • Improving your balance and strength with regular physical activity