Can Vomiting Blood Cause Death?

1. Introduction: What causes someone to vomit blood?

Vomiting is a forceful contraction of the stomach, diaphragm, and abdominal muscles leading to the expulsion of stomach contents through the mouth (reference).

Vomiting is called hematemesis when the content of vomiting is blood (red or clotted) or coffee-ground substance,

The above definition is important because it helps you differentiate vomiting blood (hematemesis) from:

• Spitting of blood.

• Blood-tinged sputum.

• And coughing blood (hemoptysis).

The above three conditions are not considered vomiting. and they are often due to bleeding from the oral cavity, throat, or chest.

Common causes of vomiting blood (hematemesis):

• Peptic ulcer disease (ulcers in the stomach or the duodenum): is the most common cause, representing 20-25% of the overall cases of hematemesis. It may reach up to 50% in some countries (reference).

• Gastritis: chronic inflammation of the stomach lining.

• Esophagitis: inflammation and erosions of the esophageal wall (commonly due to acid reflux).

• Angiodysplasia (malformed blood vessels): abnormal, tortuous, and dilated blood vessels in the wall of the stomach, duodenum, or esophagus.

• Mallory-Weiss Syndrome: a tear in the lower esophagus (commonly caused by forceful vomiting or coughing). It leads to small amounts of bright red blood at the end of the vomit.

• Tumors (polyps or cancers) of the esophagus, stomach, or duodenum.

• Esophageal varices: Dilated veins in the wall of the esophagus or the stomach fundus (common in patients with end-stage liver cirrhosis).

• Dieulafoy lesions: It is a type of angiodysplasia in which a large tortuous artery (commonly in the stomach wall) erodes and bleeds.

• Unknown: 10-15% of patients with hematemesis have no identifiable lesions (reference).

The table and the chart below illustrate the frequency of each condition as a cause of hematemesis (vomiting blood) (reference).

Rare causes of vomiting blood (hematemesis) (reference):

• Hemobilia: vomiting of blood coming from bleeding biliary ducts.

• Gastric antral vascular ectasia: a type of vascular malformations (dilated vessels at the gastric antrum).

• Hemosuccus pancreatic: bleeding from the pancreas into the duodenum (in severe pancreatitis).

• Aortoenteric fistula: an abnormal communication between the abdominal part of the aortic artery and the intestine. It leads to lethal bleeding as the aorta is the largest artery in the body.

• Cameron lesions: linear stomach ulcers in patients with large hiatal hernia. Often causes minute (occult) bleeding in the stool.

• Ectopic varices (commonly in the duodenum).

• Post-endoscopic bleeding.

2. Can hematemesis (vomiting of blood)cause death? (Statistics).

Vomiting of blood can lead to death in a small percentage of people. The risk of death depends on the amount of blood vomit, the original cause, and delay in seeking emergency treatment.

According to studies, the risk of death from vomiting blood is about 1.9%. Patients with the highest risk of death from vomiting blood are those with esophageal varices (The risk of death is about 6.1%).

The table and the chart below illustrate the risk (death percentage) according to different causes of vomiting blood (hematemesis) (reference).

The risk of death from peptic ulcer bleeding (vomiting blood or passing black stools) is about 2%.

3. What are the dangerous symptoms & signs of impending death due to vomiting blood?

A. Blood amount in the vomit.

Very small amounts of blood (such as spots or a small cup) in the vomit often are not life-threatening. Also, coffee-ground vomits in small amounts are not considered a sign of severity.

However, hematemesis is considered dangerous if the amount of blood in the vomit is massive, containing blood clots or fresh (red) blood.

B. The number of attacks.

Patients with multiple successive hematemesis attacks are at a higher risk of death than those with a single attack.

C. Presence of blood in the stool.

Combined hematemesis (vomiting of blood) and melena (passage of dark black stool) or reddish stool at the same time are considered a sign of severity.

When the upper gastrointestinal bleeding is severe, blood passes as a dark semi-liquid stool (called melena).

D. Sings of shock.

• Dizziness, lightheadedness.

• Rapid breathing (shortness of breath).

• Fast Heartbeats.

• Low blood pressure.

• Cool, clammy skin.

• Bluish tinge of fingers and lips.

• Extreme weakness, inability to stand or walk.

• In extreme cases, confusion or coma occurs.

E. Signs of severe anemia (blood loss).

• Severe pallor (whitish lips, skin, and palms).

• Dizziness, tinnitus.

• Lightheadedness.

• Fast heartbeats.

• Shortness of breath.

• Very low hemoglobin levels in blood tests.

• Chest pain.

• Weakness, extreme fatigue.

4. Who is at a higher risk of death from vomiting blood?

Some people are at higher risk of death from vomiting blood than others. Their risk is higher due to either patient-related or disease-related risk factors.

The following groups of patients are at higher risk of death from vomiting blood than others (reference1, reference2):

• Older than the age of 60.

• Delayed management (delays in seeking emergency medical help).

• Having co-morbid conditions such as heart disease, liver cirrhosis, or kidney failure.

• Patients with vomiting blood due to esophageal varices (especially their first attack).

• Patients with vomiting blood due to gastric or esophageal malignancy.

• Vomiting large amounts of blood or having multiple successive attacks of vomiting blood.

• Sings of shock (shortness of breath, fast heartbeats, low blood pressure, confusion, or coma).

• Patients with severe anemia (severe pallor due to massive blood loss).

• Combined hematemesis and reddish or dark blood (melena) in the stool in large amounts.

• Patients who are actively bleeding during the endoscopy.

• Patients with high blood urea nitrogen test.

• Patients receiving blood-thinning medications such as warfarin, new oral anticoagulant medications (as Xarelto®), and Clopidogrel.

5. Emergency tips for dealing with vomiting blood.

If you encounter a case of vomiting blood at home, here is the best you can do to prevent death from such a case:

• Call 911 or seek the nearest ER department. This is a medical emergency; any delay can be life-threatening.

• Take a picture or bring a sample of the bloody vomit to be checked by the emergency doctor.

• The person should be made to lie down until the arrival of the ambulance to prevent collapse.

• If there is another impending attack of bloody vomit, tilt the patient’s head to one side or help him to sit (vomiting while lying down may cause aspiration to the lungs).

• Cover the patients with a blanket or coat to reduce shock effects.

• Always play safe and move as fast as possible to the emergency department. Avoid any unnecessary treatments or antiemetics.