Red flags of Bleeding or Blood loss

Question 1

Severe blood loss leading to shock

Answer 1

3 star
If following symptoms and signs have been present for more than a few minutes (ie not just simple faint) or if the symptoms are worsening: dizziness, fainting, confusion. Rapid pulse of more than 100 bpm and bp of less than 90/50. Cold and clammy extremities.
A19 Red Flags of haemorrhage and shock

Question 2

Bone Marrow Failure

Answer 2

2/3 star
Symptoms of progressive anaemia, recurrent progressive infections, progressive bruising, purpura and bleeding
A20 Red Flags for Leukaemia and Lymphoma

Question 3

Vomiting of fresh or altered blood (Haematemesis) if blood is altered it looks like coffee grounds in the vomit

Answer 3

2/3 star
A6 Red Flag of diseases of the stomach
A8 Red Star diseases of the Liver

Question 4

Altered Blood in stools (melaena) stools look like black tar, suggests large amount of bleeding from the stomach.

Answer 4

2/3 star
A6 Red Flag of diseases of the stomach

Question 5

An episode of vaginal bleeding during pregnancy

Answer 5

3/2 star
Refer as emergency if any symptoms of shock present (low bp, fainting, high bpm) as internal bleeding may not become immediately apparent. Otherwise refer as high priority for high priority investigations of the cause.
A37 Red Flags of pregnancy

Question 6

Post-partum haemorrhage if post-partum bleeding is more than blood-stained discharge.

Answer 6

3/2 star
A profuse bleed of more than 500mls or the symptoms of shock (low bp, fainting, high bpm) constitutes an emergency.
A38 Red Flags of the puerperium

Question 7

Continuing Blood loss

Answer 7

3/2 star
Any situation where continual significant bleeding continues for more than a few minutes without sign of abating (e.g. nosebleed) except within the context of menstruation
A19 Red Flags of Haemorrhage and shock

Question 8

Unexplained Bleeding: either from the surface of the skin or emerging from an internal organ.

Answer 8

2 star
Cancer cells are disorganised and bleeding can often occur.
A1 Red Flags for cancer

Question 9

Infectious bloody diarrhoea or blood poisoning

Answer 9

2 star
Any episodes of diarrhoea and vomiting where food is suspected as the origin or in which blood appears in the stools . These are notifiable diseases.
A10 Red Flags of Diseases of the small and large intestines

Question 10

Blood mixed in with the stools

Answer 10

2 star
Fresh blood mixed in with the stools suggests coloic or rectal origin. Blood that drips after passing a stool is anal in origin and is usually benign with no need for referral.
A10 Red Flags of Diseases of the small and large intestines

Question 11

Coughing up Blood (if only on a single occasion and only amounts more than a teaspoon in volume are significant)

Answer 11

2 star
A17 Red Flags of lower respiratory diseases.

Question 12

Tuberculosis Infection

Answer 12

2 star
chronic productive cough, weight loss, night sweats, blood in sputum for more than 2 weeks
A17 Red Flags of diseases of the lower respiratory system

Question 13

Blood in urine or sperm

Answer 13

1/2 star
Refer all cases in men. Refer women except in the case of acute urinary infection in which case it is usually benign.
A29 Red Flag diseases of the kidneys,
A30 Red Flag diseases of the ureters, bladder and urethra.