[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Hemodynamic disorders](https://durgical.com/en/general-pathology/#a-hemodynamics) › Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does [General pathology](https://durgical.com/en/general-pathology/) · [Hemodynamic disorders](https://durgical.com/en/general-pathology/#a-hemodynamics) # Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does - Lesion Blood outside the vessels takes different forms by size and cause; its effect depends on how much, how fast and where it is lost. Updated 2026-11-01 ## Key points - Petechiae = platelets or capillaries (thrombocytopenia, platelet dysfunction, vasculitis); hemarthrosis = factors (hemophilia). - Palpable purpura = small-vessel vasculitis (IgA vasculitis). - Colours of a bruise: red-blue (hemoglobin), blue-green (biliverdin and bilirubin), golden-brown (hemosiderin). - A rapid loss of a fifth or more of the blood volume can cause hypovolemic shock. - Chronic loss (gut, menstrual) causes iron-deficiency anemia, not shock. ## What it is Hemorrhage is the escape of blood from the vessels. In skin and mucosa it is named by size: pinpoint petechiae, slightly larger purpura, extensive ecchymosis, and hematoma when it forms a collection. The pattern points to the defect: platelets and capillaries give petechiae; clotting factors give deep bleeding into joints and muscles. Severity depends on volume, speed and site: a small bleed in the brain can be fatal. ## Step by step - A vessel tears or hemostasis fails and blood leaks into the tissue. - The escaped red cells look red; macrophages engulf them. - Heme oxygenase turns heme into biliverdin (green), then bilirubin (yellow). - The iron stays as brown hemosiderin, which is why a bruise turns brown before it fades. - If the loss is fast and large, circulating volume falls and hypovolemic shock follows. ## Forms of hemorrhage | Form | What it looks like | Typical cause | | --- | --- | --- | | Petechiae | Tiny red dots that do not blanch on pressure | Thrombocytopenia, platelet dysfunction, vasculitis, meningococcemia | | [Purpura](https://durgical.com/en/conditions/iga-vasculitis/) | Somewhat larger spots; palpable when there is vasculitis | Platelets, vasculitis, vessel fragility | | Ecchymosis | Extensive bruise that changes colour | Trauma, anticoagulation, factor defects | | [Hematoma](https://durgical.com/en/conditions/subdural-haematoma/) | A collection of blood that forms a lump | Trauma, hemophilia; epidural or subdural in the skull | | Bleeding into a cavity | Hemothorax, hemopericardium, hemoperitoneum, hemarthrosis | Trauma, ruptured aneurysm, hemophilia | ## Clinical notes - Mucosal bleeding and petechiae suggest a platelet or von Willebrand factor problem. - Bleeding into joints and muscles, and delayed bleeding after surgery, suggest a factor deficiency (hemophilia A or B). - Rapid hemopericardium causes cardiac tamponade even when the volume is small. - In the closed skull, an epidural or subdural hematoma raises intracranial pressure and can herniate the brain. ## In the lab - Platelet count and bleeding time point to platelet defects; PT and aPTT to factor defects. - Hemosiderin is shown with Perls’ stain. ## Memory aid Failing platelets paint dots; failing factors fill joints. ## Test yourself Think of the answer, then tap the question to see it. ## What kind of defect usually produces petechiae? A platelet problem (number or function) or a capillary problem, as in immune thrombocytopenia or vasculitis. ## Why does a bruise turn green and then brown? Hemoglobin is broken down to biliverdin and bilirubin, and the iron stays behind as brown hemosiderin. ## What does spontaneous hemarthrosis in a boy suggest? A clotting factor deficiency, typically hemophilia A or B. ## Why does slow, chronic blood loss not cause shock? Because the body replaces the volume; what appears instead is iron-deficiency anemia from the iron lost. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/) ## Related - [Shock: types, stages and the organs it damages](https://durgical.com/en/general-pathology/shock-types-stages-and-the-organs-it-damages/) - [Disseminated intravascular coagulation: how consumption causes both clots and bleeding](https://durgical.com/en/general-pathology/disseminated-intravascular-coagulation-how-consumption-causes-both-clots-and-ble/) - [Pigments in tissue: lipofuscin, hemosiderin, melanin, bilirubin, carbon](https://durgical.com/en/general-pathology/pigments-in-tissue-lipofuscin-hemosiderin-melanin-bilirubin-carbon/) - [Hyperemia and congestion (the nutmeg liver, heart-failure cells)](https://durgical.com/en/general-pathology/hyperemia-and-congestion/) ## Related conditions - [Immune thrombocytopenia (ITP)](https://durgical.com/en/conditions/immune-thrombocytopenia/) - [Haemophilia A and B](https://durgical.com/en/conditions/haemophilia-a-and-b/) - [Von Willebrand disease](https://durgical.com/en/conditions/von-willebrand-disease/) - [Thrombotic thrombocytopenic purpura](https://durgical.com/en/conditions/thrombotic-thrombocytopenic-purpura/) - [IgA vasculitis (Henoch–Schönlein purpura)](https://durgical.com/en/conditions/iga-vasculitis/) - [Meningococcal disease (meningococcemia)](https://durgical.com/en/conditions/meningococcal-disease/) - [Intracerebral haemorrhage](https://durgical.com/en/conditions/intracerebral-haemorrhage/) - [Epidural haematoma](https://durgical.com/en/conditions/epidural-haematoma/) - [Subdural haematoma](https://durgical.com/en/conditions/subdural-haematoma/) - [Upper gastrointestinal bleeding](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/) - [Postpartum haemorrhage](https://durgical.com/en/conditions/postpartum-haemorrhage/) - [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/) - [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/) - [Vitamin K deficiency bleeding of the newborn](https://durgical.com/en/conditions/vitamin-k-deficiency-bleeding-of-the-newborn/) ## Elsewhere in DurgiPedia - [Primary hemostasis and platelets](https://durgical.com/en/physiology/primary-hemostasis-and-platelets/) - [Coagulation tests: PT/INR, aPTT and platelets](https://durgical.com/en/physiology/coagulation-tests-pt-inr-aptt-and-platelets/) - [Heme oxygenase](https://durgical.com/en/biochemistry/enzymes/heme-oxygenase/) - [Biliverdin reductase](https://durgical.com/en/biochemistry/enzymes/biliverdin-reductase/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [Bleeding into the skin: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003235.htm) (MedlinePlus, US National Library of Medicine, 2025); [Bleeding: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000045.htm) (MedlinePlus, US National Library of Medicine, 2025); [Hypovolemic shock: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000167.htm) (MedlinePlus, US National Library of Medicine, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/