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Terminal haemorrhage

Key points about terminal haemorrhage

A terminal haemorrhage is also known as a massive bleed. It refers to bleeding that occurs at an advanced stage of cancer and that could lead to death.
Bleeding can happen either internally and not be immediately obvious, or externally with a lot of blood visible.
It can lead to death in minutes or you may deteriorate slowly, with worsening symptoms such as pain, low blood pressure and restlessness.
Symptoms depend on the location of bleeding. Common ones include visible bleeding, restlessness or confusion, feeling cold, drowsy or unwell, as well as dark-coloured stools, fresh blood in stools, coffee-coloured vomit or coughing up blood.
If your doctor thinks you are at risk they will help you develop a written plan of what to do when it happens.

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Terminal haemorrhage is usually caused by spreading of a tumour into a blood vessel, causing bleeding at that point. Depending on the location and the blood vessels involved, the condition could lead to death in minutes or cause you to deteriorate slowly, with worsening and distressing symptoms such as pain, low blood pressure and restlessness.

It is important to recognise the symptoms and signs of bleeding. Call an ambulance or go straight to the hospital immediately as the condition could deteriorate quickly and lead to death. Symptoms often depend on the location of bleeding. Common symptoms include:

bleeding seen externally, from your mouth, rectum, vagina or a wound
restlessness
confusion
feeling cold
feeling drowsy
pain anywhere in your body
feeling unwell
dark-coloured stools
fresh blood in stools
coffee-coloured vomit
coughing up blood
low blood pressure.

Terminal haemorrhage is an emergency. Call an ambulance or go straight to the hospital immediately if you have any of the above symptoms.

If your doctor thinks you are going to have a massive bleed, they will discuss with you or your family members beforehand to develop a written plan. A written plan will record:

whether you want to be resuscitated in the event of bleeding
who to call if you have a massive bleed
which medication to be prescribed for pain relief and sedation.

A massive bleed is likely a life-ending event and treatment will focus on relieving symptoms and distress.

You may have many health professionals such as doctors, nurses, a palliative care specialist, an intensive care specialist or a cancer specialist involved in your care, as massive bleeding is an emergency and requires treatment from a multidisciplinary team.

Your doctor will also check whether you are on any blood-thinning medicines such as antiplatelets and anticoagulants, as it is important to stop them to prevent further bleeding.

Common medications that may be prescribed when you have a bleed include:

pain relief medications
sedating medications such as benzodiazepines
proton pump inhibitors such as pantoprazole
fresh frozen plasma
vitamin K
tranexamic acid.

Sometimes, you may need radiotherapy or surgery to stop the bleeding, depending on the cause of the bleeding.

Apps reviewed by Healthify

You may find it useful to look at some Pain management apps.

Having a massive bleed is very distressing both for the patient and the family members. You can choose to have your family members stay with you throughout the event. Discussing the risk or potential of having a bleed with your family and friends prior to the event occurring may be helpful in preparing your support people.

Below are some support services and information for people affected by cancer and their family/whānau:

Emotions and cancer(external link) Cancer Society of NZ
How we can help(external link) Cancer Society of NZ
NZ cancer services – find a hospital/service near you(external link) Healthpoint, NZ
More cancer support groups