Blood-tinged vomit: signs that need medical attention

Emergency help is appropriate when bleeding repeats, the vomit is dark and granular, or symptoms such as faintness, breathlessness or severe pain accompany it.

A pink or red tinge suggests blood mixed with vomit. It may follow irritation from repeated retching, bleeding from the oesophagus or stomach, or blood swallowed from the nose or mouth. Food and drink can mimic red blood, but uncertainty should not delay clinical advice.

Brown-black granules resembling coffee grounds can occur after blood has remained in the stomach. This appearance is a warning sign even if there is no bright-red blood.

Vomiting blood can be a presentation of oesophageal cancer or stomach cancer. Neither condition can be inferred from the symptom alone, because other causes include ulcers, inflammation and tears related to forceful vomiting.

Call an urgent medical service and describe what you saw. Remain with another adult if you feel unsteady, and do not drive. Until assessed, avoid alcohol and do not take additional aspirin or anti-inflammatory pain relief unless a clinician tells you to do so.

Record the colour, texture, approximate amount and number of episodes if this can be done safely. Tell the clinician about black stool, abdominal or chest discomfort, retching, a recent nosebleed, liver or digestive disease, and medicines that affect clotting. A quick photograph may be useful, but care comes first.

Call emergency services for a large amount of blood, continued or repeated bloody vomiting, coffee-ground material, fainting, confusion, cold clammy skin, rapid breathing, marked weakness, severe chest or abdominal pain, or black tarry bowel motions.

People taking a blood thinner or living with a known bleeding or liver condition should mention this immediately when seeking help. A clinician must judge urgency from the full situation, not the apparent size of a single tinge.

Ask which part of the digestive tract may be bleeding, whether a blood count or endoscopy is being considered, how your regular medicines should be handled, and which foods or drinks are appropriate while waiting. Confirm where to return if bleeding or dizziness recurs.