What should you know about nose bleed and vomiting blood?

Bright-red blood from the nose commonly starts in the delicate lining of the nasal passages. Blood that has been swallowed can later appear in vomit, which can make the source confusing. Vomit that looks dark, grainy, or like coffee grounds can indicate blood that has been altered by stomach acid. Causes can include irritation, an ulcer, inflammation, medicines that affect clotting, or bleeding higher in the digestive tract. Cancer of the oesophagus or stomach is one possible medical cause, but these symptoms have many other explanations.

The amount, colour, timing, and whether the blood was coughed up or vomited help clinicians work out where it came from. Feeling faint, weak, breathless, or unusually sleepy can signal significant blood loss.

If blood is being vomited, stop eating and drinking until a clinician advises you, and arrange urgent medical help. Keep a note of the colour and approximate amount, any medicines taken, and whether there was a nosebleed first. Do not drive if you feel faint. For an active nosebleed, sit upright, lean slightly forward, and pinch the soft part of the nose continuously. Do not tilt your head back, because blood may run into the throat. Spit out blood rather than swallowing it.

Call emergency services or attend an emergency department for vomiting blood, repeated bleeding, a large amount of blood, black stools, severe abdominal pain, confusion, fainting, chest discomfort, or difficulty breathing. Seek prompt assessment for a nosebleed that does not settle with firm pressure, follows an injury, or occurs while taking a blood-thinning medicine. A clinician may check your circulation, blood count, medicines, and the nose or digestive tract.

Ask: Where is the bleeding most likely coming from? Could swallowed nasal blood explain the vomit? Do any of my medicines increase bleeding? Do I need blood tests or an examination of the upper digestive tract? What warning signs should bring me back immediately?