What is Hematoma?

A hematoma happens when blood collects in one spot inside the body, like under the skin, in a muscle, or even in an organ. It’s usually caused by damaged blood vessels that leak blood into the nearby tissue. This can happen because of an injury, surgery, or problems with the blood vessels themselves.[1, 2, 3, 4]

Hematomas can show up in different parts of the body, like the leg, abdomen, brain, or even the vagina. They often happen because of injuries, like falls, hits, or blunt-force trauma. Surgeries can also sometimes cause hematomas to form.[3, 4]

Certain medications that thin the blood, like aspirin, apixaban, warfarin, clopidogrel, prasugrel, and rivaroxaban, can raise the risk of developing a hematoma. Other factors that can increase your risk include conditions like thrombocytopenia (low platelet count), aplastic anemia (when the bone marrow stops producing blood cells), alcohol use disorder, and vitamin D deficiency.[3, 4]

Sometimes, hematomas can develop on their own without any clear cause or memory of an injury. This can happen due to everyday things like sports injuries, surgery-related issues, or the use of blood-thinning medications. [3, 4].

What is a Blood clot?

A blood clot is a clump of blood that turns from liquid to a gel-like or semi-solid state. This process is essential to stop excessive bleeding, like when you get a cut [5]. Blood clots form when blood cells and other substances in the bloodstream come together to create a semi-solid mass [6].

If a cut goes deep enough to break a blood vessel, platelets in your blood rush to the site. Proteins in the plasma, the liquid part of your blood, help the platelets stick to the damaged area. Together, they form a sticky plug that seals the opening and prevents more blood from escaping [7].

Causes of Blood Clots

Blood clots can form for several reasons. One common cause is damage to a vein, which can happen after surgery, from inflammation or because of an infection or injury [8]. Blood clots might also develop if you have an inherited condition that affects how your blood clots. Being inactive for long periods, such as during a hospital stay or recovering from an injury, can also increase the risk of clot formation [9].

Certain health conditions can also cause blood clots to form. For example, thrombocytosis happens when your body produces too many platelets [10]. Some diseases can also interfere with your body’s ability to break down blood clots after they’re no longer needed [7].

Several factors can increase the risk of blood clots. These include obesity, pregnancy, prolonged immobility, smoking, traumatic injury to a blood vessel, certain surgeries, oral birth control, a family history of blood clots, chronic inflammatory diseases, diabetes, high blood pressure, high cholesterol, and having a central line placement [6].

Treating Hematoma

Hematoma treatment varies depending on the location and severity of the condition.

Leg Hematoma: For a leg hematoma, common treatments include applying a cold compress or ice pack for 20 to 30 minutes for the first 48 hours after injury to reduce swelling. Rest, elevating your foot higher than your heart, light compression with a wrapped bandage, and pain medication such as acetaminophen (Tylenol) are also recommended. Heat can be applied for 10 minutes three times daily for 48 hours following the injury to increase blood flow [3].

Abdominal Hematoma: For an abdominal hematoma, treatment varies based on the severity of symptoms, the size and stability of the hematoma, and the underlying cause. If the hematoma is growing and leading to significant blood loss, prompt action is needed to stop the bleeding. Interventional radiology is often the first line of treatment, using techniques to locate and embolize (block) the bleeding vessel [4].

Intercranial Hematoma: For intracranial hematomas, treatment may involve specialized needles and techniques designed to break down and liquefy the hematoma. This method is relatively simple to learn, doesn’t require an operating room, and can even be performed at the patient’s bedside [11].

Hemorrhagic stroke: For a hemorrhagic stroke, hemostatic therapy is administered to help prevent the hematoma from getting worse. This is particularly crucial for patients on anticoagulants, as it helps reverse coagulopathy. Treatments may include vitamin K, prothrombin complex concentrates (PCCs), recombinant activated factor VII (rFVIIa), and fresh frozen plasma (FFP), among others [12].

Treating blood clot

Treating a blood clot depends on where it is and how severe it is.

Blood thinners: The main treatment for blood clots is anticoagulant medications, commonly known as blood thinners. Medications like warfarin, heparin, and direct oral anticoagulants help reduce the risk of new clots forming and assist the body in breaking down any existing clots [13, 14, 15, 16, 6].

Thrombolytic medications: Another treatment for blood clots is thrombolytic medications, often called clot-busters. These drugs, including alteplase, anistreplase, prourokinase, reteplase, streptokinase, tenecteplase, and urokinase, help dissolve blood clots that are already present. They're usually reserved for more severe cases where the clots are causing significant problems [13, 14, 6].

Compression stockings: Compression stockings are another treatment option for blood clots. These snug, knee-high socks promote blood flow in the lower legs, reduce swelling, and prevent blood from pooling. They're especially helpful in preventing blood clots in patients who are recovering from surgery [14].

Surgery: In some cases, surgery may be needed to remove a blood clot. One option is catheterization surgery, where a surgeon inserts a thin, flexible tube into a vein and guides it to the clot. They may use a stent to widen the vein or place a filter to catch any clots that break loose, preventing them from reaching the lungs. Another procedure is a thrombectomy or embolectomy, where the surgeon directly removes the clot from the blood vessel [14, 6].

Other methods: In some cases, a vena cava filter may be used to prevent blood clots from traveling through the major vein leading to the heart. These filters are typically recommended for individuals at high risk of developing pulmonary embolism, especially if they are unable to take anticoagulant medications [14, 15, 6].

DIfferentiating between Blood clots and Hematoma

A blood clot, medically referred to as a thrombus, and a hematoma are both related to blood, but they are distinct in their formation, location, and potential health implications.

In summary, both blood clots and hematomas involve blood and can be caused by injury, but they differ in how they form, where they occur, and their potential health risks. Blood clots develop within blood vessels and can be dangerous if they don't dissolve or become too large. Hematomas, on the other hand, are collections of pooled blood outside of blood vessels, often caused by trauma or vascular issues, and typically resolve on their own over time.