Hematoma: A Comprehensive Guide for Aspiring Phlebotomists

A hematoma is a localized collection of blood outside blood vessels, often resulting from trauma or injury. While hematomas can appear similar to bruises, they involve damage to larger blood vessels and can sometimes require medical attention. In this guide, we’ll explore everything aspiring phlebotomists need to know about hematomas, including their types, causes, symptoms, treatment, and when to seek medical help.

Key Takeaways

Hematoma Definition: A hematoma is a localized collection of blood outside of blood vessels, typically resulting from trauma or injury.

Types of Hematomas: These include ear, subungual, scalp, septal, subcutaneous, retroperitoneal, and more, each differing by location and severity.

Symptoms: Hematomas often cause swelling, discoloration, pain, and warmth around the affected area.

Treatment: Many hematomas resolve on their own with rest and ice; more severe cases may need medical drainage or intervention.

Complications: If untreated, hematomas can cause infection, pressure on organs, or recurrent bleeding, making medical consultation important for severe cases.

What is a Hematoma?

A hematoma is an area of blood pooling outside of larger blood vessels, usually due to an injury that causes blood vessel walls to rupture. When blood escapes the vessel and accumulates in surrounding tissues, it forms a hematoma, leading to visible discoloration, swelling, and warmth. Unlike a hemorrhage, where blood is still actively leaking, blood in a hematoma has typically clotted.

Key Difference: Hematoma vs. Bruise

While a hematoma might resemble a bruise due to discoloration, they are distinct. A bruise results from damage to smaller blood vessels and typically heals quickly without intervention. Hematomas are more serious, caused by a rupture in larger blood vessels, and may require medical care.

Types of Hematoma

Understanding the types of hematomas is essential, as they can develop in different body areas, each with varying levels of severity:

• Ear Hematoma: Often seen in contact sports like wrestling or boxing, this hematoma forms between the cartilage and skin of the ear.
• Subungual Hematoma: Appears under the nail bed, commonly from minor trauma, like hitting a finger.
• Scalp Hematoma: Occurs on the scalp and appears as a lump or bump. Although external, it generally does not affect the brain.
• Septal Hematoma: Forms in the nose, usually after a broken nose, and can lead to nasal issues if untreated.
• Subcutaneous Hematoma: Appears just beneath the skin and usually results from injury to shallow veins.
• Retroperitoneal Hematoma: Located within the abdominal cavity, but outside organs; often a result of significant trauma.
• Splenic Hematoma: Forms within the spleen, frequently from blunt abdominal trauma.
• Hepatic Hematoma: Occurs in the liver due to injury.
• Spinal Epidural Hematoma: Forms between the spinal cord lining and vertebrae, potentially requiring urgent care.
• Intracranial Epidural Hematoma: Occurs between the skull and brain lining, often serious, especially with head trauma.
• Subdural Hematoma: Found between the skull and brain surface, this type can develop after a head injury and may worsen without treatment.

Causes of Hematoma

Hematomas are often caused by trauma, where blood vessels rupture due to:

• Physical injuries: Everyday incidents like stubbing a toe can cause subungual hematomas, while more severe trauma (e.g., vehicle accidents) can lead to internal hematomas.
• Surgical Procedures: Surgeries, including dental, medical, or cosmetic operations, can cause hematomas if they damage nearby tissues or blood vessels.
• Medication: Blood thinners like aspirin, warfarin, or dipyridamole can increase the likelihood of bleeding and hematomas.

In rare instances, a hematoma may appear without any obvious cause, especially in individuals with bleeding disorders or those taking anticoagulants.

Symptoms of Hematoma

Hematoma symptoms vary depending on the type and location. Superficial hematomas, which are closer to the skin, present with:

• Discoloration, usually dark red, blue, or black
• Swelling and tenderness
• Redness and warmth around the area
• Pain, which can vary from minor to severe 

Internal hematomas are harder to recognize, especially without visible symptoms. If a person has been in a severe accident or has a head injury, they should watch for:

• Severe headache
• Confusion or dizziness
• Vision or hearing changes
• Mood swings or personality changes
• Weakness or paralysis on one side
• Difficulty walking or frequent falls
• Loss of consciousness or seizures

Subdural hematomas, common in head injuries, may have delayed symptoms, appearing days or even weeks after the initial trauma.

Diagnosing Hematomas: When to See a Doctor

Minor hematomas, such as those under the nail or skin, usually heal on their own. However, some signs indicate a need for medical evaluation:

• Head injuries: Any head trauma should be monitored for potential intracranial hematomas. Healthcare providers might use imaging, such as CT or MRI scans, to rule out serious conditions.
• Significant pain: If a hematoma is unusually painful, consult a healthcare professional who may recommend splinting or wrapping to prevent further injury.
• Infection signs: If the area is warm, red, or swollen, an infection could be present, requiring prompt medical attention.

Treating Hematomas

Many hematomas do not need formal treatment, as the body will gradually reabsorb the blood over time. However, there are measures to manage symptoms and aid healing:

1. Rest and Elevation: Keeping the affected area elevated and limiting movement reduces blood flow, helping to prevent further bleeding.
2. Cold Compresses: Applying an ice pack wrapped in cloth can reduce swelling and ease pain. To avoid frostbite, do not place ice directly on the skin. 
3. Pain Management: Over-the-counter pain relievers, such as acetaminophen, can relieve discomfort. Avoid aspirin and other blood thinners unless prescribed by a doctor.

In severe cases, surgical intervention may be necessary. If a hematoma exerts pressure on vital organs (e.g., brain or spinal cord), surgical drainage may relieve the pressure and reduce the risk of permanent damage.

Conservative Treatment vs. Surgery

Not all hematomas inside the skull require surgery. A 2015 study found that 6.5% of individuals with subdural hematomas eventually needed surgery, while most received conservative treatment. Each case depends on symptoms, severity, and hematoma growth.

Complications of Untreated Hematomas

If left untreated, hematomas may lead to complications:

• Brain Hematomas: Can result in long-term cognitive or physical impairments. Symptoms, such as persistent headaches, slurred speech, or confusion, may indicate a more serious issue.
• Organ Compression: A hematoma near or within an organ can affect its function, leading to symptoms based on the affected area.
• Chronic Hematomas: In rare cases, chronic hematomas may continue growing, requiring surgical intervention to prevent further complications.

Hematoma Prevention Tips for Phlebotomists

For phlebotomists and medical professionals, preventing hematomas during blood draws is crucial for patient comfort and care quality:

1. Use Proper Techniques: Ensure needle insertion is smooth and avoid excessive probing, which can damage blood vessels.
2. Select an Appropriate Site: Carefully choosing the puncture site helps reduce the risk of hematoma formation.
3. Communicate with Patients: Explain post-draw care instructions, including applying pressure and keeping the arm straight, to minimize bleeding risk.

Frequently Asked Questions (FAQs)

What causes a hematoma?

Hematomas occur when blood vessels break and leak blood into surrounding tissues, often due to injury, surgery, or certain medications like blood thinners.

How do I know if a hematoma is serious?

A hematoma may need medical attention if it is large, painful, growing, or in a sensitive area like the head or abdomen. Signs of infection, such as warmth, redness, or pus, also indicate a need for medical evaluation.

What’s the difference between a bruise and a hematoma?

A bruise involves small capillaries and typically fades without intervention, whereas a hematoma involves larger blood vessels and may require treatment, especially if it causes discomfort or pressure.

How is a hematoma treated?

Treatment includes rest, ice, compression, and in severe cases, drainage by a medical professional. Pain relief can be managed with over-the-counter medications, but blood-thinning drugs should be avoided.

Can hematomas be prevented?

While accidents aren’t always preventable, taking caution in high-risk activities, using protective equipment, and managing medication carefully can reduce the likelihood of hematomas.

How long does a hematoma take to heal?

Healing times vary based on severity and location. Minor hematomas may heal within a week, while larger or internal hematomas may take weeks to months and may require monitoring.

Summary

Hematomas, while common, can vary significantly in severity and treatment needs. Minor hematomas, like those under a nail, can heal on their own with basic home care. However, more serious injuries or head traumas may require medical attention and, in rare cases, surgical intervention.

Phlebotomists and healthcare providers should be familiar with hematomas’ symptoms, types, and causes to provide informed care and advice. By understanding how to prevent hematomas and when to seek medical help, healthcare professionals can ensure patient safety and support better recovery outcomes.

For patients and aspiring phlebotomists alike, hematomas might seem intimidating, but with knowledge and care, most hematomas resolve without lasting complications.