The essentials

Vomiting blood, bright red or dark like coffee grounds, usually means bleeding in the esophagus, stomach or duodenum and needs a same-day emergency check. Blood swallowed from a nosebleed is the milder end. At the hospital, a few blood tests (hemoglobin, platelets, INR, BUN, blood type) and an upper endoscopy show how urgent it is and where the blood comes from.

Is vomiting blood an emergency?

Treat it as one until a doctor says otherwise. Upper digestive bleeding carries a reported death rate of 2 to 10%[6]. The color helps doctors: bright red usually means fresh bleeding, while dark brown flecks that look like coffee grounds are blood already changed by stomach acid[1].

When to see a doctor

  • Emergency: call 911 if you vomit more than a streak of blood, or any blood together with dizziness or fainting, confusion, fast or shallow breathing, cold, clammy or pale skin, belly pain or black stool[2]. Do not drive yourself; bring your medicines[2].
  • Today, at an emergency department if you vomited a little blood once, have stopped and feel well, especially if you take aspirin, an anti-inflammatory painkiller or a blood thinner[1].
  • At your next appointment if you are sure the blood came from a nosebleed or a cut in the mouth, it has not come back, and you feel normal.

What can cause blood in vomit that is less serious?

Vomited blood is hard to tell apart from blood coughed up from the lungs or from a nosebleed, so say whether it came with a cough or with retching[1].

  • Common Swallowed blood. Blood from a nosebleed, dental work or a cut in the mouth can be swallowed and then vomited, as can blood a baby swallows from a cracked nipple while breastfeeding[2].
  • Common Streaks after violent retching. Forceful or long vomiting can break small throat vessels and leave red streaks[1].

What serious conditions cause vomiting blood?

In the United States in 2012, about 67 people per 100,000 were admitted to the hospital for upper digestive bleeding, and 1.9% of them died there[11]. The usual sources are:

  • Common Bleeding ulcer of the stomach or duodenum. Most come from H. pylori infection or from anti-inflammatory painkillers such as aspirin, ibuprofen and naproxen; blood thinners make them bleed more[3]. See stomach ulcer symptoms.
  • Common Gastritis and esophagitis, an inflamed lining. Alcohol, anti-inflammatory drugs and long-standing acid reflux are typical causes[3]. See gastritis and its lab tests.
  • Possible Mallory-Weiss tear, a tear in the lining of the lower esophagus, often caused by severe vomiting or retching[3]. In a series of 73 tears, alcohol was involved in 44% and 23% had a complicated course, more often when the blood count was low on arrival or bleeding was active at endoscopy[10].
  • Possible Esophageal or gastric varices, swollen veins most often caused by cirrhosis of the liver[3]. They bleed heavily: 6 to 7% of people admitted to US hospitals for variceal bleeding die there[11].
  • Rare Clotting disorders (hemophilia, overly thin blood from medicines), abnormal gut vessels or poisoning[1][2].
  • Rare Tumors of the esophagus or stomach[3]. See stomach cancer warning signs.

The same lesions can also turn stool black: see black, tarry stool.

What tests are done at the hospital after vomiting blood?

How much blood is lost, can it clot, and where is it from? A blood count, chemistries, clotting and liver tests, then an upper endoscopy (EGD), answer this[1].

Tests commonly ordered after vomiting blood
TestQuestion it answersRead more
Hemoglobin (complete blood count)Blood lost; need for transfusionHemoglobin results, complete blood count
Platelet countEnough platelets to stop bleedingPlatelet count
PT/INR (and PTT)Clotting slowed by warfarin or liver diseaseProthrombin time, INR meaning
BUN and creatinineDigested blood absorbed high in the gutBUN/creatinine ratio
Liver tests and albuminLiver disease pointing to varicesHigh liver enzymes, albumin
Blood type and antibody screenMatched blood ready for transfusionBlood type test
Upper endoscopy (EGD)Finds and often treats the sourceWithin 24 hours, or right after stabilization if unstable[5]

How do I read my blood results after vomiting blood?

Fictitious example of an emergency department report after vomiting blood (United States format), man aged 58
TestResultReference rangeFlag
Hemoglobin10.9 g/dL13.2-16.6L
Platelet count112 x103/µL150-400L
INR1.50.9-1.1H
BUN (urea nitrogen)38 mg/dL7-20H
Creatinine0.9 mg/dL0.7-1.3
Albumin3.1 g/dL3.5-5.0L
ABO/Rh type; antibody screenO positive; negative
  1. Flag: L is below this lab's range, H above it; ranges vary between labs.
  2. Hemoglobin 10.9: already low, and it can keep falling for hours, so it is repeated.
  3. Low platelets, high INR and low albumin together: a pattern that suggests liver disease, so varices become a possible source.
  4. BUN 38 with a normal creatinine: a ratio of about 42, which fits bleeding high in the gut.
  5. Blood type and antibody screen: lets the blood bank prepare compatible blood.

Back home with a hospital report after vomiting blood? BloodSense explains each line in plain words before your follow-up visit.

Explain my blood test report

Hemoglobin: the number that decides transfusion

A hemoglobin below 8 g/dL makes a severe bleed needing urgent treatment more likely[7]. US guidelines suggest transfusing hospitalized patients when hemoglobin falls below 7 g/dL[4]. Later, iron tests show whether stores need rebuilding.

Platelets and INR: can the blood clot?

In active bleeding, UK guidance gives platelets below 50 x103/µL, plasma when PT or INR exceeds 1.5 times normal, and a clotting-factor concentrate to people on warfarin[5].

BUN out of proportion to creatinine

Digested blood raises BUN but not creatinine. A BUN-to-creatinine ratio above 30 makes an upper digestive source clearly more likely (likelihood ratio 7.5)[7].

The Glasgow-Blatchford score: home or hospital?

This score adds points for BUN, hemoglobin, blood pressure, pulse, black stool, fainting, liver disease and heart failure[8]. In the example, BUN 38 mg/dL (urea about 13.6 mmol/L) gives 4 points and hemoglobin 10.9 g/dL in a man gives 3: at least 7 before vital signs[8]. In 3,012 patients, 0 or 1 picked out people safe to go home (sensitivity 98.6%) and 7 or more best predicted endoscopic treatment[9]; US guidelines suggest outpatient follow-up at 0 to 1[4].

If varices are suspected, antibiotics and a drug that lowers portal pressure start before endoscopy[5][6].

What should I note before seeing the doctor?

The team will ask about these points[1].

  • When it started, how many times, and whether plain vomiting came first
  • Color and amount: streaks or a cupful, red or coffee-ground (a photo helps)
  • Any recent nosebleed, dental work, surgery or hard coughing
  • Aspirin, ibuprofen, naproxen or blood thinners, with the last dose
  • Alcohol in the last days, known liver disease, past ulcers or earlier bleeding
  • Black stool, fainting or dizziness since the episode

Questions to ask your doctor

  1. Where did the bleeding come from, and could it happen again?
  2. Do I need a test for H. pylori, and when?
  3. Which of my medicines should I stop, and which should I restart?

Frequently asked questions

Is a small streak of blood after vomiting a lot normal?

It is common after hard retching but never normal. One streak that stopped, in someone who feels well: same-day check. More blood or repeated streaks: emergency care[1][2].

Can heavy drinking make you vomit blood?

Yes: binge vomiting can tear the esophagus, and years of heavy drinking can damage the liver and lead to varices[2][10].

Should I stop my blood thinner after vomiting blood?

Not on your own: these drugs often prevent strokes or heart attacks. After treatment, outcomes appear better when they are restarted early under supervision[6].

References

  1. MedlinePlus Medical Encyclopedia. Vomiting blood. medlineplus.gov (accessed November 13, 2026)
  2. NHS. Vomiting blood. nhs.uk (accessed November 13, 2026)
  3. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of GI bleeding. niddk.nih.gov (accessed November 13, 2026)
  4. Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021;116(5):899-917. doi:10.14309/ajg.0000000000001245 (accessed November 13, 2026)
  5. National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management (CG141). Recommendations. nice.org.uk (accessed November 13, 2026)
  6. Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ. 2019;364:l536. doi:10.1136/bmj.l536 (accessed November 13, 2026)
  7. Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? JAMA. 2012;307(10):1072-9. doi:10.1001/jama.2012.253 (accessed November 13, 2026)
  8. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318-21. doi:10.1016/S0140-6736(00)02816-6 (accessed November 13, 2026)
  9. Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. doi:10.1136/bmj.i6432 (accessed November 13, 2026)
  10. Kortas DY, Haas LS, Simpson WG, Nickl NJ, Gates LK. Mallory-Weiss tear: predisposing factors and predictors of a complicated course. Am J Gastroenterol. 2001;96(10):2863-5. PMID: 11693318 (accessed November 13, 2026)
  11. Wuerth BA, Rockey DC. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: a nationwide analysis. Dig Dis Sci. 2018;63(5):1286-93. doi:10.1007/s10620-017-4882-6 (accessed November 13, 2026)
  12. Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act (EMTALA). cms.gov (accessed November 13, 2026)

This article is general health information. It does not replace a medical examination, diagnosis or treatment. If you are vomiting blood, seek care without waiting.