You don’t remember banging in to anything and you see bruises on your legs and arms. Why am I bruising and do I have to worry? I see this all the time.
Easy bruising is a common complaint for the primary care doctor. Easy bruising is bruising without a history of trauma or bruising after minor trauma that would not have caused bruising in the past.
What do I have to worry about with easy bruising?
In one United States survey of 500 healthy adults, 18 percent reported easy bruising. When you can’t remember any physical trauma, yet you see multiple or large bruises, you need to talk to your doctor. Remember that some patients (fair skinned, overweight, and female) can develop bruising with minimal trauma and bruising is very common in elderly patients as our skin gets thinner when we lose the subcutaneous fat.
The causes of easy bruising can be put into three main categories.
1. A problem with your platelets: from medications, illness including infections or cancer, and von Willebrand disease.
Location, location, location
2. A clotting problem aka coagulation disorders: coagulation factor deficiency, liver disease, vitamin K deficiency.
3. A problem with blood vessels and surrounding tissue: physical abuse, vitamin C deficiency, connective tissue disease.
: The location of bruising on the distal extremities suggests normal bruising, due to known or unknown trauma with activity (falls, sports, bumping into furniture.) So when the bruise(s) are on the upper arms or legs it’s not as worrisome as when bruising occurs on multiple areas of the body. Bruises on the trunk, back, or face need a workup for an underlying cause.
When do I worry?
1. Easy bruising is considered significant when there are five or more bruises greater than 1 cm in diameter.
What are common not-so-scary causes?
2. Bruises plus something else: Any history of significant bleeding that accompanies bruising (gum bleeding, nose bleeds, heavy menstrual cycles, bleeding after procedures or surgery) must be investigated to rule out an underlying bleeding disorder.
Drug-related bruising is most commonly due to nonsteroidal anti-inflammatory drugs (NSAIDS,) warfarin, aspirin, Plavix, and glucocorticoids (prednisone.) Dietary supplements like vitamin E, ginger, and gingko can also cause easy bruising. Antidepressants (fluoxetine, sertraline, paroxetine) are a less common but known cause of bruising.
What tests should I ask my doctor for?
Blood tests that should be done to make sure your bruising isn’t something more sinister are a complete blood count (CBC) with differential and platelet count, prothrombin time (PT,) and activated partial thromboplastin (PTT.) Start there to get reassurance that your easy bruising isn’t something more worrisome.
This too shall pass. If your bruise has been there longer than 6 hours, warm compresses (20 minutes three times a day) will help the skin reabsorb that blood.
- Dr. O
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