- Eric H Kraut, MD
Eric H Kraut, MD
- Professor of Medicine
- Director, Benign Hematology
- Division of Hematology
- The Ohio State University
Easy bruising is a common complaint in medical practice for both primary care clinicians and hematologists. Easy bruising can be defined as bruising without a history of trauma or bruising after minor trauma that would not have caused bruising in the past. Differentiating between bruising that might be considered normal versus clinically significant is challenging given that there may not be specific signs and symptoms.
This topic will describe particular aspects of the clinical evaluation that can aid a provider in distinguishing bruising that is due to a pathologic versus a benign process. Specific disorders associated with bruising and the approach to patients with a bleeding diathesis are discussed in detail elsewhere. (See "Congenital and acquired disorders of platelet function" and "Clinical manifestations and evaluation of thrombocytopenia in children" and "Approach to the adult with unexplained thrombocytopenia" and "Approach to the child with bleeding symptoms" and "Approach to the adult patient with a bleeding diathesis".)
In one United States survey of 500 healthy, ethnically-diverse adults, 18 percent of individuals reported easy bruising . This finding is consistent with many other studies in which the frequency of easy bruising in healthy individuals ranged from 12 to 55 percent [2,3]. Women are more likely than men to report easy bruising [1,4].
A bruise (ecchymosis) is a collection of blood beneath the skin, resulting from extravasation of blood from surrounding vessels. Easy bruising can result from abnormalities affecting the blood vessels themselves, the surrounding skin and subcutaneous structures, platelet number and function, or coagulation cascade function. (See "Overview of hemostasis" and "Approach to the adult patient with a bleeding diathesis".)
Physical injury to a blood vessel normally triggers a vigorous physiologic response. Damage to endothelial tissue causes activation and adhesion of circulating platelets with the assistance of von Willebrand factor. This in turn results in the rapid formation of a platelet plug at the site of injury. Stabilization of the plug via fibrin deposition subsequently results from activation of the coagulation cascade (figure 1). A problem or defect at any step of this process will increase the risk of abnormal bruising and bleeding, regardless of the degree of trauma.
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- - Associated trauma
- - Location and severity
- - Bleeding history
- - Medications
- - Nutrition
- - Family history
- Physical examination
- - Appearance and distribution
- - Other forms of bleeding
- - Other examination findings
- Laboratory testing
- - CBC, PT, and PTT
- - Tests of platelet function
- - Other tests
- FOLLOW-UP AND REFERRAL
- SUMMARY AND RECOMMENDATIONS