Easy Bruising

You may assume that every unexplained bruise indicates a serious blood disorder, or that bruising while taking an anticoagulant is always harmless. Most bruises follow minor injury and settle naturally. However, new widespread bruising, bruising with other bleeding, pinpoint non blanching spots or bruising in a non mobile baby needs prompt assessment.

A bruise forms beneath intact skin A bruise, medically called an ecchymosis, forms when small blood vessels are damaged and blood leaks into surrounding tissue. The skin surface usually remains intact. A bruise may become tender, swollen, blue, purple, brown or grey, greenish or yellow as it resolves, or less visible or differently coloured on darker skin. Colour change reflects the breakdown of blood pigments. You cannot accurately date a bruise from its colour alone. Minor bumps can cause ordinary bruises Common situations include walking into furniture, sport, falls, carrying heavy objects, blood tests, injections, tight pressure on the skin, or minor knocks you did not notice. Bruising is more common over exposed areas and bony prominences, such as the shins and forearms. A single bruise with a clear explanation and normal recovery is usually not evidence of a clotting disorder. "Easy bruising" means a change from your pattern Bruising may be considered unusual when bruises appear without remembered injury, you develop many bruises, they are unusually large, they occur in protected or unexpected areas. They take longer to settle, new bruising begins suddenly, there is bleeding elsewhere, or other people notice a marked change. Your usual pattern matters more than comparing yourself with another person. Skin becomes more fragile with age With age, skin may become thinner and lose some supporting tissue. Bruises may appear after relatively minor contact, particularly on forearms, hands and shins. Long term corticosteroid treatment and sun damage can also make skin more fragile. This pattern may be benign, but sudden change or additional bleeding still needs review. Medicines frequently influence bruising Medicines that may increase bruising include anticoagulants, aspirin, other antiplatelet medicines, anti inflammatory painkillers, corticosteroids, some antidepressants, and some cancer treatments. An anticoagulant reduces the blood's ability to form harmful clots. Examples include warfarin, apixaban and rivaroxaban. Occasional small bruises may occur during anticoagulant treatment. Severe, spontaneous or rapidly increasing bruising requires medical advice. Do not stop an anticoagulant yourself Stopping an anticoagulant can increase the risk of stroke, deep vein thrombosis, pulmonary embolism, or clotting on a heart valve. Contact the prescribing service, GP, anticoagulation clinic or NHS 111 when bruising is unusual. Call 999 for major bleeding, collapse or neurological symptoms. Take an updated medicines list to assessment. Supplements can affect bleeding Some herbal or nutritional products may influence platelets, clotting or medicine metabolism. Tell the clinician about vitamins, herbal products, bodybuilding supplements, over the counter painkillers, and traditional remedies. "Natural" does not mean that a product cannot interact with prescribed treatment. Platelets begin the clotting response Platelets are small blood components that help plug damaged vessels. A low platelet count or impaired platelet function may cause easy bruising, petechiae, nosebleeds, gum bleeding, heavy menstrual bleeding, or prolonged bleeding from cuts. A full blood count measures platelet numbers, but further tests may be needed when platelet function is suspected to be abnormal. Clotting factors strengthen the blood clot Clotting factors are proteins that work through a sequence of reactions to stabilise a clot. A factor deficiency may cause large bruises, prolonged bleeding, bleeding after surgery or dental treatment, bleeding into muscles or joints, heavy periods, or unusual bleeding in the family. Von Willebrand disease is an inherited bleeding disorder that may cause easy bruising, nosebleeds, gum bleeding, heavy periods or prolonged bleeding after injury. Mild inherited conditions may not become apparent until surgery, childbirth or a major injury. Petechiae are not ordinary bruises Petechiae are tiny pinpoint spots caused by bleeding beneath the skin. They are usually red, purple or brown, flat, non blanching, and smaller than a typical bruise. Purpura refers to larger non blanching areas that are still smaller than many bruises. Non blanching means the mark does not disappear when firm pressure is applied. Petechiae can occur after coughing, vomiting or pressure, but unexplained widespread petechiae may indicate infection, inflammation or a platelet problem. A non blanching rash plus severe illness is an emergency Call 999 or go to A&E if a non blanching rash occurs with severe illness, neck stiffness, light sensitivity, confusion, reduced responsiveness, breathing difficulty, or pale, mottled, blue or grey skin. This pattern can occur with meningitis or sepsis. The glass test may help identify non blanching spots, but it must not delay emergency help. Early serious infection may occur without a rash. Other bleeding changes the assessment Tell a clinician about recurrent nosebleeds, bleeding gums, heavy or prolonged periods, blood in urine, blood in stool, black stool. Vomiting or coughing blood, prolonged bleeding from cuts, excessive bleeding after dental work, joint or muscle swelling, or bleeding after childbirth or surgery. Bruising with bleeding from several sites suggests a broader haemostatic problem rather than fragile skin alone. General symptoms may indicate illness Seek assessment when bruising occurs with persistent fatigue, pallor, fever, recurrent or persistent infections, enlarged glands, weight loss, night sweats, bone pain, abdominal swelling, or breathlessness. A very urgent full blood count, generally within 48 hours, is recommended when an adult, child or young person has unexplained bruising or bleeding that could indicate leukaemia. This recommendation is designed to exclude an important cause quickly. Most people tested will not necessarily have leukaemia. Bruising in children needs age and development context Mobile children commonly develop accidental bruises over areas such as shins, knees, forehead and elbows. The explanation should fit the child's developmental ability, the mechanism, the size and distribution, the timing, and any other injuries. A child's bruise should never be interpreted from location alone. Bruising in a non mobile baby is unusual Babies and children who cannot yet move independently rarely acquire accidental bruises through ordinary handling. Any bruise or unexplained mark in a non mobile baby requires prompt paediatric assessment. Possible explanations include a mark that is not actually a bruise, birth related or medical factors, a clotting or blood disorder, an accidental injury, or a deliberately inflicted injury. Assessment protects the child while ensuring that medical causes are not missed. It does not mean that abuse has already been concluded. Safeguarding questions should remain calm and factual If a bruise raises concern, professionals consider how the mark was discovered, the explanation provided, the child's mobility, whether the mechanism is developmentally possible, the presence of other injuries, past health problems, and information from relevant services. The child should receive appropriate medical assessment without accusatory questioning or premature conclusions. The location and pattern can guide assessment. A clinician may pay particular attention to multiple clustered bruises, bruises with a recognisable object pattern, bruises around the ears. Neck or soft tissues, symmetrical marks, bruises inconsistent with usual activity, bruises in protected areas, or petechiae associated with a larger bruise. These observations prompt assessment. They do not independently establish who or what caused the injury. Your clinician takes a structured account of your bleeding pattern Questions may include: When bruising changed. Whether bruises are spontaneous or injury related. Whether there is bleeding elsewhere. Whether periods are unusually heavy. Whether there was excessive bleeding after surgery or childbirth. What medicines and supplements you take. Whether there is liver or kidney disease. Whether alcohol intake has changed. Whether there is a bleeding disorder in the family. Whether there are fever, infections, weight loss or bone pain Health problems in the family may be absent even when a bleeding disorder is present. Examination looks for a wider pattern Assessment may include the number and distribution of bruises, petechiae or purpura, pallor, gum or nose bleeding, enlarged lymph nodes, liver or spleen enlargement, joint or muscle swelling, signs of chronic liver disease, and other injuries. Photographs may be used within clinical records with appropriate consent and safeguarding procedures. Blood tests assess different parts of clotting Possible tests include full blood count, platelet count, blood film, clotting screen, liver tests, kidney tests, iron studies, tests for von Willebrand disease, and specific clotting factor tests. A normal basic clotting screen does not exclude every mild bleeding disorder. Testing is selected according to the pattern of bleeding. Caring for a simple bruise For an uncomplicated bruise after a known injury: rest the area briefly if painful, apply a wrapped cold pack for short intervals. Elevate the limb where practical, use appropriate pain relief, avoid massage immediately after injury, and monitor movement, swelling and sensation. Do not place ice directly on skin. Seek assessment if the swelling is severe, movement is limited, pain is increasing or the limb becomes numb, pale or tense.

A bruise is blood that has escaped beneath the skin. A safe assessment asks whether there was a plausible injury, whether the number, size or location is unusual for you, whether there are pinpoint spots or bleeding elsewhere, whether medicines or supplements have changed, and whether age, mobility or safeguarding context change the significance. The appearance of a bruise cannot identify its cause or exact age.