Easy Bruising: Bruises Without a Bump, Common Causes and Blood Tests

What it involves

MedlinePlus explains that a bruise is an area of skin discoloration that occurs when small blood vessels break and leak into the soft tissue beneath the skin. Most last about two weeks and pass through red, blue-purple and green-yellow stages as they heal, and MedlinePlus advises seeing a provider if you bruise for no reason.

Who this is for

• Patients who find bruises on their arms or legs and cannot remember hitting anything
• Patients who started a blood thinner, aspirin or steroid and now bruise more
• Patients with frequent nosebleeds, bleeding gums or tiny red dots on the skin along with bruising
• Older adults whose skin seems to bruise from the lightest touch

What to expect

• Questions about when the bruising began, where it appears and what you take, including aspirin and supplements
• An exam of the skin and a look for other signs of bleeding
• A complete blood count and other blood tests, since the practice lists blood work among its services
• A plan based on the results, with referral to a blood specialist if the numbers call for it

Ordinary bruises and what they tell you

MedlinePlus says bruises are often caused by falls, sports injuries, car accidents or blows from people or objects, and that there are three types: beneath the skin, within the muscle, and in the bone, with a bone bruise being the most severe and painful. A bruise that matches an injury you remember is usually nothing more than that. The reason for a visit is the opposite situation, a bruise without any injury, fall or other explanation, which MedlinePlus names as a reason to contact a provider.

Medicines that make bruising easier

MedlinePlus says that if you take a blood thinner you are likely to bruise more easily, and gives aspirin, warfarin, dabigatran, rivaroxaban, apixaban and clopidogrel as examples. A second MedlinePlus article lists steroids and anticoagulants such as heparin as medicines that can cause bleeding into the skin. If you bruise on one of these, do not stop the medicine yourself, because it was prescribed for a reason. Call the office and let a provider weigh the bruising against the benefit.

When bleeding under the skin is a different problem

MedlinePlus describes tiny red dots called petechiae, larger flat areas called purpura, and a very large bruised area called an ecchymosis. It says that aside from the common bruise, bleeding into the skin or mucous membranes is a significant sign that should always be checked out. A useful clue it gives is that areas of bleeding do not turn pale when you press on them, unlike the redness of skin irritation. Causes it lists range from allergic reaction and viral illness to autoimmune disorders, aging skin, and low platelets.

Platelets, clotting and the blood count

Platelets are the parts of the blood that help it clot. MedlinePlus explains that thrombocytopenia means an abnormally low number, with causes that include too little production in the bone marrow, increased removal from the bloodstream, and trapping in the spleen or liver. It names folate or vitamin B12 deficiency, cirrhosis and some medicines among the reasons. Symptoms may be none, or bruising, nosebleeds, bleeding gums and petechiae. A complete blood count with platelets is the starting test, which the complete blood count guide explains.

What the visit and the tests involve

MedlinePlus says a provider will ask whether you recently had an injury or illness, whether you take aspirin more than once a week or a blood thinner, whether this has happened repeatedly, and whether you have always had a tendency to bleed, such as after surgery or a tooth extraction. Tests may include clotting studies, a complete blood count with platelet count and differential, and, only if needed, a bone marrow biopsy. Related findings can include iron or vitamin shortages, which the anemia guide and the vitamin B12 guide cover.

Looking after skin that bruises

MedlinePlus recommends protecting aging skin by avoiding trauma such as bumping or pulling on skin areas, and using direct pressure to stop bleeding from a cut or scrape. For an ordinary bruise, it suggests ice wrapped in a towel, never placed directly on the skin, for up to 15 minutes each hour, plus raising the area above the heart and resting it. It says not to try to drain a bruise with a needle. Contact a provider for signs of infection, such as streaks of redness, pus or fever, or for extreme pressure in a bruised limb.

Sources

• MedlinePlus — Bruise
• MedlinePlus — Bleeding into the skin
• MedlinePlus — Thrombocytopenia