Assessment of easy bruising

A bruise (ecchymosis) is caused by bleeding beneath the skin as a result of extravasation of blood from surrounding blood vessels. It may develop due to abnormalities in haemostasis or alteration in the structural integrity of the blood vessel wall and surrounding subcutaneous tissue.

Easy bruising implies that no significant trauma has occurred to the skin or soft tissue to cause the bruise, and the bruises are larger and/or more frequent than what would normally be seen. It is a common complaint of patients seen in a medical practice. Surveys of normal healthy individuals report the frequency of easy bruising to range from 12% to 55%.[1]Srámek A, Eikenboom JC, Briët E, et al. Usefulness of patient interview in bleeding disorders. Arch Intern Med. 1995;155:1409-1415. http://www.ncbi.nlm.nih.gov/pubmed/7794090?tool=bestpractice.com [2]Mauer AC, Khazanov NA, Levenkova N, et al. Impact of sex, age, race, ethnicity and aspirin use on bleeding symptoms in healthy adults. J Thromb Haemost. 2011;9:100-108. http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2010.04105.x/full http://www.ncbi.nlm.nih.gov/pubmed/20942847?tool=bestpractice.com

Causes vary from those with no significant clinical consequence to underlying diseases that could be life-threatening such as severe bleeding disorders or bone marrow malignancies. Appropriate evaluation is crucial in reaching the correct diagnosis and treatment; therefore, a structured approach that incorporates the history, physical examination, and laboratory studies should be utilised.[3]Ballas M, Kraut EH. Bleeding and bruising: a diagnostic work-up. Am Fam Physician. 2008;77:1117-1124. http://www.aafp.org/afp/2008/0415/p1117.html http://www.ncbi.nlm.nih.gov/pubmed/18481559?tool=bestpractice.com However, laboratory testing is costly and results can be confusing and require an experienced physician for proper interpretation.

Referral to a haematologist for further evaluation may be needed. Appropriate evaluation is especially important before invasive procedures.