Assessment of easy bruising

Last reviewed: 26 Apr 2022

Last updated: 05 Apr 2022

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][2]

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] 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.

Differentials

Common

Purpura simplex
Actinic purpura (also known as senile purpura)
Medications
Alcohol use disorder
Drug-induced thrombocytopenia
Platelet storage pool disease
von Willebrand disease (vWD)
Vitamin K deficiency
Cirrhosis
Vasculitis

Full details

Uncommon

Hereditary haemorrhagic telangiectasia
Cushing's syndrome
Child abuse
Elder abuse
Immune thrombocytopenia (ITP)
Thrombotic thrombocytopenic purpura (TTP)
Haemolytic uraemic syndrome (HUS)
Disseminated intravascular coagulation
Wiskott-Aldrich syndrome
MYH9-related disorders
Bernard-Soulier disease
Thrombocytopenia with absent radius syndrome
Glanzmann's thrombasthenia
Acute myelogenous leukaemia
Acute lymphocytic leukaemia
Hodgkin's lymphoma
Non-Hodgkin's lymphoma
Multiple myeloma
Solid tumour with infiltration of bone marrow
Myelofibrosis
Myelodysplastic syndrome
Aplastic anaemia
Haemophilia
Factor V, VII, X, or XI deficiency
Acquired coagulation inhibitors
Vitamin C deficiency
Marfan's syndrome
Ehlers-Danlos syndrome
Acute liver failure
Gardner-Diamond syndrome

Full details

Contributors

Authors

Tzu-Fei Wang, MD

Assistant Professor of Internal Medicine

The Ohio State University

Columbus

Disclosures

TW declares that she has received an honorarium from Daiichi Sankyo.

Eric H. Kraut, MD

Professor of Internal Medicine

The Ohio State University

Columbus

Disclosures

EHK declares that he has no competing interests.

Peer reviewers

Donald M. Arnold, MDCM, MSc

Associate Professor

Department of Medicine

McMaster University

Hamilton

Ontario

Canada

Disclosures

DMA has received speaking honoraria from Amgen for presentation on immune thrombocytopenia; consulting fees from Amgen, and Bristol-Myers Squibb for ITP related studies; and research grants from Amgen, GlaxoSmithKline, and Hoffman-La Roche for clinical studies in ITP. He is co-author of a reference cited in this topic.

Deborah Siegel, MD, MSc, FRCPC

Clinical Scholar

McMaster University

St. Joseph’s Healthcare Hamilton

Hamilton

Ontario

Canada

Disclosures

DS declares that she has no competing interests.

Riten Kumar, MD, MSc

Assistant Professor of Pediatrics

Nationwide Children’s Hospital

Ohio State University

Columbus

Disclosures

RK declares that he has no competing interests.

David Keeling, BSc, MD, FRCP, FRCPath

Consultant Haematologist

Oxford Haemophilia & Thrombosis Centre

Churchill Hospital

Oxford

Disclosures

DK declares that he has no competing interests.

Professor Cheng-Hock Toh, MBChB, MD, FRCP, FRCPath

Professor of Haematology

University of Liverpool

Liverpool

Disclosures

CHT declares that he has no competing interests.

Shankaranarayana Paneesha, MBBS, MD, FRCP, FRCPath

Consultant Haematologist

Heart of England NHS Foundation Trust

Birmingham

Disclosures

SP has received a speaker fee from Janssen.

Guidelines
- Clinical evaluation of bleeding and bruising in primary care
Guidelines
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Assessment of easy bruising

Summary

Differentials

Common

Uncommon

Contributors

Authors

Tzu-Fei Wang, MD

Disclosures

Eric H. Kraut, MD

Disclosures

Peer reviewers

Donald M. Arnold, MDCM, MSc

Disclosures

Deborah Siegel, MD, MSc, FRCPC

Disclosures

Riten Kumar, MD, MSc

Disclosures

David Keeling, BSc, MD, FRCP, FRCPath

Disclosures

Professor Cheng-Hock Toh, MBChB, MD, FRCP, FRCPath

Disclosures

Shankaranarayana Paneesha, MBBS, MD, FRCP, FRCPath

Disclosures

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice