Evaluation of easy bruising
Summary
Differentials
Common
- Purpura simplex
- Actinic purpura (also known as senile purpura)
- Drugs
- Alcohol use disorder
- Drug-induced thrombocytopenia
- Platelet storage pool deficiency
- von Willebrand disease (vWD)
- Vitamin K deficiency
- Cirrhosis
- Vasculitis
Uncommon
- Hereditary hemorrhagic telangiectasia (HHT)
- Cushing syndrome
- Child abuse
- Neglect and abuse of older adults
- Immune thrombocytopenia (ITP)
- Thrombotic thrombocytopenic purpura (TTP)
- Hemolytic uremic syndrome (HUS)
- Disseminated intravascular coagulation
- Wiskott-Aldrich syndrome
- MYH9-related disorders
- Bernard-Soulier disease
- Thrombocytopenia with absent radius (TAR) syndrome
- Glanzmann thrombasthenia
- Acute myeloid leukemia
- Acute lymphoblastic leukemia
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- Multiple myeloma
- Solid tumor with infiltration of bone marrow
- Myelofibrosis
- Myelodysplastic syndrome
- Aplastic anemia
- Hemophilia
- Factor V, VII, X, or XI deficiency
- Acquired coagulation inhibitors
- Vitamin C deficiency
- Marfan syndrome
- Ehlers-Danlos syndrome (EDS)
- Acute liver failure
- Gardner-Diamond syndrome
Contributors
Authors
Yazan Abou-Ismail, MD
Associate Professor of Medicine
Associate Program Director (Hematology & Oncology Fellowship Program)
Division of Hematology & Hematologic Malignancies, Department of Internal Medicine
University of Utah
Salt Lake City
UT
Disclosures
YAI received honoraria from Sanofi and Takeda for advisory boards, and is part of the ABIM exam writer task force.
Acknowledgements
Dr Yazan Abou-Ismail would like to gratefully acknowledge Dr Tzu-Fei Wang and Dr Eric H. Kraut, previous contributors to this topic.
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
OH
Disclosures
RK declares that he has no competing interests.
David Keeling, BSc, MD, FRCP, FRCPath
Consultant Haematologist
Oxford Haemophilia & Thrombosis Centre
Churchill Hospital
Oxford
UK
Disclosures
DK declares that he has no competing interests.
Professor Cheng-Hock Toh, MBChB, MD, FRCP, FRCPath
Professor of Haematology
University of Liverpool
Liverpool
UK
Disclosures
CHT declares that he has no competing interests.
Shankaranarayana Paneesha, MBBS, MD, FRCP, FRCPath
Consultant Haematologist
Heart of England NHS Foundation Trust
Birmingham
UK
Disclosures
SP has received a speaker fee from Janssen.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Faughnan ME, Mager JJ, Hetts SW, et al. Second international guidelines for the diagnosis and management of hereditary hemorrhagic telangiectasia. Ann Intern Med. 2020 Dec 15;173(12):989-1001.Full text Abstract
Tiede A, Collins P, Knoebl P, et al. International recommendations on the diagnosis and treatment of acquired hemophilia A. Haematologica. 2020 Jul;105(7):1791-801.Full text Abstract
Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019 Dec 10;3(23):3829-66.Full text Abstract
Rodeghiero F, Tosetto A, Abshire T, et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. J Thromb Haemost. 2010;8:2063-2065.Full text
Reference articles
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