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 hemostasis 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%.
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 exam, and laboratory studies should be utilized. However, laboratory testing is costly and results can be confusing and require an experienced physician for proper interpretation.
Referral to a hematologist for further evaluation may be needed. Appropriate evaluation is especially important before invasive procedures.
- Purpura simplex
- Actinic purpura (also known as senile purpura)
- Alcohol use disorder
- Drug-induced thrombocytopenia
- Platelet storage pool disease
- von Willebrand disease (vWD)
- Vitamin K deficiency
- Hereditary hemorrhagic telangiectasia (HHT)
- Cushing syndrome
- Child abuse
- Elder abuse
- 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 syndrome
- Glanzmann thrombasthenia
- Acute myelogenous leukemia
- Acute lymphocytic leukemia
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- Multiple myeloma
- Solid tumor with infiltration of bone marrow
- Myelodysplastic syndrome
- Aplastic anemia
- Factor V, VII, X, or XI deficiency
- Acquired coagulation inhibitors
- Vitamin C deficiency
- Marfan syndrome
- Ehlers-Danlos syndrome
- Acute liver failure
- Gardner-Diamond syndrome
Tzu-Fei Wang, MD
Assistant Professor of Internal Medicine
The Ohio State University
TW declares that she has received an honorarium from Daiichi Sankyo.
Eric H. Kraut, MD
Professor of Internal Medicine
The Ohio State University
EHK declares that he has no competing interests.
Donald M. Arnold, MDCM, MSc
Department of Medicine
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
St. Joseph’s Healthcare Hamilton
DS declares that she has no competing interests.
Riten Kumar, MD, MSc
Assistant Professor of Pediatrics
Nationwide Children’s Hospital
Ohio State University
RK declares that he has no competing interests.
David Keeling, BSc, MD, FRCP, FRCPath
Oxford Haemophilia & Thrombosis Centre
DK declares that he has no competing interests.
Professor Cheng-Hock Toh, MBChB, MD, FRCP, FRCPath
Professor of Haematology
University of Liverpool
CHT declares that he has no competing interests.
Shankaranarayana Paneesha, MBBS, MD, FRCP, FRCPath
Heart of England NHS Foundation Trust
SP has received a speaker fee from Janssen.
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