Quick topics

Assessing the severity of bruises and bleeding

Easy bruising and abnormal bleeding are often seen in the clinical setting,
and have several potential causes1,3


Example causes of bleeding and bruising
Physical trauma Platelet dysfunction Scurvy Haematological
Appearance and location Palms/soles from falling, facial/truncal from abuse Purpura, nosebleed Perifollicular haemorrhage, spongy/bleeding gums Larger or more numerous bruises
Diagnostic criteria History of prior activity Use of antiplatelet drugs or dietary supplements Appearance alone No history of trauma
Scroll →

Comorbidities and polypharmacy may complicate differential diagnosis in elderly patients1

Identifying the underlying cause of bruising or bleeding in older patients may be complicated by:1,4,5


ONE

Age-related comorbid conditions

TWO

Use of anticoagulants

There have been published examples in which bleeding caused by rare bleeding disorders has been wrongly attributed to anticoagulant therapy4,5

When might a bruise be more than just a bruise?


Benign

Senile purpura

  • Occurs in an many as 10% of patients over the age of 506
  • Caused by fragile skin due to aging
  • May or may not be related to trauma

Suspicious for underlying haematological defect

  • Bruises are larger, more numerous or palpable
  • Develop spontaneously or after mild trauma

Image on left courtesy of shutterstock

Image on right cropped from ‘Acquired haemophilia: a report of 4 cases’ by Karimi M, et al. This paper was published by Austin Publishing Group under a Creative Commons Attribution (CC BY) license

SUMMARY

Unexplained bleeding and bruising require attention1,7

Unexplained or suspicious bleeding and bruising?1,7

Rare conditions should not be overlooked.1,2

Rare causes may be masked by anticoagulant therapy.4,5