Ecchymoses Bruising

Bruising is an area of discolored skin. Bruising develops when the lining ofsmall blood vessels is damaged, allowing blood cells to escape into the skinand tissues. This condition most often occurs after a person injures aparticular part of the body.

What is going on in the body?

A person may notice several stages of bruising. A bruise usually starts out asa red area or as tiny red dots or splotches on the skin. Within days to a weekor so, the bruise becomes more purple. As it heals, it becomesbrownish-yellow. Generally, bruises heal and disappear within 2 to 3 weeks.

What are the causes and risks of the symptom?

As a person ages, he or she will bruise more easily. The layer of protectivefat just under the skin becomes thinner. The small blood vessels also becomemore fragile and are more easily damaged. Frequent long-term exposure to thesun can also cause the skin to be more fragile and likely to bruise. Thetendency to bruise easily may run in families.

Other causes of bruising may include the following:

blood disorders, including problems with blood clotting such as hemophilia Aor hemophilia B

blood-related diseases such as leukemia, a blood cancer

liver disease,such as cirrhosis

lymphomas

certain disorders in which bone marrow cells grow at an abnormalrate

nutritional deficiencies, such as deficiency in vitamins C, phylloquinone, which is found in food\ \menadione, which is man-made\ \menaquinone, which is produced by the body\K, B1\ \B2\ \B6\ \pantothenic acid\ \folic acid\ \niacin\ \biotin\ Cobalamin is the general name for vitamin B12.B12, or folic acid

sepsis, or severe infection in the bloodstream

systemic lupus erythematosus, an autoimmunedisorder in which a person’s body attacks its own cells for unknownreasons

trauma, or injury

prolonged coughing or vomiting

medications, such as blood thinners

abuse, such as child abuse, spousal abuse, or elder abuse

surgery or other medical procedures

allergy-related disorders

What other signs and symptoms are associated with this symptom?

Symptoms of bruising vary depending on the cause of the bruising. The bruisemay be very small and may blend in with the texture of the skin, or it may belarge, swollen, and painful.

When evaluating symptoms, the healthcare provider may want to know:

if there is a family history of bleeding problems

when and where the bruises were discovered

if the person is taking any medications

what the person has eaten lately

if there is any history of trauma or recent injury

if the person has recently had a blood transfusion

if there is any history of vomiting blood, blood in the stools,nosebleeds, or bleeding gums

if there is any fever or other symptoms related to other parts of thebody, such as diarrhea, shortness of breath, headaches,chestpain, abdominal distress, nausea, pain in the extremities,swelling in the extremities, heavy menstrualbleeding,weakness, weight loss, dizziness, orconfusion

How is the symptom diagnosed?

Tests used to diagnose bruising will vary, depending on the suspected cause.

First, the healthcare provider will take a complete medical history, includingany other symptoms or conditions that are present and any history of injury. Athorough physical exam, to evaluate for possible underlying conditions, willalso be done.

The healthcare provider may also order X-rays, a bone biopsy, or abonescan to evaluate for injury, tumors, or other conditions.

A spinaltap may be done to obtain a sample of cerebrospinal fluid, thefluid that surrounds the spinal column and brain. This fluid can be tested forinfection and other conditions that cause bruising.

Usually, several blood tests will be ordered, such as:

prothrombin time (PT), or INR, which are tests of blood clotting

fibrinogen levels, to check for bleeding disorders

a complete blood count, or CBC, to check for abnormal white blood cells orplatelets

What can be done to prevent the symptom?

The causes of bruising will determine whether there are ways to preventbruising. Wearing protective clothing may prevent some bruising. Avoidingexcessive exposure to the sun may minimize skin damage. Other cases of bruisingmay be prevented or decreased if the cause is eliminated, such as replacingvitamins in someone who has vitamin deficiency. In other cases of bruising, theunderlying cause may not always be cured. Being careful not to bang or knockthe skin against hard surfaces may decrease the likelihood of developingbruises. Also, if a person is taking a blood thinner, it is important that theytake it exactly as prescribed in order to reduce the likelihood of bruising.

What are the long-term effects of the symptom?

Long-term effects of bruising will depend on the underlying cause of thebruising. A bruise caused by a shin hitting a chair may heal without anylong-term effects. A person who has blood disorders may require bloodtransfusions and medications over a long period of time. In somecases, a person with leukemia or cancer may have a treatable form of thedisease. In other cases, death may result.

What are the risks to others?

Bruising is not contagious, although there may be a tendency for bruising torun in families. If an underlying infection is causing the bruising, thisinfection may be contagious.

What are the treatments for the symptom?

Treatment of bruising will vary depending on the underlying cause of thebruise. When an injury occurs, the application of an ice pack off and on forthe first 24 hours will reduce further bruising and swelling. After 24 hours, ahot pack to the area will help the bruise heal more quickly.

Other treatments will vary greatly depending on the cause of the bruising. Aperson who has hemophilia may be given blood transfusions. Aperson who has nutritional deficiencies may be given special dietaryrecommendations. A person who has leukemia or cancer may require specialmedications and procedures. A person who has bacteria in the blood may needantibiotics.

What are the side effects of the treatments?

Side effects will depend on the treatment used. There are usually no sideeffects when ice or heat are used properly. There may be stomach upset orallergic reaction to antibiotics and othermedications. Treatments that require surgery pose a risk of bleeding,infection, and allergicreaction to anesthesia. Medications used for leukemia may cause more sideeffects, including hairloss or an increased risk of infection.

What happens after treatment for the symptom?

After treatment, recommendations will vary depending on the cause of thebruising and the treatment used. In some situations, no further treatment isnecessary for minor bruising. For more serious disease or injury, treatment maycontinue, and a person may have further instructions to follow.

How is the symptom monitored?

If bruising worsens, or if any other symptoms are present, monitoring by ahealthcare provider may be necessary. Any new or worsening symptoms should bereported to the healthcare provider.