purpura, haematoma, ecchymoses, contusion, petechiae
Bruising is an area of discoloured skin. Bruising develops when the lining of small blood vessels is damaged, allowing blood cells to escape into the skin and tissues. This condition most often occurs after a person injures a particular part of the body.
What is going on in the body?
A person may notice several stages of bruising. A bruise usually starts out red, or as tiny red dots or splotches on the skin. Within days to a week or so, the bruise becomes more purple, and then turns brownish-yellow as it heals. Generally, bruises heal and disappear within 2 to 3 weeks.
What are the signs and symptoms of the condition?
Symptoms of bruising vary depending on the cause of the bruising. The bruise may be very small and blend in with the texture of the skin, or it may be large, swollen, and painful.
When evaluating symptoms, the doctor may want to know:
What are the causes and risks of the condition?
- 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
- any history of vomiting blood, blood in the stools, nosebleeds, or bleeding gums
- any fever or other symptoms related to other parts of the body, such as diarrhoea, shortness of breath, headaches, chest pain, abdominal distress, nausea, pain in the extremities, swelling in the extremities, heavy menstrual bleeding, weakness, weight loss, dizziness, or confusion
As a person ages, he or she will bruise more easily. The layer of protective fat just under the skin becomes thinner. The small blood vessels also become more fragile and more easily damaged. Frequent, long-term exposure to the sun can also cause the skin to be more fragile and likely to bruise. The tendency to bruise easily may run in families.
Other causes of bruising may include:
What can be done to prevent the condition?
- blood disorders, including problems with blood clotting such as haemophilia A or haemophilia B
- blood-related diseases such as easy-bruising syndrome or leukaemia
- liver disease, such as cirrhosis
- certain disorders in which bone marrow cells grow at an abnormal rate
- nutritional deficiencies, such as deficiency in vitamins C, K, B12, or folic acid
- sepsis, or severe infection in the bloodstream
- systemic lupus erythematosus, an autoimmune disorder in which the person's body attacks its own cells for unknown reasons
- trauma, or injury
- prolonged coughing or vomiting
- medications, such as blood thinners
- abuse, such as child abuse or elderly abuse
- surgery or other medical procedures
- allergy-related disorders
The causes of bruising will determine if there are ways to prevent bruising. Wearing protective clothing may prevent some bruising. Avoiding excessive exposure to the sun may minimise skin damage. Other cases of bruising may be prevented or decreased if the cause is eliminated, such as replacing vitamins in someone who has vitamin deficiency. In other cases of bruising, the underlying cause may not always be cured. Being careful not to bang or knock the skin against hard surfaces may decrease the likelihood of developing bruises. Also, if a person is taking a blood thinner, it is important that they take it exactly as prescribed in order to reduce the likelihood of bruising.
How is the condition diagnosed?
Tests used to diagnose bruising will vary, depending on the suspected cause.
The doctor will first take a complete medical history, including any other symptoms or conditions that are present and any history of injury. A thorough physical examination, to evaluate for possible underlying conditions, will also be done.
The doctor may also order x-rays, a bone biopsy, or a bone scan to evaluate for injury, tumours, or other conditions. A spinal tap may be done to obtain a sample of cerebrospinal fluid, the fluid that surrounds the spinal column and brain. This fluid can be tested for infection and other conditions that cause bruising.
Usually several blood tests, will be ordered. These include:
- prothrombin time, or INR, tests of blood clotting
- fibrinogen levels, to check for bleeding disorders
- a full blood count (FBC) to check for abnormal white blood cells or platelets
What are the long-term effects of the condition?
Long-term effects of bruising will depend on the underlying cause of the bruising. A bruise caused from a person hitting a shin on a chair may heal without any long-term effects. A person who has blood disorders may require blood transfusions and medications over a long period of time. A person with leukaemia or cancer may be treated in some cases and may die, in other cases.
What are the risks to others?
Bruising is not contagious, although there may be a tendency for bruising to run in families. If an underlying infection is causing the bruising, this infection may be contagious.
What are the treatments for the condition?
Treatment of bruising will vary depending on the underlying cause of the bruise. When an injury occurs, the application of an icepack off and on for the first 24 hours will reduce further bruising and swelling. After 24 hours, a hot pack to the area will help the bruise heal more quickly.
Other treatments will vary greatly depending on the cause of the bruising. In a person with haemophilia, blood transfusions may be given. In a person with nutritional deficiencies, special dietary recommendations may be made. In a person with leukaemia or cancer, special medications and procedures may be necessary. If a person has bacteria in the blood, antibiotics may be required.
What are the side effects of the treatments?
Side effects will depend on the treatment used. There are usually no side effects when ice or heat are used properly. There may be stomach upset or allergic reaction to antibiotics. Treatments that require surgery pose a risk of bleeding and infection. Medications used for leukaemia may cause more side effects, including hair loss or immune system suppression.
What happens after treatment for the condition?
After treatment, recommendations will vary depending on the cause of the bruise and treatment used. In some situations no further treatment is necessary for minor bruising. For more serious disease or injury, treatment may continue, and a person may have further instructions to follow.
How is the condition monitored?
If bruising worsens or any other symptoms are present, monitoring by a doctor may be necessary. If there is bleeding from the nose, gums, an open injury, or other bleeding, such as blood in the urine or stools, medical attention should be sought. If there is a fever, swollen lymph nodes, pain in the stomach, tender joints, or bruising in many areas without a history of injury, the doctor should be notified.
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 31/1/2005
Potential conflict of interest information for reviewers available on request