Bruising

Bruising

Alternate Names

  • purpura
  • hematoma
  • ecchymoses
  • contusion
  • petechiae

Definition

Bruising is an area of discolored 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 as a red area or as tiny red dots or splotches on the skin. Within days to a week or so, the bruise becomes more purple. As it heals, the breakdown products of blood cells begin to show, turning the bruise brownish-yellow. Generally, bruises heal and disappear within 2 to 3 weeks.

Risks

What are the causes and risks of the symptom?

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 are 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 the following:
  • blood disorders, including problems with blood clotting such as hemophilia A or 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 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 a person's body attacks its own cells for unknown reasons
  • trauma, or injury
  • prolonged coughing or vomiting
  • medications, such as blood thinners, or corticosteroids
  • abuse, such as child abuse, spousal abuse, or elder abuse
  • surgery or other medical procedures
  • allergy-related disorders

Prevention

What can be done to prevent the symptom?

The causes of bruising will determine whether there are ways to prevent it. Wearing protective clothing may prevent some bruising. Avoiding excessive exposure to the sun may minimize 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 he or she takes it exactly as prescribed in order to reduce the likelihood of bruising.

Diagnosed

How is the symptom diagnosed?

Tests used to diagnose bruising will vary, depending on the suspected cause. First, the healthcare professional will take a complete medical history, including any other symptoms or conditions that are present and any history of injury. Generally, bruising is most worrisome if an otherwise healthy individual develops severe or multiple bruises and cannot tell how he or she got them.
A thorough physical exam, to evaluate for possible underlying conditions, will also be done. The healthcare provider may also order X-rays, a bone biopsy, or a bone scan to evaluate for injury, tumors, 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.
Blood tests may include:
  • prothrombin time (PT), or INR, and partial thromboplastin time (PTT) which are tests of blood clotting
  • fibrinogen and other blood clotting factor levels, to check for bleeding disorders
  • a complete blood count (CBC), to check for abnormal white blood cells or platelets

Long Term Effects

What are the long-term effects of the symptom?

Long-term effects of bruising will depend on the underlying cause of the bruising. A bruise caused by a shin hitting 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. In some cases, a person with leukemia or cancer may have a treatable form of the disease. In other cases, death may result.

Other Risks

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.

Treatments

What are the treatments for the symptom?

Treatment of bruising will vary depending on the underlying cause of the bruise. When an injury occurs, the application of an ice pack 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. A person who has hemophilia may be transfusions of concentrated clotting factors. Nutritional deficiencies may call for special dietary recommendations. Leukemia or other cancers must be treated with special medications and procedures. An individual with bacteria in the blood may need antibiotics.

Side Effects

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 is used properly. There may be stomach upset or allergic reaction to antibiotics and other medications. Medications used for leukemia may cause more side effects, including hair loss or an increased risk of infection.

After Treatment

What happens after treatment for the symptom?

After treatment, recommendations will vary depending on the cause of the bruising and the 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.

Monitor

How is the symptom monitored?

Any new or worsening bruising or other symptoms should be reported to the healthcare professional.

Sources

Professional Guide to Signs and Symptoms, Springhouse, 1997.

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