Why do I bruise so easily? Could it be something serious?

After a bump, you can expect a bruise. But what happens if we get bruises for no apparent reason? What could be behind this? Should we be worried?

Around 18 percent of adults report easy bruising. As hematologists (blood doctors), we are often asked for advice when people are concerned about bruising too easily.

Here’s how we look at the problem.

What blood does

First, it helps us understand the complex and carefully balanced systems in our body that protect us from bleeding.

Blood circulates as fluid through our blood vessels, carrying red blood cells with their oxygen load and immune cells to defend us against infections, to our brain, muscles and internal organs. Blood contains carefully balanced ingredients to protect us from bleeding in the event of an injury, while minimizing the risk of dangerous blood clot formation.

If a “puncture” occurs in a blood vessel, the blood can quickly thicken to form a gelatinous clot, minimizing blood loss until the vessel repairs itself. To achieve this, tiny fragments of cells called pads that circulate in the blood bind to the damaged wall of blood vessels.

The first test we would perform for anyone reporting easy bruising is a complete blood count.(Provided: Public Pathology Australia)

A multitude of proteins (clotting factors), attracted to platelets and the damaged vessel wall, then combine to thicken the blood at the site and form a blood clot. Like all blood cells, platelets are made in the bone marrow, while clotting factors are primarily made in the liver.

So what can go wrong? If we have a problem affecting our clotting factors, platelets, or blood vessel walls, we may find ourselves easily developing bruising or even problematic bleeding.

Could this be a problem?

In many patients reporting mild bruising, hematologists find no specific cause.

Blood doctors are generally more cautious when a person has a multitude of bleeding-related problems. For example, a disorder is more likely if the bruising is widespread and big bruisesis accompanied by frequent nosebleeds, heavy periodsbleeding problems after major dental work, surgery or childbirth – or even spontaneous severe bleeding in the joints or in the brain.

A few simple tests can help us determine if there is likely to be a serious problem.

The first thing we would do for anyone reporting easy bruising is a complete blood count. This will include a measurement of the platelet count and will reliably indicate whether the platelet count is normal.

Our platelets can be reduced for a number of reasons: either because they are not produced appropriately or in sufficient quantity in the bone marrow, or because they are cleared from the circulation too quickly.

This latter scenario occurs under a common condition called immune thrombocytopenic purpura. This pathology can affect children or adults unexpectedly or following a viral infection. Patients may develop severe reductions in their platelet counts and experience a thin rash, which is actually small bruises.

In children, it is usually a short-term condition that resolves on its own. In adults, severe cases may require treatment with drugs that suppress the immune system or stimulate platelet production. Sometimes adults need surgery to remove the spleen.

Problems with clotting proteins and diseases

Clotting factors – the proteins mentioned earlier – can be affected by a variety of hereditary or acquired causes.

Some people are born with low levels of important factors that help the blood clot when it needs to control bleeding.

Hemophilia A is seen almost exclusively in men and is caused by a genetic reduction in factor VIII (a key clotting factor). Both men and women can have von Willebrand diseasewhich implies reduced production or function of another key clotting factor.

Liver disease can also lead to clotting problems. This is why the second test we perform on anyone reporting easy bruising is to measure clotting function. If we notice an abnormality, we will follow up by testing the levels of key clotting factors.

Aspirin, often prescribed to prevent platelets from worsening the risk of heart disease or stroke, may also reduce platelet function.(ABC News: Andrew Altree-Williams)

Problems with blood vessels

Although rare today, severe vitamin C deficiency more often caused bruising and bleeding gums.”scurvy“) And deficiencies can still cause bruising.

Several diseases can cause thinning or inflammation of blood vessels, including Henoch-Schönlein purpura – an autoimmune disease that causes bruising of the legs and thighs.

Older people may have fragile skin and blood vessels, making bruising more likely.

Medications and supplements

We always ask patients about their medications and their use of alternative medicine.

Aspirin – often prescribed to prevent platelets from worsening the risk of heart disease or stroke – may also reduce platelet function.

Medicines like clopidogrel (to stop clotting problems) and nonsteroidal anti-inflammatories (like ibuprofen or other medicines for pain and inflammation) can reduce platelet function. Anti coagulants such as warfarin, apixaban, and rivaroxaban, prescribed to people at higher risk of clots leading to stroke, may affect bruising.

People using oral or inhaled products corticosteroids over a prolonged period of time (such as with chronic illnesses), you may notice increased bruising due to thinning of the skin and weakening of the blood vessel walls.

Over-the-counter supplements including gingko and vitamin E can also promote easy bruising, as do some antidepressant drugs.

Issues of abuse and trauma

Finally, blood vessels can be damaged by trauma. Clinicians should carefully ask whether the person has suffered any injuries, including a tender injury. consideration child abuse or domestic violence.

Although there are many medical conditions that can cause easy bruising, if you do not have a significant history of other forms of excessive bleeding and your blood counts and clotting function tests are normal, this should not be a cause for concern.

Sant-Rayn Pasricha is division head of population health and immunity at the Walter and Eliza Hall Institute. This piece first appeared on The conversation.