Easy Bruising

Easy bruising suggests easy bleeding. This may be normal, or may indicate abnormalities in the ability of blood to clot normally.

History

Inquire about:

• Anemia

• Easy bleeding in infancy or childhood

• Bleeding after procedures such as tooth extractions

• Character of menses

• Response to trauma

• Diet

• Drug use

A patient with a platelet defect typically will have:

• Bleeding from skin or mucous membranes (such as gingivae, nose, GI and GU tracts)

• Bleeding after minor cuts

• Petechiae, small and superficial ecchymoses

• Rare muscle hematomas

• Immediate but mild bleeding after surgery

Medications, that may alter platelet function include:

• Aspirin

• Anti-inflammatory drugs like Motrin, naproxen, or other NSAIDs

• Beta-lactam antibiotics (penicillins)

• More powerful anticoagulants such as Ticlid or Warfarin.

A patient with a clotting factor abnormality will typically have:

• Bleeding in the deep joints and muscles

• No petechiae

• Large and palpable ecchymoses

• Commonly have muscle hematomas

• Severe bleeding after surgery or trauma but not usually after minor cuts.

Laboratory Tests

If possible, initial screening tests should include:

• Platelet count

• Prothrombin time (PT)

• Activated partial thromboplastin time (aPTT).  

Since these tests are usually not readily available, evaluation typically requires referral to a medical center.

Plan and Medevac

• If easy bruising is thought to be the result of platelet dysfunction, stop any drugs that could contribute to this condition.  

• If a clotting defect were thought to be the etiology, the workup would require referral to a medical center.  

• Easy bruising does not necessitate a need for MEDEVAC.  If the bruising is a problem, prompt but non-urgent referral to a medical center is warranted.  Your clinical judgment will influence this decision.

This section provided by LT Heath A Morgan, MC, USNR, Naval Medical Center Portsmouth

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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