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bruising Alternative 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, it becomes brownish-yellow. Generally, bruises heal and disappear within 2 to 3 weeks. What other signs and symptoms are associated with this symptom? Symptoms of bruising vary depending on the cause of the bruising. The bruise may be very small and may blend in with the texture of the skin, or it may be large, 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 the body, such as diarrhea, 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 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 abuse, such as child abuse, spousal abuse, or elder abuse surgery or other medical procedures allergy-related disorders What can be done to prevent the symptom? The causes of bruising will determine whether there are ways to prevent bruising. 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 they take it exactly as prescribed in order to reduce the likelihood of bruising. 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, including any other symptoms or conditions that are present and any history of injury. 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. 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 or platelets 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. 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 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 given blood transfusions. A person who has nutritional deficiencies may be given special dietary recommendations. A person who has leukemia or cancer may require special medications and procedures. A person who has bacteria in the blood may need antibiotics. 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 and other medications. Treatments that require surgery pose a risk of bleeding, infection, and allergic reaction to anesthesia. Medications used for leukemia may cause more side effects, including hair loss or an increased risk of infection. 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. How is the symptom monitored? If bruising worsens, or if any other symptoms are present, monitoring by a healthcare provider may be necessary. Any new or worsening symptoms should be reported to the healthcare provider.

Author: Eileen McLaughlin, RN, BSN Date Written: 07/18/00 Reviewer: Melissa Sanders, PharmD Date Reviewed: 07/27/01 Potential conflict of interest information for reviewers available on request