Bruising

Bruises are relatively common finding that often accompany blunt injuries. Excessive bruising by inadequately weak force (slight push, grip, touch, etc.) should lead every physician to suspect an underlying pathology. The bruise is basically a subcutaneous hematoma resulting from injury of small blood vessels, usually after blunt injuries. It may be a blow, firm grip, etc. The bruise is initially blue; the coloring is due to show-through of blood through the skin. Blood gradually coagulates, hemoglobin in red blood cells breaks down into its metabolic products and that causes color change to greenish brown and finally to yellow. Bruises are slowly absorbed and thus fade and disappear.

Causes

Bruising occurs when a physical force affects human body. Doctors are interested in situations when bruising is more usual. These are especially situations of blood clotting disorders. Coagulation disorders cause easier bleeding into skin and bruise formation. Anticoagulation drugs usage is the main reason of coagulation disorders. Overdose or too sensitive reaction is always possible. Bruises are typically found at application areas of low molecular weight heparin. Diseases causing reduced blood clotting form a diverse group. Some affect function or number of platelets (such as leukemia and other blood disorders), other disrupts blood clotting factors (hemophilia) and other both platelets and clotting factors (Von Willebrand disease). Reduced blood clotting is typical for patients with impaired liver function (usually cirrhosis) who are unable to produce sufficient quantities of certain clotting factors dependent on vitamin K. In the past lack of vitamin C (scurvy) was a frequent cause of bruising. Nowadays it can also occur, but typically in much less serious forms. Vitamin C is important for blood vessel walls stability.

Diagnostic approach

Bruises are visible with a naked eye. Medical history is important, underlying disease is suspicious when numerous bruises occur without corresponding force (as mentioned above). It is also necessary to investigate any other bleeding problems (blood in stool, blood in urine, frequent nosebleed, etc.). Current medication of affected patient should be known, especially any anticoagulants. Blood tests shall be done to evaluate platelet count and some coagulation parameters. Further diagnostic approach depends on our clinical suspicion.

Treatment

Bruising is just a symptom and therefore we must treat its underlying cause. If bruising accompanies usage of anticoagulant drugs, it is sometimes possible to change dose or preparation itself. When there is a live disorder (or warfarin overdose) present, we administer vitamin K to correct hemostasis. By lack of vitamin C it is necessary to increase its intake in fruit or in dietary supplements. If we want to treat bruises symptomatically, we usually try to accelerate their absorption. That can be done by local administered ointments and gels. Bruise size can be reduced by cooling of the affected body part (cold compress, icing).