What causes easy bruising?

Causes of Easy Bruising

Easy bruising can be caused by a wide range of conditions from benign to serious bleeding disorders, with the most common causes being age-related capillary fragility, medication effects, and inherited bleeding disorders such as von Willebrand disease. 1

Common Causes of Easy Bruising

Medical Conditions

• Bleeding disorders:

  • Von Willebrand disease (most common inherited bleeding disorder, affecting up to 1% of population) 1
  • Platelet function disorders
  • Hemophilia and other factor deficiencies
  • Vitamin K deficiency bleeding 1

• Connective tissue disorders:

  • Ehlers-Danlos syndrome (characterized by joint hypermobility, skin hyperextensibility, and tissue fragility) 1, 2
  • Scurvy (vitamin C deficiency)

• Other medical conditions:

  • Liver disease (impaired clotting factor production)
  • Kidney disease
  • Cancer and infiltrative disorders
  • Glutaric aciduria
  • Cardio-facio-cutaneous syndrome 1

Medication-Related Causes

• Anticoagulants (e.g., warfarin) 3
• Antiplatelet medications (e.g., aspirin, NSAIDs)
• Certain antibiotics
• Steroids (can cause skin thinning)
• Alternative therapies and supplements that affect coagulation 1

Age-Related Factors

• Increased capillary fragility in older adults
• Thinning of skin and loss of supporting collagen
• Decreased fat in subcutaneous tissues

Evaluation of Easy Bruising

Key History Elements

1. Pattern and location of bruising (spontaneous vs. traumatic)
2. Family history of bleeding disorders
3. Personal history of:
   • Significant bleeding after surgery or dental procedures
   • Epistaxis (nosebleeds)
   • Bleeding from umbilical stump in infancy
   • Heavy menstrual bleeding in women 1
4. Medication review (especially anticoagulants, NSAIDs, supplements) 3

Physical Examination Findings

• Distribution and characteristics of bruises
• Evidence of mucocutaneous bleeding (suggests platelet dysfunction)
• Joint and skin laxity (suggests Ehlers-Danlos syndrome) 2
• Signs of liver disease (jaundice, splenomegaly)
• Telangiectasia (suggests hereditary hemorrhagic telangiectasia) 1

Initial Laboratory Testing

For patients with concerning history or examination findings:

1. Complete blood count (CBC) with platelet count
2. Peripheral blood smear
3. Prothrombin time (PT)
4. Activated partial thromboplastin time (aPTT)
5. For suspected platelet disorders: von Willebrand testing and platelet function studies 4, 5

Special Considerations

Women with Easy Bruising

Women more commonly report easy bruising, which may be related to:

• Hormonal factors
• Thinner skin
• Greater awareness of cosmetic concerns 6

Children with Easy Bruising

In children, consider:

• Normal childhood activity-related bruising
• Possible non-accidental trauma (child abuse) when bruising pattern is suspicious 1
• Inherited bleeding disorders (especially with positive family history)

When to Refer to a Specialist

Refer to a hematologist when:

• Initial testing reveals abnormalities
• Strong family history of bleeding disorders
• Severe or recurrent bleeding episodes
• High clinical suspicion despite normal initial testing 5

Pitfalls to Avoid

1. Dismissing concerns without proper evaluation: Easy bruising can be the first sign of a serious bleeding disorder.

2. Over-investigation: Most cases of easy bruising, especially in women, are benign and do not require extensive testing 7, 6.

3. Failing to review medications: Many common medications can contribute to easy bruising, particularly warfarin and other anticoagulants 3.

4. Missing child abuse: Unusual bruising patterns in children should prompt consideration of non-accidental trauma 1.

5. Overlooking connective tissue disorders: Conditions like Ehlers-Danlos syndrome can present primarily with easy bruising 2.