No Transfusion Required for Isolated Ecchymoses Without Active Bleeding
Ecchymoses (bruising) alone, without active bleeding, is not an indication for blood product transfusion. The presence of bruising represents past bleeding that has already occurred and does not require transfusion unless accompanied by active hemorrhage or specific laboratory thresholds are met 1.
Key Decision Points
When NOT to Transfuse (Your Scenario)
- Ecchymoses without active bleeding does not meet transfusion criteria 1
- Bruising is simply a physical sign of prior extravasation of blood into subcutaneous tissue and does not indicate ongoing hemorrhage requiring intervention 2
- The ASA guidelines specifically state that blood components should be administered "when there is evidence of bleeding" - not for bruising alone 1
When Platelets ARE Indicated (For Context)
If patient IS actively bleeding:
- Transfuse platelets to achieve platelet count > 75 × 10⁹/L 1
If patient is NOT bleeding (prophylactic thresholds):
- Chemotherapy-induced thrombocytopenia: Only transfuse if platelet count < 10 × 10⁹/L 1
- These thresholds apply to preventing future bleeding, not treating ecchymoses
Clinical Approach
Assess for Active Bleeding
- Look for microvascular bleeding (oozing from IV sites, mucous membranes, surgical sites) - this would change management 3, 4
- Distinguish ecchymoses from active coagulopathy - bruising alone represents resolved bleeding 2
- Check vital signs for hemodynamic instability suggesting ongoing blood loss 1
Laboratory Evaluation
- Obtain platelet count, PT/APTT, and fibrinogen if concerned about underlying coagulopathy 3, 4
- These tests guide treatment decisions if active bleeding develops, but are not indications for transfusion based solely on ecchymoses 1
Common Pitfalls to Avoid
Do not transfuse based on appearance alone: Ecchymoses can appear dramatic but represent subcutaneous blood that has already extravasated - transfusion will not reverse this 2
Do not use arbitrary laboratory triggers without clinical bleeding: Even with thrombocytopenia, prophylactic platelet transfusion is only indicated at very low counts (< 10 × 10⁹/L) in the absence of bleeding 1
Avoid unnecessary donor exposure: Transfusion carries risks including bacterial infection (1 in 12,000 for platelets), viral transmission, and transfusion reactions - these risks are not justified for isolated bruising 1
Bottom Line
Monitor the patient clinically for development of active bleeding, but do not transfuse for ecchymoses alone 1. If active bleeding develops, then apply appropriate transfusion thresholds based on platelet count and coagulation parameters 1, 3.