Bruising

• Contusion: History of direct trauma, pain at the site of injury, swelling and discoloration.
• Fracture: Associated with severe pain, deformity, loss of function, and a clear history of trauma.
• Hematoma: Often due to significant trauma, results in a palpable mass under the skin, tender on palpation.

• Thrombocytopenia: Petechiae, mucosal bleeding, low platelet count.
• Hemophilia: Prolonged bleeding after minor trauma, family history, spontaneous hemarthroses.
• Von Willebrand Disease: Mucosal bleeding, menorrhagia, prolonged bleeding time.
• Vitamin K Deficiency: History of malabsorption or poor dietary intake, prolonged PT/INR.
• Liver Disease: Chronic liver disease signs (jaundice, ascites), prolonged PT/INR.

• Henoch-Schönlein Purpura: Palpable purpura on buttocks/legs, abdominal pain, arthritis.
• Scurvy (Vitamin C Deficiency): Gingival bleeding, perifollicular hemorrhage, poor wound healing.
• Ehlers-Danlos Syndrome: Hypermobile joints, skin hyperextensibility, easy bruising.
• Vasculitis: Palpable purpura, systemic symptoms (fever, weight loss), renal involvement.

• Anticoagulants: History of anticoagulant use (warfarin, DOACs), prolonged PT/INR.
• Antiplatelet Agents: Use of aspirin or clopidogrel, increased tendency for bruising or bleeding.
• Steroids: Long-term steroid use, skin thinning, easy bruising.

• Senile Purpura: Elderly patients, sun-exposed areas, skin thinning.
• Leukemia: Fatigue, weight loss, recurrent infections, pancytopenia.
• Meningococcal Septicemia: Sudden onset, non-blanching rash, fever, neck stiffness.

Acute onset suggests traumatic or infectious causes, while chronic or recurrent bruising may point to coagulopathies or systemic diseases.

Bruising in areas not typically exposed to trauma (e.g., trunk, upper arms) may suggest a bleeding disorder, while localized bruising often indicates direct trauma.

Presence of systemic symptoms (e.g., fever, weight loss, night sweats) may indicate an underlying malignancy or vasculitis.

Inquire about the use of anticoagulants, antiplatelet agents, steroids, or other medications that could contribute to bruising.

• Past Medical History: History of bleeding disorders, liver disease, or recent infections.
• Drug History: Use of medications known to cause bleeding or bruising.
• Family History: Inquire about any family history of bleeding disorders or easy bruising.
• Social History: Assess for risk factors such as alcohol use (liver disease), diet (vitamin deficiencies), and physical activity.

• Full Blood Count: To assess for thrombocytopenia or anemia.
• Coagulation Profile: PT, aPTT, and INR to evaluate the coagulation cascade.
• Liver Function Tests: To assess for underlying liver disease.
• Renal Function Tests: To check for renal involvement in vasculitis or systemic diseases.
• Vitamin Levels: Particularly vitamin C, K, and B12 if nutritional deficiencies are suspected.

• X-ray: To rule out fractures in cases of trauma.
• Ultrasound: Useful for identifying hematomas or soft tissue injuries.
• CT/MRI: Consider in cases where internal bleeding or more severe injury is suspected.

• Bone Marrow Biopsy: If leukemia or another hematological malignancy is suspected.
• Skin Biopsy: In cases of vasculitis or other vascular disorders.