Operational Medicine 2001
Easy Bruising

Easy bruising suggests easy bleeding. This may be normal, or may indicate abnormalities in the ability of blood to clot normally.

History

Inquire about:

• Anemia

• Easy bleeding in infancy or childhood

• Bleeding after procedures such as tooth extractions

• Character of menses

• Response to trauma

• Diet

• Drug use

A patient with a platelet defect typically will have:

• Bleeding from skin or mucous membranes (such as gingivae, nose, GI and GU tracts)

• Bleeding after minor cuts

• Petechiae, small and superficial ecchymoses

• Rare muscle hematomas

• Immediate but mild bleeding after surgery

Medications, that may alter platelet function include:

• Aspirin

• Anti-inflammatory drugs like Motrin, naproxen, or other NSAIDs

• Beta-lactam antibiotics (penicillins)

• More powerful anticoagulants such as Ticlid or Warfarin.

A patient with a clotting factor abnormality will typically have:

• Bleeding in the deep joints and muscles

• No petechiae

• Large and palpable ecchymoses

• Commonly have muscle hematomas

• Severe bleeding after surgery or trauma but not usually after minor cuts.

Laboratory Tests

If possible, initial screening tests should include:

• Platelet count

• Prothrombin time (PT)

• Activated partial thromboplastin time (aPTT).  

Since these tests are usually not readily available, evaluation typically requires referral to a medical center.

Plan and Medevac

• If easy bruising is thought to be the result of platelet dysfunction, stop any drugs that could contribute to this condition.  

• If a clotting defect were thought to be the etiology, the workup would require referral to a medical center.  

• Easy bruising does not necessitate a need for MEDEVAC.  If the bruising is a problem, prompt but non-urgent referral to a medical center is warranted.  Your clinical judgment will influence this decision.

This section provided by LT Heath A Morgan, MC, USNR, Naval Medical Center Portsmouth

Approved for public release; Distribution is unlimited.

The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. 

Operational Medicine 2001
Health Care in Military Settings

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