Aetiology of abnormal bruising

Numerous conditions may be responsible for abnormal bruising which includes haemostatic disorders, non accidental injury (NAI) and connective tissue disorders (affects the integrity of the blood vessel) (1,2).

• abnormalities of platelets (deficiency and dysfunction)
  • autoimmune disorders (ITP, connective tissue disease, etc.)
  • systemic illness - liver disease, renal disease
  • lymphoid malignancy
  • myeloproliferative disorder (3)
    
    
• coagulation protein abnormalities
  • hemophilia - factor VIII, IX deficiency
  • Von Willebrand disease
  • vitamin K deficiency
  • plasmin or plasminogen deficiency or inhibitor
  • systemic illnesses - liver disease, amyloidosis (3)
    
    
• vascular or dermal abnormalities
  • Ehlers-Danlos syndrome
  • purpura simplex
  • senile purpura
  • vitamin C deficiency (scurvy) (1)
    
    
• medication
  • corticosteroids
  • anticoagulants - heparin, low-molecular-weight heparins, warfarin
  • antiplatelet drugs - aspirin, clopidogrel
  • nonsteroidal anti-inflammatory drugs
  • antineoplastics - cisplastin, doxorubicin
  • antibiotics - cephalosporins, penicillins, quinine (3)
    
    
• non accidental injury (NAI)

Reference:

• 1. Ballas M, Kraut EH. Bleeding and bruising: a diagnostic work-up. Am Fam Physician. 2008;77(8):1117-24.
• 2. Vora A, Makris M. Personal practice: An approach to investigation of easy bruising. Arch Dis Child. 2001;84(6):488-91.
• 3. Valente MJ, Abramson N.Easy bruisability. South Med J. 2006;99(4):366-70.