Aetiology

The causes of ecchymoses can be divided up into those that are either acquired, inherited or of miscellaneous origin:

Acquired causes:

• vitamin K deficiency
• anticoagulants:
  • warfarin
  • heparin
• liver disease

• disseminated intravascular coagulation
  • scurvy
  • steroid purpura
    
    
• Inherited causes:
  • haemophilia A and B
  • Von Willebrand disease
  • connective tissue disorders e.g. Ehlers-Danlos syndrome, Pseudoxanthoma elasticum
    
    
• other causes:
  • thrombocytopaenia
  • platelet dysfunction
  • local injury

Bruising can also be considered in terms of 'abnormal bruising' (1,2)

• 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)
• classification system focusses on the different physiological processes involved in clotting such as platelets, coagulation cascade etc.
  
  
• 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
  • haemophilia - 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.