Ecchymoses

Bruising is the extravasation of blood from the damaged vessels into the subcutaneous tissue (1). It can generally be divided into:

• normal - caused by unintentional or accidental trauma (2)
• abnormal - those with an underlying haemostatic abnormality, such as an inherited bleeding disorder or those who have been subjected to non-accidental injury (NAI)

Bruising is more obvious in white skinned people than in people with darker skin tones. The incidence also increases with increasing family size and during the summer months (when children play outside in lightweight clothing) (1)

Elderly people are also at increased risk of bruising due to poor skin and subcutaneous tissue turgor, decreased fatty tissue, ambulatory problems relating to cognitive impairment, neurological or physical disorders, effects of medications and nutritional factors (3).

Ecchymoses are purpura of greater than 1 cm diameter.

Reference:

• (1) Khair K, Liesner R. Bruising and bleeding in infants and children-a practical approach. Br J Haematol. 2006;133(3):221-31.
• (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.