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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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)


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