Evaluation of easy bruising

female sex (more common), no history of trauma or abnormal bleeding

ecchymosis (varying size, stage, and location) typically on exposed areas such as extremities (not trunk, back, nor face), no active bleeding or large hematoma

older age, bilateral bruising on extensor surfaces of forearms, no history of abnormal bleeding or systemic illness

ecchymosis seen on exposed extremities (varying number, size, and stage), no other significant findings

use of anticoagulants (especially high doses), antiplatelet agents, nonsteroidal anti-inflammatory drugs, corticosteroids, antidepressants; history of epistaxis

ecchymosis at injection site (e.g., with parenteral anticoagulants); signs of hemarthrosis or gastrointestinal bleeding

heavy alcohol use

signs of cirrhosis or liver impairment (e.g., jaundice, ascites, splenomegaly) with long-term use, alcohol odor on breath with acute intoxication

history of taking causative drug (e.g., chemotherapy, anticonvulsants, nonsteroidal anti-inflammatory drugs, antibiotics), mucosal bleeding

petechiae

abnormal bleeding with procedures, epistaxis, menorrhagia

ecchymosis may be seen

positive family history, abnormal bleeding with procedures, menorrhagia, epistaxis, postpartum hemorrhage, mucosal bleeding

ecchymosis is usually the only finding

hospitalization, prolonged intravenous antibiotics, malnutrition

may see bruises of various sizes and stages, possible cachexia

may be asymptomatic or nonspecific symptoms (e.g., anorexia, weight loss, fatigue), bleeding, hepatitis infection, heavy alcohol use, autoimmune disease

jaundice, spider angiomas, esophageal or gastric varices (could be associated with hemorrhage), abdominal distension, confusion

arthralgia, myalgia, malaise, vision changes, abdominal pain, cutaneous ulcers, hematuria, hemoptysis, wheeze, sinus pain, ear pain, headache (temporal arteritis), chest pain (angina and/or myocardial infarction)

palpable purpura (patient may mistake for bruising), bruits, asymmetric brachial pulses

positive family history, recurrent epistaxis; fatigue, pica, nail changes, hair loss (symptoms of iron-deficiency anemia)

mucocutaneous telangiectasia, visceral arteriovenous malformations

chronic/excessive corticosteroid use or source of endogenous cortisol (e.g., overproduction of adrenocorticotropic hormone [ACTH] by the pituitary in Cushing disease; overproduction of cortisol by an adrenal tumor)

acne, hirsutism, thinning skin, abdominal striae, facial plethora (red discoloration), proximal myopathy, central obesity, hypertension

recurrent injuries, unstable home environment, inconsistent/changing history, unexplained/inconsistent injuries

multiple ecchymosis found on any part(s) of the body, other signs of physical abuse (e.g., burn marks, bone fractures, head injuries, retinal hemorrhage)

recurrent injuries, unstable home environment, inconsistent/changing history, unexplained/inconsistent injuries

multiple ecchymosis found on any part(s) of the body, other signs of physical abuse (e.g., burn marks, bone fractures, head injuries)

also known as idiopathic thrombocytopenic purpura; hepatitis C, HIV, sudden onset of petechiae, mucosal bleeding, absence of systemic symptoms (or symptoms of malignancy), absence of medications that cause thrombocytopenia

petechiae and/or ecchymosis on extremities

altered mental status, sensation changes, headache, gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea)

petechiae, purpura, and/or ecchymosis on extremities; abnormal neurological examination (e.g., focal weakness, seizures, altered mental status), fever

common in children, bloody diarrhea (typical HUS); altered mental status, sensation changes, headache (atypical HUS); presentation similar to thrombotic thrombocytopenic purpura (TTP)

petechiae, purpura, and/or ecchymosis on extremities; abnormal neurological examination (e.g., focal weakness, seizures, altered mental status)

presence of underlying disorder (e.g., malignancy, sepsis, organ failure, obstetric disorders or complications)

excessive bleeding or oozing from mucosal areas or intravenous sites, ischemic tissue damage (e.g., ischemic digits)

positive family history, typically presents at birth, prolonged bleeding from umbilical stump or with procedures

petechiae, chronic eczema, lymphadenopathy, hepatosplenomegaly

formerly known as May-Hegglin anomaly; positive family history, may be associated with Alport syndrome, often found incidentally on routine blood tests

no specific findings

positive family history, abnormal bleeding with procedures, epistaxis, menorrhagia

ecchymosis is usually the only finding

positive family history, present at birth, may have congenital heart disease

absent bilateral radius bones (although thumbs are always present), other abnormalities of the upper limbs may be present

abnormal bleeding with procedures, epistaxis, menorrhagia

ecchymosis is usually the only finding

fatigue, infections, mucosal bleeding

petechiae and/or ecchymosis on extremities, pallor, fever, may appear ill

fatigue, infections, mucosal bleeding

petechiae and/or ecchymosis on extremities, pallor, fever, may appear ill, lymphadenopathy, hepatosplenomegaly

B symptoms (e.g., fever, drenching night sweats, weight loss)

lymphadenopathy, possible splenomegaly/hepatomegaly

B symptoms (e.g., fever, drenching night sweats, weight loss)

lymphadenopathy, possible splenomegaly

bone pain, fatigue; CRAB symptoms (i.e., high calcium, renal dysfunction, anemia, bone lesions)

pallor

history of metastatic disease, bone pain

possible palpable mass

nonspecific constitutional symptoms (e.g., fever, night sweats, weight loss), history of myeloproliferative disease, abdominal discomfort, early satiety

splenomegaly, hepatomegaly, features of portal hypertension

common in older patients (>65 years), history of recurrent infections, fatigue, mucosal bleeding

pallor

history of recurrent infections, significant fatigue, mucosal bleeding

pallor, tachycardia, dyspnea

positive family history, mostly male sex (females can be symptomatic carriers), abnormal bleeding with procedures

signs of joint bleeding (e.g., pain, swelling, erythema) or chronic hemarthrosis (e.g., limited range of motion)

positive family history, abnormal bleeding with procedures

signs of bleeding

older age, malignancy, postpartum (factor VIII inhibitors)

significant ecchymosis, active bleeding symptoms, life-threatening bleeding

lack of fresh fruit/vegetables over prolonged periods

dental deterioration, impaired wound healing, coiled hairs

positive family history

fits diagnostic criteria (e.g., lens subluxation, aortic dilation or dissection, dural ectasia, musculoskeletal features), tall stature, stretch marks, pectus excavatum (funnel chest), mitral valve murmur, aortic valve murmur

positive family history, joint hypermobility (this alone is not enough for a diagnosis), hyperextensive skin, unusual scars, poor wound healing, spontaneous ruptures of organ or dissection of blood vessel

joint dislocations or subluxations, translucent skin

hepatitis infection, autoimmune disease, heavy alcohol use, right upper quadrant abdominal pain, anorexia, fatigue, bleeding

jaundice, confusion (if severe)

young age, female sex, psychiatric disorder, painful bruising

ecchymosis characterized by synchronous appearance, morphology of central clearing, and frequent painful prodromes