aetiology

Last reviewed 01/2018

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:
• haemophillias A and B
• Von Willebrands 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). This 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
  • 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.