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Why Do Some People Bruise Easily?

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

Do you bruise really easily? Do your bruises look excessively large for their cause? There can be many reasons for why someone bruises really easily. This lesson goes over many of them.

Easily Bruised

Jack is a guy with an easily bruised ego. Even the slightest joke at his expense will cause him a lot of pain. But this lesson isn't about the reasons behind why his soul is easily bruised. It's about his physical body. Today, as he was walking around his home, he bumped into the corner of his kitchen counter. For most people, this wouldn't even be a cause for concern, but Jack knows that even this slight bump will cause him to easily bruise and bruise big. Why do some people bruise really easily? Let's cover some of the more common reasons as to why this occurs.

What Is A Bruise?

To better understand the causes of easy bruising, we need to quickly understand what that bruise even is. When we talk about bruises in lay terminology, we more commonly refer to the ones affecting the skin, although they can affect many other tissues and organs of our body, like the muscles and brain.

In that spirit, a skin bruise is a kind of contusion, an injury of the skin that occurs without the breakage of the skin but with accompanying skin discoloration. Bruises occur as a result of some sort of blunt physical trauma like smashing your knee into the table as you stand up, a blow to the abdomen, or nailing your hand with the hammer instead of the nail. You get the idea.

A stereotypical (albeit very large) bruise of the skin.
Bruise

When a strong enough, blunt, and compressive physical force impacts your skin, it breaks the blood vessels running through and near the skin. This causes blood to leak out into the surrounding tissues, which results in the swelling, pain, and discoloration we commonly associate with skin bruises. As the body breaks down the red blood cells that have leaked out of the blood vessels, the bruise changes color and fades as a result.

Why Do Some People Bruise Easily?

We all know that some people like Jack will bruise really easily while others will have to be hit pretty hard to get a bruise. Why? Let's find out as we ask Jack some questions. First, we ask him his age. He says he's 70. One possible reason for his easily bruised skin is the accompanying changes associated with age. One of them is a natural loss of a protective layer of fat in our skin that acts like an airbag as it cushions some blows to the skin. Having lost that fatty layer over time could be one reason for why he easily bruises.

Next, we ask Jack if he's on any medication. He says he's taking a blood thinner to reduce his chances of having another stroke. Blood thinners such as warfarin make it more difficult for our blood to clot and thus stop any bleeding. This may make what would be a very minor bruise a very big bruise, since more blood can escape from our blood vessels prior to clot formation. Besides warfarin, other medications associated with easily bruised skin include:

  • Aspirin
  • Clopidogrel
  • Certain types of steroids
  • Over the counter supplements, like high amounts of fish oil

Next, we ask if Jack his been diagnosed with any medical conditions. He lists a few, but none of them would help explain easily bruised skin. However, there are medical conditions that can make bruising worse. For example, one is thrombocytopenia, a deficiency of platelets. Platelets are cell-like components of blood responsible for the formation of blood clots. Since they are relatively deficient, then what would otherwise be a small bruise turns into a much bigger one as a result.

Besides thrombocytopenia, many other conditions have been associated with leading to easily bruised skin. Most of these affect the ability of the blood to properly clot in one way or another:

  • Factor II, V, VII, or X deficiency. These are factors important for clotting.
  • Von Willebrand disease, a disease that affects another important factor related to blood clotting
  • Hemophilia, which make people more likely to bleed excessively, even from minor trauma.
  • End stage kidney disease, which changes how the clotting system works.
  • Severe liver disease. The liver is critical for the production of important clotting factors.
  • Vitamin C or K deficiency. Vitamin C helps keep blood vessels healthy while vitamin K helps our blood clot.
  • Vasculitis, inflammation of, and damage to, the blood vessels.
  • Cancers like leukemia or multiple myeloma.

There is one other note to keep in mind. Excessive bruising not at least partially as a result of a blunt traumatic injury is not considered to be a bruise. For example, some people experience excessive bleeding into skin tissue (blood spots) as a result of many different non-traumatic causes, including the coagulation disorders noted above.

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