Easy Bruising

Last updated Nov. 3, 2025, 1:04 p.m. by ivo

Easy bruising is a very common reason for referral to a haematologist that rarely results in the diagnosis of a serious underlying bleeding disorder

Drugs

A drug history which includes any “over the counter” supplements or herbal supplements will often reveal the cause. In many cases the bruising is trivial and will not necessarily require cessation or substitution of the causative agent if there was a good indication for the drug in the first place.

Commonly, recent onset bruising follows the introduction of new medication (prescribed or non prescribed) which has an antiplatelet or anticoagulant effect.

Drugs which are expected to cause more easy bruising include:

Anticoagulants: warfarin, rivaroxaban, apixaban, dabigatran
Antiplatelet drugs: aspirin, clopidogrel, prasugrel

Drugs which commonly cause easy bruising as a consequence of their mode of action include:

Non steroidal anti-inflammatory drugs (NSAIDs) other than asprin, including ibuprofen, naproxen, celecoxib diclofenac.
Have a reversible antiplatelet effect which can result in bruising if taken regularly
Selective serotonin reuptake inhibitors (SSRIs): citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline.
The bleeding risk with these drugs is increased if used in combination with anticoagulants or antiplatelet drugs

Herbs and supplements commonly obtained without prescription include:

Fish oil, garlic, gingko biloba, ginseng, ginger, glucosamine, turmeric, angelica, cloves, vitamin E.
In all of these cases the effects will be magnified if the substances are taken in combination or with specific antiplatelet/anticoagulant drugs

Steroids, both topical and oral commonly cause bruising by thinning the skin and underlying connective tissue, rather than any effect on platelets or the coagulation system.
Age related changes in skin & connective tissue can cause bruising in the older population, particularly once a new medication (above) is added.

Medical conditions

Basic examination and investigations, including biochemistry are helpful

Cushings syndrome
End stage renal failure
Advanced liver disease
Vitamin C deficiency (scurvy)

Hereditary bleeding disorders

These are relatively uncommon conditions, but occasionally mild forms of these diseases may present in adulthood, particularly if drugs listed above have recently been started. A basic coagulation screen should be ordered.

Von Willebrands disease
Haemophilia A & B
Platelet function defects

Low platelet count

This will commonly result in petechiae – small punctate bleeding spots, most commonly seen in the lower limb. A normal FBC will exclude the following disorders as a cause of bruising.

Immune thrombocytopenia (ITP)
Blood cancers

Suggested screening tests before referral

FBC, renal and liver function, coag screen

The majority of patients with normal results will not have a significant bleeding disorder

Further tests depending on history and results of initial screen

von Willebrands screen, PFA 100 (or PFA200)*, factor VIII or IX assay

*Note that PFA testing will be abnormal (prolonged) in patients with aspirin or recent NSAID ingestion.

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