We usually consider surface bleeding as a break in the skin from where blood pours our (hemorrhage). However, it is possible for bruising to occur on the surface without a break in the skin or bleeding into the environment. This appears as a tiny patches ranging from red to blue or even purple in color. We refer to it as bruising and while we all experience bruises every now and then with trauma, some people bruise abnormally easily.
Meaning of Bruising Easily
Some people will bruise slight quicker than others and this depends on a host of factors. The blood vessels that lie in the deeper layers of the skin are shielded by layers of the superficial skin on the surface. Connective tissue and fat that lie deep to it also offer some degree of protection. It is when these skin blood vessels burst that we see the patches on the skin referred to as bruises (hematomas).
Depending on the size and form of the bruise, it can be classified as:
- Petechiae: small spots less than 3mm.
- Purpura: large spots or small patches between 3 to 10mm (1cm).
- Ecchymosis: large patches greater than 10mm (1cm).
While bruising is associated with trauma like following or a blow, some people bruise easily and even minor impact leads to bruising. This easy bruising is usually a sign of some underlying disorder. In some of the more serious causes, a slight injury that would not normally cause any bruising in an otherwise healthy person can lead to non-stop bleeding under the skin.
Reasons for Easy Bruising
It is important to understand how and why bruising occurs. Tiny blood vessels run throughout the body although we see bruising only when the surface blood vessels are broke. These tiny blood vessels do not have the same structure and strength as larger blood vessels. It can therefore be more easily injured and result in a break in the vessel. When this occurs, blood will seep out into the tissue spaces around the break.
Normally blood clots form to plug any breaks in blood vessels. These clots are formed from the cells that are normally transported in the blood vessel. The clotting mechanism is triggered the moment the blood vessel tissue is exposed and the different components of a clot aggregate at the site of the tear. This does not only occur with major injuries. It is happening throughout the day when tiny tears that we never see arises during the course of life.
It is important to understand the mechanism behind blood coagulation and the various chemicals known as clotting factors that may this possible. Since bruising can appear hours after trauma, it can sometimes be mistaken for bruising due to other causes. This may mislead a person into thinking that bruising was due to another minor injury and believe that it is a matter of easy bruising.
It is therefore important to correlate the bruising with the magnitude of the force that induced it. For example, a bruise can be expected after a fall. However, a bruise should not occur after sitting cross legged on the floor for too long or on the thighs after crossing the legs for a period of time. These latter scenarios are indicative of easy bruising and need to be medically investigated.
Causes of Easy Bruising
Not all causes of easy bruising is due to a disease. Sometimes physiological differences can make bruising occur more easily in some people, or appear to be so. Pathologies (diseases) that lead to easy bruising is usually associated with some abnormality in blood clotting.
- Advancing Age
As a person gets older, the collagen (connective tissue) in the skin as well as the subcutaneous fat reduces. The skin becomes weaker and less firm. It is therefore more easily injured than earlier in life.
- Pale Skin
Skin pigmentation can vary and some people may have a naturally pale complexion. In these cases bruising is more easily seen. The increased visibility does not mean that a person really does bruise more easily than others.
- Strenuous Workouts
Very vigorous exercise can cause tiny blood vessels to rupture as the muscles are put under severe strain. This is more likely to be seen with weight lifting beyond what a person is conditioned to manage.
- Clotting Disorders
There are many different blood clotting disorders that can present with easy bruising. This includes hemophilia and von Willebrand’s disease where there is a deficiency in the chemicals needed for clotting. Nutritional deficiencies can also play a role as some micronutrients like vitamin K are necessary for clotting.
Cancer of the blood or bone marrow which is known as leukemia, can present with easy bruising. This depends on the type of leukemia and severity of the cancer.
- Blood Cell Formation
Clotting requires different blood cells. When these blood cells are either in short supply or abnormal, clotting may be affected like in platelet disorders such as thrombocytopenia, myelodysplasia and aplastic anemia.
Blood poisoning is the common term for septicemia where bacteria and its toxins are circulating in the bloodstream. It is a life-threatening condition. One of the possible effects is impaired clotting.
- Liver Failure
The liver is responsible for producing certain blood clotting factors. When diseased, these chemicals may then be deficient.
- Henoch-Schonlein purpura is a condition where the blood vessels become inflamed and blood seeps into tissue spaces. It is believed to be due to autoimmune factors.
- Idiopathic thrombocytopenic purpura is also a blood clotting disorder where there is a low platelet count but the cause is unknown.
- Alcoholism can affect blood clotting for several reasons but it is mainly when there is alcoholic liver disease and cirrhosis that clotting disorders are seen.
- Medication can contribute to easy bruising mainly be affect normal blood clotting. This may be seen with several types of drugs but is more prominent with anti-clotting agents like aspirin and warfarin. Certain antibiotics, antidepressants, corticosteroids and anticancer drugs can also be responsible.