Management of Easy Bruising

Clinical Assessment and Laboratory Testing

The American College of Physicians recommends documenting all medications that increase bleeding risk, including anticoagulants, antiplatelet agents, NSAIDs, corticosteroids, and alternative therapies, as part of the initial approach to easy bruising 1, 2
A targeted bleeding history should include questions about significant bleeding after surgery or dental procedures, epistaxis requiring intervention, joint hemorrhages, and menorrhagia in females, according to the American Academy of Family Physicians 2
The initial laboratory screening panel should include a complete blood count with platelet count and peripheral blood smear, PT, and aPTT, as recommended by the American Society of Hematology 2
PT and aPTT do not reliably detect von Willebrand disease or Factor XIII deficiency, and normal platelet count does not exclude platelet function disorders, as noted by the National Hemophilia Foundation 2, 3

For patients with abnormal laboratory tests, the European Association for the Study of the Liver recommends against attempting to correct abnormal coagulation tests in cirrhosis patients to prevent spontaneous bleeding, as this practice lacks evidence and is not recommended 4
For patients with normal laboratory tests, the American Academy of Pediatrics recommends optimizing metabolic control in glycogen storage disease type I, as platelet defects are secondary to metabolic abnormalities and improve with better control 5

The American Society of Clinical Oncology recommends screening for von Willebrand disease and thrombocytopenia in patients with cardio-facio-cutaneous syndrome, and considering hematology consultation for immune-related thrombocytopenia or acquired hemophilia A in patients on immune checkpoint inhibitor therapy 1, 5

The American Academy of Family Physicians recommends applying pressure for 5-10 seconds to injection sites to minimize injection-related bruising 1