Easy bruising

Easy bruising means visible skin haematomas appearing after trivial or unremembered trauma. The clinical work-up sorts the cause into four buckets: (1) low platelet count (immune thrombocytopenia, drug-induced, leukaemia, splenomegaly, viral); (2) abnormal platelet function (aspirin, NSAIDs, uraemia, von Willebrand disease); (3) impaired clotting-factor synthesis (liver disease, warfarin/DOAC, vitamin K deficiency, haemophilia); (4) vessel fragility / collagen (long-term steroid use, scurvy/severe vitamin C deficiency, Ehlers-Danlos, senile purpura on sun-exposed skin). Pattern of bruising matters: lower-limb-only is common and usually benign; bruises in unusual places (back, abdomen, behind ears) raise concern and in children may signal non-accidental injury.

• Aspirin, NSAIDs, clopidogrel, anticoagulants — drugs are the commonest cause in adults.
• Liver disease — clotting factors not made; platelets often low too.
• Vitamin K deficiency — malabsorption, antibiotics, malnutrition.
• Thrombocytopenia — ITP, leukaemia, sepsis, viral infections (dengue, EBV), chemotherapy.
• Von Willebrand disease — commonest inherited bleeding disorder; mucocutaneous bleeding pattern.
• Long-term corticosteroid use — thin fragile skin.
• Chronic alcohol use — combines liver disease + thrombocytopenia + nutritional deficiencies.
• Senile purpura — flat bruises on forearms and backs of hands in older adults; benign.
• Vitamin C deficiency (scurvy) — rare in developed countries but seen in elderly, alcoholics, restrictive diets.
• Connective tissue disorders — Ehlers-Danlos.

First-line: CBC with platelet count + manual differential, peripheral smear, PT/INR, aPTT, liver function (ALT, AST, albumin, bilirubin). Add von Willebrand panel + fibrinogen if abnormal aPTT. If unexplained: bone marrow aspirate for suspected leukaemia. Mediora.AI flags low platelets and synthetic-function abnormalities in the panel; congenital bleeding disorders require haematology testing.