Bruising

Data gathering

• Site
  • the absence of trauma
  • 5 or more bruises of >1cm in diameter occurring simultaneously
  • face/torso
• Nutritional status
  • Vulnerable, malabsorption
• Family history
• Previous bleeding problems
  • Heavy periods, transfusions after surgery
• Risk factors for liver disease
  • Alcohol, IV drug use
• Medications
  • NSAIDs, Antiplatelets, Anticoagulants, Steroids

Clinical management

• Investigations
  • Bloods – FBC, U+E, LFTs, Blood film, Clotting screen, INR (if on warfarin)
• Management
  • Stop offending medication
  • If deficiency suspected – Consider trial of vitamin C or K
• Refer
  • Significant bleeding history
  • Positive family history, especially in women with menorrhagia
  • Abnormal blood results
  • Patient is pregnant or due to have elective surgery

Reference

BMJ 2017;356:j251

https://www.gp-update.co.uk/SM4/Mutable/Uploads/pdf_file/Bruising_-investigation_1.pdf